IT’S TIME FOR A NEW WARDROBE.
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.
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:
st**********@il*******************.com
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.
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