Long-term care is teetering on the brink of disaster. Even before COVID-19, the sector endured widespread economic and operational problems. And now, nursing homes and assisted living residences, are reeling from the loss of patients, lower revenues, staff recruitment and retention obstacles as well as a growing call for review and reform from the public and government agencies. And we haven’t yet seen the tide of litigation, which is bound to swell as guilt-ridden and angry families seek to take revenge for the deaths of tens of thousands of their relatives.
How can the sector survive – or more accurately, how will it survive?
Most of the inventory in congregate senior care is unattractive, inaccessible and/or unaffordable. Why?
There are several reasons.
- Systems for regulation and payment have been cobbled together over decades with little or no concern over what the consumer wants, true efficiency, operational outcomes, or quality.
- Government funding sources have empowered or contracted with various intermediaries (local authorities, state agencies and private claims management companies) to help manage payment and control utilization.
- Or developers have focused on “cherry-picking” higher income, wealthier prospects, leaving the so-called middle market and poor to fend for themselves.
The result is a hodgepodge that costs too much, includes perverse incentives, and is almost impossible to navigate. As developed economies reel from disproportionate COVID-19 related deaths among the elderly in congregate care settings, isn’t it time to look past old models, which weren’t working anyhow, and start afresh with creative ideas and 21st-century innovation? From an ethical point of view, the vulnerable elderly and disabled in our midst deserve better. The post-World War II Baby-Boom cohort is entering their 70s and could overwhelm the existing age care & support systems. From an economics point of view, we need to do something to bend the cost curve. The system, to put it bluntly, cannot survive unless we take bold steps.
On Tuesday, September 22nd we will look at what can be done to save the long-term care system. We’ll take a brief look at how we got to such a precarious point, what individual providers can do now to save what can be saved, and chart a new course for the long-term care sector.
Saving long-term care includes:
- Facts v. fantasy – the sector is full of incorrect information and enduring myths about the demographics and psychographics of ageing. We’ll bust several myths about the number of age-qualified consumers, as well as their perceptions about what they want. (Spoiler alert – these answers are not the ones you’ve heard elsewhere.)
- Measure what’s left after COVID-19 – we will look at how much “market” will be left and how it is likely to recover
- Secure, protect and defend what you can of what is left in your marketplace area
- Structures – the property plant & equipment in most congregate, long-term care settings are old and unattractive. Recent additions of purpose-built assisted living and other types of properties stand in contrast to the “Fawlty Towers” properties. Most owner/operators don’t have access to capital markets and would not be able to make the debt payments for the kinds of upgrades that have been put off for 30+ years. Imagine staying in a hotel that hadn’t had more than a paint job for 30 years? You get the picture.
- Programs – most of the programs in long term care aren’t at all designed to meet the needs and desires of consumers or their families, but are, instead, designed to restrict government funding to a specific class of individuals and / or to monitor and control payment through utilization measurement. For example, in the US, a typical 85-year-old who needs post-operative care will be covered by 5 or more different programs, including nursing home, pharmacy, medical equipment, physical therapy, home health care and community-based services. None of these talk with each other and very often actively compete with each other.
- Technology – technologies, including “ambient assisted living” are currently available to enable surveillance and physical safety of consumers in their homes. Remote patient monitoring, digital health and telehealth solutions have clear returns on investment and (because of SARS-CoV-2 / COVID-19) are meeting with widespread acceptance and adoption. Public health principles applied in long term care (relabelled as social determinants of health) are finally being applied in risk-based experiments and demonstrating their importance to improving health, safety and lowering overall costs.
- Information infrastructure – grocery stores have better technology than most congregate care centers. Why? Because the sector has been embarrassingly neglected by policymakers and politicians for decades. Country-wide investments in health information technology (HIT) for things like telemedicine and electronic medical records in the US and the UK have specifically excluded congregate long-term care.
- Outcomes – the minimum data sets required of and recorded by long-term care centers are just that – minimum. There is no data about the overall outcomes of care. Even where the data about clinical conditions is recorded, (e.g., PDPM), unlike hospitals, and medical practices there’s no attempt to measure customer or consumer satisfaction.
- Economics – how will care be funded? The most important component of any long-term care operating budget is labor. The human resources needed to care for vulnerable elderly represent 60 – 80% of every long-term care Operating Statement. These individuals are often poorly paid, foreign workers at the bottom rung of the socio-economic ladder. Why? Because operators are paid as little as possible, based on the “heads in the beds” or the (truly perverse) insurance or pension category of the consumer. A few bad actors aside, long-term care workers are paid so little not because of greedy owners but because the system doesn’t allow the owners to pay them more!
We need to save the sector, and the current COVID-19 crisis is an inflexion point where thought-leaders can and should step up and speak out. Join us, speak out for change and become part of the dialogue.
Join us September 22nd for Long-Term Care on the Brink; Saving the sector