Senior Living Communities Cut ER Visits, Resident Turnover with On-Site Urgent Care

About four years ago, Christian Living Communities (CLC) faced a problem: Resident turnover at one of its locations was too high. The nonprofit provider began working with a startup company to bring urgent care services to residents, and within a year, turnover was down to normal levels and emergency room visits were less frequent.

Today, that startup — DispatchHealth — is expanding into new markets and deepening its integration with senior living, as providers are under increasing pressure to offer more robust on-site health care services.

“This year, we have seen about 35,000 patients, and about one-third are in facilities — a combination of assisted living and a small percentage of long-term care and skilled nursing as well,” DispatchHealth founder and CEO Dr. Mark Prather told Senior Housing News. “In our markets, we’ll work with local providers to the Brookdales and Sunrises.”

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Early success

Based in the Denver area, Christian Living Communities owns and operates four properties in and around Denver and third-party manages 10 others in Colorado, Utah and Missouri through its Capella Living Solutions platform; it also has a site under development near Chicago. The company operates a mix of property types, including standalone assisted living/memory care and life plan communities. The partnership with DispatchHealth began at one of those life plan communities — Holly Creek Retirement Community in Centennial, Colorado.

“We were looking at attrition of around 15%, meaning turning over 15% of apartments in a given year,” Jayne Keller, CLC’s vice president of senior living, told SHN. “Average turnover is around 12% for this type of community.”

CLC also knew that Holly Creek residents were going to the emergency room at a higher rate than residents at similar properties, thanks to data collected through its partnership with Masterpiece Living, a multi-speciality group that has a network of about 80 senior living communities nationwide.

As CLC was confronting this situation at Holly Creek, Prather was developing his concept for DispatchHealth.

Over his 20 years as a practicing emergency department (ED) physician, Prather had observed that many seniors — as well as younger individuals — are treated in the ED unnecessarily. He became an entrepreneur to solve this issue.

“Our goal initially was to develop a mobile emergency room and bring high-acuity care into the home, assisted living, SNF,” he told SHN.

In those early days, Prather created mobile units consisting of a nurse practitioner and emergency medical responder. These teams would be dispatched in specially equipped vehicles to address a variety of conditions that might otherwise lead to an ER visit or hospitalization.

When Prather pitched the new service, CLC was eager to be an early adopter, viewing it as a potential solution to the issues at Holly Creek — and that proved to be true. Within a year, Holly Creek residents were going to the emergency room less frequently, length of stay was up, and its attrition rate had fallen 3%, meaning it was at the normal 12% level.

Operational considerations

DispatchHealth has secured more than $34 million in total funding and expanded to 10 markets. The model remains similar to the early iterations, consisting of two-person mobile units that provide care, with a board-certified emergency room physician overseeing the dispatch process.

The company has also contracted with a variety of insurance companies; users of the service typically pay between $5 and $30 out of pocket, with Medicare or Medicare Advantage covering most of the bill.

Because of this payment structure, it essentially costs nothing for a senior living provider to begin working with DispatchHealth, although there are some operational best practices to implement, Keller said.

Educating residents and staff is essential. Residents and their loved ones need to know what DispatchHealth is and when and how to utilize it. CLC shares this information during the orientation process for new residents, and gives them a magnet with DispatchHealth’s contact information on it for easy reference — the service can be accessed via phone, app or website. CLC reinforces the information with one or two education sessions annually.

DispatchHealth itself will send people to the community to conduct education sessions and also provides quarterly data on utilization. Keller encourages this information to be widely shared across the organization, as utilization tends to increase when residents see that their friends and neighbors are using the service.

Staff members need to be educated on what their role is in helping residents access DispatchHealth. Ideally, a resident or a resident’s legally appointed decision-maker will make the decision to call DispatchHealth, which insulates the community from liability around that health care choice. Residents and staff members should all be educated about when DispatchHealth is a good option and when it is not — for instance, the company does not handle cases where there’s shortness of breath or stroke symptoms. However, DispatchHealth teams have the equipment, medications and skills to immediately address many of the most common reasons why a senior living resident might call 911, such as confusion, swelling, pain, stomach virus symptoms, dehydration and flu.

In memory care and skilled nursing, residents or their appointed decision-makers can put standing orders in place so that medical personnel can call DispatchHealth without having to first get approval.

Keller also periodically reminds CLC staff that, depending on their own insurance coverage, they could use DispatchHealth themselves in situations such as having a sick child, to avoid unnecessary ED trips.

Today, CLC uses the service not just at Holly Creek but all its Denver-area communities, and Keller is hoping that DispatchHealth comes to its other markets as well.

“I want it in every single one of our communities,” she said.

The bigger picture

Other startups are also striving to help senior living and care settings cut down on hospitalizations and ED use. For example, Call9 has targeted skilled nursing, embedding paramedics at these facilities to provide on-the-spot emergency care. The company is beta-testing a new product that will be useful across the senior living continuum, Call9 Chief of Staff and VP of Communications Garrett Gleeson told SHN.

The demand for these types of services is almost sure to rise in the coming years, as senior living communities become more integrated into the overall health care system. Payers and health systems are recognizing that many of their patients and beneficiaries reside in senior housing, and will be looking to senior housing providers to help manage costs and health outcomes for these individuals.

Already, CLC touts its DispatchHealth partnership in marketing to potential referral sources, including health care providers. This has to be done thoughtfully, though, by showing how keeping costs down and enhancing seniors’ wellness benefits all parties involved.

“The provider sometimes can say, [DispatchHealth] will be stealing some of my business, so we have to educate on the front end that it’s a win-win,” Keller said.

Prather believes that senior living providers will further enhance their clinical capabilities and partnerships not just because of health system changes but consumer desires.

“I think the groups that are looking to differentiate and not just be a place to stay and sleep are really looking at what seniors want,” he said. “That could be anything from social opportunities to exercise, but it’s also health care.”

Written by Tim Mullaney

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