Senior living’s response to Covid-19 over the past year cemented the industry’s years-long paradigm shift toward greater clinical capabilities and integration across the care continuum. This shift was ongoing, pre-pandemic, due to rising acuity among residents and shifts in health care payment systems, among other factors.
Especially in light of Covid-19, providers throughout the space are investing in expanding clinical capabilities and expertise, including adding chief clinical officers or similar roles to leadership teams, or bringing new talent into these positions. Recent examples include Milestone Retirement, which named a chief clinical officer; JEA Senior Living, which hired a new VP of clinical services; and Ascension, which brought on a chief medical officer of senior care.
Such leaders are tasked with building and recruiting for other clinical leadership positions, forming partnerships with health systems, leveraging data and technology to achieve favorable health outcomes, and work with sales and marketing teams to use clinical expertise as a tool for generating leads and increasing occupancy.
Clinical leaders must accomplish these goals but strike a balance between health care and hospitality, which still plays a prominent role in the space, Senior Lifestyle Corporation Chief Clinical Officer Paula Adams told Senior Housing News.
Adams spent her entire career in positions across the health care continuum before joining the Chicago-based operator — which has a portfolio of about 200 communities across the country — in 2017. She compares the paradigm shift within senior living now to how boutique hospitals changed the makeup of the acute care sector 20 years ago, by adopting elements from hospitality to a health care setting.
The successes of blending hospitality and acute care means that there are clinicians with experience in both realms, which will be essential for providers looking to hire clinicians for their C-suite.
“You’re merging the two worlds,” she said. “Fortunately, there are [clinicians] out there who can do both.”
Instilling confidence in consumers
Covid-19 highlighted the importance of having robust infection control systems and strong clinical partnerships in senior living, and the pandemic also dramatically eroded occupancy across the industry. Strengthening clinical capabilities and rebuilding census are goals that go hand-in-hand, and clinical executives can drive both objectives.
Having clinicians in executive roles provides sales and marketing teams with another tool to generate leads and interest from seniors and their families considering a move to senior housing. Moreover, it provides peace of mind among prospects and their loved ones that their health care needs will be addressed, ALG Senior Chief Medical Officer, Dr. Kevin O’Neil, said during a recent webinar hosted by SHN.
Hickory, North Carolina-based ALG Senior supports around 160 communities across the Southeast U.S., and a significant portion of its move-ins have done so because of a health care need.
“It’s important that this is a marketing advantage to know that these health care needs and the wellness needs of our residents are being addressed,” he said.
Clinical leadership can take the lead in effectively communicating with residents, potential move-ins and their families on a range of subjects, from everyday health and wellness needs to changes in a provider’s response to extreme events such as Covid-19, Dr. Sandra Petersen, consultant to Pegasus Senior Living’s health and wellness team, said during the webinar.
Petersen started working with the Dallas-based provider in February 2020, to help it launch a new memory care program. The pandemic forced her to become a “field commander” in Pegasus’ Covid-19 response. The provider operates a portfolio of 37 communities.
In addition to spending her entire career in health care, notably as a geriatrician, Petersen spent five years in the Texas National Guard, working in disaster management. The mix of experiences prepared her for her current work.
“Training is a huge need across the organization,” she said. “We’re busy and trying to keep on top of all the regulations and the quick changes that are happening, especially as we see the states starting to open up some.”
Senior Lifestyle recognized the shift to a health-care based model years ago, and the clinical team regularly works with the provider’s sales and marketing teams, updating them on clinical initiatives and advancements and their results, so that sales leaders can introduce this information to prospects.
Especially during Covid-19, prospects and their families are updated on Senior Lifestyle’s infection control protocols — what is being done to keep communities safe and clean, the impact of infection control on dining programs and activities, and how infection control will evolve as initial vaccination efforts in long-term care wind to a close.
“Our prospects and their families need reassurance, and rightly so,” Adams said. “The education to the sales team from the clinical team was tight before; it’s even tighter now to make sure there’s a clear understanding, and it can be communicated.”
Building clinical partnerships
Clinical executives are expected to be the point people in building relationships with health systems and third-party vendors across the care continuum. These services can include in-house rehab and mental health partnerships, pharmacy services, telehealth and telemedicine initiatives, and home- and community-based services.
The shift in senior living to a health care-based model makes third-party partnerships critical, Petersen said. And these partnerships will become more essential as a growing number residents struggle with the effects of over a year of isolation from families, friends and each other.
“We’re seeing this huge mind-body connection that we know is a big part of geriatrics,” she said. “Supporting that through mental health services is something that is critical.”
Adams has spearheaded several joint venture initiatives with third-party vendors during her time at Senior Lifestyle. Notably, one of its pharmacy partners also has a wellness and rehab therapy program, enabling seamless coordination between a resident’s pharmacist, rehab specialist, physical therapist, wellness director, and the provider.
“It’s an exciting adventure for us because, in the past, [the process was] very fragmented,” she said.
Senior Lifestyle uses telehealth and telemedicine services in its skilled nursing cohorts, and Adams sees potential for expanding that to lower acuity levels of care. The provider piloted a telemedicine program in a handful of assisted living facilities last year, but it struggled because it involved multiple physicians for each resident, instead of a primary caregiver as on in the nursing home side. But the provider plans to continue exploring ways to expand the service to lower acuity settings.
Most recently, Senior Lifestyle implemented electronic health record (EHR) and medication management platforms. And the provider worked with Salesforce, which rewrote its Risk Connect online incident report platform in order to enter Senior Lifestyle’s Covid-19 community data so that updated information was available to residents and families daily.
Adams believes that technology will expedite the gathering of data, using it to explore and improve resident outcomes, and Senior Lifestyle will continue to explore ways to implement tech moving forward.
Stronger health system alignment
Perhaps most importantly, a clinical leader drives alignment with a health care system.
Most of ALG Senior’s resident population receives Medicare or Medicaid benefits, or both, O’Neil said.
He recognizes that most of the residents in ALG Senior’s communities will eventually be involved in a value-based care system in the future. The paradigm shift is an opportunity to create an integrated care model, while not losing sight of the hospitality elements that initially attract seniors to the space.
An integrated care model allows providers to get residents the preventative care they need on site, reduce the need for emergency room visits and EMT calls, drive more positive health outcomes and allow residents to stay in communities longer.
“We have to understand that the vast majority of our residents do have significant health care needs,” he said. “Much of that can be better addressed by having providers who are coming on site, and having clinical leaders that will help oversee the type of care and the quality that’s being provided.”
Covid-19 is also presenting the industry with clinical leadership opportunities to strengthen providers’ position within the health care continuum.
Prior to the pandemic, ALG Senior actively positioned itself as a valued partner for hospitals and managed care organizations, O’Neil said. He believes there is a great opportunity for providers to become part of a larger health care ecosystem.
For O’Neil, the pandemic provided openings to look at alternatives for providing necessary geriatric care and help residents achieve positive outcomes in mobility, mentation, medication and resident engagement. This allowed ALG Senior to become more hands-on with exercise programs in non-group settings, and review prescriptions protocols to ensure that anti-psychotics were not being over-prescribed.
At ALG Senior, a significant area of focus is centered on addressing geriatric programs in communities without adversely impacting the safety and quality of life and quality of care of our residents. O’Neil compared the review to inspecting a ship as it was about to leave harbor, to ensure that it was free of dents and leaks. To ensure ALG Senior’s protocols were satisfactory, his team worked with human resources and facilities management teams, incentivized workers to reduce turnover and address outbreaks in communities as they arose.
“I’ve always said geriatrics is a team sport,” he said. “It’s all of us working together.”