By RENEE STOVSKY

The skilled nursing facility is part of the bedrock of Catholic health care in the U.S. While the commitment to long-term care of the frail aged remains strong, traditional long-term care providers also must adapt to patient care preferences and health reform in order to thrive, said William J. Healy, vice president of regional operations for Catholic Health East of Newtown Square, Pa.

Health care reform is expanding the opportunity for skilled nursing facilities to provide temporary, post-acute care for people who are discharged sooner and sicker from hospitals, Healy said. At present, few traditional skilled nursing facilities are equipped to provide the necessary level of medical care for that patient population.

At the same time, Healy said, consumer preferences and cost concerns are "driving a new way of looking at long-term care — especially for patients suffering from Alzheimer's disease — as a residential household model rather than nursing home beds."

Healy, along with Catholic Health East colleague Renee Schofield, director of regional operations, will be presenting the Innovation Forum session, "Repositioning: The Future of Catholic Continuing Care" at the Catholic Health Assembly June 2 - 4 in Anaheim, Calif. Patricia Gathers, vice president of finance and strategy, is also expected to participate in the session.

"Our ministry has always been to meet and be responsive to the needs of our communities — and those needs are changing. Sicker patients are being released more rapidly from hospital settings, and they require more medically based acute care services," said Healy. "Though many of today's continuing care facilities lack the capital to extensively rebuild, they can shift operating cultures within existing organizational footprints to align themselves with hospitals seeking facilities to provide lower-cost, higher quality care."

How can a traditional skilled nursing facility transform itself into one that offers post-acute care? Among Healy's suggestions:

• Employ nurses with the same set of skills necessary in critical care hospital units.
• Ensure ready access to x-rays and laboratories to meet the medical needs of patients expediently.
• Provide for the more frequent presence of physicians or nurse practitioners at the facility.
• Streamline occupancy management by tracking patient movement throughout the system.

Homemaker caregivers
A second opportunity to rebrand skilled nursing facilities, Healy said, is to transform and soften care settings — especially for those with advanced dementia — by creating residential care households. Again, the physical transformation occurs within the existing facility's footprint, with semiprivate wards or rooms in nursing homes shifted to private rooms.

"The most important change to the household model is the fundamental shift from institutionalized nursing to the provision of primary care for the whole person by a trained universal worker, sometimes called a homemaker caregiver," Healy explained. "The nurse provides clinical assessment, treatment and patient/

caregiver training, but the day-to-day coordination of care and services to meet a resident's physical and psychosocial needs falls to the caregiver."

In practical terms, that means that while the nursing staff addresses patient issues such as pain management, nutrition, and care of residents who require tube feedings, dialysis or tracheotomy care, the homemaker caregiver is concerned with case management, leisure activities, spiritual and pastoral needs, medication administration and the like.

To convert from nursing units to what Healy calls "work flow households," traditional long-term care facilities must assess how space is configured in order to create a more homelike environment. This requires careful thought to the placement of carts for medication, laundry and food-service delivery, the placement of furnishings and the use of floor and wall coverings, alternative lighting and bulletin boards.

The demand for such households, Healy said, is growing rapidly. "It's projected that one out of every two people who reaches the age of 85 will have Alzheimer's disease. As their illness advances, they will not be able to remain out in the community. They will require the protection of long-term facilities — and traditional beds in nursing homes do not meet their needs."

Independent living
Once continuing care organizations have successfully converted existing facilities into post-acute care and residential care units, Healy sees another important opportunity to meet the housing needs of younger, healthier seniors with new construction of active adult apartments.

"Right now, there is a strong demand for apartments to be marketed between low-income HUD housing and luxury CCRCs (continuing care retirement communities) for an underserved middle-income senior population," he said. "Seniors whose annual income exceeds HUD's $25,000 limit — which is easy to do on just Social Security and a small pension — but who cannot afford monthly CCRC rents of $3,000 and up have very few choices."

Healy said marketers divide seniors into three segments — those aged 65-74, 75-84 and 85-plus. The youngest group is growing the fastest, and while the majority of its members do not yet want to live in communities that offer communal meals, group activities and so forth, they are interested in downsizing from their current living situations.

"These people still want to live as they did in their 50s, but they want to do it without all the responsibilities of home ownership," Healy said. "Built on the same campus, contemporary, affordable, moderate-income housing can help feed the rebranded nursing home with independent living units."

Healy pointed out that while the first two repositioning strategies — post-acute care and residential care households — require nominal capital funding, this last strategy will be more expensive to undertake. Nonetheless, he said, it will be well worth the investment.

"The 65- to 74-year-olds are only the leading edge of the baby boomers. As our country's population continues to grow older, there will only be more demand for aging-in-place options like quality market-rate apartment complexes," he said.

Copyright © 2013 by the Catholic Health Association of the United States
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