Editor’s Note: The following article is based on a webinar that covered several topics that will be under discussion during our upcoming RETHINK conference in Chicago, Aug. 18-20. To learn more about RETHINK and purchase a ticket, please go to: https://skillednursingnews.com/snn-live-event/rethink/

Nursing homes looking to reimagine their company’s future are right now focused on reimbursement diversification beyond traditional Medicaid and Medicare reliance, while also developing innovative care models to meet the needs of individual communities.

For Georgia nonprofit A.G. Rhodes, a heavy investment in memory care and dementia services has played a huge part in reimagined care models, which includes a new $40 million facility dedicated to these services.

A.G. Rhodes CEO Deke Cateau also mentioned the team is exploring PACE programs, home health and hospice to broaden its care spectrum. A.G Rhodes’ involvement in the dementia care space leverages Georgia’s reimbursement incentives, he added.

“We’ve been looking at these ancillary services that we could possibly control to scale on our own, and thus work against some of the overreliance [on Medicare and Medicaid],” said Cateau. “We’re also looking very closely at insurances and third party payers, and how we can appeal to them in particular. In a value-based world, we are trying to make our offerings more attractive to them.”

Transitions Healthcare, meanwhile, has developed care models focused on assisting residents transition back home rather than focus on long-term stays within its eight properties across Maryland and Pennsylvania. A lot of investment is put into what services each community needs, while also thinking about how the nursing home sector will fit in with the wider care continuum in the years to come, said Transitions CEO Matthew Maurano.

“We’ve recognized that transitioning people to different levels of care means something different for every different community that we serve,” added Maurano. “When you look at the population of the United States, 12 million Americans are over the age of 80. People over the age of 85 will double over the next 20 years, so we are definitely needed. The question is, how do we fit in?”

Forging innovative care models and delivery methods

Transitions Healthcare’s custom solutions involved respiratory care in Pennsylvania, for one, which led to the opening of a ventilator unit; it’s one of 12 in the whole state, Maurano said.

“In Irwin, Penn., innovative transitions took the form of an in-house dialysis unit, because there were a ton of dialysis outpatient centers in that area … for other places the need was more memory or behavioral care,” said Maurano. “It all took on different aspects, and we’ve had to plug in and be innovative for different communities and different partners.”

Partnerships for a specific need in the community soon involved the American Heart Association, Maurano said, to implement certified heart care centers based on local needs, as well as local community hospitals and outpatient centers for the same endeavor.

It all comes down to ensuring there are heart-certified centers that can meet the needs of communities with a lot of congestive heart failure patients – Transitions drills down on diagnostic questions with its partners, asking them which diagnoses they’re having a hard time placing or finding the proper specialized care.

From there, Maurano and the team at Transitions build around those needs.

Delivering care to match state incentives

In addition to meeting the needs of the community, Cateau said A.G. Rhodes looks at what the state is incentivizing when considering where to invest. It’s all about following demographics and paying attention to what the state sees as needed services within the nursing home sector.

Fortunately, demographic needs and state incentives line up here, Cateau said.

“The reality of the demographics is that dementia, memory care numbers are growing, vastly disproportionately to the amount of beds we have in nursing homes,” Cateau said of the state.

Georgia is “fairly well reimbursed” for dementia and memory care, he said, with patient cognitive level placing treatment at a higher payment level within Georgia’s Medicaid structure. A lot of other operators have shied away from such services in the previous couple decades, leaving a need the nonprofit saw fit to fill.

“We’ve embraced that need. We recently built a brand new $40 million, 72-unit skilled nursing and memory care community, all private rooms, and a neighborhood-style model of care,” said Cateau. “It opened last July, and it’s been doing magnificently well since then.”

A.G. Rhodes’ two other communities may get a dementia and memory care overhaul as well, especially considering the only other avenue for people in the community to get such care is through costly private pay.

Staff were unsure at first if duties would transfer over well to dementia and memory care, but Cateau said about 70% of these new responsibilities ended up being what staff were doing already. About 50% of existing residents were already diagnosed with dementia or memory care issues, while 20% were undiagnosed.

“We’ve thrown ourselves into a huge investment as far as a physical location, but also a very huge investment in training through the Eden Alternative and some other training models that we’ve been using since 2015,” said Cateau.