A Solution To Reduce Medicare Spending Per Beneficiary For Hospital Systems, ACO’s, Healthcare Plans and Skilled Nursing Facilities
According to the Centers for Medicare and Medicaid Services, 40.3% of all Medicare spending during a patient’s MSPB Episode occurs after the patient is discharged from the hospital. The highest Post-
Identifying and eliminating avoidable Post-
The problem exists because many physicians “automatically” admit their patients to SNF’s after the hospital discharge even if they only require daily custodial assistance. This discharge pattern occurs because physicians may be unaware of viable alternative non-
In fact, a 2003-
The Community Integration Model’s solution involves the use of a sophisticated software platform that “clinically matches” a patient’s diagnosis and care needs to specific individual Assisted Living or Memory Care communities along with the medical oversight of a Medicare Home Health Agency for patients that do not necessarily require an in-
WHAT YOU MAY NOT KNOW ABOUT TODAY’S POST-
In the past decade, the Assisted Living industry landscape has changed drastically. Assisted Living was once thought of as retirement communities with state of the art shuffleboard facilities. That is no longer the case.
Only 10 years ago, the average Assisted Living Facility resident was 74 years of age and only needed minimal assistance with the Activities of Daily Living (ADLs).
This profile has dramatically changed. According to the National Center for Assisted Living2. Over half of the residents are over 85 years old and the typical resident is an 87-
Bathing 72%
Dressing 52%
Toileting 36%
Transferring 25%
Eating 22%
ARE ASSISTED LIVING FACILITIES EFFECTIVELY MANAGING PATIENTS WITH MULTIPLE CHRONIC CONDITIONS?
Today’s Assisted Living/Residential Care providers have become increasingly adept at effectively supporting the health and well-
As evidence, 67% of all Medicare beneficiaries and 75% percent of all seniors in assisted living have multiple chronic conditions including:
High Blood Pressure: 57%
Alzheimer's /Dementia: 42%
Heart Disease: 34%
Depression: 28%
Arthritis: 27%
Osteoporosis: 21%
Diabetes: 17%
COPD 15%
Cancer: 11%
Stroke: 11%
Approximately 26% of assisted living residents have been diagnosed with 4 to 10 of the most common chronic conditions, 50% of residents have been diagnosed with 2–3 of the most common chronic conditions and 18% have been diagnosed with one chronic condition.
Noteworthy is the fact that only 6% of assisted living residents have never been diagnosed with any of the top 10 chronic conditions.
HOW ELSE ARE ASSISTED LIVING FACILITIES EFFECTIVELY CARING FOR THEIR RESIDENTS?
Proper diet and accurate medication management are also extremely important factors in effective post-
CAN PROFESSIONAL SKILLED NURSING SERVICES BE PERFORMED BY MEDICARE-
Many medical professionals and physicians are not aware that Assisted Living with Medicare-
Medicare-
Medicare-
Wound Care
Physical Therapy
Speech & Language Pathology
Occupational Therapy
Registered Nursing Visits
Social Work Intervention
Certified Nursing Assistant services
The growing trend towards long-
Silverado Senior Care, a Memory Care Leader headquartered in Irvine, California, for example, recently reported at the National Readmissions Prevention Collaborative Conference in May, 2014, that many of their Assisted Living communities offer more actual nursing hours per day per person than many Skilled Nursing Facilities.
With the launch of the MSPB Measures, hospitals are already seeking alternatives to skilled nursing facilities that reduce or eliminate Medicare funded services especially using The Community Integration Model.
Essentially, hospitals will be evaluating any post-
Health plans and managed care organizations are likely to be even more aggressive in their pursuit of seeking privately paid services.
Every hospital’s goal is to discharge patients to environments that can effectively manage a patients specific care needs. Assisted Living/Residential Care settings are uniquely positioned to effectively manage many post-
WHY IS IT IMPORTANT TO BE IN THE LEAST RESTRICTIVE ENVIRONMENT?
Many health professionals are unaware of the landmark U.S. Supreme Court decision in 1999, which states that individuals with disabilities must be given the right to receive services in the least restrictive environment possible (Olmstead v. L.C. Olmstead).
Today’s assisted living and residential care communities have been experiencing ever increasing patient acuity and has effectively repositioned itself to be not only a viable discharge option for seniors with multiple chronic conditions, but in many cases, is the preferred, least restrictive option that meets the care needs of the post acute patient.
WHAT OTHER FACTS ARE IMPORTANT TO KNOW ABOUT THE CHANGES IN ASSISTED LIVING ENVIRONMENTS?
The National Study on Residential Care Facilities conducted by the Center for Disease Control in 2012 highlighted several important assisted living statistics. Nearly 6 in 10 residential care communities had 4–25 beds, but more than 7 in 10 residents lived in communities with more than 50 beds.
A higher percentage of communities with 26–50 beds and more than 50 beds were chain-
A higher percentage of communities with more than 50 beds provided dementia-
The same national study identified that assisted living patient acuity rates have been climbing for the past 5 years.