Without a crystal ball, it is impossible to define exactly what the healthcare situation for America’s burgeoning senior population will look like in 10 years and beyond. Some things are certain, some are probable and some are anyone’s guess. For certain, the pressures of demographics and economics will force sweeping changes. Accountable care will probably be the framework for implementing these changes. And hopefully – along with improved access, efficiencies, and sustainability – accountable care will yield an overall improvement in the quality and dignity of life for seniors. At the nexus of this lofty goal will be innovative thinkers and planners who understand the possibilities inherent in the future of post-acute care. In the words of Peter Drucker, “The entrepreneur always searches for change, responds to it, and exploits it as an opportunity.”
It has become arcane to refer to aging as The Golden Years, yet there exists for post-acute care providers A Golden Opportunity to significantly alter and improve the way we think about healthcare for seniors. The question is – are we ready? The post-acute care provider has historically lived in the shadow of the acute care provider, but times are changing. The spotlight can and must continue to shift toward pre- and post-acute prevention and intervention strategies for accountable care to be fully effective.
One compelling statistic demonstrates the powerful potential for improving future quality and profitability in post-acute care: Research findings by The Advisory Board Company indicate that one out of five seniors (65 and above) who experience an episode that results in an acute stay will be readmitted for an additional acute stay within 30 days. This dangerous and expensive recycling of seniors within the healthcare system is forcing a new paradigm that matches the other health and wellness trends we find throughout the Boomer culture. There is no question that accountable care will have a direct effect on post-acute care and the design of such facilities, but what will these changes look like and how can post-acute care providers prepare for the future?
In his intriguing article, “The Way We Age Now,” first published in April 2007, Dr. Antul Gawande raises the standard for quality care beyond simply “freedom from the ravages of disease” to include “retention of enough function for active engagement in the world.” He makes the point that medicine has “been shown to apply the knowledge we already know about how to make old age better.” To Gawande, “Age is inevitably linked with decline. Yet decline can occur in two ways: one is early and precipitately with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals; and the other way is more gradual, preserving for as long as possible your ability to control your own life.”
As culture increasingly insists on these holistic outcomes, systems will find ever-expanding markets for more emphasis on lifestyle, nutrition, prevention and living situations. The implications for accountable care in effecting this kind of a paradigm shift are virtually limitless. Is it possible to envision a hospital/physician/healthcare system reluctantly utilized only when necessary that could remake itself into a health and wellness resource center that elicits voluntary and lifelong participation?
The shift in senior living from a medical model to a hospitality model has been well documented. Post-acute providers have begun to learn that a mindset of extreme customer service is more than just good marketing – it is good business. Both staff members that are empowered to humanize their interactions and customers who have a personalized, individualized experience receive a value that resonates at deep levels. This is where raving fans are born. A change in corporate culture of this magnitude is a difficult, yet profitable process. Its implications affect virtually every aspect of design, development and delivery of services. One telling measure of this new way of thinking is the degree to which providers begin to adopt new language. Who wants to go to a facility or be admitted to a home? Who wouldn’t prefer a spa to a shower room? Who wouldn’t prefer a personal attendant to a nurse or the term guest to patient?
Post-acute can be defined as a short-term stay in rehab, a return to home, an assisted living community or a skilled nursing community. Today, many seniors are discharged from a hospital to a nursing home for recuperation. The patient is later discharged from the nursing home to assisted living or returns to a home environment. At times during this process, there may be gaps in the continuum of care that can lead to a precipitous return to an acute facility. To be sure, CCRC’s have historically offered their residents a holistic philosophy employing the six dimensions of wellness, which are reflective in the services and amenities offered. Keeping the resident healthy and adopting an aging-in-place philosophy has helped to keep their census at high levels. In the past decade offering rehab onsite has not only proven to be financially profitable but gives the resident the comforts of home and one-stop shopping. Studies of the CCRC lifestyle clearly show that years can be added to one’s life by living in a CCRC community. Most CCRC communities offer wonderful opportunities to strengthen and build upon recuperative efforts with fitness and exercise programs. Unfortunately, only about 5 percent of the senior population benefits from this lifestyle. So what about the other 95 percent of patients who rely on multiple providers for their care?
Acute care can create collaborations with established post-acute care providers and others to form a more seamless approach to eliminating gaps in service. Why recreate the wheel? What if, for example, a surgical rehab is bundled with a six-month membership at a fitness center, water aerobics or some classes on nutrition? Connections with transportation, home care providers, equipment providers, personal physicians, life coaches, and others can create a broader range of value added services for increased financial sustainability.
Post-acute providers can become an ever-expanding resource to deliver what is new in technology and education to seniors and their families. Some of these advances can include:
- Diet and exercise applications that are delivered via cell phone
- Advances in security technology
- Touch screen, visual communication with doctors and family
- Automated medication management
- Personal monitoring, banking, healthy cooking, risk management, pet care and social networking
There is a need for customer/patient-centered offerings that lead to overall improvement. Follow-up education and hands-on “take me home with you” assistance to reduce re-admissions is an important first step. Technology will also play a positive role in accountable care outcomes for the care team. Where the acute care providers are focused on electronic medical records, telemedicine and healthcare exchange as a way to improve care; post-acute providers are focused on technology that reduces staffing while providing better support to patients.
It is important to note that technology is reaching beyond communication into additional tools that will improve patient care. Emerging technologies can remotely monitor blood pressure and heart rates. Sensors in patient rooms can analyze behaviors to identify slowing mobility, while other systems can oversee medication usage and water and food consumption. Preemptively these technologies can help in avoiding acute care admissions by addressing problems before they become an acute-care admission.
In many ways, the healthcare systems for future seniors will be educations and recreational as much as they will be restorative centers. We will always push against the future for the latest advances and medical devices but equally important will be designing for the kind of programs and holistic outcomes envisioned here. As we look ahead to the future, a number of design changes to post-acute care facilities will be required to interface with acute care systems and bridge the gaps in continuing care from the hospital to the home. These design changes will include advancements in technology, communication, education, hospitality and sufficient access to rehab services and providers. Designing a post-acute care facility for the future will require out-of-the-box thinking and planning.
For example, seamless communication between providers will require appropriate spaces to interact. Entrances, living accommodations, dining rooms, recreation spaces and support areas all need to be focused around the concept of hospitality. The institutional age is over. Care planning and report rooms with web-based teleconferencing capability will be needed to monitor and assist in the post-acute treatment and recovery. Education classrooms will be required for both patients and families to provide information on treatment and lifestyle changes. Fitness centers, kitchens, theaters, and libraries will need to be convenient and comfortable. Direct access from the rehab patient rooms to therapy increases ambulation and improves patient treatment, resulting in quicker recuperation and improved patient experience. A separate outside entrance for therapy provides easy access and allows continued use for outpatient therapy after discharge. The therapy area can also be expanded to provide ongoing health and wellness education opportunities for residents. An added benefit is the development of a positive identity with a skilled nursing provider beyond a one-time visit to a nursing home. The future of post-acute care will be enhanced by improved facility designs and technology that will ultimately assist the care team to provide accountable care. The end goal is to bridge the continuum of care for seniors and provide better healthcare delivery outcomes for all involved.
The future of post-acute care and design in an accountable care world will require a bold new path for the way we think about healthcare for seniors in our country. Solid partnerships, wise foresight, and strategic design can translate A Golden Opportunity into outcomes that are truly amazing.
About the Authors
Bill Hull is the Director of Sales for Haskell Senior Living Solutions who specializes in healthcare and senior living at Haskell, the pre-eminent firm to turn to for total facility solutions in healthcare and senior living. Bonita Patteson is the Director of Marketing for Haskell Senior Living Solutions (HSLS)
Bonita Carter Patteson, Director of Marketing for Haskell Senior Living Solutions