As the skilled nursing industry continues to move toward higher-acuity residents, many senior living operators have abandoned the space entirely, preferring to leave the increasingly medical business to standalone buildings and rehab partners.

But one family-owned operator in Northeast Ohio — which started out in the SNF world five decades ago — believes the future of skilled care includes both higher-level services and a spectrum of living settings for its residents, and has set out to transform itself into a post-acute network.

Founded in a ranch-style building with nine residents in 1965, Ohman Family Living eventually grew to three campuses with a central focus on skilled nursing care. After years of operating under individual property names — Holly Hill, Briar Hill, and Blossom Hill — the company recently rebranded to focus on its family history and range of other living options, which include 249 skilled nursing beds, 65 assisted living units, and a small number of independent living residences.

Skilled Nursing News spoke with company co-presidents George Ohman, Jr. and Andy Ohman, both sons of its founders, as well as vice president of operations Kurt Ingersoll and vice president of growth strategies Joshua Wallace to learn more about how a regional operator can build out a network of complementary partners — and why they see promise in becoming a full-service senior living and care provider.

What was your plan for building a post-acute network?

Wallace: As I helped head up some of the strategic relationships, one of the things that became very evident to me — and this is more or less some of the impetus behind it — was that everybody’s been talking about readmissions.

One of the first strategic relationships that has led to even further growth … is Physicians Ambulance. Physicians Ambulance is a family-owned and -operated company that had a very similar culture — mission-driven, values-driven organization — and we recognized with our home care team, that we could help solve the problem if we didn’t have to do a non-emergent transfer by way of 911, because 911 has to take people back to the local and nearest hospital.

That has really blossomed and developed some neat case studies. That, among some of our advanced care plans that we’ve established, has really helped us to say: How do we achieve the triple aim in health care by containing people within our infrastructure, and how do we utilize people like Physicians Ambulance to ensure that if they’re coming out of an acute stay, that they — even as we’re building out 90 days — stay out of the hospital system and [are] contained within our regional footprint?

Ingersoll: You ask about the post-acute network, and what we think of as a post-acute health care system. There’s a number of organizations in our area that have one or multiple levels of care, but we feature everything from home health to independent living, AL, memory care, to the skilled nursing, post-acute care world.

We’re thinking about ourselves as an integrated system where we can try to mitigate those readmissions — even out to the 90-day mark and beyond. One example of how we can utilize our system is: We had a patient who had discharged from one of our local hospitals and gone straight home, and she had requested our home health care, and no one had sent a referral.

We found out on a Monday morning that she had been sent home on a Friday, and had been sitting in her chair all weekend long, unable to get up and move. We were able to get the Physicians Ambulance dispatched out there without a 911 call. We were able to pick her up in less than an hour from finding out, and bring her into one of our facilities where she was able to be kept safe and successfully avoid a readmission back into the hospital — even when we hadn’t been aware, originally, that she was being sent home.

We’re trying to do that both from hospital discharges, as well as from people who are trying to make a transition back into home, and maybe want to try to get back to their original home or independent living but not might be making it. How can we plug them back in?

We can plug them back in through transportation to our assisted living, if they don’t have a qualifying Medicare stay, or if they do have a qualifying Medicare stay, right back into our skilled nursing facility in order to continue and further their rehab in the lowest-cost setting that is going to provide them the highest level of care — and allow them to thrive based on their current situation.

Providers often tell me that so much of the battle is just knowing where a resident is and what they’re doing — and then convincing residents, families, and payers that they can safely receive care in a SNF.

Ingersoll: We’re trying to think of ourselves as a system. If we find out about the referral through the normal channel, or if it’s a discharge into home, or if it’s someone who just comes to up to the community, how can we be one phone call — so that someone can call one number to us, and we can be that trusted provider that can plug them into the best level of care, the lowest-cost setting that gives them the highest probability of regaining their independence and going back to their prior level of function, or even better?

Wallace: Another collaborative relationship that we’re building and developing, and this is more or less on the back end — on one of our campuses, Blossom, we’ve entered into a relationship with a hospice. Typically, hospice is either done at an isolated location, where they’re a hospice house with nothing else attached to it, or it’s done in a hospital setting.

We are establishing a general inpatient level of care for high-acuity, pain management patients. Two ways that this also highlights and works as a system is: If we have a residential care hospice patient at our other two locations, say Briar or Holly, if they need pain management, they won’t necessarily need to go out to the hospital anymore. We can do an inter-facility transfer to have them go stay in this hospice pain management unit for an average length of stay of three to five days, and then they can return back into Briar and Holly once the pain has been put under control.

This also helps align with the hospitals. One of the things that the hospitals are looking to manage is their mortality rate. If they have a high-acuity hospice patient that needs to move to a hospice house, they can also discharge straight into the general inpatient level of care at our Blossom location, and then once stabilized, we can then evaluate other levels of care — like a regular SNF-hospice arrangement that is your more typical or traditional relationship that exists.

It’s just another means of enhancing some of the clinical care in order to be able to have that containment within the CCRC [continuing care retirement community], or having multiple levels of care at one trusted caregiver.

When you explore these partnerships, do you get a positive reception? Is there general awareness of network-building, or is there tension from providers that might see you as competitors?

Andy Ohman: Some of these connections or relationships that we’re building, we’ve had for years. Some of them are relatively new. In building these relationships, what we’re trying to stress is first of all, our desire to work with these various groups. Also, our goal right now, before we do any growth or expansion outside of our communities, is to enhance physically and service-wise our existing facilities so we can be this type of one-stop shop.

What helps all of this, too, is our family — you have ownership and management on site, which not too many places can offer today. You don’t have the changeover in staffing and administration, which hinders the process of building this type of network that we’re trying to do. We have I don’t know how many years of experience, but management’s been on site for 50-some years.

George and I and our sister are second-generation. We’ve got two sons, two sons-in-law who are third-generation. It’s continued on, which provides a significant amount of stability, and this is our trigger point which will enable us to do what we need to do as ownership, management, on-site. The relationships stay the same. They don’t change as administration changes.

George Ohman: The relationships that Andy’s talking about are complementary relationships, rather than competing relationships. When working with Physicians Ambulance, that’s a complementary relationship. In working with the one hospice that we have a significant relationship with, it’s a complementary relationship. We have a relationship with the hospital systems here in Northeast Ohio, and we’re again trying to build that complementary relationship … to avoid anything that would be competing.

I think if we have the answers, and we can demonstrate that we have the answers by good data points, then we get a listening from the physicians and from the administrative men and women of the hospital systems that we’re trying to do business with.

Wallace: We started working with some physicians’ groups as well, and we perceive that in the near future, the skilled nursing environment is going to look like a med-surg unit of a hospital because of payer pressures. We now have, in our buildings, hospitalists and NPs rounding upwards to five days a week, and with certain disease states such as CHF, COPD, pneumonia, we’ve seen our readmission rates drop into the single digits, and leveraging much of those data points to say: What greater clinical engagement and oversight, we can help you achieve your triple aim in health care. That’s where we’ve been able to find alignment.

A lot of companies in the senior living space are moving away from skilled nursing. Where do you see yourselves expanding — further into senior living, more communities?

George Ohman: We’re exploring right now, with our therapy company: What would life look like on our campuses if we did a health and wellness program, not only for independent living, not only for assisted living or memory care, but what about our skilled nursing folks who are here long-stay? What could we do to promote health and wellness, and to keep people invigorated beyond just the typical activity program that you find in a skilled nursing facility? And so that’s the kind of forward thinking that we’re trying to embrace.

Andy Ohman: It is our desire, there is conversation, there are architectural drawings for advancement in independent living and assisted living. We truly see the need to expand more into independent living with services — which is really an area that has not been provided with any great significance in our county or in our individual communities.

Having a campus allows us to provide therapy services with the same therapy staff through independent living. Two of our facilities right now have some independent living on a smaller scale. It allows us to provide therapy, meal service, even nursing service with familiar faces to these people — whether they’re in the independent living, or advance to assisted living, or advance to long-term care, or are in our short-term rehab.

We look to develop, physically, our campus into a full CCRC.