Over the past several years, assisted living (AL) providers have seen a significant change in the population they serve; these realities include a population that is aging, needs assistance with more activities of daily living (ADLs), and is dependent on a growing number of medications to manage chronic health conditions. There is also a rising number of AL residents with a dementia diagnosis.

In response to these trends, a majority of states have recently restructured rules and regulations to set new minimum standards for AL providers that bring harsher penalties for noncompliance.

Many AL operators view these trends as an opportunity, and they have begun the process of reinventing the role they play in the continuum of senior care by retooling care and service offerings. Those that succeed in this transformation reap the benefits of affording their residents a greater chance to age in place and, in many cases, avoid transfer to a more institutional setting. These providers have effectively captured a piece of the skilled nursing facility (SNF) market.

Most successful AL operators embracing these trends share common approaches and best practices, including those listed below.

Key Partnerships

External relationship building is a critical success factor in developing a broad care and service delivery platform. These relationships include home health and hospice providers that will enable expansion into therapy services and social services, as well as pharmacy vendors that can enhance medication review and management with this population.

Many AL providers are also working in concert with Institutional Special Needs Plan (I-SNP) organizations to provide enhanced clinical services and standard pathways, as well as greater physician and nurse practitioner support.

Enhanced Staff Competencies

Successful AL providers will have a robust training and educational process to limit scenarios in which staff do not have the skills necessary to address a resident’s medical condition. Careful attention must be paid—at the time of orientation and regularly thereafter—to ensure staff competencies address the enhanced acuity of the community’s population.

Physician and Nurse Practitioner Engagement

Although a formal medical director arrangement is not required by regulation in AL facilities, many AL providers have taken the step to contract with a physician to serve in this role. This relationship brings an added layer of support and accountability to the health services team.

Hospitalization Avoidance

Hospitalization avoidance is a significant benefit to the resident, the provider, and the referring hospital (if that is the referring source). AL providers will need to think and act like skilled nursing centers and begin embracing best-in-class approaches to identify changes in resident condition, in order that interventions may be put in place to avoid exacerbation of continued decline.

Quality Assurance and Performance Improvement (QAPI)

Providers who follow this enhanced acuity path will want to ensure that their Quality Assurance and Performance Improvement (QAPI) system is firmly in place and serves as the core of quality management and improvement initiatives. This process will be vital in assessing clinical and regulatory weaknesses and determining root causes that can be mitigated collectively by the interdisciplinary team.

While making the higher acuity pivot may bring with it some risks, the benefits of this transition are numerous and can result in significant returns—for the residents and the provider, as well as the health care community at large. As a manager and consultant to post-acute, long-term care, and senior living communities, as well as hospital and health systems across the country, Health Dimensions Group (HDG) has a unique insight into strategy for these operations. For more information on how HDG can help you evaluate risk strategies for your organization, please get in touch with us at info@hdgi1.com or 763.537.5700.