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November 26th, 2017

Assisted Living owners and operators – are you a post-acute care provider?

If so, you should probably tell somebody, because no one else thinks you are.

But what do YOU say? Are you a post-acute care provider or not?

What is a post-acute care provider?

The concept is pretty simple: since the term “post-acute” is used ONLY in the context of healthcare, it means you are committed to managing the overall healthcare needs of your residents. It also means that healthcare occupies a prominent position in your dialogue, your marketing, and your website.  By making this commitment, you hold yourself out as meriting referrals from the healthcare system.

It also means that you have adapted an Integrated Care Model in which your organization puts healthcare on equal footing with your more customary hospitality and real estate focus.

Why should assisted living be post-acute care providers?

Once again, straightforward answers:

  • Profit – a commitment to managing the healthcare needs of your residents will reduce resident turnover, increase length of stay, and stabilize census.
  • Survival – if you don’t evolve away from the antiquated “hospitality only” model and accept that you cannot separate seniors from their healthcare, your competitors surely will.  And if you’re ambivalent about whether or not to be a post-acute care provider, then your ambivalence is music to your competitor’s ears, because you will not be given a place in healthcare referral networks.

Finally, I leave you with a challenge shown in the following Figure.

Post acute

For a rapidly growing population of fragile seniors, Assisted Living should be THE DOMINANT REFERRAL. The industry needs to go out there and take its rightful place in our healthcare system and put itself in the center of patient referrals. But this also means that owners and operators must evolve to adapting Integrated Care and becoming post-acute care providers.






November 8th, 2016

I’m delighted to announce that I have joined Presbyterian Senior Living as their new Vice President and Corporate Medical Director.

 

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






August 27th, 2016

Beyond ‘Hospitality-Only’…Way Beyond

profitable-tools

Q.  What’s most important to corporate owners of assisted living?

A.  Profitability. Above all else, profitability.

And that’s the way it should be!

No one is in business to lose money.

No one wants to work for a business that’s losing money.

No one wants to be part of an organization where you and your co-workers have no job security, where your job may be eliminated at any time because you can no longer be afforded.

Without profit, a business is not sustainable, it’s temporary, and of very little use to the people it serves.  And, quite frankly, it will probably create more problems than it solves.

There are valid arguments about the manner in which profit is obtained, and how that profit is used.  But the inescapable message remains:

“No margin, no mission.”

Q.  What’s the leading way for corporate owners of assisted living communities to attain profitability?

A.  Occupancy. Above all else, occupancy.

And that’s the way it should be!

The marker of a profitable, thriving, engaging, successful assisted living community is full occupancy and nothing less.

This is where you want to be, where your co-workers want to be, where your residents and families want to be.

You are most likely to feel good in this environment.  You are valued, happy, fairly compensated.  You look forward to coming to work.  And your supervisors and co-workers are glad to see you when you arrive, and you are glad to see them.

Q.  What’s an innovative approach for an assisted living corporation to achieve profitability?

A.  Healthcare. Not above all else, but in mutual support and cooperation with professionals from real estate and hospitality – all 3 disciplines working together in partnership for the benefit of all.

And that’s the way it should be!

Healthcare, in a partnership with real estate and hospitality.

And Healthcare has another unique value:  it can be used as a ‘tool,’ an ‘instrument’ by which profitability is achieved.

Q.  How can healthcare be used as a tool to help achieve profitability?

A.  Like this:

  • Healthcare alignments
    • Reach new customers (hospitals, skilled nursing facilities, rehab facilities, long term acute care hospitals, Home Health organizations) by implementing health analytics and quality metrics. Show them your data to demonstrate that you are the Go To Assisted Living Community for discharged seniors who need more support than they can arrange at home.
  • Transitions
    • Attain seamless transitions and coordination of care when residents move to your community and within your referral network.
  • Readmissions
  • Value based care and bundled payments
    • Embrace these new opportunities! Understand that 2/3 of the target price identified for many bundles falls into the post-acute care arena.  This opens huge opportunities to partner in healthcare networks with your post-acute brothers and sisters to reduce overall healthcare costs.  The reward?  Advancing your value, cementing old relationships, building new customers, and not only assuring your survival but also promising profitability for the future.

All these measures will help you to keep your old customers and get you new ones.  And that combination will bolster your occupancy and keep you profitable.

Healthcare as a tool.

Healthcare  – previously untapped, but now an assisted living community’s best friend.

And that’s the way it should be!

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






July 13th, 2016

An Unwanted, Complicated Journey

The seniors who are attracted to Assisted Living are those who are overwhelmed with the burden of their healthcare and require, as the name states, “assistance.”

They and their families and support system are no longer capable of meeting their myriad healthcare needs.  And so, a life of complete independence has slowly collapsed into a life in which others must assist with basic healthcare essentials.

For most, accepting this realization has actually been an unwanted and very complicated journey.  A journey that relentlessly and systematically progressed through stages not unlike those described by Elizabeth Kubler Ross in “On Death and Dying” that began with ‘denial’ and now ends with final and very reluctant ‘acceptance.’

But the pill gets even harder to swallow, as the loss of independence also means, at long last, confronting personal and family “issues” that have long-lurked just beneath the surface but which can no longer be avoided.  Financial issues, inheritance issues, family acrimony, and the heart wrenching decisions involved in selling their home, selling or giving away most of their cherished possessions, and leaving behind a lifetime of memories (both good and bad) and all that is familiar.  They will now be restricted to a small apartment in a building full of strangers.  Not only that, but their privacy will be constantly invaded with never ending questions and a set of constantly changing and unfamiliar caregivers parading in and out of their new “home” multiple times daily whether they are invited or not.  And, for better or worse, there will be the constant pressure to participate in a truckload of activities.

Such is the new reality for those seniors whose fragile health has brought them to this setting.  They each bring with them an average of 8 chronic diseases and the need for 6-7 different types of prescribed medicines that treat these diseases.  And the host of support services that must be orchestrated and synchronized to provide the healthcare that drove them to this assisted living setting include:

  • Primary care doctors and a variety of specialists.
  • Home Health services from time to time.
  • Lab testing services.
  • Personal care services.
  • Pharmacies.
  • Durable medical equipment companies for oxygen, mobility devices, and more.
  • Transportation services.
  • And a never-ending series of forms to complete to justify the need for all of the above.

This means that an average sized assisted living community with 50 residents not only manages, every day, hundreds of chronic diseases, dispenses hundreds of medications, but must also interface literally with hundreds and hundreds of different healthcare personnel in the course of caring for their residents.

Assisted living communities are usually beautiful (if not outright gorgeous) buildings where hospitality ‘rules’ the day.  But it takes no imagination to appreciate the complexity of managing a community of seniors who all have these healthcare challenges.

So one might inherently assume that, in addition to real estate professionals and hospitality professionals, healthcare professionals would also occupy influential leadership positions in assisted living corporations and the trade associations that represent them and who guide them with a stated emphasis on quality management.

Here’s the Paradox

Seniors come to assisted living to get assistance with their healthcare.  And yet there are no healthcare professionals in the boardrooms of most assisted living corporations and the trade organizations who represent and advise them.

Go to the web and take a look at the board members of these corporations and trade organizations.  Where are the healthcare professionals?  Where did they go???

Who sits on these boards where the critical decisions are made about their individual communities?

Businessmen and businesswomen, financial analysists, hospitality experts, lawyers.  These folks are all necessary, to be sure.  But do you see any healthcare professionals?  If not, then that begs the question:  “If you (the reader) need help with YOUR healthcare, to whom do YOU turn for advice – Your financial analysist?  Your lawyer?  A local businessman?  The hospitality manager of your local Holiday Inn?  Of course not!  So why would you, or any of us, expect and accept anything different for the fragile seniors in assisted living?

Does the lack of healthcare leadership in these organizations explain the following rather unflattering statistics?

  • Length of stay 22 months and declining.
  • Annual resident turnover 54% and increasing.
  • The leading cause for turnover overwhelmingly due to declining resident health, and this is also increasing.

All of these statistics are going in the wrong direction!  They are getting worse, not better.

The Need to Evolve

Assisted living must evolve into an Integrated Care model.  A model in which healthcare professionals work peer-to-peer and side-by-side in the boardrooms with real estate and hospitality professionals to design and manage the best possible services to our fragile seniors.  You cannot separate seniors from the healthcare needs that deliver them to your doors.  Period!

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






June 26th, 2016

LEAVING ASSISTED LIVING

Revolving Door 2

Why do the 90% do it?

What do these people LEAVE assisted living, and what can be done about it?

People talk about COMING to assisted living.  Website after website tries to convince seniors to “Choose ME!”  “Choose ME!”  “Choose ME!”

Assisted living communities invest enormous budgets on Sales and Marketing dedicated to getting seniors to COME to their communities, yet they invest NOTHING on learning why seniors LEAVE their communities.

When was the last time you heard a discussion about why people LEAVE assisted living?  After all – LEAVING is 50% of the discussion, right?  Everyone who COMES to assisted living must ultimately, at some point, LEAVE.  So why do we address only half of the conversation (COMING) and ignore the other half (LEAVING)?

And what are the consequences of this ‘one-eyed’ view?

By ignoring half of the conversation, we ignore half of the opportunities to stabilize occupancy.

Let’s take a deeper look into LEAVING and see if we can make any progress in our understanding about it. Knowledge and understanding is what may ultimately help us put the brakes on the revolving door into and out of assisted living.

WHY DO PEOPLE LEAVE ASSISTED LIVING?

Declining health, that’s why.

When people leave, over 90% of them are forced to do so because of declining health.  The other 10% leave for a variety of other reasons, and that includes, perhaps, only about 5% who leave for hospitality reasons.

So, to make the greatest impact on leaving, do we address the 5% who leave for hospitality reasons, or the 90% who leave for health reasons?  I choose the latter.

WHAT PRECIPITATES DECLINING HEALTH?

An acute health event of some kind is the harbinger of declining health and what usually precipitates leaving.  And this is why residents are lost to the ER or hospital.  Here are some examples we’re all familiar with:

  • they fall, or
  • they get a urinary tract infection, or
  • they get pneumonia, or
  • they get a foot infection, or
  • they get weak and dizzy, or
  • they get short of breath, or
  • they die, or
  • and on and on.

WHAT CAN WE DO ABOUT LEAVING?

How can we reduce the acute health events that cause the 90% to leave?  Do we perseverate on the 5% and continue with the same well-worn “solutions?”

  • A new lunch menu?
  • Another activity added to the 20 other activities already available?
  • A gelato machine?
  • A mini bar?
  • Even better hospitality?

Or should we gain a better understanding of resident health so we can manage it better?

If we choose the latter, then perhaps…just perhaps…we might discover something we could do to stabilize the health of the 90% and prevent or reduce the decline.  And if we had a more targeted focus on resident health, then perhaps these acute events would be more predictable and manageable than they are currently, so that we could identify them earlier and solve them before losing the resident to the hospital.

WHAT SHOULD WE TARGET?

Chronic Diseases and their management – THAT’S the target.

Assisted living residents have a lot of chronic diseases.  Our research database of 9000 assisted living residents tells us that each resident averages 7-8 different chronic diseases (many residents have more), and they each take a minimum of 6-7 different types of prescribed medications every day to support these diseases.  So this is the key – chronic diseases and how they are managed – that may help us keep the 90% from leaving.

Let me illustrate how proactive management of the 90%’s chronic diseases can potentially cause fewer residents to leave.

ACUTE HEALTH EVENTS CAN TEACH US HOW TO MANAGE

CHRONIC DISEASES BETTER.

INSIGHT:  Every chronic disease is associated with a set of acute health events that precipitate resident decline.

Here’s the mindset that you MUST have:  it is NEVER acceptable to lose a resident to the ER or hospital.  And whenever it happens, we will review our care of this resident to determine what we can improve from this point onward so that it doesn’t occur for other residents.

The Table below is an example only and is not meant to be complete.  It shows how acute health events can teach us how to manage chronic diseases better. The Table shows:

  • 3 of the many chronic diseases (left column) that residents can have.
  • Some acute health events (middle column) associated with them.
  • Some common causes of the acute health events (right column).

Chronic Diseases

You can use a Table like this to understand how you might reduce the number of residents who leave.

For example – let’s say you lose a resident to the ER because he developed pneumonia.  When you review the resident’s record, it turns out he has COPD as a chronic disease which put him at risk for this acute event.  The Table tells you some of the common causes or symptoms this resident may have exhibited that led to him getting pneumonia.  You then review this resident with your care staff to discover what you can implement to reduce the likelihood of other residents with COPD from coming down with pneumonia.  Examples might be:

  • Closer monitoring of COPD residents during meals to check for choking episodes.
  • Making sure COPD residents are up to date with their pneumonia, flu, and shingles vaccinations.
  • Proactively connecting COPD residents with their doctors at the first sign of a cold or sinus problem, especially during allergy seasons.

Similar Quality Improvement approaches could be considered for every single resident that is lost to the ER or hospital.

This pattern of Continuous Quality Improvement provides the best chances for reducing the number of residents leaving your community.

FINAL REMARKS

Learning about why the 90% LEAVE your community will open an entirely new dialogue that will help you provide better care to your residents.  Implementing the lessons learned from this dialogue will lead to more stable resident health and therefore a more stable occupancy.

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






June 3rd, 2016

“Those that don’t learn from history are doomed to repeat it.”

Dot.Com bubble, senior housing bubble

When I began practicing medicine 25+ years ago, hospitals were the center of the healthcare universe.  From the hospitals’ viewpoint, physician offices were just appendages whose role was to feed them with patients.  And when the patients were discharged with a list of cursory and usually verbal-only instructions, they were “out of sight and out of mind” the micro-second they crossed the hospitals’ exit door threshold.  I should know…I was complicit in all that.

And most physicians were unaware of senior housing and what it actually is (let’s define it as:  independent and assisted living).  We knew very little (OK…we knew nothing!) about the senior housing communities in our very own cities, even those that were practically within walking distance from us.  For most of us, assisted living was “something like a nursing home, but not quite.” Our ignorance about senior housing didn’t really matter, though, because the residents, although fragile and medically complicated, came to us in our offices just like every other patient.

When it came to nursing homes, providing care there was viewed more like charity work.  It was primarily done in a physician’s spare time, usually at the end of the day and on his way home from the office or the hospital.  Or, our rounding was done on our day off work, or perhaps early and hurriedly on a weekend morning.

Fast Forward 25 Years

What a difference 25 years makes!  The worlds of healthcare and senior housing have collided, and neither will ever be the same.  And that means both have been thrust into a new relationship to which each must adapt.

For healthcare, hospitals are no longer the ‘center of the healthcare universe.’  Quite the contrary – doctors now avoid hospitalizing their patients if at all possible.  And those patients who are hospitalized have a diminishing length of stay, so that a greater burden of their recovery occurs somewhere in the community – home, senior housing, the post-acute care setting (nursing homes, rehab centers, long term acute care hospitals), etc.

And for seniors, whose demographic is experiencing explosive growth, the community (not hospitals) is now the primary focus of healthcare delivery.  That means the burden of managing the rising acuity levels of many incoming residents has been set right in the laps of senior housing owners and operators who have no choice but to ‘deal with it.’

By necessity, therefore, the identity of senior housing is gradually morphing, evolving. Now, what previously was an almost exclusive focus on a pure hospitality model has a few receptive and innovative providers budding into an Integrated Care model, one that  incorporates a healthcare focus to meet the myriad healthcare demands of their residents.

But this changing landscape of healthcare and senior housing is only in its natal form, and the relevant players are still trying to figure out how to react.  As it stands now, most senior housing owners and operators still plod onwards, resolute to hang on to their well-worn hospitality-only model until the very end.  Many of them will go the way of the dinosaurs.

Others are beginning to listen and react positively to the winds of change.  And the latter inspire hope.

Remember the dot.com bubble?  Predictions…

I’ve heard it predicted that senior housing will evolve into either a predominantly hospitality model or an integrated care model that incorporates a focus on healthcare.

But I don’t buy this.

Senior Housing pop

I don’t believe that pure hospitality models of senior housing have a future.  So when you look at them, you’re seeing ‘the past.’  I believe these proponents are living in a bubble, just like the dot.com bubble that popped in 2001.  And as the needle and the bubble get closer and closer, the only thing that will get their attention is a loud POP!

Integrated Care

Senior housing is evolving into an Integrated Care triad:  hospitality, real estate, and now healthcare.

No matter how you tweek the hospitality amenities of senior housing, and no matter how you promote the real estate investment advantages of senior housing to one’s investors, you simply cannot escape the new necessity of incorporating a healthcare focus.  You cannot separate seniors from their health.

The New Reality Is A Good Reality

We have arrived at the juncture where the major outcomes of senior housing and healthcare are inextricably linked.  And this is good!  Profitability and high census is achieved via stabilized resident health and lower overall healthcare costs.  Everybody wins.

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






May 25th, 2016

IT’S TIME FOR A NEW WARDROBE.

Emperor

Managing the healthcare of seniors in assisted living (AL) is incredibly complex and challenging.  But these complexities are surprisingly underestimated by senior housing leaders.

To illustrate, let’s break down some of these challenges and look at them individually.  And then let’s stand back to gain a perspective of this monumental task.

 “BE CAREFUL WHAT YOU ASK FOR…”

Our example describes a typical AL that houses 50 fragile residents.

We begin by walking through the front door.  Our database of 8,348 residents living in 450 ALs tells us that the average resident we see has 8 chronic health conditions and takes 6 different types of prescribed medicines every day.

Now let’s think about what that means.  That means that the health aides and nurse (who may be either part time or full time) employed by this 50 resident AL have the responsibility to manage 400 chronic health conditions and dispense at least 300 prescribed medicines to residents every single day.  An impressive challenge!

As we look around this community and compare it to our database, it becomes quickly evident that more than 80% of residents have various forms of arthritis or mobility issues.  Conversing with the residents reveals that 70 – 80% of them have various forms of heart or blood pressure problems, and that about 75% of them have some form of dementia.  And as you get to know a few of them a little better, you’re not at all surprised to discover that nearly half of them struggle with depression.  What may surprise you, however, is that more than 1/3rd of them are taking anti-psychotics.

HEALTHCARE SUPPORT SERVICES IN ASSISTED LIVING

Now consider the healthcare services that are required to support this fragile group of seniors and their myriad health issues.

Let’s begin with doctors.  For residents new to your area, the first challenge is to identify doctors who accept new Medicare patients.  This can pose significant difficulties.  Then, most ALs have not yet embraced onsite physician care.  Although this would be to their obvious advantage, it’s still uncommon.  So, the reality is, in most cases, that every resident has their own set of doctors, perhaps 2 or 3 or more of them.  That means this AL’s healthcare team must interface with 100 or more different doctors on behalf of the residents – arranging appointments, receiving and transmitting test results, requesting prescription refills, requesting various forms to be completed, communicating changes in resident condition, and on and on.

Next is the variety of important ancillary healthcare support services that most residents depend on:

  • Home Health companies
  • Independent Rehab or Physical Therapy companies
  • Personal Care Service companies
  • Hospice companies
  • Pharmacies
  • Durable Medical Equipment companies
  • Companies who provide wearable healthcare technology

ALs are usually affiliated with multiple vendors from each of these service groups who each send a variety of their employees to the AL to interface either with select residents, care staff, or both.  This amounts to literally hundreds of additional healthcare professionals coming and going throughout the AL, none of whom are employed by nor accountable to the AL but are rather employed by and accountable to their own locally or corporately owned employers.  AL health staff must just do their best, with varying degrees of success, to communicate and coordinate with all of these individuals.

And so, your 50 resident AL literally has hundreds and hundreds of different  healthcare professionals with which it must interact, communicate, help arrange appointments, notify of test results, help schedule tests, help schedule services, schedule bus rides for doctors’ visits and various medical tests, communicate health issues with families, and more.  And they must manage all this with an annual employee turnover rate that averages 42%!

From a physician’s viewpoint, no wonder I am constantly amazed at the complexity of managing resident health in the AL setting.  And this complexity and enormous challenge is reflected in the troubling statistics from the past 10 years or so:

  • Length of resident stay has deteriorated from 36 months to 22 months.
  • Annual resident turnover has skyrocketed from 41% to 54%.
  • The leading cause of turnover is declining resident health, and this has increased from 72% of residents who leave to 92% currently.

BOTTOM LINE

And so, a small handful of health aids and a nurse (who works part time or full time) orchestrate the healthcare of these 50 fragile seniors.  In doing so, they help manage hundreds of chronic health conditions, dispense hundreds of prescribed medications daily, interface with hundreds of healthcare professionals from a variety of disciplines, and coordinate the transport of these residents to hundreds of doctors’ offices, clinics, hospitals, x-ray facilities, laboratory testing centers, and elsewhere.

THE EMPTY CHAIR

The corporations who own and operate these ALs rightly embrace a dedicated focus on hospitality.  And they build their leadership teams with individuals having expertise in finance, hospitality, and business.

empty_chair

But most are also remiss in openly distancing themselves, even to the point of being dismissive, from a focus on the healthcare of their residents, reflecting this lack of commitment with an empty chair in their boardroom.

The empty chair also fuels ongoing pressures to persuade seniors to avoid ALs altogether and remain in what is often a modest home in preference to an AL’s impressive architecture, really nice employees, and tasty lunch.

For now, the emperor wears no clothes.

But this MUST change.

FINAL THOUGHT

Senior housing and healthcare have collided.  The survivors will be those who embrace change and integrate their housing and healthcare models.  They will be stronger.

But as for the others…………?

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






May 7th, 2016

An Assisted Living owner’s “Come to Jesus” Dialogue with Self.

 

How many residents leave your AL every year?

  • 54% leave for all causes.  And it’s getting worse.  Length of stay is down to 22 months.

What is the most common reason residents leave your AL?

  • 92% are forced to leave each year because of declining health.

That means you must replace about ½ of your residents each year just due to declining health?

  • Yes.

What does it cost you to replace a resident?

You own a 100 bed AL with occupancy at the national average (88.4%).  How much do you estimate it costs you to replace the residents who leave each year due to declining health?

  • $176,800.00/year!

If you do nothing different this year, how much will it cost you next year to replace the residents who leave due to declining health?

  • $176,800.00.

There are about 36,000 ALs in the U.S., but let’s just consider the 10 largest AL corporations.  How much does it cost them every year to replace the residents who leave due to failing health?

  • Here’s the corporate breakdown showing the estimated cost to replace the residents who leave due to declining health:

Corporate Losses - Health

That’s seems like an exorbitant amount of money that’s invested to just ‘keep up’ with occupancy with no growth.  So let me ask you – if 92% of your residents leave due to failing health, and only about 5% of your residents leave due to hospitality issues, where is the greater opportunity for reducing these staggering financial losses?

  • Resident healthcare presents the far greater opportunity to reduce financial losses, but we must also continue our focus on hospitality.

What’s your next step?

  • I’m going to review healthcare strategies with my Corporate Medical Officer.

I thought you didn’t have a Corporate Medical officer.  Most ALs don’t see the need.

  • I don’t have one either.  But you can bet I’m going to hire one ASAP!  The world of assisted living and healthcare has changed, and our C-suite can no longer be without one.

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






April 22nd, 2016

How Can The Dead Help The Living?

We Need You

If you’re dead and were a resident in an assisted living community (AL), I want your health data.

Don’t be shy, and don’t worry – it won’t hurt.  And you can take comfort in knowing that you may be helping your living friends and colleagues.

You may have thought, in your final moments, that you no longer had anything to offer, nothing more to give.  Perhaps you even welcomed your approaching demise as a long and anticipated relief from suffering and even despair.

But I say that more than ever before, you are needed.  You have a great deal to offer, especially now.  You have the opportunity to do something noble, without even raising a finger. And it’s something that will still allow you to remain physically and molecularly intact…for as long as Mother Nature allows, that is.

WE NEED YOUR DATA

Give us your health data.  You have a treasure trove of data that might be able to teach us how to provide better care for the living.

Sure…the insights derived from your data will probably prolong the lives of your breathing AL friends and family and delay your ultimate reunion.  But no doubt you’ve already discovered that patience is more easily achieved in your world than in ours.  And you at last fully understand the intense pressure that drives the need for living people to discover and implement healthcare solutions ASAP.

All we need to do is to obtain your health data from your last days and compare these data to the same health data of your living AL friends and family.  We then explore these differences and put the lessons we learn into action.  We ask the question:  “What are the differences in health between dead people and living people?”

Here are a couple of examples that illustrate how the lessons we learn might help your AL friends and family:

  • What if we discovered that 20% of the AL residents where you lived have diabetes, but a disproportionate 80% of the residents who’ve died have diabetes? Wouldn’t that suggest to your AL managers that a more intense focus on the way they manage diabetic residents should be considered?
  • What if 30% of the AL residents where you lived are taking antipsychotics, but a disproportionate 75% of the residents who’ve died were taking antipsychotics? Wouldn’t you expect your AL to rethink and possibly improve its approach to the management of its living residents taking antipsychotics?
  • What if only 10% of the AL residents where you lived have very high health acuity levels, but a disproportionate 90% of the residents who’ve died had high acuity levels? Wouldn’t that prompt your AL to consider implementing a method of acuity based resident monitoring?  If so, they might discover your friends’ health decline at an earlier time point and be able to intervene sooner and thus keep them in the land of the living longer.

Personally, I think dead people have a lot to offer. I think they are too often overlooked and under-appreciated, because they might have answers that could help living people improve the quality and length of their lives.

And in the assisted living world, longer life translates into more stable occupancy, increased length of stay, reduced resident turnover, and improved profitability.

Important answers may lie in dead people’s health data.  And I truly believe these folks would be more than happy to cooperate.

All we need are volunteers.

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






April 1st, 2016

You mean…like “Hospital Compare?”

Hospital Compare

That’s exactly what I mean.

Why not?  Why not implement an online, head-to-head comparison of the healthcare features of assisted living communities using objective health data?  Wouldn’t consumers be interested in a 1 page summary describing the healthcare metrics of the top 4 or 5 local ALs they are considering?

I have to be honest…as much as I object in principle to government regulation and interference in American healthcare, I like (and even appreciate) Medicare.gov forcing key members in the healthcare sector (shown below) to make their quality healthcare metrics available to the public.

I can view a wide variety of quality measures that indicate the ability of these members to provide care for me or my loved ones.  I can then use this information when choosing a hospital or nursing home, etc. that best fits my needs.

And it’s the healthcare that causes me to seek out these members – not their lunch, not their wonderful cafeteria, not their gift shop, not their beautiful building with cool design elements of one kind or another.  These ancillary features, although not insignificant, are just amenities.  They add ‘color’ but not ‘substance.’  They are NOT my reason for seeking them out.  It is because I need help with my healthcare that causes me to seek them out.  If I didn’t need help with my healthcare, I wouldn’t go there.  And because of that, my primary concern is learning the ability of these members to manage or provide the healthcare I need.

So…why not add ‘Assisted Living Compare’ to the list?  Since the only reason prospective residents seek this setting is similar to the other members – because they need help with their healthcare – then isn’t it intuitive that consumers would be interested in these comparisons if this information were available to them?

You may think that the assisted living industry might be reluctant or even resist measuring and revealing healthcare metrics and participate in something that may seem invasive and unwanted.  But there is growing precedent that strongly suggests such a requirement is near.

And just like Poe’s ‘The Telltale Heart,’ if you listen quietly, you can hear the heartbeat of government regulation within the very walls that surround you.

Take, for example, the 2015 GAO report that investigated the use of anti-psychotics in nursing homes.  The report recommended expanded actions to reduce the use of antispychotics in assisted living.

Or a 2015 request to the GAO from the Comptroller General of the United States to review Medicaid spending and federal and state oversight of care provided to Medicaid enrollees in Assisted Living Communities.

Or the new 2016 DOJ report describing the implementation of regional Task Forces to assess care standards in nursing homes, assisted living, and other long term care providers.

Or consider the renaming of the long term care industry, now known as the Long Term Post Acute Care (LTPAC) industry  – a single moniker that no longer means only nursing homes but now includes the full spectrum of community based healthcare, including assisted living.  The motivation for this change is to eliminate provider silos and facilitate person centric healthcare.

LTPAC

And as far as the government is concerned, you can bet that regulations that apply to one of the members of the LTPAC community will surely ultimately apply to them all.  So those regulations that haven’t yet spilled over into the assisted living industry are on their way – it’s just a matter of time.

And as long as the assisted living industry passively views itself solely as a hospitality industry with little interest in self-discovery of the healthcare it manages, then the regulations that should come from within the industry will most surely be imposed from without.

Yep…that means the government!

And the government is just like my weird aunt Betty.  Once you let it into your house, it NEVER LEAVES!

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






March 14th, 2016

“ADAPT…OR BECOME IRRELEVANT.”

dinosaure

A recent and very popular article about the failure of Nokia should be a bellwether to the senior housing industry, especially assisted living.  Unheeded, a reader’s comment (shown above) may come true for many communities.

The assisted living industry markets itself as being almost exclusively a hospitality model.  Indeed, assisted living marketing differs little from the marketing of hotels and vacation spas.

But this really misses the point, because consumers of assisted living “expect” hospitality, so hospitality is in no way a distinguishing feature.

Just as when you go to a grocery store, you expect (and take for granted) that the food will be fresh and appealing.   Marketing among grocery stores that promotes one store’s food as fresher and more appealing than another store’s food doesn’t distinguish them.  It rings hollow.  “Of course I shop at your store because the food is fresh and appealing – that’s to be expected.  Do you honestly think I would shop there because the food is old and rotten?”

But the unending clarion call in assisted living is that “our hospitality is better than your hospitality,” “our building is more beautiful than your building,” and “our lunch tastes better than your lunch.”  Quite honestly – beyond a certain point, no matter how you phrase it – this is just not interesting.  It’s boring, tiresome, worn out.

And a perseverance on hospitality ignores the origin of what drives residents to the assisted living setting in the first place – they need assistance managing their health.  Weakening health in seniors who are overwhelmed with debilitating chronic health conditions is what drives them to this setting.  It’s what causes their need for assistance with ‘activities of daily living’ (ADLs – which is about the only health amenity mentioned by this industry).  People who don’t have weakening health are not found in assisted living.

Whether it’s admitted or not, coming to grips with managing resident health in a serious way is no longer an option for assisted living.  And just as Nokia failed to adapt to a world that was changing around it, assisted living will face the same fate if it doesn’t similarly adapt to a changing world and renew its commitment to resident health – health that is increasingly complex and of higher acuity.

Most assisted living communities have a ‘schizophrenia’ when speaking about healthcare.  On the one hand, many communities wish to recruit and care for residents of higher acuity – residents who ordinarily would be candidates for a nursing home – as assisted living could provide more-or-less equivalent care in a much less costly setting than occurs in nursing homes.

But on the other hand, assisted living has a paranoia about the negative comparisons to nursing homes, and so actively avoid discussions of healthcare in order to prevent this comparison.

THE NEW OPPORTUNITY – Embrace Resident Healthcare

But adapting to a world that is changing around assisted living is also The New Opportunity!  And the new opportunity is to Embrace Resident Healthcare.

Here are 2 action steps assisted living can do to immediately take advantage of The New Opportunity:

Add healthcare professionals to positions of authority and leadership.

  • The best model to embrace is an Integrated Care model in which your leadership is comprised of expertise from Real Estate, Hospitality, and Healthcare. These leaders will work cooperatively as a team to provide better management of your communities than when your team was incomplete.

Take control the dialogue.

  • Don’t walk away from the healthcare dialogue – embrace it! And take control of it!  Work with your healthcare leadership to use your own resident health data to customize resident–centered healthcare and to also construct a positive dialogue – a dialogue that showcases your quality care and that underpins and supports all your wonderful hospitality amenities.

“We didn’t do anything wrong, but somehow, we lost.”  Words from a company whose failure to adapt to change around it caused it to be “removed the competition.”

Nokia started losing long before they were sold to Microsoft.  But by the time they finally realized it, it was too late.  Don’t let this happen to your assisted living community.

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






March 5th, 2016

“To Do No Harm” Is Only Half of the Story

broken-down car

(click to enlarge)

Imagine that your car engine started acting up, so you take it to a garage to have it fixed.  The garage boasts that it’s the best garage in town, because if you do business with them, they will not only fix your engine, they won’t create new problems!

You think to yourself, “This is weird.  Why does ‘not creating new problems,’ –  not giving me a problem that didn’t exist before – make you the best garage in town?”

And yet, this is exactly what’s happened in healthcare.  The expectations have been set so low, that a point of distinction and a marker of quality is that when you’re hospitalized, you won’t get new problems and become  worse off than before you were hospitalized!

  • You won’t have a new and life threatening infection you didn’t have before.
  • Your medicines won’t be totally screwed up when you’re discharged.
  • You won’t bounce right back to the hospital and be readmitted within the next few days or weeks because of a faulty and impossible-to-understand discharge process with instructions that are either nonexistent or impossible to follow.
  • And we won’t fail to notify and provide records of your hospitalization to your clinician and fail to make arrangements for you to be evaluated within a few days after your discharge.

We MUST be better than this!

We should not accept NOT creating new problems as some type of virtue.

We must identify problems pre-emptively, BEFORE they exist, and PREVENT them from happening in the first place.  And when a problem unexpectedly does occur, we must address it quickly and efficiently and prevent further health decline.

This is especially true in settings like assisted living, where the residents are elderly and fragile with multiple chronic health conditions and have limited tolerance for taking on yet another health problem – even something as minor as a cold or a minor urinary tract infection.

Especially in assisted living, our standards must be that:

  • We know exactly the health conditions of our residents, because we’ve measured them, and this allows us to develop the services specifically suited to THEM and not to a fictional AL where we have only guessed at what the health needs are.
  • We monitor our residents proactively, identify declining health issues early, and intervene immediately to keep our residents well and prevent ER visits and hospitalization.
  • We have implemented efficient arrangements with clinicians that allow timely solutions to health issues rather than waiting for days due to faulty communication and care processes.
  • We know the risk profile of every resident, and this allows customized monitoring, and facilitates early identification and intervention of declining health.
  • And if a resident who is admitted to the hospital returns to us, we have a program in place that will assure there will be NO AVOIDABLE READMISSIONS!

This should not be the future.

This should be, and must be, NOW.

E-mail me with comments:  stevenfuller@illuminationanalytics.com

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






February 20th, 2016

A Shot Across the Bow

A recent article in McKnight’s is a shot across the bow for communities who consider themselves to be members of the post-acute care continuum.

It urged these communities to tell their “data story.”  To measure and promote their performance if they want to survive the imminent changes in payment models coming their way.

And it also warned of the risks of NOT telling your data story – namely, you won’t be included in the referral networks that are forming.  And in the very competitive market of post-acute care, this could be devastating.

If you want a ‘seat at the table’ when getting referrals, you will need a data story.  Telling your story can be achieved creatively with “Data Marketing” that will differentiate you from your competitors, showcase your exceptional outcomes, and demonstrate how you can be trusted to provide care excellence.

A data story begins with measurement.  And when it comes to resident health outcomes, here are some important metrics (and there are others):

  • # ER visits
  • # hospitalizations
  • # 30-day re-admissions
  • # falls
  • # doctor visits
  • # ambulance calls
  • # Pressure ulcers
  • % residents taking antipsychotics
  • Resident, employee, and family satisfaction surveys
  • Staff training for the specific health conditions and medications that are most common in your community.
  • Results of Quality Improvement Projects that address Gaps in Care, protocols for immunization and pain control.

And now that you have some measurements, meet with your staff and write your story.  Weave a narrative that describes your community in a unique way that tells people why they should choose you.  Convince them that you excel in the care you provide.  Tell them:

  • This is who we are.
  • These are some of our quality improvement projects.
  • Here’s the ongoing training our staff experiences.
  • Here are our outcomes and why you will feel safe and secure with us.
  • Here’s what our staff, residents, and families say about us.
  • Here’s what our local hospitals say about us.

You should tailor your story to the interests of your referral base, so everyone’s story will be customized.

Caveat Emptor

Here’s an important caveat that could easily be overlooked:  the unintended consequences of the increasing dependence on the use of ancillary services, such as PT/OT, Home Health, and Hospice in assisted living and other residential communities:

  • You need to know the metrics of these agencies that operate within your communities, because THEIR performance contributes to YOUR health outcomes.
  • I strongly recommend that independent and assisted living communities carefully review the performance metrics of the agencies that operate within your walls.

 The Boomers

Finally, boomer children will also want to hear your stories, as they are becoming more sophisticated in researching the communities who will become the primary caretakers of their parents.  They want to be informed beyond the hospitality basics that every community advertises.  And they don’t like surprises.

I recently spoke with a neighbor who needed assisted living for her father.  He had moved in with her family about a year ago after suffering a stroke.  His declining health had become more than she and her family could handle.  She told me of her difficulty in choosing an AL, because when she went to the websites and then visited some of them in person, “They all look the same, they say the same things, and they even have the same exact photos of the same exact elderly models!  How am I supposed to know where my dad will get the best care?”

Your data will reassure the boomers, for data are an untapped reservoir of wealth to guide and showcase your performance.  And there are almost unlimited possibilities in using them creatively for market differentiation.

So use your data, tell your story, and differentiate yourself.

Or…you can join your competitors, ignore your data, and be just another talking head.

Heads

 

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






February 7th, 2016

3 little words that make so much difference.

OK…even if you don’t work in healthcare, the answer to the question may seem obvious.  So I’m going to throw you a bit of a twist that might change the way you think.

Let’s add 3 little words and see if your response is any different:

In senior housing, what’s the difference between a doctor and a nurse?”

Hmmmm…that’s interesting.  I’ll bet you probably haven’t thought about it in quite this way.   It’s amazing how 3 little words can affect your thinking and perception, right?

Surprisingly, the answer to this question is actually very important.  And it’s important to understand the answer, as it demonstrates some of the most unique features of healthcare delivery and management in the social model of senior housing vs. a medical model of ‘housing’.

I’m going to give my version of the answer in 3 parts, one article for each part.  Today is Part 1, and Parts 2 and 3 will follow over the next few weeks.

So here we go:

QUESTION

In senior housing, what’s the difference between a doctor and a nurse?”

ANSWER

“The company who signs the paycheck.”

Think about this, because it’s really interesting.

COMMONALITY

What doctors and nurses have in common is that they are both accountable to their employer who pays them.  Just as with any employer, doctors and nurses must uphold the standards and follow the directives of their employers.  If they don’t,  they can be fired or lose their license or both.

DIFFERENCES

Where doctors and nurses differ in senior housing is:

  • who employs them.
  • who writes their paychecks.
  • who manages them.
  • who can fire them.

Doctors’ employers are usually the doctors themselves (if self-employed), other doctors, or medical professionals in the healthcare system.  The entire professional focus of these individuals is dedicated to patient care.  Thus, for their employment, doctors are accountable to other doctors and medical professionals for upholding well-defined standards of care and best practices.

Nurses’ employers, in contrast, are the senior housing communities in which they work.  Most of these communities (with few exceptions) are owned and operated by real estate and/or hospitality businesses which are completely unrelated to the healthcare field.  Thus, nurses who manage the health of senior housing residents are required to follow the directives of the non-healthcare related businesses that pay them.  In this area, standards of care and best practices are not nearly as well-defined as in the medical industry.

Does this imply that the way nurses manage the health of senior housing residents is influenced by the type of employer they have (healthcare vs. real estate/hospitality)?

I invite commentary from readers, especially those having direct experience in this area.

Please e-mail:  stevenfuller@illuminationanalytics.com.

Steven Fuller

Dr. Steven Fuller

 

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






January 28th, 2016

Uncomfortable  Questions

Dementia is a devastating disease.

Everyone knows this.  And in our society, it dominates the attention of the victim, the family, caregivers, healthcare professionals, nonprofit organizations, centers of research, and so many others.

Senior housing is not immune from the impact of dementia, as it is charged with designing an environment for the safe care of these residents.  Many assisted living communities have developed separate Memory Care Units with unique architectural and care designs, specially trained staff, and specialized programs and services.

When a person has dementia, for the remainder of that person’s life, the entire world revolves around the care and treatment of his dementia.

And therein lies the trap…

The temptation to view dementia out of context

From the healthcare standpoint, dementia is only one of many chronic health issues that afflict seniors.  There are other health issues that are just as important.

Let me illustrate:

The following Health Profile shows 17 of the most common chronic health conditions found in assisted living (AL) residents.  These conditions are shown in order of frequency, from the most frequent on the left of the profile to the least frequent on the right.

Chronic health conditions(click on Figure to enlarge)

As you can see, dementia is just one of the many distressing chronic health conditions that consume AL residents.  And it’s not even the most frequent, but rather the 4th most frequent.

And what I haven’t shown is that dementia residents typically have about 8 chronic health conditions and take 6-7 different prescribed medicines, just like all the other AL residents.  So from the healthcare standpoint, dementia residents aren’t so different after all.  They have a similar assortment of chronic health conditions and take similar medicines.  And they must all be managed with equal skill and attention.

So this raises a few interesting and even uncomfortable questions:  are we, unintentionally, overemphasizing the significance of dementia in the care of AL residents?  Is the disproportionate emphasis on the care and services provided to dementia residents distracting us from providing similar support that would benefit residents having other chronic health conditions?

For example:  there are Memory Care Units for dementia residents.  But have you seen specialized units dedicated to the aggressive care and management of other, equally important, chronic health conditions, some of which are even more frequent?  If you were to search, could you locate assisted living communities advertising that they have:

  • ‘Diabetes Care Units’ for residents suffering from the complications of diabetes?
  • ‘Respiratory Care Units’ for residents whose lives are dominated by severe COPD and who struggle for every single breath?
  • ‘Chronic Pain Units’ for residents with severe arthritis or other musculoskeletal problems who are in pain with every movement, every waking moment?
  • ‘Cardiac Units,’ because residents with heart problems present the highest risk for hospital readmissions?
  • ‘Depression Units,’ as this common condition ravages the quality of life of its victims and also puts them at higher risk for hospitalization and readmissions?

These specialized units are not generally available.  So why is dementia singled out with special units and services not afforded to residents with other chronic health conditions?

I’m afraid I don’t have an answer here.  But I think it’s important to raise this issue for discussion, and I’m very interested in readers’ opinions.  Perhaps it will remind us that residents with dementia are ‘more’ than their chronic disease and have many dimensions.  And from the healthcare standpoint in assisted living, we should consider whether to implement a more balanced and proportionate emphasis in the care directed at all chronic health conditions.

Please e-mail me with your comments and suggestions:

StevenFuller@illuminationanalytics.com.

 

Steven Fuller

 

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






January 15th, 2016

An innovative way to use dementia data

Dementia Profile(click image to enlarge)

The better you understand your assisted living residents, the better the care you can provide.

If you know only 1 fact about a resident (like someone you just met a second ago), then you can only guess whether anything you say or offer may be of interest or benefit to that person.  But if you know many facts about a resident and have a broad understanding of him (like with a childhood friend), then you can anticipate almost with certainty how he would react to a particular situation or event.

So how can you clearly articulate this important concept of ‘understanding’ of assisted living residents, which intuitively makes a lot of sense but is still somewhat vague and intangible.  How do you make ‘understanding’ a concrete and actionable tool you can use every day to help your residents?  Here’s an idea that may help:

DEMENTIA PROFILE

Create a Dementia Profile* – a Profile that distills important health information from a variety of sources (shown in the Figure above) and blended into a clear silhouette.  Having this key health information available at your fingertips in the form of an easily accessible and understood Dementia Profile will do the following:

  • Increase your understanding of dementia residents.
  • Provide support for data-driven decisions about the most appropriate services that are needed.
  • Shine a light on areas that need improvement.
  • Predict the needs of your future dementia residents.
  • Identify important areas for staff training and education.
  • Allow comparison of the Dementia Profiles of different communities owned by the same corporation. This may reveal community-specific differences that would otherwise go unrecognized when data are dispersed or not captured.
    • And this would yield opportunities to customize resident healthcare and provide data-driven, resident-centric care. For example – a Dementia Profile showing more ER visits or more falls in one community in comparison to its sister communities may prompt further investigation that could unveil opportunities for improvement.
  • Standardize your method of collecting and organizing disease-specific data. This will allow consistency in data analyses on a corporate level and yield greater appreciation of best practices.
  • Market differentiation and highlight you as a leader in innovative resident healthcare.

As an extension of this concept, you could create Profiles for each of the dominate health conditions in your community.  Just as with Dementia Profiles, you can also design the following:

  • Cardiac Profile
  • Diabetes Profile
  • Depression Profile
  • Anxiety Profile
  • Breathing Profile
  • Parkinson’s Profile

Now you can use these profiles to predict the needs of all your prospective residents and develop customized solutions.  When someone calls or tours your community, and you learn about some of the chronic health conditions that they can no longer manage, you can refer to the appropriate Profile as a marketing tool.  You tell them, with specifics, about the programs and services you currently have in place precisely for that condition.

Can you imagine how comforting and reassuring this would be to those customers?  Can you imagine the favorable reaction of your local referral base (doctors, hospitals, SNFs, etc.) when they see your innovative approach!  And can you even imagine the favorable reaction of your state surveyors?

To implement a Dementia Profile is not a matter of data – in most cases the data are either easily available or can be easily obtained.

What’s needed is:

  • Vision
  • Leadership
  • The courage to be bold and try something new.

Please e-mail me at stevenfuller@illuminationanalytics.com to discuss your thoughts about Dementia Profiles.

*A conceptually similar approach has recently been described in the care of dementia patients in England.

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






January 9th, 2016

The hole that can no longer be ignored.

Senior Housing Hole

Any discussion about senior housing that does not include senior healthcare has a huge hole in it.

Not a tiny hole that you can step over, tiptoe around, avoid, pretend it doesn’t exist.  A HUGE gaping hole that will ultimately consume you, because prospective residents and their families and especially health referral sources increasingly demand to know how you manage the health of their loved ones, as this is the very reason that compels them to your doors.  Residents who are deciding why they should choose YOU rather than a competitor in the same town.

Research shows that assisted living seniors each have an average of 8 chronic health conditions and take about 7 different prescribed medicines (many of them taken more than once a day).  For a 100 bed assisted living community, that means its aides and its nurse are helping manage 800 chronic health conditions and dispensing more than 700 medicines every single day, 7 days a week, 365 days a year!

How could you NOT talk about this?!  And yet, so few do!

What an opportunity to promote your experience and expertise about a topic so precious and intimate to your residents – their health, which they have handed over to you with whole-hearted trust.

How could you NOT openly discuss this?  Why do you not discuss the training of your staff, your experience in managing not only these health conditions but also the medicines that support them, the customized and personalized care approaches you have designed for specific health conditions, and more?

If you’re an owner of senior housing, surely you must realize that housing for seniors is totally different than housing for younger folks.  Sure…younger folks have health issues.  But they have fewer of them, and they are healthy enough to easily manage them on their own.  So the reason why younger folks are attracted to your properties has nothing to do with health.

In senior housing, however, especially assisted living, it’s the exact opposite.  The ONLY reason why residents come to you is because of their health and because they can no longer manage their own health and now depend on YOU for assistance.

With this realization, and with the understanding that profitable senior housing investments depend on maximizing occupancy at the most efficient cost, isn’t it logical that you would insist that your operators put resident health as a prominent and visible priority?

And yet the following statistics demonstrate more focus is urgently required.  Over the past 10 years for assisted living,

  • Length of stay has plummeted from 36 months to 22 months.
  • Annual resident turnover, pressured by acuity creep, has skyrocketed from 41% to 54%!
  • The leading reason for resident turnover is declining resident health, and this has risen sharply from 72% of those residents who leave to 92% currently!

Although occupancy nationally in assisted living averages about 88% (according to the 4Q15 figures from NIC), what if, by implementing a focus on resident health, you could maintain that occupancy with a lower turnover rate and therefore with lower cost?  What if you could reduce turnover by 10% or 20% or more?  At a conservatively estimated cost of $4000/turnover, that would result in significant cost savings.  Improved profitability would be achieved by stabilized resident health.  Everybody wins!

Every senior in your community has a host of chronic health issues – every single one of them.  When your discussions do not include general information about resident health and the services you have designed to support these health issues, you prevent your customers from learning about your strengths and expertise in this crucial area, and you hide your most promising market differentiator.

Every owner and operator of senior housing, especially assisted living, would benefit from informative discussions about the health issues managed in their communities.  What an opportunity to display your commitment to quality, personalized, resident-centered care!

For ideas about how to ‘close the hole’ in senior housing discussions, please e-mail me:  stevenfuller@illuminationanalytics.com.

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.






January 2nd, 2016

3 Keys to Success for all Readmissions Programs

When was the last time you ever heard of a doctor who was avoidably readmitted to the hospital?

That’s right – a doctor:

  • who himself was a patient in a hospital (doctors get sick too, you know),
  • who was discharged from the hospital,
  • and then who developed a problem that lingered unsolved and that led to him to being avoidably and unnecessarily readmitted back to the hospital within 30 days?

C’mon…name one doctor who fits this description, just one!  About 2 million Medicare patients are readmitted to the hospital each year, so surely at least one doctor must be among them, right?

As I reflect back on my 25 years of medical practice, both as a hospital-based and a community-based doctor in multiple regions of the United States, having admitted and discharged literally thousands of patients over my career, I honestly cannot think of one single doctor who fits this description.

Although I can recall many many many other patients who fit, I do not recall one…single…doctor…

Why is this?  Why do readmissions happen to ‘other people’ but not to doctors?

As a doctor myself, I can tell you why.  And I can tell you with 99.9999% certainty.  It’s really not that complicated.

The reason why doctors are never (well, probably almost never) readmitted to the hospital is because they automatically employ 3 fundamental principles that make readmissions almost unheard of.  Those principles are:

3 Keys to Success

  1. Doctors are closely connected with their own doctor.

    • The connection between doctors and their colleagues in times of sickness are close and unshakable and most importantly – immediate.
  2. Doctors have direct and efficient communication with their colleagues.

    • The guidance a doctor requires to successfully navigate through his recovery is provided by timely and skillful communication with his healthcare colleagues. This ensures timely access to the support services he needs.
  3. Doctors and their caregivers are vigilant to any changes in health condition.

    • Problems are identified early and solved BEFORE they ever have the chance to wreak havoc. And so readmissions for doctors rarely happen.

If you don’t believe that these are the keys to success, if you believe that it must surely be more complicated than these rather simple and intuitive steps, then I’ll ask you again:  “When was the last time you ever heard of a doctor who was avoidably readmitted to the hospital?”

And these principles extend to patients who are not doctors just as well.  To further illustrate, I can’t tell you how many hospital admissions and readmissions were avoided in my medical practice because a patient or his spouse or another family member or a friend, called me and told me about a change of condition.  I either addressed the problem directly by phone, or I asked the patient to come to my office.  But problems were identified early, treatment was initiated early, and the issue was ‘nipped in the bud.’  No admission and therefore no readmission.

I’ve now taken these Keys to Success and adapted them to a new readmissions program specifically for assisted living.  The name of the program is STRAIGHT LINE, and the 3 Keys are named as follows:

  1. Connect

  2. Communicate

  3. Confine the Decline

The Keys, adapted specifically for assisted living, are described in 3 concise online videos with downloadable text.  They instruct how to establish a straight, direct connection and communication between residents and their doctors as well as proactive and early identification of changes in condition.

The goal is to achieve the same readmission rate for assisted living residents that doctors experience for themselves – almost ZERO.

Visit STRAIGHT LINE to learn how to reduce readmissions in your community.

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@straightlineconnect.com.






December 21st, 2015

‘Patient Alignment’… It may not be sexy, but it’s better.

Hospitals are assessed costly financial penalties when their discharged patients are un-necessarily re-admitted within 30 days of discharge.  Skilled nursing facilities are soon expected to encounter similar penalties.  And who’s next to get the axe and join the ‘penalty club’…Home Health?  Hospice?  Long term acute care hospitals?  Inpatient rehab facilities?

But wait a minute…isn’t this all backwards?  Shouldn’t we change ‘Re-admissions’ to ‘Never admitted in the first place?’

Re-admissions – the problem is real, and many successful programs are now available for hospitals.  And a unique new program is also available for assisted living communities as well.

But the name “Re-admissions” conveys the heart of the problem – a reactive and faulty mindset:  to admit again.  No sooner have you gotten home, then for 1 out of 5 Medicare patients things fall apart, and it’s time to get admitted again!

This re-active, victim-oriented mindset is geared to fixing a problem after it occurs.  Instead, we should cultivate a pro-active and savvy patient-oriented mindset determined to prevent problems from happening!

A lasting solution to re-admissions demands a change in mindset – changing our thinking to a pro-active approach that encourages realigning our interventions on high risk patients before they become ill and while they’re still home.  The goal would be to prevent the index hospitalization whenever possible.

The good news is that it doesn’t cost anything to change your thinking.  In fact – it will probably cost a lot less in the long run.

Think about it…

Patients who suffer a re-admission don’t just appear “out of the blue.”  Most of them are already in the healthcare system long before they ever require a hospitalization.  They already have doctors and often have multiple other care providers as well.  They are known, their medical histories are known, their medications are known, and many of their social and demographic characteristics are known.

Enough already!

We already have more than enough information that’s needed to pro-actively identify and risk stratify patients.  So why have we ignored all this information and waited for admissions and re-admissions to occur BEFORE doing something about it?  Why do we spend all of our time and resources cleaning up after a bomb explodes rather than preventing the explosion to begin with?

I believe the solution is easier than we imagine, even though we may have convinced ourselves that the only remedy surely must be complex.

Our mindset needs to be pro-active and pre-emptive – we need to derive solutions for problems BEFORE they occur, or at the very worst, at the very earliest onset of symptoms so that interventions can be rapidly deployed long before hospitalization would ever be required.

Here’s a solution that may help.  What’s your suggestion?

The starting place for solutions is the doctor’s office, since this is the primary repository of patient health information.  The doctor’s Electronic Health Record should contain algorithms that risk-stratify every patient (low/medium/high risk).  The patient’s risk level should be color coded and prominently displayed on the doctor’s viewing screen.  Risk reduction strategies should be developed, and suggestions for specific action steps should “pop up” in the viewing screen and be available for the doctor to click and implement before he ends the patient visit.

As an example, the doctor would implement an entirely different plan of action for each the following 2 patients:

  • Joyce is a 85 year old woman with 3 chronic health conditions, who takes 2 different prescription medicines, and who has a loving and supportive family and friends with whom she spends much of her time.
  • Mary is an 75 year old woman of modest means with 8 chronic health conditions, who takes 10 different prescription medicines, whose husband has dementia, and whose family lives in a different state. Mary rarely socializes – she just doesn’t have the time or energy and can’t afford the out-of-state travel to see her family who are also very busy.

Today’s reactive approach by most providers is to deal with the acute problem that precipitated the office visits, and then to send these patients on their way.  But with new, pro-active thinking that focuses on patient alignment, the follow-up plans for these 2 patients would be totally different.

  • For Joyce (risk level Green), routine evidence-based care would be provided with attention to education about her chronic health conditions and medicines as well as the importance of routine follow-up visits.
  • But for Mary (risk level Red), in addition to evidence-based care, a host of social and healthcare support services would be employed, and close regular follow-up visits would occur with her doctor for close monitoring and rapid response to changes in condition.

This approach exemplifies Mary’s alignment with her doctor and healthcare support system and is our best chance for reducing costly hospitalizations and re-admissions.

So, what’s my suggestion for “Re-naming Re-admissions?”

I suggest “Patient Alignment.”

OK…”Patient Alignment” isn’t sexy.  But this change in name might prod our thinking so that we focus on keeping our patients aligned with our community-based healthcare team rather than letting patients fall through the cracks and end up getting hospitalized and then readmitted.

“Patient Alignment” may not be as sexy as “Re-admissions.” But sex isn’t everything, and I believe that proactively keeping patients aligned is better than reactively trying to fix them after allowing a problem to un-necessarily spin out of control.

What’s your suggestion for re-naming re-admissions?

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.






December 17th, 2015

Acuity Creep – the growing prevalence of assisted living (AL) residents who are older, frailer, and who need more services, more supervision, and more medical attention.

Coming to grips with Acuity Creep is a growing challenge recognized by the majority of AL managers.  This is because the impact of rising acuity pervades AL operations, as it affects staffing requirements, risk for hospitalization, resident turnover, technology needs, cost control, and more.

But incorporating acuity into the thinking and decision-making in assisted living is not straightforward, because the concept can seem somewhat vague, difficult to ‘wrap your head around,’ and impossible to meaningfully quantify.  In addition, a tangible, easy, and practical scoring method has not been available to conscientious AL owners and managers who want to provide the best living environment possible for their residents.  Thus, 45% of McKnight’s survey respondents indicated uncertainty in how to react to acuity creep and are looking for new ways to manage it.  But in order to manage this growing challenge, acuity must first be measured.

From a physician’s perspective, acuity is driven primarily by 2 factors:

A community dwelling senior living independently at home with good health or who has only a few chronic health conditions requiring a couple of prescribed medicines generally has very low acuity.   In contrast, an AL resident who has many chronic health conditions requiring many different prescribed medicines has a very high acuity.  And the medical literature supports the observation that residents with greater acuity are at greater risk for hospitalization which in turn puts the AL at risk for losing a resident.

This understanding now offers an opportunity to develop an Acuity Score whose value is based on the parameters of chronic health conditions and prescribed medicines.  The value of this score is that a single, discreet, specific number (the Acuity Score) can now be calculated for every resident and  will give insight to the scope of health services and amenities residents require.  It can be calculated for new residents to help an AL prepare staffing requirements.  And the average Acuity Score for an AL can be compared to the average score for sister ALs in a corporate portfolio so that regional directors can appreciate the hidden acuity differences between buildings and therefore adjust staffing accordingly.

An example in the use of this method for calculating Acuity Scores for 2 different ALs is shown below in Figure 1.  Each vertical bar is an individual resident, and the numbers above the bars are their calculated Acuity Scores.  The normal Acuity Score for non-institutionalized seniors living independently at home is less than 15.

Figure 1.

Acuity-Score

(Click on Figure to enlarge)

There are several important observations to be made about the acuity in these 2 ALs.

  • Note the wide variability in Acuity Scores of the residents within each AL. This gives an immediate visual appreciation of the challenges faced when managing the health of seniors with such divergent health needs.
  • Acuity Scores can be used to customize resident monitoring, such that an AL may wish to monitor high acuity residents differently and more frequently than low acuity residents.
  • The Acuity Score could be used when implementing an acuity-based staffing model. Staffing requirements, including staff training and education, for the AL represented in the top graph (Acuity Score = 62) may be different than the requirements for the AL represented in the bottom graph (Acuity Score = 37).
  • The Acuity Score could be used to help determine whether a perspective new resident may be a good fit for a particular AL. For example, an AL with an average Acuity Score of 37 may not wish to accept a new resident whose Acuity Score is 90 because they don’t currently have the staffing to meet the needs of such a resident.

Figure 2 below shows the average Acuity Scores of 50 different ALs.  This visualization gives an immediate appreciation of how ALs differ from one another in resident acuity.

Figure 2.

Avg Acuity Score

(Click on Figure to enlarge)

Conclusion:

The Acuity Score offers a new and novel tool that transforms the somewhat nebulous concept of acuity into a specific number, a value that can be used to bring insight about AL resident health and guide the direction and focus of resident health management.  To learn more about the Acuity Score, please e-mail me at stevenfuller@illuminationanalytics.com.

 

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.






December 14th, 2015

Creative use of marketing innovation in assisted living.

Here’s a creative idea to differentiate your community and showoff at the same time.

Tell your story in a way no one else can – by using your health data.

Tampa's Best

Surround a photo of your community with colorful health data and an informative Table of key health metrics that you track.  And then have your team develop a storyline that showcases the excellent resident care you provide.

Your story might go something like this (although you would write it in your own unique way):

  • Graph #1: This is who we are:
    • Show a graph of the health features that your community manages on a daily basis. These are your areas of expertise.
    • Discuss how you customize employee training to meet the specific health concerns of your residents in your community.
  • Graph #2: These are some data that help direct our Quality Improvement Projects.  We call them ‘Gaps in Care’ or ‘Assuring Care Consistency.’
    • Discuss some of the quality improvement projects you have developed.
    • Emphasize that these projects are data-driven and allow you to offer personalized, resident-centered care.
  • Graph #3: This is one way we emphasize resident safety and minimize our residents’ risk of hospitalization.
    • Discuss how you proactively monitor the health acuity of every single resident.
    • Discuss the programs you’ve developed to personalize your resident monitoring.
    • Discuss your community’s readmission program.
  • Key Metrics Table: These are just some of the quality indicators we continuously monitor to assure our residents, their families, and our referral base that we provide state-of-the-art care.
    • These metrics will demonstrate your commitment to quality resident care.
    • Your marketer can demonstrate how your community is prepared for inclusion in health referral networks.

Marketing collateral developed in this way is absolutely unique and will grab the intrigue and attention of your referral base in a way your competitors cannot match.  It will open unique discussions and distinguish you as a quality-oriented community.

Your health data are an untapped reservoir of opportunity that is yours for the taking.

Contact me to help you tell your story.

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.






December 4th, 2015

The daily release of medical reports in the media offers new and important health knowledge to the general public.  It also provides assisted living communities (ALs) with untapped opportunities to be on the cutting edge of resident care.

But the challenge is to filter through this information and make the relevant findings actionable.  That is, how can knowledge that was just released today be used to improve the care of our residents…NOW, and put us on the cutting edge of resident care?

Here’s the latest example:

A new report has shown that patients who have both depression and COPD are at increased risk of readmission to the hospital.

OPPORTUNITY:  For assisted living, this identifies a group of residents who will benefit from personalized care.

For example:  in response to the article above, your analytics consultant could immediately deliver you a list of your residents who have both depression and lung disease.  You could then meet with your staff and develop Quality Improvement Initiatives for this small group, such as:

  • Connecting this group with their doctors to be sure that each of these conditions is being optimally managed.
  • Starting a support group so that these residents could meet together weekly to discuss their thoughts and ideas of how to overcome the daily challenges they face.
  • Educational sessions where this group is instructed on their medications, how to use inhalers properly in order to get the maximal benefit, becoming alerted to medication side effects, recognizing the early signs of breathing difficulties or depression, etc.
  • Perhaps having a buddy system where the members of this small group would reach out to one another if they are becoming concerned about their depression.
  • Educating your staff as to warning signs of early clinical deterioration for both COPD and depression.
  • Other ideas your staff may formulate that would work best in your AL.

AL resident turnover is 54%, and at an estimated $4000/turnover, is a major source of financial loss.  Furthermore, over 90% of resident turnover is due to declining health. Thus, a focus on resident health presents a huge opportunity to make a positive impact on your AL.

To reduce resident turnover and the associated financial loss, it is critical to identify medically high risk residents.  Doing so allows ALs to pre-emptively implement programs targeting their high risk groups with staff training and education as well as personalized resident management that will help keep residents healthier longer.

By partnering with an analytics consultant, ALs now have the ability to turn newly released medical knowledge, hot off the presses, into immediate, actionable, and personalized care for their residents.  By exploring their own resident health data, ALs can target specific residents who will benefit from new reports through the development of personalized and customized health management.  The anticipated outcome?  Improved profitability through better resident health, reduced resident turnover, and longer lengths of stay.

This “pre-emptive” approach for your different groups of high risk residents will attack potential problems BEFORE they become problems.  This will help stabilize resident health and ward off preventable health deterioration.  And your exemplary care will translate into financial benefits and market differentiation.

Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.

 






November 27th, 2015

Acuity Creep – the growing prevalence of assisted living (AL) residents who are older, frailer, and who need more services, more supervision, and more medical attention.

Coming to grips with Acuity Creep is a growing challenge recognized by the majority of AL managers.  This is because the impact of rising acuity pervades AL operations, as it affects staffing requirements, risk for hospitalization, resident turnover, technology needs, cost control, and more.

But incorporating acuity into the thinking and decision-making in assisted living is not straightforward, because the concept can seem somewhat vague, difficult to ‘wrap your head around,’ and impossible to meaningfully quantify.  In addition, a tangible, easy, and practical scoring method has not been available to conscientious AL owners and managers who want to provide the best living environment possible for their residents.  Thus, 45% of McKnight’s survey respondents indicated uncertainty in how to react to acuity creep and are looking for new ways to manage it.  But in order to manage this growing challenge, acuity must first be measured.

From a physician’s perspective, acuity is driven primarily by 2 factors:

A community dwelling senior living independently at home with good health or who has only a few chronic health conditions requiring a couple of prescribed medicines generally has very low acuity.   In contrast, an AL resident who has many chronic health conditions requiring many different prescribed medicines has a very high acuity.  And the medical literature supports the observation that residents with greater acuity are at greater risk for hospitalization which in turn puts the AL at risk for losing a resident.

This understanding now offers an opportunity to develop an Acuity Score whose value is based on the parameters of chronic health conditions and prescribed medicines.  The value of this score is that a single, discreet, specific number (the Acuity Score) can now be calculated for every resident and  will give insight to the scope of health services and amenities residents require.  It can be calculated for new residents to help an AL prepare staffing requirements.  And the average Acuity Score for an AL can be compared to the average score for sister ALs in a corporate portfolio so that regional directors can appreciate the hidden acuity differences between buildings and therefore adjust staffing accordingly.

An example in the use of this method for calculating Acuity Scores for 2 different ALs is shown below in Figure 1.  Each vertical bar is an individual resident, and the numbers above the bars are their calculated Acuity Scores.  The normal Acuity Score for non-institutionalized seniors living independently at home is less than 15.

Figure 1.

Acuity Score

(Click on Figure to enlarge)

There are several important observations to be made about the acuity in these 2 ALs.

  • Note the wide variability in Acuity Scores of the residents within each AL. This gives an immediate visual appreciation of the challenges faced when managing the health of seniors with such divergent health needs.
  • Acuity Scores can be used to customize resident monitoring, such that an AL may wish to monitor high acuity residents differently and more frequently than low acuity residents.
  • The Acuity Score could be used when implementing an acuity-based staffing model. Staffing requirements, including staff training and education, for the AL represented in the top graph (Acuity Score = 62) may be different than the requirements for the AL represented in the bottom graph (Acuity Score = 37).
  • The Acuity Score could be used to help determine whether a perspective new resident may be a good fit for a particular AL. For example, an AL with an average Acuity Score of 37 may not wish to accept a new resident whose Acuity Score is 90 because they don’t currently have the staffing to meet the needs of such a resident.

Figure 2 below shows the average Acuity Scores of 50 different ALs.  This visualization gives an immediate appreciation of how ALs differ from one another in resident acuity.

Figure 2.

Avg Acuity Score

(Click on Figure to enlarge)

Conclusion:

The Acuity Score offers a new and novel tool that transforms the somewhat nebulous concept of acuity into a specific number, a value that can be used to bring insight about AL resident health and guide the direction and focus of resident health management.  To learn more about the Acuity Score, please e-mail me at stevenfuller@illuminationanalytics.com.

Dr. Steven Fuller

Dr. Steven Fuller

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.

 






November 27th, 2015

Medicare Readmission Penalties

After 4 years of Medicare’s focused effort to reduce 30 day readmissions, 75% of hospitals have failed to meet goals and continue to be plagued with penalties.  A high risk population for both hospital admissions and readmissions is seniors, as they are the highest consumers of our healthcare dollars.

Multiple chronic illnesses drive healthcare system use by seniors and are a greater risk factor for hospitalization than age.  And rehospitalization occurs almost exclusively in seniors having multiple (not just a few) chronic illnesses.

So how do assisted living (AL) seniors compare to community dwelling seniors with respect to their risk for hospitalization?  This is a question of immense importance for the assisted living industry, as the ability to objectively risk stratify seniors has significant financial and caregiving implications.  Resident turnover in ALs is 54%, and over 90% of resident turnover is due to failing health that often includes a trip to the ER or a hospitalization that subsequently precludes the resident from returning to the AL.

Analytics are an invaluable tool that can lead healthcare management in assisted living.  In this case, an innovative Acuity Index is developed that compares the hospitalization risk of assisted-living seniors to community dwelling seniors.  This method uses a literature-based approach that relies primarily on the number of chronic health conditions and prescribed medicines taken by seniors in both settings.

The Figure below shows the extent to which the hospitalization risk for assisted-living seniors exceeds the risk of community dwelling seniors by the multiple shown above each red vertical bar (each bar is an individual resident).

Acuity Index

(click on Figure to enlarge)

So as an example, the resident represented by the vertical bar on the far right of the Figure has 7.8 times the risk of being hospitalized in comparison to a community dwelling senior.  In contrast, the resident represented by the vertical bar on the far left of the Figure has about the same hospitalization risk (0.8 times the risk) as a community dwelling senior.

The value of this analysis and data visualization is to give an AL manager an immediate appreciation of the hospitalization risk of every resident in his/her community so that healthcare resources can be efficiently deployed proactively (e.g. frequency of monitoring, doctor visits and follow-up, attention to control of high risk chronic illnesses, gap analysis, quality improvement initiatives, etc).  The long term outcome will be stabilization of resident health, reduced resident turnover, and increased AL profitability.

This is exactly the kind of information that will appeal to referral networks, as it uniquely demonstrates a commitment to care excellence.

Please e-mail me to learn how your AL can benefit from analytics and the Acuity Index.

Dr. Steven Fuller

 

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.






November 27th, 2015

A new medical study of over 1 million patients found that the most common causes for hospital re-admissions were cardiovascular and pulmonary diagnoses.Readmissions

(click figure to enlarge)

These are 2 of the 8-9 chronic illnesses that afflict the average assisted living resident.  And hospital readmissions are becoming a key determinant that referral sources depend on when choosing their post-acute providers.

Thus, it is of high importance that Assisted Living communities use analytic tools to quickly identify these high risk chronic illnesses in their communities and assure optimal management.

Gap analysis affords a unique and easily applied solution.  Gaps in high risk chronic illnesses are easily identified and target a deeper analysis that yields resident-specific solutions.

Please e-mail me to learn more about applying Gap Analysis in your assisted living community.

Dr. Steven Fuller

Dr. Steven Fuller, President

 

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.






November 27th, 2015

Here are some unexpected statistics describing the assisted living industry.

Despite the investment profitability in senior housing, and despite an ardent focus on the incredible hospitality offered – luxurious accommodations and surroundings, fine dining, architectural design awards, and much more – the following facts about assisted living are also true:

In only 10 years (2000 – 2010),

  • LOS (length of stay) has plummeted from 36 months to 22 months.
  • Annual resident turnover has skyrocketed from 41% to 47% (and to 54% in 2013)!
  • The leading reason for resident turnover is the declining resident health, and this has climbed sharply from 72% of those residents who leave to 92%.

The opportunity is clear – an Integrated Care model of assisted living is needed to advance the paradigm of this incredible and essential industry.  A model that encourages equal participation of real estate, hospitality, and healthcare.  And the ROI is clear – the potential to save thousands of dollars annually by reducing resident turnover via the stabilization of resident health, being included in health referral networks, and market differentiation to attract new residents.

Healthcare’s contribution must go far beyond the mere providing of ADLs, for the figures above have occurred despite the providing of ADLs.  It must include a deeper understanding of AL resident health which will lead to improved health management.

An Integrated Care model begins with measuring resident health, for “what isn’t measured can’t be managed.”  This will lead to insights that will optimize resident health, and that translates into decreased resident turnover, longer lengths of stay, and improved profitability.

Integrated care, a model in which healthcare works equally and cooperatively with real estate and hospitality, will preserve the social model of assisted living while providing insights to optimize its management.  These are insights that will inspire data driven solutions and address the threat of government regulation by proactively responding to the most prevalent and topical health issues, such as the use of anti-psychotics, the care of dementia, polypharmacy, and avoidable hospital re-admissions.

And Integrated Care uniquely provides an opportunity for market differentiation.  The question is:  “Who will lead?”

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com.






November 18th, 2015

Re-admissions and Assisted Living

McKnights reports that progress is being made in reducing avoidable hospital re-admissions.  One of the key factors responsible for this improvement is the creation of preferred referral networks in which hospitals only send referrals to the small fraction of post-acute care providers who “make the cut” and are therefore included in their referral network.

This changing referral pattern is the new world of post-acute care.  Assisted living communities must be able to provide data-driven evidence that they have programs in place that will deliver the outcomes to merit referrals from hospitals, SNFs, rehab facilities, and others.

One such program is a readmission programA program to minimize avoidable re-admissions is no longer an option for the few, but a necessity for all.

In addition, it has never been more important than now to measure the health characteristics of seniors in your community.   Guessing never replaces data – we can do better…much better.  It is essential to learn everything possible about resident health which is the top reason why your residents have asked you to assume the responsibility of managing their care.

Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@illuminationanalytics.com or stevenfuller@straightlineconnect.com.






November 9th, 2015

STRAIGHT LINE is a newly released and transformative online service that instructs assisted living communities how to minimize avoidable hospital re-admissions.  This concise program of highly selected, indispensable knowledge is intuitive and easily available as 3 core teaching modules with downloadable text.  A clever, modern, and effective presentation of the STRAIGHT LINE program allows easy access whenever, where ever, and as often as desired.

The foundation for STRAIGHT LINE is a combination of the medical literature, individual reports and success stories, and the extensive clinical experience of Dr. Steven Fuller whose commitment to medicine includes more than 25 years of direct patient care. Dr. Fuller has discharged thousands of patients from hospitals and has provided medical care to thousands of patients discharged from hospitals in a wide variety of community-based settings. He knows what works!

Since 2013, hospitals have faced considerable financial penalties when certain Medicare patients they discharge are avoidably re-admitted within 30 days.  Soon, similar penalties for skilled nursing facilities are slated.  This is leading to referral networks whose membership is restricted to those post-acute care providers that can demonstrate superior outcomes.  Assisted living communities who adapt a program supporting a reduction in avoidable hospital re-admissions will have a distinct advantage to being included in these networks.

To engage the STRAIGHT LINE program and slash avoidable re-admissions in your assisted living community, visit www.straightlineconnect.com.

Dr. Steven Fuller is a triple board certified physician/entrepreneur whose professional focus is to enhance the healthcare of senior housing residents.  He supports an Integrated Care model of senior housing that includes 3 equal and interactive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  stevenfuller@straightlineconnect.com.






August 21st, 2015

Data – the new opportunity for Assisted Living.

Here’s a recent article in McKnight’s that highlights the unique value of using analytics to measure assisted living resident health.  The use of analytics to discover the prevalence of antipsychotics is the first step in developing your Gap Analysis to ensure your care excellence.

There is a treasure of untapped wealth in the health rooms of every assisted living community…DATA!

Don’t overlook the importance of your data – the new currency of healthcare in assisted living.

Steven Fuller 1

 

Dr. Steven Fuller, President

Illumination Analytics

StevenFuller@IlluminationAnalytics.com

www.IlluminationAnalytics.com

 

Profitability through HEALTH PROFILES for the Assisted Living Industry!






August 13th, 2014

success

I welcome as a guest blogger Mr. Anthony Santiago, CEO of a new and exciting senior housing group called Affinitas Life.  This innovative company applies Blue Ocean thinking to senior housing and arrives at a refreshingly different destination than most others.  Expect to hear more about this very creative and imaginative group.

Achieving long term success in the highly competitive senior housing industry requires developers to adapt a vision that reaches beyond the buildings they construct and include a strategy to support the numerous health needs of its aging residents.  A system of integrated health data storage and analysis is a necessity to realize this goal.


We discovered an innovative organization that is spearheading this initiative – Illumination Analytics, developed by a Johns Hopkins trained physician, Dr. Steven Fuller.  Dr. Fuller has developed a system which uses highly selected but easily available health data to create HEALTH PROFILES for an assisted living residence. This delivers a venue to us operators and consultants that facilitates a quantitative approach to improve resident retention and attrition.  Managers access user friendly dashboards that allow them to ‘visualize’ key performance indicators that yield invaluable insights which we believe will maximize resident health and independence.


These unique analytics enable a health centric approach that we can now use as another barometer in our toolbox around our move-ins and move-outs.  The right data, easily accessed and visualized, is the new commodity and standard for excellence.

 






July 29th, 2014

Different

From its inception, Illumination Analytics was different.  It was developed by a physician with a single, targeted, and pragmatic focus – to understand the health of Assisted Living residents.

It’s a paradox that so little is known about the health of these seniors and how it differs from the health of seniors who live in other settings.  Indeed, even the most basic health question about this group eludes our current understanding:  “What are the specific health reasons that cause seniors to move into assisted living?”  And so many additional and important questions await answers.

The decision to move into assisted living is understandably huge for seniors, since it requires them to sell their homes and most of their possessions and leave everything familiar behind them.  The only reason over 1 million residents choose this alternative is because they need assistance with managing their health.

If we are to do a good job managing the health of assisted living seniors, then we must thoroughly understand it, and this means developing meaningful metrics to measure their health.

This is the purpose of Illumination Analytics – to begin filling the void of health knowledge of assisted living residents.

We were recently introduced to a new and very like-minded group that appears to have a refreshingly novel and parallel approach to senior living – AFFINITAS Life.  Our attraction to this creative and curious organization is that it supports an entirely different way of thinking about senior living.  It encourages the merging of like-minded and innovative ideas using strategic relationships to learn about senior living residents’ health.  Their goal is to offer an alternative option to the status quo within senior housing and an option to the traditional retirement living model.  From what I have read, this kind of approach can evolutionize and transform the health management of senior living residents.

We believe this ‘different kind of thinking and approach’ to senior living is exactly what’s needed, and we can’t wait to learn more!”






June 27th, 2014

 

research 2

Illumination Analytics is conducting a research study.  Our aim is to understand the specific health issues that cause many seniors to lose their independence and transition to higher levels of care.

TITLE:

 “A Comparison of the Basic Health Characteristics of Seniors Living in 3 settings:  Independently at home, Assisted Living, and Skilled Nursing.”

BRIEF DESCRIPTION:

Community dwelling seniors with declining health gradually require transition to more supportive settings that often include assisted living and ultimately skilled nursing.  Yet knowledge of the specific health characteristics that determine this transition from independence to dependence is lacking.

Illumination Analytics seeks to understand the specific health issues that drive this transition which is too often resisted by seniors until forced by failing health, and which is costly to the individuals, their families, and society.

SPECIFIC DE-IDENTIFIED HEALTH INFORMATION REQUIRED:

  • Demographics:  age, gender, height, weight, payor (Medicaid vs. other), type of living residence (non-institutional home, assisted living, skilled nursing).
  • List of diagnoses
  • List of Medications

 OPPORTUNITY FOR COLLABORATION:

To conduct this study, we seek collaborators who collect and will share de-identified health information for seniors 65 years of age and older.

  • Hospitals
  • Medical clinics
  • Physician practices
  • Insurers
  • EHR or eMAR companies
  • Home Health companies
  • Personal care companies
  • Assisted living facilities
  • Skilled nursing facilities
  • Private individuals who are willing to participate

All collaborators will have free access to all reports generated and be listed as participants in publications generated from this study.

TO PARTICIPATE IN THIS UNIQUE STUDY, PLEASE CONTACT:

DR. STEVEN FULLER

stevenfuller@illuminationanalytics.com

208-830-0476

www.illuminationanalytics.com






June 20th, 2014

Here are 7 advantages that physician-developed HEALTH PROFILES by Illumination Analytics will give your Assisted Living Community:

IA Logo

  • Your administrators will start each day with an ‘At-a-Glance’ dashboard that shows precisely all the essential health issues in their building.
    • Now that your residents’ health is measured, it can be more effectively managed.
  • You will have a unique tool for customized, more efficient, and risk-adjusted staffing.
  • You will have a display of high, medium, and low risk residents to direct your health management.
  • You will have an innovative marketing tool that is a ‘Market Differentiator.’
  • You will be able to compare the HEALTH PROFILES of your different buildings in a single view.
    • And you will discover differences among buildings you may never have been aware of.
  • You will have direct access and consultation with a physician to get the most insight and meaning and understanding from your analytics.
  • You will have a health analytics service that is FAST, straightforward, inexpensive, and TOTALLY unique.

Want more?

You’ve got it…much more.  All you have to do is ask.

But we don’t give you a lot of numbers and charts and tables and regurgitated data you DON’T need.

We only give you what you DO need, nothing more.

Contact Illumination Analytics today.






June 8th, 2014

I don’t know about you, but when I get into a car, I want to know who’s driving.  After all, it’s the driver that determines where we go and how fast and safely we get there.  Sure…the rest of us (the passengers) have something to say, but for the most part it’s just gab and conversation, “background noise.”

Passengers

Managing the health of assisted living (AL) residents is sort of like driving a car.  The AL is the car, and the residents’ chronic health conditions (CHCs) are the passengers.  The most common CHCs are the drivers of the car – the ones that need the most attention and management (and who will get you into trouble if you ignore them!).  The other CHCs in the AL are the passengers – the ones who are less common, generally more stable, easier to manage, and require less attention.

Being able to differentiate the drivers from the passengers in your AL car might help you with your health management.  If you can accurately identify the most common CHCs (i.e. the drivers) in your AL (not by guessing or intuition), you can then focus your management most intensely on THEM in order to keep them as stable as possible.  And this will help keep your residents out of the ER and the hospital.

ALs can seem like a random collection of a confusing multitude of chronic illnesses.  And it might seem impossible or too time-consuming to sort through all the health data and try to make sense of it.

But there’s a way you can identify the drivers and separate them from the passengers.  Analytics.

Analytics allows you to use your existing health data to measure and analyze your residents’ health.  And this is surprisingly easy, inexpensive, and incredibly valuable.

Take care of the passengers in your AL, but ESPECIALLY take care of the drivers!






May 25th, 2014

Story 1

Just after being seated at a local restaurant, your server brings you an entire meal – soup, appetizer, salad, entree, dessert…everything.  Some of the food appeals to you and some of it doesn’t.  It was brought to you without the server either asking or knowing anything about your preferences.  You wonder:  “How could the server possibly know what I wanted without ever having asked?”

Story 2

You go to a local clothing store to purchase some items for a special occasion.  As soon as you walk in, the clerk brings you several outfits and then escorts you to the cashier.  You were never asked your preferences or measured for your size, but you are expected to take the clothes and pay for them.  Some of the clothes don’t even appeal to you, and you have no idea whether any of them fit you.  You wonder:  “How can I be expected to take these clothes without having been asked my preferences or size?”

Story 3

You’re touring an Assisted Living Community with your mom, because she needs help managing her health and can no longer live independently.  The Director immediately takes you to the dining room for lunch.  Granted, it’s a nice dining room, and the food is good.  But that’s not why you’re there.  You stress that you’re there because your mom needs help managing her health, and you want to learn more.

Your mom has 6 different chronic health conditions – a heart condition, high blood pressure, arthritis, and some others.  And she takes at least 1 prescribed medicine for every one of them.  It’s complicated for your mom to balance all these health conditions, keep track of all the medicines, and arrange all the doctor visits.  You want to know this AL’s experience and expertise managing their residents’ health, because THIS is the reason for your tour.  And yet when you ask the Director to show you this information, you’re told the information is not available because they don’t measure the health of their residents.  You wonder, “How can an AL manage resident health if they don’t measure resident health?”

Now…which story is true?  You decide…

Analytics – “you can’t successfully manage what you don’t measure.”

As a physician, I can’t speak about the restaurant or clothing store.  But I can address the AL, because I’ve had the same question too.  When AL marketers have paraded through my office over the years, why did I only hear about good food and nice people and NEVER about what mattered most to me and my patients:  the ability of an AL to manage my patients’ health?

The reason is clear and not the fault of the AL:  there simply wasn’t a practical way of doing it…of defining the metrics and using powerful analytics to measure resident health.  ALs previously had no choice but to operate under these limitations.  Until now, ALs have not been offered an analytics service that is easy, cost effective, flexible, and capable of measuring resident health with insights that can be used to enhance health management and improve marketing.

Analytics  But analytics are now available for the assisted living industry.  And to meet expectations of the baby boomers, to remain profitable, and to reduce resident turnover, analytics will very quickly become a welcome essential for the demands all ALs are facing:  rising resident health acuity, inclusion in emerging health referral networks, resourcing and educating staff.

Analytics uniquely allows ALs to VISUALIZE resident health and use the insights to implement customized health management strategies, assign resident risk levels, and facilitate risk adjusted staffing.

For ALs, the choice is simple:  analytics now, or analytics later.  Whether you lead or whether you follow, everyone is still in the same parade.






April 25th, 2014

Here’s an example of what an Illumination Analytics Long Term Care partner can tell you with 100% confidence and accuracy about their facility, simply by looking at a couple of HEALTH PROFILE dashboards immediately available at their fingertips:

Differences

“Our Medicaid residents:

  • Have more Chronic Health Conditions, including:
  • More heart problems
  • More depression
  • More musculoskeletal problems
  • More diabetes
  • More kidney problems
  • But have less Parkinson’s
  • Take more Prescription Medicines, including:
  • Take more pain meds
  • Take more heart meds
  • Take more lung meds
  • Take more anxiety meds
  • Take more diabetes meds
  • Take more anti-psychotic meds
  • But take fewer anti-Parkinson meds

And we know the exact percentages that apply to each of the categories above.  In addition:

  • Our Medicaid residents each have an average of 8.3 Chronic Health Conditions per resident
  • Our non-Medicaid residents each have an average of 5.0 Chronic Health Conditions per resident.
  • Our Medicaid residents are each prescribed an average of 5.7 Meds
  • Our non-Medicaid residents are each prescribed an average of 3.5 RxMeds.”

Another partner has very different findings, however.  They found that the differences between their Medicaid and non-Medicaid residents are not nearly as great.  We also see that other features are very different between the different buildings of our partners, such as resident risk levels, resident health acuity, types of chronic health conditions, and types of prescribed medicines.

These observations support our expectation that LTC HEALTH PROFILES of different facilities will differ markedly from one another and most likely depend on facility size, location, type of ownership, management, characteristics of the referral base, etc.  As an illustration of the latter, facilities that are located near hospitals will probably have very different HEALTH PROFILES than facilities in more rural settings.  It follows, therefore, that the most effective and appealing services and amenities of these facilities would also be expected to differ.

It also supports what will most likely be discovered by regional directors who oversee the operation of multiple facilities:  the health characteristics of the residents living in your different buildings may be very different from one another.  This implies that the services and amenities that most appeal to residents will also differ between different buildings.  The lesson learned here is the value of “Customized Management” – management that is based on the characteristics of the residents who actually reside in your facilities rather than “guesses” or “blueprints” that are imposed on residents and which may not provide a ‘best fit.’

HEALTH PROFILES has transformed some simple health data into usable, accessible, and immediately available health information.  Now you can direct your management team use this information to develop services and amenities to enhance the care that match your specific residents, reduce cost, and improve your marketing to your referral networks.

And this is just the beginning!






April 20th, 2014

There are about 40 million seniors aged 65 years and older in the US, yet only a small fraction of them (about 2.5%) live in assisted living.  The vast majority of seniors live independently in their communities.  So this raises the question:  what is different about this small fraction of seniors who need assisted living?  Why do some seniors need assisted living and some don’t?

Why     (Click to enlarge)

The answer is entirely determined by the seniors’ health.  This small group of assisted living seniors has reached a point in their lives where they can no longer manage their declining health independently, and so they need assistance.

So, what is it about their declining health that causes them to lose the ability to manage their lives independently?  What are the specific features of their health that transform them from being independent to being dependent and needing assisted living?  Understanding the answer to this question may give insights into how to successfully manage and stabilize the health of assisted living seniors.

Does this small group of seniors need assisted living because they have such severe health conditions (like severe heart failure or lung disease or hypertension) that just can’t be managed at home?

  • The answer is no.  With the exception of neurologic diseases, seniors with more severe health conditions reside in SNFs or rehab facilities because their healthcare requires more resources than is available in assisted living.

Is it because assisted living seniors have different chronic diseases than seniors living independently at home?

  • The answer is again no.  Independently living seniors have the same chronic diseases as assisted living seniors, with the most common chronic diseases in both the assisted living and independent settings being hypertension, heart conditions, arthritis, diabetes, and a variety of others.

So, if most seniors have the same chronic diseases, and if it’s not the severity of the disease that distinguishes them in the assisted living setting, then what is unique about the health of assisted living seniors that is different than the health of independently living seniors?

This is where the insights revealed by health analytics are helpful.  HEALTH PROFILES is discovering a pattern that indicates that what compels the need for assisted living is not the residents’ specific disease they have or the severity of their chronic disease.  It is the NUMBER of chronic diseases they have.

Eighty percent of independently living seniors have at least one chronic health condition, while more than 50% have more than one.  But at some point, for those seniors who accumulate 3 or 4 chronic health conditions or even more, no matter what those conditions are*, the challenges of managing the seniors’ health overwhelms their
ability to do so.  There is simply too much for the seniors and their caregivers to keep track of.  It is at this point that seniors seek assisted living.

Now – with this insight that it’s the “Sheer Numbers” of chronic health conditions that bring residents to assisted living, what are some beneficial implications and opportunities for managing these individuals?

  • Understand and appreciate that the residents who come to your doors do so ONLY because their health has become unmanageable for them.  They bring with them not only MANY health needs but also a lifetime of behavior (of both the resident and their families) that has adapted to these needs.  And since health is the major focus in their lives, and they will expect YOU to also adapt to their health needs.  This is a huge management challenge that deserves a deliberate and focused management approach.
  • Employees need ongoing continuing education about the most common chronic health conditions in your facility.  The more informed and educated your employees, the better the care they will provide.
  • All employees, in every department, can be involved in applying proactive strategies for identifying declining health EARLY in order to apply immediate intervention.
  • Realize that the world of healthcare is changing and that Health Referral Networks are the future.  To be included in these important referral networks, you will be required to use analytics to measure the health of your residents.  The earlier you begin this approach, the better.  A great place to start is by investing in HEALTH PROFILES, and this will not only direct how and where to enhance your health management but also provide opportunities to showcase and market your care excellence to your referral networks and your community.

*With exception of neurologic diseases.  Click here.






April 6th, 2014

Our general discussions about assisted living residents tend to lump all residents
into 1 category.  We don’t lend sufficient importance to the different health characteristics the residents have and how these differences may impact the services provided by the AL.  The unintended consequence of lumping the residents into 1 category is to misunderstand the health challenges of caring for this population.  In fact, AL residents are not a homogeneous population, and their differences in health conditions really do matter.

Not the Same     (click to enlarge)

Our early discovery using health analytics highlights some valuable insights.  Preliminary data from HEALTH PROFILES suggests many assisted living facilities have 2 very distinct types of residents all living under one roof, yet with very different characteristics and needs.  Our results suggest that distinguishing these 2 categories may be important, because successful management hinges on very different caregiver skills and facility health services.

Here are 2 different categories that stand out:

  • Neurologic Disorders
    • The most common are dementia, stroke, and Parkinsons.  Less common conditions include MS (multiple sclerosis), ALS (amyotrophic lateral sclerosis), and others.
  • Medically Overburdened
    • These are residents having a large number of health issues resulting in a high complexity of care (i.e., a high HEALTH BURDEN).

The common feature of both these groups is loss of independence, and that’s what had led them to assisted living.  But the reasons causing this loss are very different between the 2 groups.  And that suggests that successful health management of the 2 groups is also very different.

The following table is an overview of some distinguishing attributes:Table     (click to enlarge)

In general, for the Medically Overburdened resident, management centers on stabilizing health and maintaining the tenuous equilibrium of a multitude of chronic health conditions and the wide variety (and potential toxicity) of all the medicines used to treat them.  Caregivers must have a broad knowledge base about these health issues in order to provide competent care and identify any early signs of declining health.  The primary risk is losing the resident to the ER or hospitalization.  There is a greater need for close communication with residents’ doctors in order to maintain the balance of a multitude of medical needs.

For residents whose care is dominated by Neurologic Disorders, the greatest risk is continuing loss of independence and ability for self-care rather than loss to the ER or hospitalization.  Residents’ abilities may range from being ambulatory with intact cognition and fully verbal all the way to a nonverbal, vegetative state requiring total personal care.  Medical management is usually uncomplicated and straightforward, as the medical issues are often much less complex.  Therefore, caregivers must be most proficient in hands-on personal care

These are examples of the tangible insights that health analytics can provide and promote.  They help us become more aware of issues immediately before us and show us where we can enhance our management.

Focused thinking guided by analytics is beneficial to everyone.






March 29th, 2014

Assisted Living – are you a ‘BLACK BOX” to your referral network?

Black Box     Does anyone in your local community know ANYTHING about the health issues you’re capable of managing?  Is anyone in your community familiar with the experience, expertise and high performance of your health management team?  After all, this is the ONLY reason residents come to your facility…because they need assistance with managing their health.

They won’t know unless you tell them…unless you show them.  And you won’t be able to tell them or show them ANYTHING unless you FIRST measure your resident’s health.

You are probably aware that hospitals, doctors, SNFs, potential residents and their families, and others in your local community know very little about the spectrum of health management you perform every day and the high standards you follow.  But you should also be aware of the lost opportunities for making a very unique and positive impression by showing them data…showing them that you take the health of your residents so seriously that you apply knowledge-based  management.  Management based on health measurement and tracking of health outcomes, not on guesses and intuition.

Open box     But I repeat – no one will know this unless you tell them and show them.  And you will miss a uniquely valuable opportunity to market and showcase your facility whose transparency will positively distinguish you and usher you into the health networks of the very near future.

 






March 20th, 2014

It may be surprising to learn that hospitals begin their discharge process NOT at the time of discharge but rather at the time a patient is admitted to the hospital, often while the patient is still in the Emergency Room.   As part of a plan of care, physicians and other caregivers must try to anticipate or estimate the length of stay so that appropriate discharge plans can be arranged.

First     For assisted living, if you expect to continue getting referrals from your local hospitals, then you need to “constantly be in the mind” of physicians and hospital social workers and discharge planners starting from the time a patient enters their Emergency Room.  These hospital personnel need an immediate link or access to your Facility Health Profile which will show them whether you have the experience and expertise and are the best candidate to manage the care of their patient at the time of anticipated discharge.

For example, let’s say the following is your FACILITY HEALTH PROFILE.  This shows your residents’ most common Chronic Health Conditions and types of Prescribed Medicines.

Facility Profile     (click to enlarge)

If hospital discharge planners see this profile, then they immediately see all the most common chronic health conditions and prescribed medicines that you manage in your facility.  If these areas overlap with their patient, then they may be more likely to trust YOU to continue their patient’s health management following discharge rather than other assisted living facilities for whom they have no information.

Now let’s say this is your HEALTH BURDEN PROFILE which is a measure of your residents’ health risk.  Low risk residents are in green on the left side of the graph while high risk residents are in red on the right side of the graph.

Health Burden Profile - reverse     (click to enlarge)

From this graph the hospital can see that your facility is skilled in caring for high risk residents (in red).  From the hospital’s standpoint, this PROFILE may be helpful in determining the timing of discharge and whether to keep the patient an extra 1-2 days for further recovery or to transition directly to your facility.

Getting your HEALTH PROFILES and not only making them available but easily accessible to your local hospitals and skilled nursing facilities will keep you ahead of the curve and demonstrate your leadership in your future health referral networks.  It also provides unique and unparalleled marketing opportunities, as multiple discharge planners in your referral networks will have the opportunity to easily view your HEALTH PROFILES daily and show them to interested colleagues as well as potential residents and their families.

The advantages of being FIRST and paving the way for others cannot be overstated.






March 9th, 2014

Assisted Living administrators – The following could be you:

Facility Profile

(click image to enlarge)

“This is PRECISELY what’s in my assisted living community.

These are all the essential health issues in my community – in one glance.  These are all the chronic health conditions and all the types of prescribed medicines of all my residents.  All in a single glance.

I also KNOW the average number of chronic health conditions each resident has, and I KNOW the average number of prescribed medicines each residents takes.

I am now a position to develop knowledge-based management strategies for my residents, because I know exactly what’s in my community.  No more guessing, no more intuition.  Only precision.

As an assisted living ED, I begin each day reviewing my AL’s HEALTH PROFILE, and I emphasize the health management strategies that apply specifically to my AL.

As a regional VP for an assisted living company, I regularly review the HEALTH PROFILES of all the ALs in my territory.  I therefore know EXACTLY all the essential health issues of all my ALs.  I appreciate how my ALs differ from one another in the health issues in their buildings, and this knowledge allows me to confidently support health initiatives that are specifically targeted for each individual AL.

As an assisted living company, we encourage our ALs to show their HEALTH PROFILES to their local hospitals and doctors.  We want to demonstrate our company’s commitment to care excellence.  We want them to know our HEALTH PROFILES so that they feel assured of our competence and dedication to caring for the patients they refer to us.  And we want them to view us differently than all the other ALs (who don’t use HEALTH PROFILES) in our community.”

And there is more…much more.  Because there are more HEALTH PROFILES available yielding even more actionable insight.

This is the kind of information that will be invaluable in tomorrow’s senior living market.  And starting today prepares you for tomorrow.






March 1st, 2014

doctor-referral

Looking back on more than 20 years of medical practice, I’ve listened to many marketers attempting to convince me to refer my patients to their particular assisted living facility.  And I remember being impressed about how differently the marketers and I view ALs.

The marketers focused almost exclusively on the social aspects:  beautiful facility, nice people, great food.  And as marketer after marketer would come through my office, the “pitches’ were always identical: beautiful facility, nice people, great food.   From my view, it was impossible to distinguish one AL from another.

My interests, however, as a physician, were completely different.  I was focused on my patients’ health.  Of course I wanted them to live in a comfortable setting, and from what I was told, all the ALs in my community were equally qualified.  But my primary interest was whether the new people managing my patients’ health were knowledgeable, capable and able to render good and compassionate care.

It always surprised me that not a single marketer offered me the one thing that would have made me choose THEM in a heartbeat:  metrics.  The one feature that would have made the greatest impression is the one thing I was never shown…some type of HEALTH PROFILE, anything that demonstrated they understood and were committed to the huge responsibility of managing my patients’ health.

Here are just a few things that I wanted to know and whose answers would have made a lasting and very positive impression and would have resulted in my referrals:

  • I wanted to know the types of chronic health conditions and medications that are currently managed in this marketer’s AL so that I could have an idea of what the health environment was like.
  • I wanted to know whether an AL could manage my patient with heart failure or lung disease or severe arthritis or chronic pain or depression and who is taking 8 different medicines at different times of the day.
  • I wanted to know whether a facility somehow differentiates or adjusts its staffing to account for the Risk Level of individual residents – that is, does it care for residents with many health needs any differently than it does for residents with only minimal needs.
  • I wanted to know WHO is managing the health of all the residents.  Are these caregivers educated about the kinds of health conditions my patients have and the medicines they take?  And how do the caregivers keep track of and become informed of all the health needs that they are managing?  This is a huge task when caring for so many people.
  • I wanted to know whether the AL PROACTIVELY manages the health needs of my patients, or do they just wait until my patients get sick before intervening or sending them to the ER.  And how can the AL demonstrate its answer to me?

These answers are more important now than ever, and they will be essential in the future if an AL wants to be included in their local community health referral networks (along with ACOs, hospitals, SNFs, rehab facilities, home health, and hospice).

Take Home Message

The best way an AL can impress physicians and get their referrals is to show them metrics that prove its ability to provide excellent care management.

 






February 23rd, 2014

Hidden Treasures in Your Assisted Living Database

Revealed Only by Analytics

Treasure    The principles of successful health management in Assisted Living are straightforward:  help your residents manage their chronic health conditions and their prescribed medicines.  Successful management will ultimately be decided by a longer length of stay and reduced resident turnover.

But before you can effectively manage your residents’ health, you must measure your residents’ health.  And this is where health analytics becomes your new best friend.

Here are 10 examples showing how analytics allows Health information in ALs to be used in new ways:

  • ***Analytics prepares you for the very near future when referrals will be more ‘Network based’ – i.e. coming from a Network of providers who base their referrals on OUTCOMES and VALUE.  Ultimately, in one way or another, the members of tomorrow’s healthcare team (hospitals, ACOs, individual physicians and their practices, SNFs, Home Health, Hospice, and even Assisted Living) will either be rewarded or penalized for their good or bad outcomes.  As a result, everyone (and this MUST include assisted living) is measuring the care they provide so that they can prove their care excellence.  In the future…no proof, no referrals.
  • Analytics takes basic health information hidden in paper charts and elsewhere and allows you to ‘visualize’ and immediately appreciate all the essential health issues and risk profiles of every single resident in your facility.
  • Analytics should be precise yet simple, easy to understand, easy to obtain, inexpensive, and provide immediate actionable insight.
  • Analytics allows owners of multiple facilities to compare health information between facilities.
    • Each facility may have different HEALTH PROFILES and characteristics not previously appreciated.
    • These differences will determine programs and services for employees and residents specific to each facility.
  • Analytics allows comparison of health information of different populations.  This insight encourages the tailoring of specific services to specific populations, increasing the value and effectiveness of the services.
    • Medicaid vs. non-Medicaid
    • Men vs. women
    • Age brackets
    • RISK PROFILE brackets
  • Analytics shows where to focus staffing, resident monitoring, and employee education.
  • Analytics objectively supports appropriate rent charges (higher risk = higher rent).
  • Analytics extends the value of other vendors offering complimentary services.
  • Analytics identifies high risk residents in order to reveal targeted programs, services, and monitoring that will bring the greatest value.
    • Analytics suggests customized or “risk adjusted” management strategies and illustrates that all residents are not identical and therefore would not be expected to benefit maximally from identical services.
  • Analytics is a market differentiator that offers unique and unparalleled marketing opportunities:
    • Demonstrates your commitment to care excellence.
    • Allows targeted conversations with prospective residents and their families about the specific health issues that have brought them to your door.
    • Analytics gives reason to have regular promotional contact with referral sources as you provide them with regular monthly updates of the health analytics of your facility.

A final thought:  Every resident turnover costs an AL about $4000, and failing health is by far the leading cause of resident turnover.  Analytics targets where to proactively implement solutions to reduce failing health.  Enabling a healthier and more independent resident population not only leads to higher profits, but it’s just good business.






February 16th, 2014

Say ‘Good-bye’ to the silo…

Falling Silo

And then say ‘Hello’ to the members of your new health team:

  • Hospitals
  • SNFs
  • Insurers
  • Home Health
  • Hospice

The days of individual care settings working separately and independently are coming to an end.  Modern healthcare and value-based purchasing are eliminating silos.  Instead, they are building teams – i.e. Networks.  You will either be on the team (in the Network) or not on the team.  There will be no ‘in-between.’

And, as in professional sports, if team members don’t perform, they will be ‘disinvited’ from the team.  In the assisted living world, you simply won’t be included in the referral network.  Old referral relationships will give way to new relationships shaped by new standards.

AL Referrals

What will be needed to be included on the team?

Proof.  Proof of experience, and proof of expertise in health management.  And the tools you will need to obtain and demonstrate your proof are targeted Metrics and Analytics.  You will need these tools to use the data you already have to make quality and value decisions.

In other words, you will need to demonstrate that you qualify to be on the team.  Word-of-mouth opinion or guessing or intuition or even established referral relationships will no longer be sufficient.

Data sharing will be mandatory to be included on the team.  Your referral sources will be financially motivated in the care YOU manage in your facility, because they will be financially penalized if the care you manage has poor outcomes.

Your referral sources will want to know your HEALTH PROFILES – what health conditions you have in your facility and your experience in caring for these conditions, and they will want to see your RISK PROFILES and learn what you are doing to address your high risk residents, and they will want to know your health-related outcomes.

There is a lot at stake for every team member, so top teams will only enlist top performers.

Here are 5 concrete action steps to get on the team:

  • Measure your residents’ health.
  • Measure your residents’ health risk.
  • Measure your health-related outcomes.
  • Develop PROACTIVE health management strategies to keep your residents as healthy and independent as possible.
  • Make all of the above immediately available to your referral sources and every individual who tours your facility.

The good news is: this does not have to be complicated; this does not have to be expensive.  Simple, straightforward, intuitive, and inexpensive analytic approaches are available and ready for you NOW .  And the time to act is now, as eloquently articulated by Traci Bild, a leading expert in senior housing marketing and sales.

The other good news is:  this is just good business practice.  And it’s a market differentiator.  At least for now, while everyone else is using identical marketing strategies, you can beat these strategies by showcasing your analytics and proving your expertise with precision measurements and “data-backed fact.”

There’s an advantage to being first in your market, to being ‘ahead of the curve.’  And it’s surprisingly easy.  But sitting back and waiting for a competitor to be first will only assure you a place on the sidelines and make it harder to be included in referral networks in the future.

And the future is very near.






February 7th, 2014

FTF     Assisted Living:  the residents that come to your doors, either from a hospital, SNF, or directly from their own home, all have 1 thing in common:   failing health.  And they have come to you for the sole purpose of helping them and their families manage their failing health.

Managing the lives of a diverse group of people is a daunting challenge.  But when this group is exclusively elderly who are all at various stages of failing health and who each have a multitude of chronic health conditions and take a wide assortment of prescribed medicines, then the challenge of health management can become formidable and even intimidating.

Managing the complexities of failing health requires strategy and data, not intuition.  And in order to understand the health of your residents, you must measure it.  Then, the data you obtain must be presented in a way that is easy to access, understand, and evaluate so that you can quickly use the insights you discover to develop approaches to stabilize your residents’ health, increase their length of stay, and reduce resident turnover.

Prioritize Health Management in your facility.  After all, the better and more stable your residents’ health, the more profitable you will be.  Make health management one of the 1st things you talk about with prospective residents and a continuous topic with your employees.  Bring it out in the open, show everyone your FACILITY HEALTH PROFILES.  Reassure families and prospective residents and all your referral sources of your experience and expertise in caring for THEIR most pressing issue at the time of your initial conversation with them.  Prove to them your seriousness and absolute commitment in successfully managing the health issues that, for them, have become unmanageable.






February 4th, 2014

Lose money     If you’re a 50 bed Assisted Living Facility, the residents you lose due to failing health cost you over $80,000.00 every year.  A 100 bed AL loses about $165,000.00/year.  If you’re a corporation that owns multiple ALs, then the amount of money you lose every year because of failing resident health is staggering.

What if you had a tool that directs where to target your health management and marketing so that you could reduce this loss?  With targeted and focused health management, you save at least  $4000 for every prevented resident turnover.

 

HEALTH PROFILES.

 






January 29th, 2014

BOOMERS – if you are considering Assisted Living for a parent or loved one, how do you know which facility to choose?  Since the failing health of your loved one is the only reason that brings you to assisted living, how do you know whether a particular Facility is capable or up-to-the-task of managing your loved one’s health?  Consider the following examples:

Choice

Among your dad’s health issues is a heart condition that demands regular visits with a cardiologist as well as several different heart medicines given at specific times of the day.

  • Wouldn’t you like to see some evidence that the Assisted Living communities you’re considering have experience caring for people with similar conditions and have knowledge of the medicines he’s prescribed?

Your uncle has been a long-time smoker in the past and now has lung disease that requires continuous oxygen, regular use of inhalers, as well as several other prescription medicines.

  • What is the experience of the Assisted Living Facility you’re considering in caring for residents with similar lung conditions?  Are they familiar with inhalers, the proper way to use inhalers, and the other medicines your loved one takes?  Are their employees knowledgeable about lung disease so that they can identify breathing problems early and make appropriate arrangements with you and your uncle’s doctors?

Joe’s mother-in-law has memory lapses.  She’s a little unsteady on her feet and sometimes forgets to use her walker, making her a fall risk.  She also gets her medicines confused or forgets to take them occasionally, and now this has made her blood pressure very difficult to control.

  • What is the experience of the Assisted Living Facilities you’re considering in caring for residents with memory issues?  Do they have many other residents with this particular health issue, giving their employees experience and insight with managing this condition?

Mary’s father worked hard all his life on his farm, but this has left him with severe arthritis, chronic back pain, and depression because of his current physical limitations and gradual loss of independence.  And the prescription pain medicines he takes have occasional side effects that interfere with his other medicines and chronic health problems.  His depression causes him to want to just stay in his room most of the day and not socialize.

  • Is the Assisted Living Facility you’re considering familiar with caring for residents with severe arthritis?  Do the employees have much experience and knowledge about prescription pain medicines?  What’s your facility’s experience in caring for residents with depression?

Would you be interested and even comforted in seeing unbiased and objective health information about the different ALs in your community…information that would help you in choosing the AL that has the greatest expertise in caring for the health conditions your loved one has?

Make health management part of the discussion when you visit and learn about Assisted Living Facilities.  Ask them for their HEALTH PROFILES or other objective documentation of their health management.   This information will allow the Assisted Living Facility the opportunity to showcase their health management expertise, and it will give you the comfort and assurance you need in knowing that you’ve made the best choice possible for your loved one.






January 25th, 2014

transparency 1     Mary’s mom needs assisted living, and so Mary schedules tours at 3 nearby facilities.

  • Assisted Living Facility A:  Beautiful facility, nice people, no health metrics available.
  • Assisted Living Facility B:  Beautiful facility, nice people, no health metrics available.
  • Assisted Living Facility C: Beautiful facility, nice people.  The administrator welcomes Mary’s health questions and states her Facility promotes transparency and full disclosure in the health management of their residents.  She presents their FACILITY HEALTH PROFILE which displays the types of health conditions and prescribed medicines that are managed in this Facility.  This reassures Mary, because her mother suffers from several of the same type of health conditions and also takes several of the same type of prescribed medicines displayed on the profile.  As Mary tours the Facility, she is impressed that the friendly and contented residents are a testimony to the expertise of this Facility’s ability to competently manage the health of its residents.

Which facility stands out among the others and is Mary’s probable choice?

It is essential to be mindful that the only reason that residents move to assisted living is because of failing health, and the leading reason why residents leave assisted living is because of failing health.

Openness and transparency in promoting an assisted living facility’s health management will not only enhance the care it provides, but it can also be its best marketing tool.  It conveys trust and confidence in the expertise and care excellence it offers its prospective residents and their families.  This is just good business.






January 22nd, 2014

Assisted Living Facilities – are you measuring the health of your residents?  Your referrals will want to know this answer.  They want to be assured of your expertise in managing the health of their mother, their father, or their customers.

But if you don’t measure your residents’ health, then how can you effectively manage their health?  Furthermore, how can you discuss the health management you provide in your AL with your local hospitals, SNFs, or ACOs if you have no specific and meaningful data that you can show them?  What impression does that convey?

The noted management consultant, Peter Drucker, said,

  • “If you don’t measure it, you can’t manage it.”

And W. E. Deming, a renowned financial consultant, said,

  • “In God we trust.  Everyone else bring data…”

The assisted living industry increasingly understands that hospitals, ACOs, and SNFs have become more than just coveted referral sources.  They are partners in the care continuum of the frail elderly, as all share in the reward as well as the cost of their family member’s and customer’s health management.

And families scrutinize ALs more now, because the significant expenses they experience create high expectations for satisfaction.  They need to be assured that the beautiful physical surroundings and advertised amenities are matched by an equal fervor and expertise in health management.

FACILITY HEALTH PROFILE     RESIDENT HEALTH PROFILE     Health Burden Profile - Joe

So that brings us back to HEALTH PROFILES.  Here are just a few questions that will help guide your focus in managing your residents’ health and promote your expertise to your referral sources.  The answers are immediately available, with a single glance, in your AL’s HEALTH PROFILES.  But without HEALTH PROFILES, how long would it take you to quickly and accurately dig out this information from your paper charts?

Questions

1. What are the top 5 most common health conditions of the residents in your Facility?

a. What specific programs have you developed that are geared to helping residents with these most common conditions?

2. What percentage of your residents has each of the top ten most common Chronic Health Conditions of the elderly?

a. This answer will help guide where to target employee in-service education. Informed employees will take better care of your residents.

b. If you are part of a larger group of ALs owned by the same family or corporation, how does this profile compare to the profile of your sister ALs?

i. A family of ALs within a corporation may discover that the health needs and services of each AL may differ and would benefit from offering health services and education specific to the needs of an individual AL.

3. What is the average number of Chronic Health Conditions experienced by each of the residents in your AL?

a. This is important to know, because the more Chronic Health Conditions a resident has, the greater the risk of failing health, and the more health support he/she will require.

4. What are the top 5 most common prescribed medicines taken by residents in your AL?

a. Do you offer your medication aids in-service education that focuses on the most common meds that they pass to your residents?

5. Which residents pose the highest risk for failing health and loss to the ER, hospital, or nursing home?

a. Do you offer “risk adjusted monitoring”, where you monitor high-risk residents more frequently and more thoroughly than your lower risk residents?

‘At-a-Glance’ HEALTH PROFILES allows you to answer these questions easily, immediately, with a simple glance. Show them to your referral sources, even your state regulatory agencies, so that everyone will see your sincerity and commitment to providing the best health management possible.

 






January 18th, 2014

 

FACILITY HEALTH PROFILE       RESIDENT HEALTH PROFILE       HEALTH BURDEN PROFILE

Assisted Living Facilities…are you ready?  The time is coming when “Show me your HEALTH PROFILES” may be one of the 1st requests you receive from your referral sources.  Prospective residents, hospitals, SNFs, and ACOs can see your beautiful facilities and learn of your amenities either in person or online or both.  But they will also need to be assured that you are competent and capable of managing the health of your residents, since failing health is the ONLY reason that brings residents to your door.

Steve Moran, a perceptive Senior Housing blogger and strong advocate for Assisted Living, reminds us that the consequences of negative publicity generated from care deficiencies can leave a lasting impression.  Public perception of an industry that performs a noble and essential service for the frail and vulnerable elderly easily becomes tarnished and the focus of potentially overly-stringent and burdensome regulatory legislation.

The best defense to fight this perception is a strong offense.  And the strongest offense is to openly promote the care excellence performed by your facility.  Show your HEALTH PROFILES voluntarily, openly display them to your referral sources, current and prospective residents, and their families.  Proudly describe the programs and services you’ve adopted in your facility in response to the most common health issues of your residents.  And describe your expertise managing these health issues. This positive, receptive, and transparent attitude will reassure your residents and their families and demonstrate that you are ahead-of-the-curve and a leader among your competition.






January 14th, 2014

HEALTH DYNAMICS Figure

HBP 1_28_14  (Click for larger view)

Assisted Living Facilities manage the lives of frail seniors.  This is a daunting challenge, and information that provides insight into the health dynamics of residents will assist an AL in reducing resident turnover by maintaining optimum resident health and independence.

We developed new and discerning data analytics that describe the health dynamics of an AL’s residents.  It transforms the usual vague impression about resident health into clear and focused insight about each individual resident and the health risk he/she imposes on an AL.  This insight is actionable by targeting where to appropriate the time and monitoring resources of employees.

The HEALTH DYNAMICS data places the HEALTH BURDEN PROFILE of an AL just above a Health Attrition line.  This allows AL employees to visualize and better appreciate the health risk of every resident by noting a resident’s proximity to the Inflection Point (the point of transition from Baseline Health to Failing Health).

Graph:  The HEALTH BURDEN PROFILE was developed by Illumination Analytics using easily available basic health information of an AL’s residents.  Health Burden reflects a resident’s risk for failing health.  The higher the Health Burden Score, the higher the risk for loss of the resident to the ER, hospitalization, or transfer to a nursing home.  Each individual bar represents the health burden score calculated for a specific resident.  The coded names of all the residents in this AL are listed horizontally.

  • Low Health Burden scores are green and located to the left, while higher Health Burden scores are red and located to the right.
  • The contrast between the Health Burden scores of non-institutional seniors living independently in the community (whose values average less than 15) is immediately appreciated when compared to the scores of seniors living in this particular AL whose values range between 8 and 144.

Green and Yellow Health Attrition lines (below the graph):  These lines represent the current state of health of a resident – either baseline (green) or failing (yellow), separated by The Inflection Point.

  • Residents are grouped into Low Risk, Medium Risk, and High Risk based on their Health Burden Scores.
  • The closer to the inflection point a resident is located (towards the right on the green line), the higher the Health Burden score and risk of failing health.
  • Conversely, the farther away from the inflection point a resident is located (towards the left on the green line), the lower the Health Burden score and the more stable the resident is.

The 3 Risk Groups suggest a targeted and ‘risk-based’ approach to managing residents:

  • Low Risk:  The most stable residents.  These residents require less frequent monitoring.
  • Medium Risk:  Residents with intermediate risk.
  • High Risk:  These residents require frequent monitoring.

Be vigilant and prepared for immediate pro-active intervention at the very earliest sign the resident has crossed the Inflection Point and entered into Failing Health.

These HEALTH DYNAMICS data can be constructed for every AL.  The tangible advantage of being able to VISUALIZE the health risk of every resident using analytics opens new insights that will enhance AL health management, promising greater profitability and improved marketing.

 

 

 






January 11th, 2014

…the ONLY reason residents choose Assisted Living is FAILING HEALTH

…the LEADING reason residents leave Assisted Living is FAILING HEALTH

The better an Assisted Living Facility manages its residents’ health, the more profitable it will be!

Paper charts

Essential health information buried in paper charts, OR

 

FACILITY HEALTH PROFILE    Essential health information of your Facility and of every resident in ‘At-a-Glance’ HEALTH PROFILES…

Illumination Analytics – HEALTH PROFILES for Assisted Living:

  • ‘At-a-Glance’  HEALTH PROFILES
  • Quick
  • Easy
  • Immediately useful
  • Inexpensive
  • Essential

 






December 23rd, 2013

Failing health is the leading cause of resident turnover in Assisted Living Facilities (ALs). Estimating an AL’s annual cost of failing resident health can be accomplished using published data.  We developed a method of using published information (listed below) to construct the following graph:

Financial Calculator  (Click for larger view)

To estimate the annual cost of resident turnover due to either Health Attrition (failing health) or Residential Attrition (loss of a resident who leaves one AL to go to another AL), simply do the following:

  • Locate your facility’s total bed capacity on the horizontal axis (not census, but total capacity).
  • The corresponding value on the vertical axis is then an estimate of the annual dollars lost due to either type of attrition.

This is an estimate only using national data.  Individual ALs should use their own data and compare to these values.

We hope this information will be useful as a guide for finding opportunities to increase AL profitability.

 

These are the sources for this graph:

  • $4000 – an estimate of the average cost of a resident turnover
  • 50% – an estimate of the average annual AL resident turnover in 2013
  • 88.7% – the average occupancy of an AL in the US in 2013
  • 92% – ‘Health Attrition’ (the percentage of resident turnovers due to failing health)
  • 5% – ‘Residential Attrition’ (the percentage of resident turnovers due to a resident moving from one AL to another)






December 21st, 2013

Here is an easy overview describing the basics of Analytics for Assisted Living.

Analytics for Assisted Living






December 18th, 2013

There are over 1 million fragile older adults living in 40,000 US Assisted Living Communities (ALs) (ALFA 2011), and yet the vast majority of ALs do not have relationships with physicians who provide on-site primary care.  And very few, if any, of the ALs use analytics to objectively measure and describe their resident’s health and the health management they provide.

Assisted Living Communities were originally promoted to support residents in a non-medical setting to bridge the gap between independent living and the nursing home.  But the landscape for ALs has dramatically changed since their inception.

The average age of an AL resident is now 87 years (Harris-Wallace et al, 2011, Seniors Housing & Care Journal).  Thirty-seven percent of residents receive assistance with 3 or more activities of daily living (NCAL 2012), most of the residents have 3 or more chronic medical conditions and are taking multiple medications having a variety of potential side effects, and 42% have at least some degree of memory impairment or dementia (NCAL 2012).

Assisted Living Communities are no longer a predominantly non-medical setting.  They attract high acuity and high risk residents whose medical needs will only intensify in the future due to:

  • A very competitive senior housing market,
  • Resident expectations to age in place and experience the progression of chronic medical conditions in one setting that provides ongoing care and monitoring,
  • Pressure from hospitals and skilled nursing facilities who discharge medically complex patients to the community while still having many medical needs.

In other words, times have changed!  But there are 2 winning ideas that ALs can adapt to remain competitive and successful in the future:

Partnership  Establish partnerships with primary care physicians to provide on-site full primary care to your residents.  Meet with a few local physicians and ask them what they require in order for them to provide a regular presence in your AL.  Encourage their presence by helping them overcome the time and travel inefficiencies they face by giving them the support they need when coming to your AL.

IA Logo  Adopt Analytics, and this is important.  The time is quickly arriving when referral sources (families, hospitals, skilled nursing facilities, insurers, and others) will no longer be satisfied with ‘word-of-mouth’ opinions when choosing an AL.  You will soon be required to demonstrate your care excellence with objective measurements of your residents’ health as well as the health management you provide.  See www.IlluminationAnalytics.com to learn about a practical and cost effective new analytics service developed by a physician strictly for the needs of ALs.






December 17th, 2013

Health Burden is an easily understood and intuitive term that refers to the complexity of a resident’s health as well as the time, resources, and attention needed to safely manage a resident.

Although some residents with a lower Health Burden may be capable of managing some of their health demands, those with a higher Health Burden will usually require greater assistance from the AL, and this reflects a greater demand for:

  • Staff time
  • Staff expertise
  • Personal Care services
  • Wound checks
  • Dietary Restrictions
  • Medication supervision and delivery
  • Coordination of Healthcare services
  • Lab services
  • Need for transportation to doctors’ appointments

Health Burden also reflects a resident’s risk for failing health.  Those with a higher Health Burden are at greatest risk for loss to the ER, hospitalization, and transfer to a nursing home.  Efficiently managing staff time by Pro-actively focusing their time resources on residents having high Health Burden scores will help stabilize residents’ health, preserve census, and increase AL profitability.

The Health Burden of AL residents isn’t often discussed. Although most of us can intuitively distinguish a resident with a high health burden from one with a low burden, without the ability to easily ‘measure’ or ‘put a number’ on a resident’s health burden, the discussions remain vague, and the value of this important concept goes unappreciated.  Without actually measuring the health burden, AL resources are more or less distributed equally on all residents.

Health Burden Profile

(Click for larger view)

Illumination Analytics has developed a novel method for objectively measuring the health burden of every resident.  This allows the creation of a HEALTH BURDEN PROFILE of an AL which in turn yields the following benefits:

  • It functions as a resident risk profile, such that residents with higher Health Burden scores pose a greater risk for failing health.  This directs where to focus employee time resources.
  • It yields an average Health Burden score for your AL, and this can be used as one of the determinants in level of appropriate staffing.  It can also be used in marketing.  If your AL has a higher Health Burden score, you can promote yourself as having experience managing the health of more complex residents, and this increases your referral base.
  • By putting a “number” on a resident’s burden of care, it objectively helps justify the level of charge an AL must implement for a resident and removes the appearance of an arbitrary judgment.

Local hospitals and SNFs are significant referral sources for new residents, but they are being subjected to penalties for bad referral outcomes, such as ‘bounce backs’ for unnecessary 30 day readmissions, etc.

As a result, in the near future they will be requiring health metrics that demonstrate care and management excellence provided by the Assisted Living Facilities in their referral base.

HEALTH BURDEN PROFILES will help you seize this opportunity to showcase your facility as a leader in Assisted Living health management.  You will differentiate yourself from among all your competition by showing the hospitals and SNFs real-time data (not just ‘feelings’ or ‘guesses’) that guide your health management. And you will be prepared for the near future when health metrics will be a prerequisite for referrals.






November 29th, 2013

This may seem like an odd question.  You’re probably asking, “What do you mean, and how can I possibly ‘visualize’ our residents’ health?

In fact, you’re right…this is an ‘odd’ question, because until recently the ability to visualize huge amounts of health data and make sense of it was impossible, so it wouldn’t even have occurred to ask such a question.

Health Burden Profile  But times have changed.  Health technology has acquired the ability to access large data bases and to quickly, efficiently, and effectively find meaningful relationships that can then be visualized.  Actually seeing or visualizing these relationships yields knowledge and actionable insights not otherwise achievable.

What does this mean for the Assisted Living Industry?  It means that YES…you can visualize your residents’ health.  You can see:

  • ‘At-a-Glance’ all the most important health concerns in your Facility.
  • ‘At-a-Glance’ all the essential health information of every resident in your Facility.
  • ‘At-a-Glance’ a health risk profile of every resident that helps differentiate the more fragile from the more robust residents, and this allows you to know specifically where to target employee time and services.

Resident health information (i.e. the Facility’s health data base) is usually buried in paper charts.  Abstracting bits and pieces of this information whenever a resident’s health issue or question arises is cumbersome and time consuming, and this means most of the value that can be obtained from this data base is inaccessible.  But visualization gives easy access to that knowledge, and this leads to actionable insights that will direct better decisions.  It will enhance resident health, and it will profit the Facility.

 






November 25th, 2013

Why FACILITY HEALTH PROFILES are Important

When a family is shopping around for an Assisted Living Facility for their parent, they find there is almost no unbiased and objective way of determining whether a specific Facility is capable of managing their parent’s medical needs.  These families have important questions, such as, “Are you capable of managing my mother’s pain medicines?” or “Can you safely manage my father with his heart condition?” or “My mother has severe arthritis – can you safely manage her with her mobility issues?” or “My mother takes a lot of medicines.  Is your staff familiar with these medicines, and can they deliver them safely?”

Hospitals, skilled nursing facilities, and even home health agencies have metrics that allow comparisons of the healthcare they deliver, and these are easily found on the Medicare.gov website.  Although Assisted Living Facilities manage a wide variety of chronic health conditions and deliver a broad array of prescribed medicines to their residents, they have no way of providing objective comparisons that allow them to demonstrate their expertise in health management.  The only sources of information a Facility can provide to their prospective residents are opinions – opinions learned through word of mouth from friends and colleagues, advertising via the Internet and print media, and then touring each Facility.  To be sure, these sources of information are important.  Yet a missing link is the ability to make objective comparisons.

FACILITY HEALTH PROFILE

But now Assisted Living Facilities now have a new weapon in their marketing arsenal – HEALTH PROFILES by Illumination Analytics.  These profiles showcase a Facility’s experience in managing a senior’s most common chronic health conditions and prescribed medicines.  They provide objective documentation of all the essential health management occurring in their Facility.  They open the opportunity for a Facility to discuss the services and programs they have developed specifically in response to the most common health issues experienced by their current residents.  Families now have a way to compare Assisted Living Facilities and of choosing the one Facility that objectively demonstrates the most expertise in caring for the specific health interests of their parents.

Another metric is the Facility’s HEALTH BURDEN SCORE.  This is a new metric that estimates the average health management burden of the residents in a Facility.  The greater the Health Burden Score, the greater the overall complexity of the average resident’s health management.  As a reference, the normal health burden score for a non-institutional senior is less than 15.  Our early experience has shown average scores in Assisted Living Facilities range from 31 to 64.

Assisted Living Facilities will benefit from HEALTH PROFILES through enhanced health management and improved marketing.  Those who embrace these profiles will be prepared for the near future when health analytics will be a prerequisite for referrals.