The coronavirus pandemic has pushed many senior living providers to think about new ways to include health care partners in their operations. For Ascension Living — the senior care subsidiary of St. Louis-based health system Ascension — having the backing of a large health care player has been an advantage.
When the Covid-19 hit earlier this year, Ascension Living turned to the Catholic health system for assistance with telehealth, group purchasing, staffing and medical leadership, according to Ascension Living President Danny Stricker.
“Within the telehealth and technology space, as we learn to navigate this pandemic … there are going to be additional opportunities to put health care services more at the forefront within senior living,” Stricker said during a recent appearance on the Senior Housing News Transform podcast.
Ascension Living completed a strategic capital plan in November, and is continuing on that path despite Covid-19, with middle-market and hospital-to-home models among the innovations it’s targeting for the future. Overall, Ascension Living’s experience in navigating the pandemic as part of a larger health system could be instructive for other senior living providers and in the industry as a whole. That’s because health systems have increasingly been aligning with senior living providers in recent years, through mergers and other types of transactions, raising questions about the benefits and the tradeoffs of such arrangements.
On Ascension Living’s top challenges so far during Covid-19:
We’ve had several challenges in managing through this Covid 19 pandemic. We’ve organized ourselves to respond to this pandemic, and I continue to be amazed at the flexibility of our teams, and their being responsive to the various changes.
Mobilizing to make sure that we can distribute adequate PPE was one of the early challenges, and our teams responded very well. There have been several regulatory changes that continue to evolve, and we’re navigating through those to make sure that we’re not only meeting the needs of the residents, but also from the governing bodies to make sure that we’re being compliant.
Being successful in this era, I believe, has many similar foundations as pre-Covid times. For us, staying true to who we are as a Catholic ministry, and serving our residents, our participants, with that core philosophy in mind, is certainly helping us deal with this pandemic moving forward.
The month of September was the first month since the start of the pandemic — which by my count is going on seven months — that we saw overall occupancy rise in Ascension Living.
We’ve seen the impact change by service line. For example, it’s not a surprise our skilled nursing communities continue to be the most challenged as it comes to occupancy. That said, we’ve seen a rebound within our short-term rehab census in September.
Our memory care service line has also seen an occupancy gain over the past 90 days. I think that is due to the specialization that we provide with respect to memory care, and the programmatic approach that we take to make sure that, holistically, the memory care residents have all that they need to be successful, which is really hard to do at home.
We’ve also seen nice growth and stabilization within our Program of All-Inclusive Care for the Elderly (PACE) programs. And our independent living is also starting to rebound and pick up with move-ins.
So, overall, each service line has had a different impact, but we’re starting to see some positive movement across the board.
On whether the pandemic has changed Ascension Living’s ongoing strategic plans:
We put together a very thoughtful three-year strategic capital plan and completed all that work in November before the pandemic started. A lot of the core pillars of that strategic plan continue to remain solid. I’ll give you some examples.
First, we know that there’s an increased demand for aging-in-place, as well as more affordable options for older adults. And we also know that, with Covid-19, the reality is that there’s a heightened level of fear and hesitation to leave the home, which we’ve all experienced, particularly as it relates to our move-ins. In May, we took the time to reassess our strategic plan to see if Covid would alter it or not. Within our core pillars, we believe that we still have a very solid strategic capital plan to make sure that we invest in service lines to meet people where they are, and closer to home.
First, we really want to continue to invest in our PACE service line. PACE, for us, is a very mission-focused service line that continues to meet the needs of frail seniors and elderly at home with the supportive care of an interdisciplinary team. That model of care, we also think, has implications more broadly as it relates to organizing ourselves for value-based care. So, we want to continue to invest in and grow our PACE programs.
We also are structuring ourselves to continue to invest our resources as well as our strategic growth plan around our memory support. We’ve seen our memory support occupancy remain fairly stable and start to pick up. As you look at the needs of memory care, and the services that it provides, it takes a lot of focus to do this well. We believe that we have a core program that enables seniors and their families that are experiencing challenges with dementia or other forms of memory care needs.
We also are looking at a short-term rehab model that maximizes the value-based care programs that are ongoing, and focusing on piloting this fiscal year [in] some short-term rehab sites within our hospitals — or the skilled nursing units, is what they used to be called. We’re going to continue to invest our time to stand up a couple pilot sites. In the midst of the pandemic, we stood up our first market for a live-at-home program, which is a care management model, on-demand services for people that continue to want to remain at home. And we are coordinating services for them, ranging from home care all the way through their food and housekeeping. We are continuing to learn from that initial pilot, and we’ll continue to try to grow that program in the new markets.
Those core pillars for us — as well as investing and repositioning our current communities and finding opportunities for growth — that is going to continue to drive our overall strategy in the coming years.
On the role of health care in senior living amid the pandemic, and how Ascension Living has worked with the Ascension health system:
It’s really become a value to us as we’ve navigated through this pandemic.
Right now, our residents have access to essential online care, 24/7. We’re also working with Ascension to develop a broader telehealth support model that’s appropriate for our residents and our participants. And I think virtual visits are certainly not going to be going away anytime soon.
We’ve seen a lot of benefits of our residents being able to see specialized providers faster, as well as mitigating some of the challenges that come with traditional physician visits, such as transportation. We also expect that, within the telehealth and technology space, as we learn to navigate this pandemic … there are going to be additional opportunities to put health care services more at the forefront within the senior living in the housing services.
It’s been a pleasure working with our counterparts across Ascension in several other areas. First, our group purchasing organization, which is called the resource group, has done an outstanding job in partnering with our communities and our leaders in making sure that we have adequate PPE, not only back when we were headed into this pandemic in March, but also going forward.
The other area that we found extreme value in is our physician leadership across Ascension. We stood up a medical director call and learned a tremendous amount across the country as to what our medical directors and physician leaders were learning within their practices as well as in our communities. Having the physician support and leadership of some of our Ascension counterparts and colleagues have just been an extreme help. And, we had great collaboration across Ascension for testing, and that has really helped us remain proactive in our testing approach.
The last area that I’m very proud of with regard to our collaboration within Ascension is our ability to support each other from a staffing perspective. I mentioned earlier that we had several Ascension Living associates travel across the country to support some of our needs, as we had associates on furlough. We also had our several acute care nurses and team members travel and help out our communities that were experiencing higher levels of associate furloughs. And that support combined has really been remarkable in helping us respond, as well as continue to plan on being successful within this pandemic.
On how Ascension Living has used telehealth during the pandemic:
I would say the biggest benefit and the primary benefit has been the primary care virtual visit.
Instead of waiting for an appointment that may take a couple of days — or, depending on the provider or specialty, a couple of weeks — being able to see our physicians faster has certainly helped us support the aging-in-place that our residents strive for.
We certainly believe that there will be more opportunities in health care interventions that can be supported via telehealth and/or remote monitoring. So, we are very excited about the growth in that space, and it’s really all to the benefit of our residents that want more convenient access.
We certainly commend the leadership at CMS and all the state agencies. They have been great partners as we’ve all worked together to make sure that we’re delivering not only safe care, but also compliant care. The waivers that they have put in place [for telehealth], we are certainly advocating that they remain.
On how the pandemic affects Ascension Living thoughts on middle-market senior housing:
One of the key values that senior living provides to older adults — on top of the various services that we provide, such as health care and dining and housekeeping and the care coordination — is really the socialization aspect. It’s that sense of community. When you talk to our residents, and you ask them why they chose to move into one of our communities, [they will say] that being part of a broader community with access to services is one of the key drivers. With us being a mission-based Catholic organization, we also have a very heavy focus on the spiritual care that we provide our residents.
Our thinking is that the benefits of senior living do not go away because of Covid-19. I believe that the value of senior living perhaps will become even more relevant as we continue to move forward in this pandemic.
As it relates to the other housing services and the middle market, we’re certainly challenging ourselves right now to say, how do we make sure that our communities are positioned well to offer a more middle-market pricing model that is flexible and provides that same benefit? We’re still working through that. We do believe that there is substantial growth opportunity for the middle-market. And I’m very confident that our industry will continue to be creative and work together and collaborate to serve this population as well.
On how the pandemic is affecting the preferences of prospective residents or their families:
The number-one challenge as we work with our prospective residents is still the same. It’s, ‘I’m not ready to make that decision yet.’ That decision point is not going away.
Safety components are certainly at the forefront of our marketing plan to make sure that we communicate and demonstrate — with outcomes — as they choose to move in with us, number one, they’re going to have transparency. They will understand where we are with respect to not only Covid-19, but in general how we’re doing as it relates to the health care services that we provide. That, for us, is going to be a key driver in our re-marketing plan that we’re working on implementing right now. We believe that we can communicate and demonstrate on a daily basis that, if you choose to move in with us, you are just as safe with us as you are being at home.
On Ascension Living’s growth plans:
We did a thorough market evaluation, a demand projection per service line. Given some of the occupancy challenges within skilled nursing, we’re trying to reimagine how we serve the community, and how we can repurpose spaces in a way that can be meaningful to prospective residents as well as to be competitive, both in the middle market and the traditional senior living market. We have a new vice president of transformation that is spearheading efforts for our repositioning. And we have a strategic growth team that includes representatives and leaders from every discipline to make sure that we’re approaching this in the very best way to make sure that we achieve growth.
We’re also looking at taking a community and trying to add in more middle-market, independent living, and we’re going to try that out and see what we can learn from it. So, we anticipate to continue this journey internally for the foreseeable future, and make sure that we invest in our communities.
The other key component for us is around new growth and new markets. We have a lot of growth resources right now around our PACE program. I would love for us to double our PACE size in the next three to four years. Today, we serve 700 participants every day. But I would love for us to be able to grow that to over 1,400 in the next several years.
As I mentioned earlier, we are going to pilot the transitional rehab-to-home care model within the hospital space. Before the pandemic, our VP of strategy spent time talking with prospective residents and patients that were evaluating short-term rehab needs. A lot of our patients that we’re evaluating for skilled nursing, they would rather stay in the hospital for an extra week or a week and a half as opposed to being transferred out to a skilled nursing facility. We are going to test that and see what that model looks like in a couple of our markets this next year.
On the challenges that lie ahead:
I think we all have varying projections on what this all looks like. One thing that keeps me up at night is, what does the combined Covid and flu season look like? The good news is that from a flu perspective, the precautions that you take to prevent the flu are the same ones that you take to prevent Covid-19. We’re definitely promoting getting your flu shot. We think it’s more important than ever that you receive one this year. As we wait for a vaccine, we cannot stop or let our guard down.
Six-plus months from now, I think if we continue to be relentless in our focus on infection control and prevention, as well as be open to and advocating for the Covid-19 vaccine as it becomes available, that will position us well to continue to respond and to continue to also see a return of our occupancy and volumes to pre Covid-19 levels.
[In the short-term,] it’s going to take a lot of partnership within our industry. As long as our dialogue remains open, and we are transparent with where we are from an economic perspective, we will continue to see support from government agencies as well as CMS.
For us, what’s really going to be important is that we continue operationally to focus on the areas that we have most influence on. We can’t always control every day if a resident or an associate ends up having Covid. For example, if they have Covid upon admission, and that was missed at the hospital, we don’t always have control over that.
What we can do is make sure that, as we learn about it, we continue to mobilize and care for that for that individual with all the resources that we have. The areas of control that we can have most influence on — on the expense side, or within our labor side — I think that’s an opportunity for us. I think the harder one is supplies. When you look at our days of supplies on hand, compared to where they were pre-Covid, we obviously are carrying much more supplies every day, which is a good thing, as well as our ongoing testing that we are providing.
It’s definitely a day-by-day learning journey that we’re all on. And as I said earlier, as long as we keep open the collaboration and communication with those organizations and governing bodies that are supporting us now, I think we’re going to weather the storm just fine.