Skilled nursing isn’t dying, but the standalone skilled nursing facility — or SNF — just might be. And that could be good news for the future of continuing care retirement communities (CCRCs) and similar full-continuum offerings.
While skilled nursing is perhaps more needed than ever, the service offering is evolving toward greater integration along the care continuum due to increased resident frailty and longer resident lifespans, according to experts who spoke with Senior Housing News. The changes are felt in two key ways.
* Increased need for hospital-grade health care resources and services on site, as well as more cohesive partnerships with hospitals
* Increased need for continuing care retirement communities (CCRC), which create a seamless transitional experience as residents move through the care continuum
The statistics suggest such a shift could be underway. About a quarter of skilled nursing beds could disappear by 2022, according to some projections; meanwhile, the CCRC sector is thriving. And though some CCRCs are cutting down on skilled nursing beds, others are taking advantage of the current boom time to update their skilled nursing wings.
Beyond a CCRC, though, is the use of care-continuum campuses. There, residents don’t just move through stages of care but benefit in each stage from the resources offered by the others. This is where skilled nursing residents might find maximum care value in the coming years, and where providers could find the best business opportunities.
The rehab route
A patient’s road to a SNF often begins with a short rehab stint covered by Medicare following surgery — typically a joint replacement, like a hip or a knee. And a campus approach to rehab helps both patient and provider.
“Rehab is a wonderful way for an owner and operator of a community to … introduce that resident to life on their campus,” said David Dillard, principal of D2 Architecture in Dallas. “There is a hospitality attitude about it. Our clients have very smartly put a lot of money and elegance not only in the physical therapy room … but the thought is that if [seniors] really like where they stay because the food is so good and the lounge was so nice and the fireplace was so warm and the place was so pretty and the people were so nice, they’ll come back there five or 10 years later to live.”
D2’s most recent standalone SNFs are Carriage House Manor in Sulphur Springs, Texas, and Orchard View in Columbus, Georgia. But D2 is also working on an expansion of the 20-acre C.C. Young Senior Living in Dallas, building a 221-resident, 10-level integrated transitional living center called The Vista, featuring skilled nursing, memory care, assisted living, rehab, and other services.
The key design elements with that construction — which will cost $84 million and open in 2018 — are two-fold. The first is that the rehab and skilled care areas have virtually identical floor plans. Over the years as trends in care and patient needs change, Dillard said, the owner can add or subtract either skilled care or rehab with minimal changes to actual construction.
“That’s a big trend: the interchangeability of residents by frailty without changing the architecture, because changing architecture is terribly expensive,” Dillard said. “So we are creating stage sets for different players to step onto as the years go by, without spending a great deal of money changing the architecture itself.”
The other trend is a neighborhood-driven floor plan: an L shape with 16 units on each side of the L, leading to a household-like feel on either side. These two trends — similar floor plans and the neighborhood feeling — are blended with what Dillard calls the vertical “stack” layout, where a single floor layout is copied from the first floor to the top.
“Going vertical is a major trend, and that more often happens in an urban environment,” Dillard said.
In San Francisco, Chief Information Officer Michael Staff believes the Jewish Senior Living Group (JSLG) is getting closer to maximum consumer satisfaction through use of the campus model. JSLG’s San Francisco Campus for Jewish Living (SFCJL) offers 120 post-acute beds, 250 long-term care beds, and 12 acute geriatric psychiatric hospital beds. Occupancy for SFCJL “hovers around 95%,” Skaff said.
That figure puts JSLG well above the national average. SNF occupancy in the 3rd quarter of 2017 was 81.6%, according to the National Investment Center for Seniors Housing & Care (NIC). The Kaiser Family Foundation puts the 2015 national average of SNF occupancy at 82%, while professional services firm CliftonLarsonAllen LLP’s 2016 data shows the national median of SNF occupancy at 85%.
Now, JSLG is expanding the service offerings on its nine-acre campus by adding 190 units of assisted living and memory care, and also building a services facility called Byer Square. Slated to open in 2019, Byer Square which will offer primary care, fitness, and nutrition services for both older adults and community members.
Future design trend: the end of standalone SNFs
“To me, part of the model of the future is trying to co-locate to the greatest degree possible these services so that they are more easily accessible, and so that there is more of a smooth transition through levels of care,” Skaff said. “You’ll see more and more health care campuses, not just standalone SNFs.”
Though JSLG is not renovating its SNF, Skaff and his colleagues view the construction of the Square and the assisted living units as an addition to the SNF offering, as they represent complementary services that improve the SNF and make the campus more appealing. If Skaff was building a SNF from scratch today, this is the model he would use.
Matt Smith, principal at Eagle, Idaho-based Cascadia Healthcare, sees a move in the next three to five years away from standalones in favor of continuing care retirement communities, or CCRCs, with shared facilities and staff.
“We think the baby boomers are going to expect a newer type of building,” Smith said. “A lot of people believe these campuses are the new trend, where you have your spectrum of life on one campus — independent living all the way to skilled and hospice. You can buy a share in them and you move from one all the way through. The nurses then share and the doctors can share. That’s definitely a trend.”
Click here to access the complete report, which takes a deep dive into SNF design, and reveals how industry leaders are using design to improve care, increase resident and staff satisfaction and build their brand awareness — all while remaining on budget.
Written by Jack Silverstein