ORLANDO, FL — Assisted living is having a moment, creating a new call to action from industry experts for operators to create and maintain relationships with legislators and regulators to better educate them about what assisted living is — and what it is not.
The American Health Care Association / National Center for Assisted Living announced Saturday night that it was canceling Delivering Solutions 24, its 2024 convention, due to the impending Hurricane Milton. The annual meeting was scheduled to begin Monday and go through Wednesday.
But NCAL Day, the assisted living-focused event that typically precedes the larger gathering, went on as planned on Sunday, with NCAL putting attendance at more than 200 providers.
During a panel discussion on the future of assisted living that capped the day, NCAL Executive Director LaShuan Bethea noted her perception that mentions of and questions about assisted living have been more prominent since the COVID-19 pandemic. In many cases, she said, assisted living no longer simply is being grouped under the long-term care umbrella; rather, it is being singled out in the national media and even mentioned in federal legislation.
Bethea didn’t mention specific media attention, but senior living resident elopements and elopement-related deaths were the focus of a Washington Post package of stories in December, kicking off the publication’s “Memory Inc.” series. That series subsequently questioned a providers’ use of a staffing algorithm and accused a senior living referral site of manipulating reviews of communities.
The initial Post articles and others from lay media outlets prompted the US Senate Special Committee on Aging to launch a review of the assisted living industry and to hold a hearing during which senators asked for a federal study of assisted living, sought consumer feedback and pondered federal oversight.
Federal bills about private equity also have mentioned assisted living.
The good news, Bethea said, is that more people now are aware of assisted living. But she warned that those specific mentions should not be equated with them understanding what assisted living is and understanding how it differs from nursing homes and other settings on the long-term care continuum.
Assisted living can differ from state to state and from provider to provider, Bethea noted. That potential, she said, makes it important for the industry and providers to develop relationships with legislators, regulators and family members of residents and prospective residents, so they are able to ask individual providers which model they follow and whether that embrace is due to provider choice, regulatory requirements or some other factor.
“Now that people have a very keen awareness that there is this entity provider of services to seniors called assisted living, there is another spotlight on assisted living to understand what we’re doing and how we’re doing it,” Bethea said. “We have the responsibility to make sure that when they say ‘assisted living,’ they don’t mean skilled nursing, that they actually understand and know what it means to say assisted living and what we do.”
A new generation of consumers
That focus on education is even more important as the profile of the assisted living resident is changing, the executive director said.
For one, residents’ average age is increasing. Twenty years ago, she said, the average age was in the 75-to-80 year range. Today, however, the average age of an assisted living resident is around 85, “and growing by a couple of months every year,” meaning that residents are moving into communities more frail than were previous generations, Bethea said.
And residents are more likely now to need assistance to manage their greater number and degree of medical complexities, even though those complexities don’t require a nursing home level of care.
Those facts, Bethea said, require providers to be more mindful of the individuals moving into their communities, whether they can meet their needs, and, if so, what they must do to meet those needs.
Population health, she said, has the ability to play a role in improving resident outcomes.
“Where coordination of care exists, we know that there are different outcomes. We know there are decreased rehospitalizations, often times a decrease in the number of medications residents are taking, a decrease in the number of falls,” Bethea said. “These are some of the things that are positively coining out of having coordination of care or involving population health in communities.”
Other benefits, she said, are that the quality-of-life improvement raised by addressing medical needs can lead to a longer length of stay for residents and a need for fewer staff members for providers.
Also changing is how providers approach the business, the panelists noted. Operators have needed to embrace various facets of doing business, including personalized care, technology integration, wellness and mental health programming, and affordability, according to Jill Schewe, AHCA/NCAL director of policy and regulatory affairs.
“Providers are having to come up with creative ways to do those things,” Schewe said.
The best way to approach those changes is through data, according to AHCA/NCAL Director of Quality Improvement Pamela Truscott.
“Anecdotal information isn’t enough” to offer prospective residents, Truscott said. “They want to see results, they want to see trends, they want to see how you compare to the neighbors down the street. They want to know by looking that you do what you say you’re going to do.”
Higher-performing providers set themselves apart from lower-performing providers by what they do with their data, she said, adding that the key is to look at the story the data are telling — where an organization shows strength and where opportunities for improvement are evident — and then acting.
Although data are collected in a variety of ways, Truscott said, customer satisfaction surveys are one way to gather information from residents, family members and team members on where an operator should direct quality improvement efforts. She added that quality improvement also circumvents arbitration regulations from “popping up,” because it places providers well ahead of the curve.
“Our residents are changing. They are changing by the second,” Truscott said. “It’s important to be able to continuously improve what we do for the betterment of our residents.”
NCAL Immediate Past Chairman Gerald Hamilton, owner and operator of BeeHive Homes, Albuquerque, NM, moderated the discussion.
