News

Acuity of Care

Post PDPM, and Higher Acuity for Assisted Living Facilities

Michael McConnell, BSHCM, PTA

In the dawn of the Silver Tsunami, we find ourselves tackling an ever-changing, long-term care environment.  We are working in an industry where rehab patients are receiving less therapy, with the urge to return these same individuals to their previous level of function. Shorter rehab stays are doing nothing in short of fueling recavitism.  In truth, as a result of PDPM, the need for skilled therapy services is more critical now than ever to drive quality measures. Meeting criteria for a skilled nursing stay and complications with managed care organizations are making it more difficult for our Seniors to receive the appropriate level of skilled attention. Therefore, I predict there will be an overwhelming need for assisted living facilities in the not too distant future to meet the rehabilitation needs of an aging American population.  

For a long time now, the shift in Acuity of care has already been occurring. Even before PDPM, there has always existed the necessity to move on to the next continuum of care. Patients with co-morbidities that continue to require the need for nursing and/or therapy care are usually set up with Home Health or Outpatient services. For many, these services aren’t always enough. Challenges with staffing clinicians…changes in reimbursement models for HH agencies (Patient Driven Group Model) … and the inconveniences that can be associated with arranging transportation to go to outpatient visits can sometimes be too much. The assisted living environment offers the perfect balance to meet the health needs of our Seniors after or in lieu of a skilled nursing stay.  

Assisted living facilities (ALs) of today are geared towards offering a variety of services and in treating different levels of care. Levels of care range from medication mgmt. and assistance with activities of daily living (ADLs) to general oversight for patient safety.  At a portion of the cost of a traditional SNF stay, a stent at an AL may be beneficial for Seniors with: 

• Co-morbidities that may need regular monitoring by nursing staff 

• Denied coverage from their Managed Medicare policy to return to SNF environment 

• Feelings of not being safe or successful at home, due to inadequate or lack of skilled therapy services 

• Recent medical procedures that don’t necessarily meet a 3-day hospitalization but continue to require increased care until strong enough to be able to successfully care for themselves independently (Assumed that the hospital is not part of an ACO network) 

To maintain market competitiveness in a growing industry, AL facilities are looking for new ways to market their product while meeting the challenges associated with delivering a higher level of care. Some have hired additional nursing staff and volunteer caregivers to offer a full spectrum of services. Most in-house services that are available at a SNF level, such as physician services, podiatry, dentistry, and optometry can be performed through routine visits by such providers. Other AL facilities have seen the benefits of skilled rehabilitation services. More and more ALs are partnering with contract therapy companies to provide on-site PT, OT, and ST therapy services.   

Assisted living facilities offer a unique environment for a successful outpatient therapy clinic. While operating as a separate entity, the therapy clinic can provide immediate care for patients in need of rehabilitative services. Eliminating the need for transportation of residents to outpatient appointments and can be very beneficial for ALs with memory care. It goes without saying that the resident has the choice where they want to attend outpatient therapy. Outpatient clinics in ALs can offer up to five times per week therapy on an outpatient basis, pending medical necessity. Comparatively, today’s seniors can receive more therapy on an outpatient basis versus an inpatient SNF stay.  

SNFs of today are finding themselves in an advantageous position to offer a higher acuity of care by creating Hemodialysis chairs and vent units. PDPM reimbursement models have led SNF management organizations to question the financial viability to provide the amount of therapy to rehab patients as under the Prospective Payor System (PPS). They are choosing instead to invest extra time and resources in other clinical and capital projects versus therapy programming and outcome measures. The lack of skilled therapy services provided to seniors at the SNF level or post-discharge from an acute care hospital is ultimately creating a need for Interim/respite care at an AL facility.  

Residential care facilities utilize a pre-admission screening process that assists with identifying medical necessity, determining level of care, and in establishing mode of payment. There are a few different avenues that Seniors can take when financing an abbreviated stay at a residential care facility. Seniors are not always able to pay privately for such services, but there are Long-term care policies that can aid with all or a portion of the payment. Unfortunately, there are often qualifying periods before accessing this benefit. Another option that is available to Seniors that qualify is a stay at a residential care facility that accepts Medicaid, Medicaid waiver, and SSI benefits. Organizations such as Crestline Construction, LLC, and Hubbard Development Co., LLC, are leading the charge in Indiana and developing communities like Lake Meadows Assisted Living in Fishers, IN that offer these benefits. 

The Silver Tsunami is fast approaching the long-term care industry. The need and development for additional senior living communities that offer nursing oversight, therapy, dietary support, and other life-sustaining necessities, such as AL facilities are growing. This change did not happen overnight but instead has been occurring for years now. The reimbursement models for SNF (PDPM) and Home Health services (PDGM) have created a need for transitional care that the AL community is finding they can meet.