Bringing Quality and Financial Viability to Long-Term Care

The post-acute and long-term care community faces a myriad of challenges in the wake of the pandemic. The good news is this gives clinicians a prime opportunity to have a seat at the table and to advance the skills of leaders to navigate our care teams effectively.

To get an industry expert’s view on improving the quality and financial viability of long-term care, I spoke with Dr. Michael Wasserman, past president of the California Association of Long-Term Care Medicine (CALTCM). Wasserman said it is absolutely essential to instill principles of geriatrics and geriatric medicine into our approach of caring for folks in senior living facilities.

Wasserman believes structural elements should be addressed. But perhaps even more critical is the need for strong, effective, and competent leadership to effect necessary changes. Clinical team members — physicians, nurse practitioners, PAs, pharmacists, social workers and nurses — must bring their knowledge of caring for vulnerable adults into the system. Otherwise, initiatives may struggle to succeed in achieving quality and financial sustainability.

Administrators, directors of nursing and other leaders need to enable clinicians to perform their roles while also helping to educate and train the surrounding care team. A missed opportunity in the industry for many years is that clinicians aren't enabled to be an integral part of everything that goes on to create a culture of care from the ground up.

“It's not just about the profit and loss. It's not just about wages and staffing. It's also about the clinical care.” — Dr. Michael Wasserman

The Need for More Certified Medical Directors

Only 10 to 15% of senior living facilities have competent, engaged and qualified medical directors. That means more than 80% of senior living facilities around the country either don't have competent medical directors or don't engage with them.

Consider this statistic along with fact that the Centers for Medicare and Medicaid — from a regulatory perspective — looks at the medical director as the leader responsible for medical care that takes place in the facility.

That priority has been ignored for decades despite efforts by the Society for Post-Acute and Long-Term Care Medicine. This group has attempted to promote the role of medical director and to develop a certification program for medical directors. It hasn't worked.

Objections from agencies and facility operators include:

• We don't have certified medical directors
• We don't have medical directors with the necessary background in geriatrics
• How can you force us to hire medical directors if we can't find?

Every facility providing care for seniors should have a medical director. If you have a medical director who doesn't have the tools or expertise they need, then develop them by giving them access and time to invest in their education and give them the mentoring they need to develop. They will learn and grow, and then they will then have the tools to instill the principles of your caring mission within the care team.

“There are so many ways to improve care smartly, while most effectively utilizing the resources and the staff we have. But that will only happen when we absolutely include the clinical folks.” — Dr. Michael Wasserman

Leveraging Geriatrics Data Sets

Geriatrics is not just about evidence-based medicine. And unfortunately, there isn't a lot of evidence-based medicine leveraged today when it comes to 95-year-old facility residents.

Social and psychological factors matter, and the existing data sets don't capture them. Thus, those data sets are inadequate, which means there are huge opportunities within these gaps.

Recently, Wasserman worked on a team looking at the concept of well-being and considered the metrics that could be captured to measure it.

One of the key tenets of geriatric medicine is quality of life and function, but there are no metrics associated with measuring quality of life. When we look at social isolation and social determinants of care, there is a dire need to develop metrics that give us insight into these areas.

“Everything technological right now is billing-centric; it needs to be care-centric.” — Dr. Michael Wasserman

The Future of Data and Technology

Amazon offers innovative stores where you walk in, pick out a quick snack or a full week of groceries, and leave. You never go through a checkout stand. You never pull out your credit card or hand over a wad of cash. How does Amazon do that?

The answer lies in sensors, technology and artificial intelligence.

If Amazon can use these things to create a futuristic grocery shopping experience, why aren't we using them in long-term care?

Right now, everything technological is billing-centric, and it needs to be more care-centric. Just imagine a senior living facility where the certified nursing assistant (CNA) provides care to a resident, and everything they do is captured via artificial intelligence (AI). The CNA doesn't have to wait until the end of their shift to try to remember what they did and document it accurately.

Many studies show that staff documentation at senior care facilities is sorely lacking. In the facility of the future, AI will accurately capture it all. As that data is analyzed, there is the opportunity to effectively foster AI solutions and algorithms. Otherwise, it’s impossible to develop AI with data that is inaccurately input by human beings.

It's time for all of us to engage. We're all getting older, and we all have loved ones who are getting older, too. The senior care industry needs structural change. And it’s our time to innovate and enable our teams to deliver that next level experience.

This discussion with Dr. Michael Wasserman was taken from our show Netsmart Care Threads. If you want to hear more episodes like this one, check us out on Apple Podcasts.

If you don’t use Apple Podcasts, you can find every episode here.