Assisted living providers looking for ways to grab a piece of the post-acute care pie and simultaneously improve occupancy are exploring short-term care models that function as a private-pay bridge from hospital to home.
In the skilled nursing industry, the split between the short-term, Medicare-reimbursed and long-term, Medicaid-reimbursed models is growing. As healthcare reform puts greater emphasis on the healthcare continuum and post-acute care, a similar split may start to occur in assisted living as well.
“Managed care will eventually look at assisted living for lower-acuity patients as an alternative to skilled care, and potentially as an alternative to home care, because that way they’d have access to a nurse supervising [residents] 24/7,” says Jeff Garber, vice president of strategic initiatives at Mary Free Bed Rehabilitation Hospital in Michigan. “There’s a huge opportunity for assisted living to retool for a short-term patient.”
Hospitals may start referring patients who don’t qualify for an admission or skilled nursing coverage to assisted living communities on a short-term basis, he says, or for pre-surgery, especially in the orthopedics field. “I think it will be huge for [orthopedics],” Garber says. “For orthopedic surgeons if the protocols they need for therapy post-surgery are there, it will be very attractive.”
Senior living companies are already starting to position themselves. Some, such as Kindred Healthcare and Brookdale Senior Living, are growing their post-acute care platforms with an emphasis on home care and rehabilitation.
Georgia-based The Arbor Company has created a transitional living program as a direct response to the Accountable Care Organization movement, says Francine O’Neill, R.N., senior vice president of resident care and co-developer of the program.
Called Transitional Living Care (TLC), the program was designed to house seniors who go to the emergency room but aren’t officially admitted because they don’t have a qualified diagnosis, thus ineligible for Medicare-covered skilled nursing benefits.
The private-pay program is for a 14-30 day stay until the resident in question can be evaluated, and The Arbor Company charges on a per diem basis depending on the market and level of care.
“Most readmissions into hospitals are determined to have been due to medication mismanagement, falls, or lack of follow-up care,” says Shirley Paulk, R.N., senior vice president of marketing at The Arbor Company who developed TLC along with O’Neill. “We know those are three areas we excel in. We have an environment geared more toward safety than [a private residence.]”
In certain cases, some getting discharged from a hospital might not need skilled nursing care, or may not qualify for Medicare coverage due to the three-day-stay rule, she says, but they do need some help. The Arbor Company offers therapy on-site at all of its communities and partners with a home health and therapy provider.
This allows the senior living operator to work with discharge planners for short-term care plans for discharged patients that allows them to transition from acute care back to their home.
“It’s been great for us—a short-term stay, in terms of revenue, sometimes it’s a wash. There’s a lot of energy going into moving someone in. But at some point in time, that person may need to move in permanently, and we’ll probably be at the top of their list,” says O’Neill.
So far, the company has been successful at marketing the program on the west coast of South Florida to emergency room discharge case workers. Typically the program is only offered at communities with vacancy, and exact participation numbers are unknown as The Arbor Company hasn’t separately tracked TLC versus respite care clients.
“We’ve done a good job of branding [TLC] and surrounding ourselves with strong partners the hospitals recognize. It’s been successful so far, although it seems to be really market driven,” Paulk says, adding that the company has already cared for a “number” of people on short notice. “It’s not the core of our business—just a need in the marketplace we’ve found that has helped us particularly in areas where we’re challenged with our occupancy.”
Written by Alyssa Gerace