“The quicker you let go of old cheese, the sooner you find new cheese.”
Spencer Johnson
Imagine this … Last Tuesday evening Dorothy Davis, a 76-year old resident in your assisted living community, ate a marvelous mac-n-cheese dinner in your dining room, returned to her apartment, slipped in the bathroom, broke her hip, and went to the hospital. By Saturday, she was back in her apartment and under your care.
Seems like Dorothy skipped a step, doesn’t it? Where did the rehab go?
We know that rehab did not vanish, but it has moved further down the care continuum. As Medicare is transitioning from reimbursement based on services/volume to reimbursement for outcomes/value, rehab services are migrating from skilled nursing facilities and rehab centers to assisted living communities and home settings.
That means in the case of Dorothy, there now exists an opportunity for the team at your AL to support her as she heals and regains her strength. You could do this by providing therapy, or you could rely more heavily on your home care provider. Either way, the burden of providing more nursing and therapy to higher acuity residents is headed your way. In fact, it’s already here.
Savvy communities are changing their business model.
Forward thinking assisted living leaders have already adapted to the need. They realize that they must be ready to care for more medically complex residents, and they are ramping up to provide more therapy and support.
What can your AL do to smoothly make the transition?
1. Adopt a “Total Wellness Model” where you keep residents stronger longer.
Innovative ALs are developing “total wellness programs” that address the spectrum of residents’ needs. At one end of this spectrum are residents who are currently healthy. To ensure that these folks continue to safely “age in place,” most ALs (and independent living communities too) have already created wellness programs. These generally consist of group exercise sessions and educational forums on wellness.
Some ALs have gone a step further to provide “functional maintenance programs” that are individually designed by and monitored by a physical therapist. Sessions are carried out by a rehabilitation technician, and each resident’s progress is tracked over time. As health and fitness levels change, the program is adjusted to adapt to those changes. If a decline is noted, then the PT is notified, and the program is modified or additional therapy is provided. At Therapy Management, Inc., our functional maintenance program is called “Resilience,” and it’s proven to be a great tool for our AL clients and their residents.
For those residents who have had a significant physical decline (due to injury, surgery, or illness), ALs have implemented person-centered programs that provide more intensive therapy (PT, OT, Speech).
In the case of Dorothy, if she lived in a savvy AL, then upon return from the hospital, the therapy team at her AL would have created a care plan, and Dorothy would have received PT and OT. Once Dorothy had regained her prior level of function, she could enlist in a “functional maintenance program” to stay stronger over the long term.
2. Think and act more like a SNF.
For ALs who want to take higher acuity patients, they need to show they are a good choice for referring hospitals. Since SNFs have been doing this for years, ALs can take a few pages out of the SNF playbook.
- Understand the market. SNFs (and their therapy providers) typically have access to CMS data that shows the flow of patients from local hospitals to the next level of care – SNF, home with home care, etc. It would benefit your AL to also have access to this competitive data, so you know where referrals are going now, and you can determine how to position your community accordingly.
- Woo the hospitals. All hospitals will tell you that they want to know that you produce good outcomes, and that your patients are not returning to the hospital. Beyond that, each hospital/health system has a different way of measuring the “value” it gives potential referral sources. If your AL wants to get into a hospital’s referral network, then you’ll need to meet with the appropriate hospital leaders, and ask them what they are most interested in when comparing facilities. While they may want to see all your data, they likely give more weight to certain quality measures and outcomes. For example, one hospital might give more weight to resident satisfaction and number of falls in your facility. Another hospital might care more about staffing levels and star ratings.
- Show your outcomes. Once you know what matters most to your referral sources, then show them what’s in it for them. Provide them with short, sweet outcomes data (1 page!) by diagnosis/disease. Show them that your patients make progress over time, and show them that your facility continues to evolve and improve.
Whether you like it or not, rehab has moved (just like that darn cheese). Is your AL ready to embrace the opportunity? If so, we can help.
Therapy Management, Inc. works with senior communities to provide the full spectrum of wellness and therapy services – in SNFs, ALs, and ILs via contract therapy and home care. We empower our clients with innovative programs, outcomes reports, competitive data, and marketing support, so they can stand out in their marketplace. Call us at 248-349-9595.
