CCRC Sees New Move-Ins by Reversing Continuum of Care


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A continuing care retirement community (CCRC) is built on the idea of just that: a continuum of care. Typically, that means low acuity, or fewer care needs, moving in the direction of higher acuity, or more care needs. Often, the first point of contact is with someone on the lower end of the care spectrum and the sale is based on that person being able to move through the continuum as he or she ages.

But one Illinois CCRC is putting that process into reverse by first making contact with those people who need the most care and helping them to transition back into an independent living environment.

“Our goal is to help people consider alternatives to going back home, such as moving to independent living at Oak Trace,” says Michelle Hart-Carlson, administrator at the Oak Trace Health Center of Oak Trace Senior Living. The Downers Grove-based senior living community is owned and operated by Lifespace Communities.


Often after a hospitalization, someone will enter a community for rehab/short-term skilled nursing with the intention and goal of staying for as short a time as possible, then moving home. Usually that short-term client isn’t aware of, or hasn’t considered, other options.

“In order to help a customer consider making that decision, we need a collaborative approach from the entire community that demonstrates that Oak Trace is a great place to live, whether or not a person requires health care, she says, adding that the CCRC’s population ranges from vibrant, active boomers who want the freedom to live their lives in total independence to those who require short-term or ongoing attention from its health center professionals.

At the Oak Trace Health Center — its skilled nursing facility that encompasses rehab, memory care and long-term care and assisted living — staff first identify residents who are capable of rehabilitation. Then, a collaborative team of nursing staff, therapy assistants, social services and the family helps them reach that goal.

Last year four health center patients went the opposite direction of the normal progression through the continuum of care — moving into the CCRC’s independent living environment following short-term rehab. While two went directly from rehab to independent living, the other two went from rehab to assisted living and then moved into independent living.

“When they saw what is was like to live in a CCRC, they inquired about our independent living services,” Hart-Carlson says. Oak Trace leverages its entire staff in its marketing efforts to identify health center patients who might be appropriate for independent living. And patients using Oak Trace’s health center are invited to utilize campus amenities during their treatment, such as dining at the bistro, or the cafe. And those receiving short-term care are also invited to participate in campus activities.

After patients complete their rehab program, Oak Trace delivers three meals and medication daily to their home for the three days following their release. Former patients can also opt to continue receiving food from Oak Trace after the three day free period by enrolling in its meal delivery plan.

“We try to stay in touch so that for those who do go home, we’re offering virtual CCRC services,” she says. “We stay in touch with them so we are their No. 1 choice if they need services again.” Other senior living communities have also found that expanding a community’s resources to seniors outside campus walls not only meets many seniors’ desire to age in place, but it improves that senior living community’s marketability as well.

In addition, some clients who stayed in touch with Oak Trace through its meal delivery program have become permanent residents, Hart-Carlson says.

“It goes back to our marketing efforts,” she says, noting that staff strive to show short-term clients the benefits of CCRC living. “We look and see how every department can contribute to that.” Oak Trace is also part of an Accountable Care Organization (ACO) with a local health system, and keeping tabs on past clients through food delivery also helps to lower readmission rates to the hospital, the community has found. “This is another stop gap for readmissions,” she says. “The employees delivering food can ask, ‘Did your therapy get started? Did you get all your medications?”

Written by Cassandra Dowell

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