Fax machines, PalmPilots, nursing homes? COVID-19 is driving changes in long-term care Posted on June 21, 2021June 22, 2021 By KRIS B. MAMULA Pittsburgh Post-Gazette Nursing homes are “generally grim” places and now is the time for them to go the way of PalmPilots, Blackberries and fax machines. That assessment comes from a blog post — a piece written by Senior Living Foresights publisher Steve Moran, of Sacramento, Calif., that also concluded there will always be a need for skilled nursing care, just not in its current form. “There’s a growing awareness that there are alternatives,” Mr. Moran said, adding that COVID-19 has brought a day of reckoning for the sprawling Soviet barracks-style nursing homes of yesteryear, still common in many communities. “Smaller is where it’s going to be.” He’s not alone in thinking that the business of providing care for the elderly has to change. Voices like his have been amplified by a pandemic that claimed the lives of more than 130,000 nursing home residents in the U.S. and led to painful soul searching in long term care circles. Nowhere are those discussions more urgent than in Pennsylvania, which led the nation in the number of nursing home deaths per 1,000 residents, with 10,120 residents dying of COVID-19 as of May 25, according to the Centers for Disease Control and Prevention. “As an industry, we are going to have to rethink how we provide care, particularly around infectious diseases,” said Dennis Biondo, executive director of Allegheny County’s four Kane Community Living Centers, where occupancy shrunk 25% between 2019 and 2021 — to 709 from 977. “With lower census comes thoughts about renovation and changes to accommodate consumer preferences and anticipate regulatory changes,” he said. In terms of census drops, the skilled nursing operations at the Kanes may be the canary in the coal mine. The COVID-19 outbreak, fewer patient referrals from hospitals for rehabilitation from joint replacement and other medical problems have combined with other factors to drive down nursing home occupancy rates, especially in Pittsburgh, which had an occupancy rate of 70.9% at the end of March. That compared to 87.7% during the first three months of 2020, according to Washington, D.C.-based analytics company National Investment Center for Seniors Housing & Care. In senior housing overall — which includes assisted living and continuing care retirement communities — COVID-19 chopped occupancy rates in Pittsburgh and Los Angeles to their lowest levels of occupied units since the National Investment Center began reporting data in 2005. Nationwide, though, occupancy rates have been inching up since January, according to Bill Kauffman, National Investment Center senior principal. “How fast will occupancy bounce back we just don’t know yet,” he said. “No one can tell you how fast it will come back.” Too many beds? Long-term care’s inward look started with considering whether operators have too many beds, said Martin Siefering, principal at New York City-based Perkins Eastman Architects DPC. “Even before the pandemic, many of our clients saw a decline in census,” he said. “Everybody’s questioning whether they want to be in this business.” The full impact of COVID-19 on long term care is happening in real time, so the nursing home of the future is still taking shape. But some things are clear. COVID-19, a respiratory disease spread by tiny air droplets, will likely prompt regulatory improvements in air exchange in nursing homes, increasing the amount of fresh air circulating from the outside, said Mr. Siefering, an architect who serves on Perkins Eastman’s senior living leadership team. The pandemic will also likely accelerate the downsizing of long term care facilities as operators adapt to consumer preferences. For example, that might mean eliminating the semi-private rooms and shared bathrooms that are common at Pittsburgh-area facilities. Mr. Siefering worries about the costs of new regulations at a time when skilled nursing facilities are financially stressed. “If they’re going to mandate more requirements, who’s going to pay for it? A lot of providers are broke right now.” The $166 billion nursing home industry, encompassing 15,600 skilled care facilities nationwide, projects a $34 billion revenue hit, along with the closing or merger of 1,800 facilities due to COVID-19, according to a February study by the American Health Care Association, a Washington, D.C.-based lobbying and trade group. Moreover, long-term care facilities are facing a critical staffing shortage, which will require an increase in wages to attract and retain qualified personnel. Nursing homes and other medical facilities often turn to temporary staffing agencies to fill holes in the schedule, but those costs are rising — in one case, the hourly rate for aides doubled. Margaret “Peggy” Sampsel, a retired billing and collections clerk, says she has seen the future of long term care — and loves it. Ms. Sampsel, 70, who lives in a senior housing complex in Butler, had a heart attack in January that left her hospitalized for 32 days at Butler Memorial Hospital. She became so weak that she was admitted to the 220-bed Sunnyview Nursing and Rehabilitation Center to regain her strength. Ms. Sampsel was a patient for three days at Sunnyview when she asked to be moved to a newly opened facility — the 29-bed Advanced Care Center, a joint project of Adams Township-based Lutheran SeniorLife and Butler Health System. Inside, the facility looks more like someone’s home with fireplaces, stuffed chairs and plenty of natural light. “Let me tell you what, it’s the most beautiful place you’d ever want to be in,” Ms. Sampsel said. “Physical therapy, occupational therapy — just amazing. You have to see it to believe it.” The Advanced Care Center borrows a lot from the Green House concept of nursing care, an idea born in 2003 in Tupelo, Miss., where geriatrician Bill Thomas and Steve McAlilly, CEO of Methodist Senior Services, opened a skilled nursing center that looked more like a home than an institution. Two questions the Green House team often asked when furnishing the facility: Would you have it at home? Would you do it that way at home? The result was fewer beds and higher quality, personalized care which enhanced job satisfaction for the staff. And job satisfaction for nursing home workers matters — nursing homes in every state reported staffing shortages for every four-week period reviewed since June 1, 2020, according to a new report from AARP, a Washington, D.C-based education and advocacy outfit. One key point: the Advanced Care Center accepts patients with Medicare and Medicaid health care coverage, putting amenities that consumers prefer within reach of most people. It’s not an easy fete. Medicaid, which covers more than 60% of nursing home residents nationwide, pays about $8.25 an hour for skilled care, underfunding care by $9,000 per resident per year, according to a 2016 study by the American Health Care Association. Financial constraints like these mean the skilled care industry will be hard pressed to rebuild or make other changes post-COVID-19, Perkins Eastman’s Mr. Siefering said. A silver lining in the disease outbreak has been the opportunity for providers to reassess their services, said David Fenoglietto, Lutheran SeniorLife president and CEO. That doesn’t mean there won’t be room in the future for the Sunnyviews and the Kane Community Living Centers of the world, he said. “There’s a need for both sizes,” he said. Demographic trends indicate that the need for dementia care will continue to rise with the aging of the Baby Boomer generation, he said. Strong demand is forecast. The population of people ages 65 and older is projected to nearly double to 95 million by 2060 from 52 million in 2018, according to the Population Reference Bureau, a Washington D.C.-based nonprofit. The Pennsylvania Health Care Cost Containment Council said the number of state residents age 85 and older is projected to exceed 400,000 by 2030. “It’s an opportunity for all of us to look into the future,” Mr. Fenoglietto said. “We have to pivot, do things differently.” Kris B. Mamula: firstname.lastname@example.org or 412-263-1699 First Published June 21, 2021, 6:00am. Read the full article here.