Rising acuity at nursing homes has meant a greater need for the presence of various clinical specialties at facilities. But navigating better interdisciplinary team care is a complicated matter, made more so with staffing shortages, tighter regulation and lower reimbursements.
As the needs of the nursing home population continue to evolve, many providers believe it’s not enough to say you can provide certain services – you need to deliver, and prove that the care level is appropriate. This means soliciting experts for consulting or joining your team as an operator, and having administrative leaders extensively trained in relevant resident needs by these experts.
In fact, meeting the needs of today’s resident populations takes the form of initiatives and programs, and in some cases entire divisions devoted to specialized care for conditions such as dementia and behavioral health issues.
“Implementing interdisciplinary care teams can help address the complex needs of residents,” added Shawn Neville, COO for SALMON Health and Retirement, in an email to Skilled Nursing News.
Reimbursement and regulation hurdles, however, stymy such innovative endeavors, providers say.
One such specialized need is dementia care. SNFs are increasingly tasked with caring for dementia patients, as well as opioid use disorder services or OUD, according to a study published in Health Affairs.
“This practice raises ethical concerns and the potential for inadequate care if nursing homes lack the expertise and resources to provide specialized care for these populations,” said Neville, suggesting facilities work from the ground up, assessing the capacity and capabilities of regional nursing homes to care for such patients.
Opportunistic operators have used this need as a way to increase occupancy as staffing shortages and policy challenges persist, the study found.
“Providers need to be committed to providing all of the necessary expertise and support to surround the care of the patient,” said Jennifer Hertzog, vice president of marketing and business development for Marquis Health Consulting Services. “[Dementia care] isn’t traditional care … this particular population comes with unique and special needs as others do. The industry needs to be prepared to support the need, with resources and expertise.”
Hertzog named behavioral health patients as another patient population rapidly on the rise, and in need of support in the industry. It’s a topic that is routinely discussed among leaders at Marquis, but the company hasn’t ventured down that road quite yet.
“It’s obviously a high demand area and one that I haven’t seen any organization really step out in a very committed way,” said Hertzog.
Unmet resident needs benefit from the right environment
A confluence of residents with similar needs can facilitate better specialized programs.
For example, a UC Irvine study on dementia patients in SNFs found dementia patients had their needs well met if they were in the majority. Neville said these findings bring up important considerations for improving care outcomes.
“Being in the majority within a care setting may create an environment more tailored to the specific needs of individuals with dementia. It can enhance staff expertise, training, and familiarity in managing dementia-related behaviors and providing appropriate support,” Neville said.
A higher presence of dementia patients can also facilitate the development of specialized programs, activities and therapeutic interventions designed for people living with dementia, he said, and foster a sense of belonging and community among residents.
Presbyterian SeniorCare Network is working toward meeting the needs of individuals living with dementia, with dedicated centers to care for residents with dementia, such as its Center for Innovation & Care Transformation, founded last year.
“I feel like we’re on to something,” said Shawn Shuman, senior director of innovation and care transformation at Presbyterian SeniorCare Network. “We are actively working to do audits of how we care, and what does it look like – what types of programs do we have? What types of stimuli do we have for those particular communities, and how can we better meet family’s needs, as well as those individuals that we’re caring for that are living with dementia in our skilled communities?”
For Tina Thomas, senior vice president of operations for Mission Health Communities, dementia patients are better cared for generally when the right experts are in place for acute dementia cases, and to train existing staff.
Another key to meeting this particular resident population is exposing residents to life enrichment activities. One example – having children visit the facility or have a child daycare on premises can positively impact dementia patients, noted Thomas.
Eyes on innovation
Since its inception more than a decade ago, Marquis has focused heavily on meeting the needs of resident populations, between acuity management and chronic illnesses – an entire division of the company is focused on specialized care, according to Hertzog.
That translates to recruiting the right partners based on a certain unmet needs in a geographic area, bringing programming and infrastructure to support certain populations, she said.
Hertzog agrees that SNF operators have utilized the need for dementia care to improve overall occupancy. For Marquis, hiring industry experts like Jean Krautzel, who has focused more than 20 years of her career to dementia and Alzheimer’s care among skilled nursing patients.
In a similar vein, nonprofit Presbyterian SeniorCare Network founded the Center for Innovation & Care Transformation, which has a dementia care component to it, along with collaborative healthy living clinics and standardized care management, education and resources.
The Center, funded with the support of the Network’s parent board of directors and a foundation grant, allows for opportunities and for the organization to “dream,” said Shuman. Presbyterian SeniorCare Network developed its Dementia 360, which was expanded by the Center. The program provides caregiver support and care coordination services to individuals living with dementia at home, thanks to a health plan partnership serving members who meet income and disability eligibility criteria.
Catering to slightly different dementia needs, Woodside Place is another example of a dementia-specific residential care community. Its residents have more mobility and active lifestyles, however. SNF dementia patients would fall under Presbyterian’s Woodside Neighborhoods, another dementia intensive model.
“The staff, that team that are caring for individuals with dementia, they have a certain level of training … they have training in non-violent crisis intervention, or how to intervene when there’s a crisis with a person living with dementia has a distress reaction,” said Shuman.
In other words, meeting the patient’s needs while also de-escalating and approaching a situation in a non-provoking way can be achieved better help sometimes from a behavioral health partner, Shuman said.
Most recently, Presbyterian SeniorCare Network expanded its Center to include consulting too for other operators that are trying to build similar types of dementia care communities.
Mission Health has focused on behavioral health management programming, and life enrichment for dementia care patients, Thomas said. For acuity across all resident populations, remote patient monitoring and telehealth services have added efficiencies and better outcomes at facilities.
Lacking reimbursement and cumbersome regulations unfortunately serve as roadblocks to such sources of innovation, Thomas said, with resources stretched thin as the space has habitually been underfunded.
A one-size-fits-all mandate impedes operator initiatives to better provide specialty services, with different needs across “different states, different markets and different populations,” Thomas said.
The upcoming federal staffing minimum rule is a great example of how regulations might impede innovation, and in turn impact unmet needs among the SNF populations.
“The funding that should go along with it, the amount of caregivers and workforce that would have to be increased to meet that staffing mandate is pretty tremendous,” added Thomas.
Building to better meet unmet need
Krautzel identified locations based on community and market need for Marquis for its Journeys program, which focuses on Alzhiemer’s and related dementia illnesses. Currently, Marquis has 14 locations in its mid-Atlantic division that are actively working on meeting the standards of the company’s Journeys program.
“For us, this isn’t just about building occupancy, this is about meeting an unmet need, a growing demand for specialized care and doing it the right way,” said Hertzog.
Some standards include having a board-certified geriatrician to direct the program, and a certified dementia practitioner, Hertzog said.
Another interesting partnership for specialized care includes a palliative care partner that understands dementia disease progression.
Marquis has spent the last six months to a year identifying locations for Journeys, and recruiting the right people, with the goal of officially launching the program some time in 2023.
Its 2022 initiative was focused on chronic illness support, Hertzog said, again with a palliative care component. While it’s too early to garner any true clinical metrics on the program, Hertzog said she has seen patients realize great benefit.
“There is either a physician or an advanced practitioner, who is consultatively involved several days a week at the center to support the patient as their disease progresses, to support them in understanding and being comfortable with the decision not to go back and forth in the hospital,” said Hertzog.
Instead, patients are focused on the things that matter to them and give them life, even as their disease progresses.
Companies featured in this article:
Marquis Health Services, Mission Health Communities, Presbyterian SeniorCare Network, Salmon Health and Retirement
