Senior living stakeholders have pondered for years whether the industry is more hospitality or health care. In recent times, many have arrived at the same conclusion — it’s both.
On the one hand, senior living residents are arriving in communities with more care needs than in the past, including in low-acuity settings such as independent living. On the other, the basic value proposition of senior living still hinges on whether prospective residents will be able to find comfort, purpose and engagement — not just health care — as they move into their new homes.
Some operators, including Bickford Senior Living and Pathway to Living, have been able to walk that line by partnering with other health care or other organizations that help fill gaps in their communities and offer a better quality of care.
For instance, Olathe, Kansas-based Bickford is among its other initiatives working with HomeCare Advocacy Network (HCAN) to offer in-home care to both residents and older adults living outside of communities in four markets. And, Chicago-based Pathway is building an infrastructure and support system with primary care provider Oak Street Health designed to support a value-based model of care delivery.
Both also have improved resident outcomes by getting further upstream in their health care journeys — an area where the industry has not done a great job in recent years, according to Bickford Executive Vice President Alan Fairbanks.
“At the end of the day, [we are] doing a much better job with meeting the holistic needs of a resident versus just becoming … the warehouse of the elderly,” Fairbanks said during a panel discussion at the 2022 NIC Spring Conference in Dallas. “It’s not just about the length of stay, it’s about giving them a better quality of life, keeping them happier and healthier for longer.”
By partnering with service and care providers, Bickford and Pathway have emerged as early leaders in the race to embrace new ways of delivering health care to older adults amid an industry-wide shift to home- and value-based care.
Other ways operators have sought to meet this trend is through collaborating with or launching Medicare Advantage plans, like what Juniper Communities and a handful of other operators are doing through the Perennial Consortium; or Lifespark’s efforts to build on MA momentum in senior living as a “payvider,” or a payer that is also a care provider.
Moving away from ‘sick care’
In the past, senior living operators relied on what Fairbanks referred to as a model of “sick care,” wherein residents and operators simply wait until they get sick or have a health event to seek out health care. Under that model, residents and their families are responsible for navigating the “roller coaster of care,” sometimes with negative consequences.
But Fairbanks and Bickford see it another way. Senior living operators already know more about their residents than most, given that they interact with them every day. At the same time, there is a direct connection between resident health and wellness and a senior living operator’s bottom line.
Given those factors, Fairbanks believes it behooves senior living operators to make residents’ health care journeys — both in and out of their communities — as smooth as possible.
“Aren’t we obligated … to get them in a model that gives them the best chance to be successful, to be healthier for longer?” Fairbanks said. “That’s our job, and we should be getting them into the best possible situation that we can.”
Bickford currently offers home-based care in four of its markets: two in Chicago; one in the Cedar Rapids/Iowa City market and one in the Muscatine/Quad Cities market. The company is also expanding into three new markets in the next month and a half.
Although home care can logically act as a referral feeder, Bickford has a broader goal of joining a larger provider network, and eventually, providing more value-based care services in its 62 senior living communities
“Our big focus is how we can best create a performing network-of-care model in certain markets,” Fairbanks told SHN this week. “And really meaningfully begin to step into a ‘well-care’ system versus the ‘sick-care’ system that we live in today.”
Not only does Fairbanks believe that care coordination is better for residents, he also believes it is a plus for senior living operators and staff in terms of efficiency.
“The win for the staff is the fact that they’re dealing with a set number of individuals; there’s consistency, communication and collaboration,” Fairbanks said. “And the RN isn’t talking to 15 different doctors trying to scramble to get orders and deal with that.”
He added: “You’re dealing with one physician group — maybe two or three at most.”
Bickford looks for new preferred care partners through careful vetting, and by ensuring both parties have aligned expectations and goals.
“This is about collaboration and coordination of care and services, and conversations that we have on a regular basis,” Fairbanks said.
Benefits of value-based care
Like Bickford, Pathway has similar goals of keeping residents “happy, healthy and home” in its 48 communities, according to Director of Value-Based Care Laurie Geschrey. When residents come to a Pathway community, it isn’t just because of the bells and whistles, she said.
“No one moves in their mother because of a bistro,” Geschrey said during the NIC panel. “They move their mother in because that elderly individual needs additional care.”
As such, the company has for about two years operated a value-based care model in five of its assisted living communities. Among residents who have opted into using the value-based care model, Pathway has seen an average of 23% to 25% fewer days spent in the hospital or in rehabilitation, “which is huge,” Geschrey said.
“Those are Medicaid residents, so any day that they’re out of the community, we don’t get paid,” she added. “So when I can reduce that by 23% to 25%, that adds up.”
Pathway’s leaders also see differences in hospitalization outcomes among residents under the value-based model versus those in the more traditional fee-for-service model. Although Pathway has many care partners it values and directs residents to them, once a resident leaves for the hospital, “they get lost in a … broken healthcare system,” according to Geschrey.
But under a value-based model where Pathway is part of a care coordination team, the operator can track residents from discharge, to the hospital, to a rehabilitation facility and then finally back to the community where they live.
“They are back in the community usually within seven to 10 days,” Geschrey said. “In a fee-for-service world, they may never come back.”
Senior living operators should not be shy about marketing their care coordination and preventive care capabilities, either. Because at the end of the day, that is what residents and their families will come to expect out of senior living communities amid the industry’s greater shift to value-based care.
“We should be selling our wellness programs, not just necessarily what we’re going to do if something happens to your mother,” Geschrey said.