LeadingAge Magazine · May/June 2013 • Volume 03 • Number 03
This article is reprinted with permission from Catholic Health World, Apr. 1, 2013. Copyright ©2013 by The Catholic Health Association of the United States.


The skilled nursing community is part of the bedrock of Catholic health care in the U.S. While the commitment to long-term care of the frail aged remains strong, traditional long-term care providers also must adapt to patient care preferences and health reform in order to thrive, said William J. Healy, vice president of regional operations for Catholic Health East of Newtown Square, PA.

Health care reform is expanding the opportunity for skilled nursing communities to provide temporary, post-acute care for people who are discharged sooner and sicker from hospitals, Healy said. At present, few traditional skilled nursing communities are equipped to provide the necessary level of medical care for that patient population.

At the same time, Healy said, consumer preferences and cost concerns are “driving a new way of looking at long-term care—especially for patients suffering from Alzheimer’s disease—as a residential household model rather than nursing home beds.”

“Our ministry has always been to meet and be responsive to the needs of our communities—and those needs are changing. Sicker patients are being released more rapidly from hospital settings, and they require more medically based acute care services,” said Healy. “Though many of today’s continuing care facilities lack the capital to extensively rebuild, they can shift operating cultures within existing organizational footprints to align themselves with hospitals seeking facilities to provide lower-cost, higher-quality care.”

How can a traditional skilled nursing provider transform itself into one that offers post-acute care? Among Healy’s suggestions:

  • Employ nurses with the same set of skills necessary in critical care hospital units.
  • Ensure ready access to x-rays and laboratories to meet the medical needs of patients expediently.
  • Provide for the more frequent presence of physicians or nurse practitioners at the community.
  • Streamline occupancy management by tracking patient movement throughout the system.

 

A second opportunity to rebrand skilled nursing facilities, Healy said, is to transform and soften care settings—especially for those with advanced dementia—by creating residential care households. Again, the physical transformation occurs within the existing facility’s footprint, with semiprivate wards or rooms in nursing homes shifted to private rooms.

“The most important change to the household model is the fundamental shift from institutionalized nursing to the provision of primary care for the whole person by a trained universal worker, sometimes called a homemaker caregiver,” Healy explained. “The nurse provides clinical assessment, treatment and patient/caregiver training, but the day-to-day coordination of care and services to meet a resident’s physical and psychosocial needs falls to the caregiver.”

In practical terms, that means that while the nursing staff addresses patient issues such as pain management, nutrition, and care of residents who require tube feedings, dialysis or tracheotomy care, the homemaker caregiver is concerned with case management, leisure activities, spiritual and pastoral needs, medication administration and the like.

To convert from nursing units to what Healy calls “work flow households,” traditional long-term care providers must assess how space is configured in order to create a more homelike environment. This requires careful thought to the placement of carts for medication, laundry and food-service delivery, the placement of furnishings and the use of floor and wall coverings, alternative lighting and bulletin boards.

The demand for such households, Healy said, is growing rapidly. “It’s projected that one out of every two people who reaches the age of 85 will have Alzheimer’s disease. As their illness advances, they will not be able to remain out in the community. They will require the protection of long-term providers—and traditional beds in nursing homes do not meet their needs.”

Once continuing care organizations have successfully converted existing facilities into post-acute care and residential care units, Healy sees another important opportunity to meet the housing needs of younger, healthier seniors with new construction of active adult apartments.

“Right now, there is a strong demand for apartments to be marketed between low-income HUD housing and luxury CCRCs for an underserved middle-income senior population,” he said. “Seniors whose annual income exceeds HUD’s $25,000 limit—which is easy to do on just Social Security and a small pension—but who cannot afford monthly CCRC rents of $3,000 and up have very few choices.”

Healy said marketers divide seniors into three segments—those aged 65-74, 75-84 and 85-plus. The youngest group is growing the fastest, and while the majority of its members do not yet want to live in communities that offer communal meals, group activities and so forth, they are interested in downsizing from their current living situations.

“These people still want to live as they did in their 50s, but they want to do it without all the responsibilities of home ownership,” Healy said. “Built on the same campus, contemporary, affordable, moderate-income housing can help feed the rebranded nursing home with independent living units.”

Healy pointed out that while the first two repositioning strategies—post-acute care and residential care households—require nominal capital funding, this last strategy will be more expensive to undertake. Nonetheless, he said, it will be well worth the investment.

“The 65- to 74-year-olds are only the leading edge of the baby boomers. As our country’s population continues to grow older, there will only be more demand for aging-in-place options like quality market-rate apartment complexes,” he said.


To get more detail about the significant changes outlined in this Catholic Health World article, LeadingAge interviewed William Healy, vice president of regional operations for Catholic Health East of Newtown Square, PA.

The day of this conversation was significant, as it marked the day that Catholic Health East and Trinity Health, Livonia, MI, formally consolidated to create one of the nation's largest Catholic health systems, serving people in 21 states. Learn more about the CHE/Trinity consolidation.


LeadingAge: First, today [May 1] is the day of the consolidation of Catholic Health East and Trinity Health. How will this affect CHE going forward?

William Healy: We’re in the process of integrating our operations, but will still have two divisions, one here and one in Livonia, MI. Our continuing care ministries will be integrated into one division, including skilled nursing, assisted living, CCRCs, senior housing and PACE. CHE is the largest PACE provider in the country. Trinity has approximately 33 communities that are across the spectrum of skilled nursing, CCRCs and assisted living.

Trinity Health is historically larger than us and both systems are predominantly hospital-based. This gives us an opportunity to really leverage and create synergies around continuing and long-term care. The founders of both ministries have strong heritages and missions around serving the elderly.


LeadingAge: In the Catholic Health World article you said that “few traditional skilled nursing communities are equipped to provide the necessary level of medical care for that patient population.” Has that been the case with Catholic Health East’s nursing homes in the past?

William Healy: I would go so far as to say it describes a good share of skilled nursing across the country, not just Catholic. We are traditionally caretakers for people who are chronically ill but medically stable. Now we need to convert to being clinicians for those who may be chronically ill but also medically unstable. That’s been the challenge for skilled nursing, and will continue to be as we try to be relevant members of the new continuum under health care reform, focusing on value-based purchasing and providing the patient with the highest value for the lowest dollar.

Some [nursing homes] are doing an exceptional job [at making this change] but by and large traditional providers are struggling through that culture change. If we can help them preserve their future, that’s our challenge.


LeadingAge: In the article you offered four ways a traditional skilled nursing provider can transform itself into one that offers post-acute care. Are you actively working toward all of those changes?

William Healy: We are focusing on “never events”—that is the elimination of falls, pressure ulcers, and medication errors. Also, we want to reduce readmissions to the hospital, by refocusing from custodial care of the long-term care resident to a clinical nursing model for the post-acute patient. This entails recruiting RNs with critical care training and hospital skills. This has been a gradual yet steady process that we have been working on for a couple of years.

CHE created a vision statement in 2007 that is very consistent with the tenets of the [Affordable Care Act], which is to provide the best care across the continuum for the highest value and lowest cost. In reflecting upon what CHE’s leadership envisioned in 2007, we’re proud that we’ve been setting the stage.


LeadingAge: Regarding the “big picture” strategy you outlined, where are you on the timeline toward achieving all of those changes?

William Healy: In our evolution toward preserving the future of the Catholic continuing care ministry we envision three phases: First is the phase we are currently invested in to convert the skilled nursing facility into a post-acute care center. The next phase will be to further reposition a portion of a skilled nursing facility’s beds into a household model of care for long-term care residents. Some of our ministries have made this shift while others are currently in process. Beyond that, there is a third phase which is currently on the drawing board, with a three- to five-year window, and that is the development of a housing model [that is] more contemporary to the senior market.


LeadingAge: Regarding that new housing model, have you clarified what it might look like yet? And for providing services to people in those communities, would you borrow anything from the PACE model?

William Healy: Not entirely, but we know that we need to focus on middle-income seniors that have historically been squeezed out of access to quality housing between the affordable and high-income ends of the spectrum. We have noted that some of the most effective and financially viable PACE programs are those that are connected to senior housing. We expect that PACE and programs like it will continue to expand as our populations continue to age in place at home or in senior housing.