What this all suggests is that we are rapidly and with abandon, turning our assisted living communities into medical care communities

During the last panel of the last day at the NIC Small and Midcap conference Bob Kramer asked the industry panelists this question:

Do we want to get involved in the medicalization of residents?

When i grow UpThe idea behind the question looks sort of like this (at the risk of putting words in Bob Kramer’s mouth):

  • Assisted living providers have galloped into the world of providing medical care to residents. Likely more than half of all assisted living communities have a licensed nurse at least 40 hours a week and many have licensed nurses 24/7.
  • More than ever we are seeing residents come to assisted living after a rapid condition change that requires a higher level of care and an immediate change in living status.
  • Marketing teams particularly like these medical need residents because the sales cycle is almost always extremely short.
  • This new generation of residents require significantly higher levels of staffing which increases costs and revenue.
  • Because residents are more frail at move-in they have shorter lengths of stay.
  • Because residents have higher needs, there is more opportunity for families to file suit and complain to news media.
  • While just a teeny tiny barely audible noise, there are a few voices suggesting that maybe we ought to have federal regulation of assisted living. These voices include a few in the sector who operate buildings in states that have stupid assisted living rules. Their thinking is that it would standardize care across the country and allow for more medicalized services in those difficult states.
  • It is clear that today there are residents in skilled nursing that would be better served in assisted living. They would have a higher quality of life, likely receive more hands-on hours of care each day and cost the system less money.

Is This Really What We Want

What this all suggests is that we are rapidly and with abandon, turning our assisted living communities into medical care communities. We have mostly gotten to this place by accident in an effort to hold on to residents longer and serve a market demand. It comes, though, with some real and potential costs:

  • With the overall population being and looking more frail it becomes much harder to attract “lifestyle residents”. This is kind of a shame because assisted living has so much promise as a next chapter lifestyle experience for elders.
  • As the medicalization of assisted living continues some bad stuff will happen. Some of it will be perception and in other cases it will be real bad stuff. It is tough because even great senior living providers occasionally have a bad employee or bad manager that does real damage to people and to the business.
  • When that happens we could see a serious movement toward federal regulation. While there may be some collateral benefits for some providers in a few states it will be a horrible thing for the industry and for residents. It won’t improve care. It will make care more expensive and it will create a brand new litigation fest for attorneys. 
  • It is inevitable that assisted living providers will see pushback from the skilled nursing side of senior living since assisted living will be sucking up the highest margin skilled nursing residents.
  • We will need to get serious about collecting, compiling and delivering data on medical outcomes.

Overall, this shift is likely a good thing for consumers because it means more options. It is likely, overall a good thing for the industry providing more opportunity for development. We need though to be thoughtful about how we move down this path. We need to be able to tell our story, to talk to the public about how we tell our stories; how we describe the different care options.    

We need to think about these changes like a giant chess game anticipating how other constituencies will react and respond to our moves.

 Steve Moran