Positioning senior living communities, and assisted living in particular, to take advantage of post-acute care partnerships in light of healthcare reform and the managed care movement may seem like a good idea, but partnerships might not be for everyone considering some key challenges that accompany increased responsibility.
Pressure to keep seniors from being hospitalized or rehospitalized is mounting as hospitals’ Medicare reimbursements will soon hinge on readmission figures. Discharging an elderly patient into a proven, effective post-acute care setting, then, is paramount, and some assisted living providers are looking to get in on the action.
But there’s one area in particular where assisted living communities are often big offenders in sending residents to the emergency room: falls.
“What do we do with falls?” asked Pat Mulloy, chairman and CEO of Elmcroft Senior Living, during a panel at the ALFA 2012 Community event in May. It’s a big issue: Many times when residents fall, they’re automatically sent to the emergency room to keep the assisted living community from being held liable.
That response—a fall, then emergency room—could be a hospital’s worst nightmare. It doesn’t exactly make the assisted living provider seem like an optimal choice for discharges if there’s a large chance a patient will be readmitted, especially if it’s unnecessary and primarily for liability reasons, the panel agreed.
The reality is, while some assisted living providers may have a certain care model that makes them a good post-acute care partner—whether it’s staffed 24/7 by RNs, or has an on-site doctor—that’s not true for everyone.
“Keep in mind that you might not always be able to participate [in the managed care model],” said Patricia Will, CEO of Houston, Tex.-headquartered Belmont Village Senior Living. There’s regulatory risk, she says, and thus liability. “It’s an area we’re at odds with ourselves. We all know the ER visits are not good for our residents, but there’s liability.”
Participating in an ACO or some similar model takes intentionality, says Victor Kintz, managing director of operations at Polaris Group, a consulting service for the post-acute and long-term care industry.
“We as players in the post acute continuum can make a huge difference in overall costs to Medicare and the “system,” if we do in fact reduce admissions to the hospital,” he says.
But to do that, providers must make sure they have the staff competencies to deal with “keeping” the “sub-acute” patient, Kintz continues, while still delivering cost-savings for the new healthcare delivery system. Their ability to accommodate residents at a higher acuity than what they might normally care for must be considered when trying to attain a partnership position.
“The question is really about “mission,” and how that fits into the CCRC community, and the healthcare community in general,” he says.
Written by Alyssa Gerace