You are the executive director of a 100 unit assisted living community. The location and quality of your community are at the upper end of “middle of the pack”. There is too much inventory in the marketplace and you are running right around 80% occupancy. You know that pretty much everyone else is running the same occupancy level. You have done all the traditional things you are supposed to do.
You meet a few times a week with your on-site marketing director. You and your corporate marketing person are convinced that your marketing director is above average in both capability and performance. You have signed a contract with the largest on-line referral sources and, while it costs you a lot of money, you are getting some move-ins. As you talk to executive directors of other communities, you have come to believe that everyone is having the same problem and that, in fact, you may be doing somewhat better than your competitors. Still, things are not what you would like them to be. You get uncomfortable questions from your regional each week and your regional is getting uncomfortable questions from the home office. You’ re not exactly worried about getting fired, but you are not feeling like you have the kind of job security you would like. As importantly, you would like to move up in the organization and you know maintaining an 80% occupancy level, no matter how bad the marketplace, will not get you there.
A Time to be Bold
You have been hearing about things like medical model assisted living, ACO’s, and PACE programs you know that Obamacare is part of the new landscape. You are tired of living in the world of 80%. You stumble across this series at Senior Housing Forum, titled “The New Healthcare Paradigm” and think, “What the heck, might as well try it.” You decide to amp up your ability to provide medical interventions in your community. You begin to carefully keep track of transfers to hospitals and to look at ways you you can prevent those transfers. You start building relationships with Hospital Administrators and Senior HMO’s. The work starts to pay off. You get a call from the discharge planner of your favorite hospital and they ask if you can take one of their patients who needs medical and rehab services. You have bulked up your program for just this kind of event. You say yes. A nurse case manager who is responsible for placing post acute hospital patients hears what you are doing. After touring your community comes to realize she has 4-6 patients a month she has been placing in skilled nursing who could do just as well in your assisted living community.
She tells you most will be with you for a few weeks then go home, but some will stay as long term residents. You get a call from a PACE care manager who says they are hearing great things. She has a low income resident they were going to place in skilled nursing for a few weeks, but thinks you could do a better job and that the PACE program will foot the bill until the resident is strong enough to go home. You say yes, the care manager loves it and begins to recommend your community. Word gets out about what you are doing. The local newspaper comes and does a human interest story on how you are improving the lives of seniors. Inquiries increase, occupancy increases and because you were the first one to tackle these relationships and they are working well, it is more difficult for other assisted living communities in your marketplace to build their own relationships. This is why the New Healthcare Paradigm can do great things for your community.
This series will give you the tools to make this happen in your community. Would this work for you? Steve Moran
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Love the concept you present. But what about all those who are not hospitalized? Wouldn’t it add to a living facility to have personalized wellness coaching avaialable to all residents so that they can improve their health outcomes and reduce hospitalizations? That’s my idea of a senior living community of the future.
Charlene, I think this is a great idea. The challenge that everyone seems to have is that will people love the idea, no one wan’t to pay for it. I would be interested in hearing how you work with this challenge.
Steve Moran
Good article – thanks for starting to paint this picture. Certainly, those providers who position themselves to be good business partners within the emerging health care model, and, those providers whose business models make it easy to say “yes” to referral sources, will be the providers that excel and succeed within the new paradigm. Providers need to be flexible, responsive, and bleed customer service to those referral sources that need partners in care for those they serve.
This sounds great but what about Medicare/Medicaid reimbursement? Many hospital discharges qualify for at least a couple weeks.
Hi Barbara
Good question and I will in an upcoming article address this question in more detail. I wrote an article several weeks ago on the California Medicaid program The program only exists in 7 California counties, but there are also a number of waiver programs in other states.
With respect to Medicare, today there is no provision for assisted living to receive direct payments. That being said, there are some ways that Assisted Living will be able to tap into some of these dollars.
Steve Moran
Steve,
A well written article. Thank you. In fact we have a PACE provider in El Paso and it continues to fill my otherwise empty beds in the skilled nursing facility. In the Assisted Living Community (ALC) however, although we have CBA/Community Based Alternative (a waiver program in Texas) my ALC continues to struggle with low utilization. I thought I was the best marketer there is, but my ALC had been a challenge for a long time now.
Keep up the good work.
;)Dioni