As we see the steady – and hopefully permanent – decline of COVID-19 in the U.S., the challenge for the long-term care (LTC) industry is a come-back. What we can expect is that the come-back will not look quite like the post-PDPM (Patient Driven Payment Model) from the pre-COVID-19 days.
There are many influencers that will determine LTC‚ resurgence, but one fact remains: any business that provides housing depends on occupancy. The public, as well as referrals, have lost confidence in skilled nursing homes after the tragic death of thousands of residents during the pandemic, and census numbers are only slowly recovering. Federal bail-out bills favor funding for home care and aging-in-place. During recent years of low interest rates, some LTC companies have become over-leveraged for various reasons, from borrowing to pay the rent, to purchasing personal protective equipment for staff. Further, pre-pandemic loans still weigh heavy on the balance statement and low occupancy will not help pay down debt. Many are being forced to divest their skilled nursing facilities, while others are focused on offering high-end amenities and four-star services. Reimbursement for skilled facilities is barely enough to cover day-to-day operations and state and federal unemployment bail-out pay make it more attractive to stay at home with remote-learning children than work in a LTC facility.
However, in the most dynamic time in healthcare providership, some things remain certain. Because Medicare does not pay for assisted living services, most citizens will not be able to afford it. By 2050, the population of seniors in the U.S. will be 22% – a startling number when compared to only 8% in 19501. Chronic diseases with “multiple comorbidities, like diabetes, will continue to rise. Thirteen million people are expected to suffer from dementia by 2030 and in 2020, 15.3 billion hours of healthcare was provided by non-paid caregivers2.” Medicare Advantage plans, telemedicine, and home care resources will not be able to handle the number of citizens who are expected to require 24/7 hands-on care. There is a future for skilled nursing facilities and assisted living facilities that have the capability to plan for the future. And the future is now.
Under such financial, labor, and public perception pressures, what can those facilities do to stay in business and thrive in a post-COVID-19 world? It’s a complex question, but the answers must be prioritized:
First, remain compliant with federal and state regulations. Avoid deficiencies and possible civil monetary penalties that damage reputation, star ratings, halt new admissions and tug on purse strings. While meeting the mandates for adequate staffing, strong leadership in infection control is a must. From administrators to the most recently employed housekeeping staff, everyone must practice infection control like an innate characteristic if we want to resolve the perception of failure during the pandemic. As visitations to nursing facilities begins to open, demonstrate to visitors and vendors newly upgraded infection control practices that remain in place, even when the pandemic subsides.
The stressors of new staff and short staff will continue as the LTC workforce is perceived to be lagging in wages and benefits. Automated processes in the facility can promote efficiencies and must be evaluated and prioritized due to the cost of such investments. For example, it may be time to revisit food service software that can help craft therapeutic diets, track food trays, print menus, provide paperless menus, schedule staff, check food allergies, reorder food and supplies, all while keeping food budgets in line.
Seek supportive vendor services. Pharmacies have tools that can lower the cost of pharmaceutical care with formulary programs. Pharmacy interfacing electronic health records (EHRs) can eliminate the need for faxing orders from an antiquated fax machine by communicating orders directly from your system to theirs, enabling real-time receipt, prompt order fulfillment, and more face-time with residents. Bi-directional systems or web-based tools can assist staff to track the status of new orders and eliminate faxing refill requests to the pharmacy. Automated dispensing machines provide secure access to emergency and first-dose medications and supplies.
Advanced pharmacy delivery systems are making multidose packaging easier to supply and more efficient for staff to administer. Pharmacy-programmed safety infusion pumps take the guess work out, provide safely administered infusion drugs, and avoid medication administration errors.
2021 and 2022 are going to be challenging, strenuous, and unpredictable as the LTC landscape looks more like a sandstorm than an oasis. Providers in the industry, from skilled facilities and senior living, to long term care providers, must look forward and anticipate the changes in state and federal regulations and new customer preferences. We must define our needs, prioritize our requirements that sustain our businesses and relationships, and provide efficiencies that enable us to best serve the seniors who have served us so very well.
