Nursing home operators have lamented for years how difficult it is to address infrastructure problems in their facilities. In some locations and under some circumstances, they’ve been able to make changes over time.
The COVID-19 pandemic, however, means that such changes are not optional if operators want to survive – and they cannot be incremental.
“The cost-effective model of nursing home care simply does not work in today’s environment,” PruittHealth CEO Neil Pruitt Jr. said during a June 10 panel at LeadingAge’s Collaborative Care & Health IT Innovations Summit. “You can’t prevent COVID with three and four people in a room, and so our organization has really ramped up our private room inventory.”
Right now, about 15% of PruittHealth’s inventory consists of private rooms, with the goal of reaching 25% in the next two years and “even upwards of 30% within five years.”
Pruitt also called out ventilation systems as an example of infrastructure that did not work during the pandemic; as a result, the Georgia-based operator has added an air ionization system to all its buildings and is looking at ways to create positive and negative air pressure, Pruitt said.
“We aren’t going back, and those advancements need to be going forward,” he told the panel.
The discussion was centered on the use of technology in senior housing and care, as well as the costs to payers and providers. PruittHealth has service lines in skilled nursing, home health, hospice, pharmacy and care management as well as an institutional special needs plan (I-SNP) with 2,100 members.
I-SNPs are a type of Medicare Advantage plan for beneficiaries who need institutional care, and the coronavirus hit those plans hard. Of PruittHealth’s I-SNP members, about 63% contracted COVID-19 and 22% were hospitalized, Pruitt said, which led to “dramatic losses.” The focus became fighting COVID-19, and it ended up bringing about a variety of innovations, he explained.
“Our companies accomplished more in the past 14 months than we did in the previous seven years,” he said. “We did things like set up a call center staffed 24 hours a day that people could call in and ask about their loved ones, and we could look directly into their patient record. That call center is still up today. We embraced transparency early on, we published all of our infection rates on our website, and our vaccination rates are published there as well, [in] real time.”
PruittHealth also established online methods of communication for residents and their family members, including video chats that people could schedule themselves on PruittHealth’s site. The operator has, since the start of the pandemic, conducted more than 55,000 such chats.
Communication during the pandemic was one of the ways Ohio Living made use of technology, CEO Larry Gumina noted during the panel.
“As we look at the technology that we embraced during the pandemic, and then what’s going to carry us forward post pandemic, what I want to talk about is human capital,” Gumina said. “It’s the communication, making sure that we were transparently communicating with our families … we did the video chats, we did the iPads for family members.”
Communication with family members is something that Ohio Living will carry forward for residents, as well as with employees, he said.
Meanwhile, PruittHealth also set up cameras in hallways to ensure that infection control procedures were being followed, in addition to setting up an emergency alert system to communicate with family members and track data.
“These analytics are not going away,” Pruitt said. “These efficiencies are really allowing us to deliver better care. Pre-pandemic, we had a team of consultants that would hop in their cars and spend too many hours behind the windshield, and now we can do that by looking through cameras and looking at vital signs.”
All vital signs are now integrated into PruittHealth’s electronic health record through a partnership with the Rosie system, he said, which allows physicians to remotely track patient status and helped the I-SNP health plan restore hospitalization rates to a level closer to normal.
However, as Medical Director of the Office of Health Affairs and Advocacy at Humana Alex Ding observed on the panel, technology on its own will not cure all the struggles of providing quality long-term care.
“What we’ve learned during the pandemic is that just a technology solution on its own does not work, especially with [the senior] patient demographic,” Ding said. “It cannot just be that we rely on technology alone, but we’ve got to have these other components, like personal relationship components.”
This is especially true given the digital divide that opened up amid the pandemic, he said, highlighting the disparities in access to broadband as one example of a place where marginalized or disadvantaged patients could fall through the cracks without human support.
But even with those concerns, the genie is out of the bottle with regard to the ways technology can be used in skilled nursing facilities, Pruitt believes.
“There’s a lot of terrible things that came out of the pandemic, but I think that health care is not stepping back into the past,” he said. “We’re going to move forward with health technology, and we’re going to move forward with a more enlightened workforce.”
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