Strategic Planning for Higher Levels of Care in the Shadow of a Pandemic

Guest article by Brad Paulis, ASA, FCA, MAAA, Partner; and Chris Borcik, FSA, FCA, MAAA, Principal, at Continuing Care Actuaries

Much of 2020 and early 2021 was a constant struggle of assessing the latest information and reacting as quickly as possible to answer the question, “What needs to be done now to keep residents safe?” Now, as residents and employees are getting vaccinated, a pivot toward strategic planning for the long-term is crucial. What changes should be made to meet resident demands in the post-pandemic world?

There has been constant pressure for communities to steer away from skilled nursing over the last 20 years. Before the pandemic, many communities were shrinking or eliminating their skilled nursing beds to provide additional and enhanced assisted living and/or memory care residences. Some developers were planning new communities without skilled nursing complements, only including them in the plan if the new community’s management team insisted skilled nursing be a part of the project.

In the new COVID-19 world, this trend has accelerated. Because of the communal nature of skilled nursing facilities and the high-risk elder population being served, those living in skilled nursing are at increased risk of infection and severe illness from COVID-19.  Additionally, much of the national media attention around COVID-19 followed the spread of the disease and the high mortality rate of those infected while living in a senior living facility. In reality, there were very few deaths in independent and assisted living, with the majority of deaths occurring in skilled nursing.

Will skilled nursing utilization bounce back after the pandemic, or is this a permanent shift in nursing utilization? Consumer demand will determine the future of skilled nursing. Health care demand has not changed, and a significant portion of the senior population will require care. Will they feel comfortable going into a skilled nursing facility after the pandemic comes to an end, or will they prefer having in-home skilled nursing care in the future?

In our respective work with long-term care companies, we have seen reduced utilization of skilled nursing, as many seniors avoided care during the pandemic to reduce the risk of infection, when possible. If skilled nursing utilization remains below historical levels, this will increase demand for in-home nursing care, assisted living and dementia care.

As skilled nursing bed complements continue to diminish, there are three areas that communities should examine to help with long-term planning:

  1. Home Care: How do you currently manage in-home care? If it is not currently part of your community, should you add this service or allow outside providers to bring this service to your residents? If you do allow outside providers into your community, should you regulate who is permitted on campus or only allow providers that have specific agreements with the community to control the quality of care? 
  2. Assisted Living: With increasing home and dementia care and decreasing skilled nursing care, what is the right level of assisted living care in your community? What is the smallest number of beds for a unit to operate efficiently, while remaining large enough to meet the demand in your community? 
  3. Dementia Care: In this ever-changing world, communities need to be up to date on best practices for dementia care. Additionally, if communities must lock down again in the future to ensure the safety of their residents, how do they improve activities that maintain resident socialization?  

 This is especially critical in independent living, where residences may be dispersed throughout the campus, isolating residents further.

When working on strategic planning, the following will help drive decision making:

  • Define the philosophy of care in the community. Where should certain services be provided?
  • Determine efficient unit operations by examining a range of options and weighing the pros and cons of each.
  • Develop expected population movements. Create baseline assumptions and then do stress testing to see how ILU occupancy and resident health care utilization could change the population in each level of care.
  • Complete an operational revenue analysis. Do expense changes make sense with your current contract(s)? How are your accounting and actuarial benchmarks affected by the changes that you could make?

In the post-pandemic world, it is critical to remain flexible. Now is the right time to start asking some big questions about how your community must change to meet future residents’ needs, wants and expectations.

For more articles from guest contributors and senior living thought leaders on the Love & Company blog, click here.

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