Welltower, Johns Hopkins Unveil Assisted Living Quality Framework

Welltower (NYSE: WELL) has released the results of a study conducted for the health care real estate investment trust (REIT) by Johns Hopkins Medicine (JHM) that may eventually establish best operating practices in assisted living and memory care communities across the country.

The National Assisted Living Quality report is the result of a three-plus-year process involving Toledo, Ohio-based Welltower, Baltimore, Maryland-based Johns Hopkins, and a dozen stakeholders. The report comes on the heels of recent scrutiny of assisted living quality, including a Government Accountability Office (GAO) report issued earlier this year, which identified quality concerns related to Medicaid-reimbursed AL settings. 

Driven by demographic, health care shifts


Welltower approached JHM in April 2015 for advice in developing national quality-of-care standards in its assisted living and memory care communities. Welltower — aware of changes to the U.S. health care system to one focused on preventative, value-based care, and mindful of the pending “silver tsunami” of baby boomers transitioning to senior housing — became convinced that measuring care quality and building a culture of quality and quality improvement was imperative to fulfilling the needs of future residents.

As America ages, the assisted living industry will need not only to provide high quality care to older adults but will need to prove to various constituencies that it is providing high quality care,” Bruce Leff, M.D., professor of medicine at Johns Hopkins, wrote in the report’s introduction. “Welltower is convinced that measuring care quality and building a culture of quality and quality improvement among its operating partners would position the assisted living industry for the future. We call this the Welltower Hypothesis.”

JHM began the process by interviewing Welltower’s senior leadership team, top assisted living operator leaders, operators’ quality of care and data personnel, and health system leaders; reviewed the literature on quality of care issues for memory care in assisted living; examined the current state of quality of care indicators; and recommended next steps.


A stakeholder dream team

For more insight into the study, JHM reached out to a who’s who of 12 people with expertise in various aspects of the industry. This group included 11 high-profile executives such as Silverado Senior Care President/CEO and Chairman Loren Shook, Argentum Chief Operating Officer Maribeth Bersani, American Seniors Housing (ASHA) president David Schless and Sunrise Senior Living Chief Clinical Officer Sue Coppola. The 12th stakeholder, Susan Yedor, is the daughter of two assisted living residents.

The stakeholder team identified five key areas of care quality that can serve as the basis for the development of a culture of quality measurement and quality improvement in assisted living at the national level:

  1. Culture
  2. Environment
  3. Health care services
  4. Coordination and integration with community
  5. Resident quality of life

JHM conducted interviews with the stakeholders between November 2017 and last February, and hosted a stakeholder summit in April.

Next steps

The report is only the first step to what Welltower believes will be a radical change in measuring quality of care in assisted living and memory care.

The report authors identified next steps such as developing and implementing a quality learning collaborative among assisted living operators, creating a critical incident reporting system across Welltower’s network of properties, mapping indicators to be used in the near term for quality improvement efforts, and sharing the results of the stakeholder network with a broader range of industry professionals for feedback and endorsement.

Written by Chuck Sudo

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