Spring 2025

Vol. 52 No. 1

Cover Story

The Value of Adopting Provider-Owned Networks

https://www.providermagazine.com/Issues/2025/Spring/Pages/The-Value-of-Adopting-Provider-Owned-Networks.aspx

The Value of Adopting Provider-Owned Networks

<img src="/Issues/2025/Spring/PublishingImages/CF-Networks.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Value-based care, or population health management, has been a hot topic in health care for some time now, but how to integrate the care model into the long term care setting is just beginning to evolve into something tangible for skilled nursing facilities (SNFs), assisted living (AL) communities, and related providers. Enter into the conversation assistance from the American Health Care Association/National Center for Assisted Living’s (AHCA/NCAL) provider-owned networks team, whose purpose is to help providers explore integrated networks to create efficiencies in care and cost as well as to pursue business ventures including quality-based reimbursement and value-based contracts with managed care organizations (MCOs) (<a href="/Issues/2025/Spring/Pages/Overview-of-the-Solutions-Model.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">see outline of the model</a>). Katie Colgan, AHCA/NCAL executive director of integrated networks, said provider-owned networks help SNFs and other long term care providers to drive substantial opportunities for innovation in delivery of care, to design and implement population health management models, to reduce and eliminate burdens such as audits and authorizations, and to achieve reimbursement for value under a continuum of risk options. “These options are critical now more than ever to help providers, payers, and policymakers design and implement new care models as fee-for-service payments shift to value-based care based on quality outcomes,” she said. The point of value-based care or managed care principles is to offer heightened preventive care to patients/residents and get ahead of possibly more serious developments. This type of care is encouraged by the federal government’s quality measures, giving SNFs and AL communities a set of goals to beat or achieve. SNFs, for example, are measured on rehospitalizations, fall prevention, and curbing the use of antipsychotics, among others.<h3>Why a Networks Solution Now?</h3>Colgan said around 10 years ago, the AHCA Board of Directors started to look at the concept of provider-owned networks and the feasibility of what the association could achieve for its members in the space. The point, she said, was to find a way to help provider members improve quality in a managed care environment and prepare for value-based models. <img src="/Issues/2025/Spring/PublishingImages/Katie-Colgan.jpg" alt="Katie Colgan" class="ms-rtePosition-1" style="margin:5px;" />Since that time, managed care has only increased its presence, and by 2019, it was even more apparent that long term care providers could utilize assistance in better positioning themselves for the opportunities in shared savings and value-based care programs. Thus, the provider-owned network solution was born. “It’s a way for us to bring together a group of providers in a new way to focus to improve on quality and contracts and work with managed care plans, with all of us working toward the same goal,” she said. “What we have been able to do is put in place a number of brand-new relationships with managed care plans. So, we are working together to improve outcomes, improve the quality of life for residents, decrease administrative burdens, and improve reimbursement options because we create savings for the health care systems.” With AHCA/NCAL’s assistance to vet and develop these networks, member providers now own their own integrated networks in 11 states: Florida, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Nebraska, North Carolina, and Ohio, Colgan said, with plans to add additional states as makes sense. Each of the states has a well-developed core of providers with healthy managed care penetration. States that do not have these two factors may not be good candidates for provider-owned networks at this point in time. Colgan said the actual implementation of managed care contracts with providers drills down into what each long term care group views as their priority care issue, in collaboration with the MCOs. “Together the network providers and the MCO will come in and introduce a pilot, for instance, and focus on reducing falls. At the direction of the providers, the network will then go into a building with a high fall rate and educate and try out solutions that will help bring those numbers down,” she said. SNFs will get to collaborate with the health plans (managed care) in new ways, and health plans will see the providers as partners seeking to share in savings from the improved care by reducing falls, per the example. “This really puts us in the long term care space in the driver’s seat,” Colgan said. “Before, managed care was treating SNFs as ancillary services, but networks change that perception so that the plans work with SNFs and ALs like they do with hospitals and physician groups.”<h3>Indiana Health Care Quality Partners</h3>Colgan said a prime example of how the provider-owned network model has worked well is in Indiana. In 2022, Indiana providers came together to form Indiana Quality Health Care Partners (INHCQP), motivated by the state’s impending move to managed long term services and supports (mLTSS). Over 300 facilities came together to form INHCQP, and as a result, the payers bidding for the mLTSS business with the state were highly motivated to partner with the network to create new shared savings models. Colgan emphasized that one mLTSS payer specifically stated in their written bid to Indiana officials that they planned to create shared savings with INHCQP providers. After the final plans were chosen and mLTSS began in 2024, all three payers committed to shared savings models with INHCQP. According to Colgan, in 2025, the provider owners of INHCQP are eligible for over $3 million of shared savings, which otherwise would not have been available if the network was not formed, offering a vehicle for the providers to collectively demonstrate their quality improvement to the payers. The shared savings are available if providers meet benchmarks in key quality areas, including: <ul><li>Decreasing inpatient hospitalization days</li><li>Decreasing emergency room (ER) visits</li><li>Decreasing readmissions</li><li>Decreasing catheter use</li><li>Decreasing use of antipsychotics</li><li>Decreasing falls with major injury</li><li>Increasing vaccines</li><li>Decreasing pressure ulcers</li></ul>In implementing the shared savings program, INHCQP was able to work with the payer to optimize how each building participates in the program, leveraging the volume of the network to partner within the entire group of over 300 buildings to create the best environment for quality improvement and success in the program. According to Colgan, this is only one opportunity with one payer, and the INHCQP network is developing similar programs with the other two mLTSS plans to help create consistency in quality measurement across residents in the buildings of provider members. This way, provider members can focus on their individual resident needs, and network staff can support program development and achievement of consistent quality goals across many buildings.<h3>Nebraska Targets Advance Care Planning </h3>Nebraska shows that any number of priority issues can arise when the provider network model is active. In Nebraska, state long term care stakeholders held a Fall 2024 Advance Care Planning In-Person Education event, which addressed how best to keep hospital readmissions low. Through high-level outreach with its members, the state AHCA/NCAL affiliate identified that network members would benefit from education on advance care planning, resulting in 80 individuals attending the full-day workshop led by David Gifford, MD, AHCA/NCAL chief medical officer (CMO) and network CMO. Workshop topics included end-of-life trajectory, surplus safety measures, and managing dementia behaviors. “Being CMO for Vetter Senior Living, I was really impressed that Dr. Gifford took the time and effort to come in person to speak with us in Nebraska,” said Gary Anthone, MD, CMO, Vetter Health Services, in Elkhorn, Neb. “Not knowing him as well as some of my Vetter team members did, I found him to be truly humble and approachable. Having someone who has ‘lived’ senior care speak to us in person about improving quality let me know that the NHCA [Nebraska Health Care Association] and the NHCQP leadership teams are serious about what they stand for. Vetter is striving to take senior care to the next level.” The advance care planning session delivered valuable information, he said, since it is important to remember to treat patients with dignity, instead of thinking of them as revenue generators. “This is what I think will impact the care our residents will benefit from.” <img src="/Issues/2025/Spring/PublishingImages/Chay-Indra.jpg" alt="Chay Indra" class="ms-rtePosition-2" style="margin:5px;" />Chay Indra, senior director of clinical operations at Vetter Senior Living, said the focus on advance care planning gets to the clinical issues involved when a resident does not always want to be treated in a hospital setting, making it important to mitigate negative outcomes from falls or for those with dementia to limit interventions. “Dr. Gifford looked at the country as a whole when he presented to us, a lot of different buildings and different organizations. And he gave us the best information from that research. One area that stood out is facility huddles—making sure there is clinical communication on a daily basis plays a role in reducing ER visits,” Indra said. When discussing advance care planning, providers spend a lot of time communicating with families and residents about the type of care they want. “A family member may say, ‘OMG, my mom is not feeling well, so send her to the hospital.’ But that family member may not know we have a lot of services we can provide in the facility. This is education needed for the families,” she said. “We can do IV fluids and testing and monitoring in the building and report back to a doctor before possibly sending a resident to the ER.” Other situations can lead to education from the network model, Indra said. “Falls are a big area to cover. We want to promote independence but still be safe. Why a person falls is important; it could be meds or the oxygen tubing that gets in the way when walking. It is all about being more intentional with the managed care quality measures,” she said. Dr. Gifford indicates that “networks have the ability to bring providers together to align quality goals with payment, and providers with payers, so that all can work collectively to improve outcomes for long term care residents,” describing networks as “one of the most exciting initiatives to impact nursing facility quality” in the past several decades.<h3>Ohio Pilots Nursing Program</h3>In Ohio, the Ohio Health Care Association Quality Partners (OHCAQP) Network has created a collaboration with a managed Medicaid health plan for an innovative nurse practitioner program that Leah Elliott, clinical care manager at OHCAQP, called a “transformative” effort to bring quality improvements and cost efficiencies to long term care providers operating in the state, with support from a major national Medicaid payer. <img src="/Issues/2025/Spring/PublishingImages/Caprice.jpg" alt="Caprice Scherpf" class="ms-rtePosition-1" style="margin:5px;" />One of the leaders of the pilot program on the ground level is Caprice Scherpf, the director of nursing services at Majestic Care of Middletown, Ohio. She has been in health care for two decades, with 17 of those years as a nurse. She said the nurse practitioner pilot program focuses on improved quality outcomes brought on by the attention an additional clinician provides. “It is another opportunity for extra clinical oversight and collaboration. We are intent on managing chronic conditions, minimizing falls and pressure ulcers, and helping to prevent anything that might result in a drastic decline in functional abilities. Having the nurse practitioner as part of this team [in the managed care setting] is about asking how we can do our best for the resident in our interventions,” she said. Scherpf’s building is one of the first to take part in the nurse practitioner pilot program, and she has nothing but praise for the health insurer, calling them a wonderful group to work with. She notes that communication is a key between the nurse practitioner and the facility staff. “There is a high level of collaboration, and the nurse practitioner has a wonderful bedside manner and takes the extra time for residents, really advocating for them,” Scherpf said. About 35 out of the 135 residents in the building now have the nurse practitioner benefit. <img src="/Issues/2025/Spring/PublishingImages/Leah-Elliott.jpg" alt="Leah Elliott" class="ms-rtePosition-2" style="margin:5px;" />This means there are a fair number of “hands in the pot” when it comes to care being provided for residents under managed care contracting, she said, which makes it important to know the protocol for which clinician does what in the decision-making process. “When there is a change in condition of a resident, the nurse practitioner is notified first and works with the primary care provider ultimately on a course of action. It is the same process we see for the other managed care company in the building,” Scherpf said. The pilot is thus far open-ended, but she hopes the nurse practitioner is in the building as long as possible. “It has given an extra layer of review and has paid off for residents and families,” she said. “We are seeing positive results and will be documenting them as we go along.” Patrick Connole is a veteran journalist and a former senior writer and editor for Provider, where he gained experience reporting on the long term care profession. Connole previously worked for Dow Jones, Reuters, and McGraw-Hill covering business news.

Integrated networks help providers improve the quality of life for residents, decrease administrative burdens, and improve reimbursement options.

2025-03-10T04:00:00Z

Management

Our Focus on Quality Care Doesn’t Change

https://www.providermagazine.com/Issues/2025/Spring/Pages/Editor's-Desk.aspx

Our Focus on Quality Care Doesn’t Change

When it seems that everything is changing—new regulations, different guidelines, unknown timetables—we naturally search for something that isn’t shifting. In the long term care sector, one thing that doesn’t change is our focus on delivering the highest quality of care for our residents. In recent years, the discussion around delivering quality care has focused on value-based care. Value-based care, or population health management, is a model of integrated care that emphasizes positive health outcomes for a group of people. This is a shift away from the fee-for-service models of the past. In this issue, Provider digs deeper into how managed care and <a href="/Issues/2025/Spring/Pages/Need-for-a-Bigger-Tent.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">accountable care organizations</a> were slow to embrace long term care residents in value-based care models. While the characteristics and needs of community-dwelling versus long term care facility-dwelling individuals are different, solutions need to be developed that meet the needs of all older adults. We examine the growing number of <a href="/Issues/2025/Spring/Pages/The-Value-of-Adopting-Provider-Owned-Networks.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">provider-owned networks</a>, whose purpose is to help providers explore integrated networks to create efficiencies in care and cost, and in pursuing business ventures including quality-based reimbursement and value-based contracts with managed care organizations. The need for models of long term care will only increase over the next few decades as <a href="/Issues/2025/Spring/Pages/Finding-Solutions-for-the-Booming-Long-Term-Care-Population.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">the silver tsunami</a> of older adults brings challenges and opportunities alike. This issue features the first in a four-part series on the silver tsunami and its effects on long term care. This issue also shows how assisted living communities are ideally positioned to integrate the key components of a successful <a href="/Issues/2025/Spring/Pages/The-Role-of-Population-Health-Management-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">population health management program</a> and how meeting the distinct needs of residents from diverse backgrounds is part of delivering the best care. Don’t miss out on the 2025 AHCA/NCAL Quality Summit, held April 7-9 in Atlanta, and the 2025 Population Health Management Summit, held April 9-10 in Atlanta. Visit <a href="http://www.ahcancal.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">ahcancal.org</a> to learn more and register.

In the long term care sector, one thing that doesn’t change is our focus on delivering the highest quality of care for our residents.

2025-02-10T05:00:00Z

Editor's Desk

Need for a Bigger Tent

https://www.providermagazine.com/Issues/2025/Spring/Pages/Need-for-a-Bigger-Tent.aspx

Need for a Bigger Tent

All older patients are not the same. The characteristics and needs of community-dwelling versus long term care (LTC) facility-dwelling individuals are different. Unsure how to manage LTC residents, particularly high-needs and frail older adults, health care payers such as managed care organizations (MCOs) and accountable care organizations (ACOs) were slow to embrace this population in the early days of value-based care.However, as large numbers of American adults age into their seventies and eighties, this subpopulation of older adults is growing and is gaining attention. In recent years, institutional special-needs plans (I-SNPs) and ACO REACH models have shown some promise as ways to serve this distinct population. However, gaps and challenges remain, and there is a need for public policy and other actions to acknowledge and address the distinction between community- and congregate-dwelling older adults. The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has been focusing on this issue and looking at what new value-based care models may provide solutions and enable cost-effective quality care for even the frailest and sickest older adults in whatever setting they reside. In its recent Strategic Vision document, the Center for Medicare and Medicaid Innovation (CMMI) stressed the need for a focus on population and systems transformation, rather than setting. This is significant, as there is a growing interest in and need to serve subpopulations that are not reached by a risk-based, fee-for-service model and can’t afford or don’t have access to affordable/accessible housing. However, there are some settings that naturally lend themselves to population health initiatives to support this population, such as nursing homes and assisted living communities. There are challenges when creating policy and payment for this subpopulation of congregate-dwelling seniors. For example, in AHCA/NCAL’s assessment, only about 50 percent of the long term care nursing home population meet the current ACO REACH High Needs criteria, thereby limiting participation even though it is a highly medically complex and frail population that would benefit from the REACH model. <img src="/PublishingImages/Headshots/Nisha-Hammel.jpg" alt="Nisha Hammel" class="ms-rtePosition-1" style="margin:5px;" />According to Nisha Hammel, vice president, reimbursement policy and population health at AHCA/NCAL, “The ACO REACH model could capture the needs of this subpopulation by allowing this long-stay population to be aligned at the facility level, recognizing the role that the integrated care team plays in care coordination.” She added that AHCA/NCAL members support arrangements that offer providers an opportunity to assume greater leadership for and meaningful participation in the full care experience of residents/patients. In keeping with other models such as the Program of All-Inclusive Care for the Elderly (PACE), I-SNPs, and IE-SNPs, the association suggests that policymakers consider the nursing facility level of care as a criterion to meet the high needs threshold. This would create pathways for this subpopulation and support the commitment of the Centers for Medicare & Medicaid Services (CMS) to promoting value-based care for vulnerable and underserved populations. <h3>Community- Versus Congregate-Dwelling Older Adults</h3>Hammel observed that while various value-based care models have demonstrated successes, these programs were designed with the community-based population in mind; therefore, she said, “Our long term care providers are constantly trying to fit a square peg in a round hole. The needs and characteristics in our setting are unique.” There are some obvious differences between these two populations. As Fred Bentley, managing director of ATI Advisory’s Post-Acute/Long Term Care and Senior Living Practice, observed, “Individuals residing in long term care settings tend to have much higher acuity, so they have more complex medical needs and more functional impairments; and there is 24/7 monitoring in the facility setting.” However, some residents may have significant challenges accessing primary care and routine care services even if there is full-time medical staff onsite. <img src="/Issues/2025/Spring/PublishingImages/Anthony-Laflen.jpg" alt="Anthongy Laflen" class="ms-rtePosition-2" style="margin:5px;" />“People in the community tend to be more independent, but they’re not without their challenges. They’re often plagued by mobility issues, chronic disease, social isolation, and transportation challenges,” said Anthony Laflen, vice president of value-based care innovation at PointClickCare. LTC residents tend to have more complex medical needs, he said, and often have cognitive issues. While issues with many social determinants of health—such as food and/or housing insecurity—diminish when people enter congregate living, they still may have challenges such as lack of family support and feelings of loss. At the same time, some community-dwellers would benefit from moving into a congregate-living setting but can’t afford it or perceive that it is unaffordable. Laflen said, “In some states, income insecurity is off the charts.” As a result, at least some older adults may resist the decision to make such a move even as their food insecurity and isolation increase. As a result, they are sicker and have greater health care needs when they finally do make the move. Hammel offered, “If you recognize the distinction between community- and congregate-dwelling individuals and then tailor programs accordingly, we can create policy solutions and programs to address these populations more successfully and achieve the shared goal of improved care and quality outcomes and smarter spending.”<h3>Gaps To Be Filled</h3>While I-SNPs, REACH ACOs, Medicare Advantage (MA) plans, and PACE programs play a key role in providing care for older adults, gaps exist that need to be filled—especially for high-needs residents of long term care facilities. Bentley said, “The biggest gap is that in contrast to I-SNPs, where you know eligibility is fairly broad if the individual lives in the long term care setting, it’s not nearly as broad for those individuals who are in a Medicare fee-for-service program.” He noted that CMS is taking steps to try and broaden criteria, but there is a need for a model that fills these gaps. “We need to be advocating for broadening the eligibility criteria,” he stressed.“The REACH ACO model and SNPs offer an opportunity to address the unique needs of LTC populations by fostering integrated care, reducing fragmentation, and aligning incentives across providers and payers. However, to maximize the potential of these models, it is essential to address systemic gaps,” said Laflen. These, he offered, include siloed care delivery with poor communication between settings and limited integration with broader health systems; lack of continuity in transitions that can result in missed opportunities for early interventions; and gaps in reimbursement, including barriers to funding for holistic care and limited incentives for preventive care. Keith Persinger, chief operating officer at Provider Partners and chief executive officer at Provider Partners Connect Care, noted managed and value-based care programs like I-SNP and ACO High Needs REACH help address these issues by creating incentives for coordinated care management. In short, Kristen Ratcliff McGovern, partner at Sirona Strategies, said, “The largest gap remaining is the permanent availability of an accountable care model for high-needs beneficiaries in long term care settings, as I-SNPs and Medicare Advantage will not be the right fit for every provider and beneficiary. This could look like a permanent ACO model that is designed after the ACO REACH High-Needs Track.”<h3>Need for New Models</h3>To help create meaningful and realistic value-based care participation options for long term and post-acute care providers, especially those with high-needs populations, AHCA/NCAL and the National Association of ACOs convened a roundtable of stakeholders, including LTC providers, ACO leaders, patient advocacy groups, payers, and others. They agreed on several recommendations to help CMS improve existing value-based arrangements and develop future model concepts that would enable providers to engage within broader accountable care arrangements. To find better ways to create meaningful participation options in ACOs for long term and post-acute care (LTPAC) providers, the group recommends: <ul><li>Alignment/participation options for beneficiaries residing in LTC facilities, which includes recognizing needing nursing facility level of care is a participation criteria in and of itself.</li><li>Financial methodology changes. </li><li>Quality measurement. </li><li>Data.</li></ul>The roundtable group agreed on several concepts that would be key for future model concepts and key principles that CMS should adopt for developing a voluntary episode-based payment model specifically for SNF providers. These concepts included: <ul><li>Addressing persistent and unresolved health care delivery system problems.</li><li>Delivering improved patient outcomes while reducing unnecessary health care costs.</li><li>Assurance of scalability.</li><li>Meaningful risk and reward for participants within the ACO.</li><li>Alignment with the CMMI strategic vision.</li><li>A sense of predictability and stability.</li></ul>The group stressed the need for a voluntary model with adequate non-financial incentives to spur participation and prioritize data sharing. Laflen suggested the need for specialized care models that address chronic conditions, frailty, and polypharmacy. At the same time, for any value-based care models to be effective, accurate and current data will be essential, which presents a challenge and an opportunity. Laflen explained, “We need to continue to lead the charge on getting and using more robust data to make coverage decisions and identify issues such as spikes or dips in readmissions.” In addition, AHCA/NCAL is advocating for recognition from policy makers that I-SNPs in particular are smaller, location-specific, and highly specialized Medicare Advantage plans for medically complex congregate dwelling residents. This means these plans may need to be treated differently from large national MA plans focused on community dwelling seniors who do not have the same challenges.<h3>Advocating with Policymakers</h3>There is still much uncertainty about how the new Administration will approach oversight of LTPAC and the move to value-based care. As with any change of leadership, there are important opportunities for AHCA/NCAL members to educate new representatives and others about this care setting and the need for appropriate models of care. It is key for them to make their voice heard and offer guidance and resources as policymakers work on these issues. <img src="/Issues/2025/Spring/PublishingImages/Kristen-McGovern.jpg" alt="Kristen Ratcliff McGovern" class="ms-rtePosition-2" style="margin:5px;" />McGovern noted, “Long term and post-acute care providers have been largely left out of the discussion around value-based care and post-acute care. Members should continue to elevate these priorities and highlight the important role they play in value-based care. To date, some of the most significant cost savings and care improvements realized by community-based ACOs and other episodic payment and delivery system reform models have been generated by intentional and targeted post-acute care partnerships.” Bentley said, “I think there is a compelling argument that there is an opportunity for increased cost-effectiveness and reduced waste in the care of high-needs patients. If we can reduce emergency room visits and lower hospitalizations, as well as do a better job of managing chronic diseases, by extending coverage to more long term care residents, it has great potential.” Laflen said, “If I had 10 minutes in an elevator with a policymaker, I would say, ‘Let’s put our dollars into a methodology that drives improved outcomes for the patient and reductions in spending. These are the two things I focus on. If we can stop people from going to the emergency room or hospital—and we can with a value-based care model specific to our high-needs long term care population—this meets both of those goals.’” He added, “With the average hospitalization cost at about $15,300, preventing that admission results in significant quantifiable savings. We can create programs that not only save the federal government money but enable facilities to provide excellent care and promote optimal quality of life for residents.” Persinger agreed that the cost-savings aspect of any new or revised value-based care models is likely to resonate with policymakers. “They’re looking at ways to reduce the total cost of care, including for Medicare. Of course, the goal of delivering better care to residents is obviously what everyone wants and should aim to accomplish. Better coordinated care creates higher quality care and reduces the total cost of care.” He suggested the value of sharing data with policymakers that shows the benefits of nursing home care for residents, where and how you are accomplishing cost savings, and where a different value-based care model might present opportunities for greater savings and/or improved care coordination. <img src="/Articles/PublishingImages/headshots/JoanneKaldy.jpg" alt="Joanne Kaldy" class="ms-rtePosition-2" style="margin:5px;width:175px;height:219px;" />The key is to continue to be part of the dialogue and discussion. AHCA/NCAL and other organizations are leading the way, but they need input and support from their members. Robert Zorowitz, MD, MBA, CMD, regional vice president, health services, Northeast region, Humana, said, “We don’t know what’s going to happen in the coming months, but the people at CMS are thoughtful and serious about ways to improve care, and CMMI has tried a variety of demonstration projects. We need to keep advocating for the changes we believe will benefit our patients and our facilities, and we are fortunate to have leaders at our professional organizations to guide our efforts.” Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.

Unsure how to manage LTC residents, particularly high-needs and frail older adults, health care payers such as managed care organizations and accountable care organizations were slow to embrace this population in the early days of value-based care.

2025-03-10T04:00:00Z

Management;Caregiving

Cover Feature

Joanne Kaldy

52

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The Role of Population Health Management in Assisted Living	https://www.providermagazine.com/Issues/2025/Spring/Pages/The-Role-of-Population-Health-Management-in-Assisted-Living.aspx	The Role of Population Health Management in Assisted Living	<p><img src="/Issues/2025/Spring/PublishingImages/AL-1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />It is no surprise that our population is aging, and as we get older, the prevalence of chronic conditions increases.<br></p><p>The average age of an individual living in an assisted living community is 84 years. As adults age and manage more medical conditions, they increasingly seek options that emphasize health and wellness. It’s no longer just about living longer; the focus has shifted to living a long, high-quality life. A significant part of achieving this goal lies in integrating proactive, timely primary care and coordinated supportive services into daily living, a population health management approach. <br></p><p>Assisted living communities are ideally positioned to integrate the key components of a successful population health management program: data collection and analysis, preventative care strategies, and chronic disease management. In fact, many communities have already embraced this approach.<br></p><p>Population health management is built on a foundation of collaboration, communication, and coordination. To effectively provide person-centered care and services, assisted living communities must foster ongoing conversations among residents, their families, the assisted living support team, health care providers, and others to ensure that everyone involved is aligned and working toward the residents’ health and well-being. Establishing an environment where residents’ needs and preferences are the focal point not only enhances care outcomes but also significantly increases resident satisfaction.<br>Population health management focuses on improving health outcomes for a defined group of individuals. In this case, the group consists of individuals living and thriving in assisted living communities. Examples of health outcomes that can be managed include reducing hospital admissions, improving mobility and preventing falls, managing cognitive health and dementia, and enhancing nutrition.<br></p><p>Assisted living communities are increasingly leveraging artificial intelligence and electronic health records to monitor and proactively address residents’ health needs. For instance, wearables that track steps can help identify changes in physical activity, while temperature-monitoring devices enable early detection of illnesses. Gait and balance assessments are also commonly offered to identify and mitigate fall risks. Early detection of changes in conditions or function facilitates early intervention by the primary care team, mitigating the exacerbation of illness. These interventions exemplify how assisted living communities are becoming a prime setting for population health management.<br></p><p>In addition, many assisted living communities incorporate wellness programs, such as exercise classes, walking groups, social engagement activities, cognitive stimulation programs, vaccination clinics, and health education workshops. The integration of these wellness programs shifts the community’s focus from reacting to health declines to actively preventing them.<br></p><p>Ultimately, these early interventions and proactive health and wellness strategies reduce the need for costly treatments and hospitalizations. This combination of collaboration, communication, data-driven insights, preventive care, and a wellness-oriented approach results in an improved quality of life and better health outcomes for individuals in assisted living communities.<br></p><p><img src="/PublishingImages/Headshots/LBethea.jpg" alt="LaShuan Bethea" class="ms-rtePosition-2" style="margin:5px;" />The American Health Care Association/National Center for Assisted Living offers <a href="https://www.ahcancal.org/Reimbursement/Pages/Population-Health-Management.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">population health management</a> resources and will host the Population Health Management Summit on April 9-10, 2025, in Atlanta. Assisted living providers are encouraged to attend and learn more about the future of health care delivery and how population health management can bring lasting benefits to an organization. For more information and to register, please visit <a href="https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx</a>. </p><p><em>LaShuan Bethea is the executive director of the National Center for Assisted Living (NCAL).</em><br></p>	Proactive, timely care integrated with coordinated support services leads to longer, higher quality lives for seniors.	2025-03-10T04:00:00Z	<img alt="" src="/Issues/2025/Spring/PublishingImages/AL-2.jpg" style="BORDER:0px solid;" />	Assisted Living	Spotlight on Assisted Living
Elevating Equity in Long Term and Post-Acute Care	https://www.providermagazine.com/Issues/2025/Spring/Pages/Elevating-Equity-in-Long-Term--and-Post-Acute-Care.aspx	Elevating Equity in Long Term and Post-Acute Care	<p><img src="/Issues/2025/Spring/PublishingImages/caregiving-1.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Envision a place where stories from every part of the world come together—diverse languages, traditions, and beliefs woven into daily life. As health care providers navigate the distinct needs of residents from diverse backgrounds, the challenge becomes obvious. We must deliver not only medical care, but compassionate, culturally aware, and appropriate care that honors each resident’s identity. Achieving this balance, in addition to promoting health equity, is key to ensuring every resident feels valued. <br></p><p>Cultural competence and health equity are progressively more relevant in long term and post-acute care settings due to the growing diversity of the aging population and the increased focus on reducing health disparities. These settings often care for vulnerable populations, such as older adults, individuals with disabilities, and those with debilitating chronic conditions, who come from different backgrounds. Providing culturally competent care ensures that we respect residents’ preferences, beliefs, and traditions. Focusing on health equities addresses disparities in access to quality health care and resources in a progressively evolving medical landscape. </p><h3>Cultural Competence</h3><p>Every resident has their own preferences that should be respected. According to the State Operations Manual from the Centers for Medicare & Medicaid Services,<sup>1</sup> cultural competence in health care means providing high-quality, respectful, and equitable care to residents from different cultural backgrounds. It often also requires recognizing and addressing cultural, social, and linguistic differences that can influence resident care and, ultimately, health outcomes.</p><h3>Health Equity</h3><p>Health equity ensures that all individuals have fair and impartial access to health care resources and addresses insecurities, regardless of race, ethnicity, age, socioeconomic status, gender, disability, or geographic location. It aims to eliminate disparities in health outcomes so that residents receive culturally appropriate and equal-access care.</p><h3>Importance in Long Term and Post-Acute Care</h3><p>Diversity presents unique opportunities and challenges in health care settings. Providers must appreciate that residents have distinct health risks, chronic disease burdens, cultural health beliefs, and barriers to accessing care, such as language or socioeconomic disparities. Additionally, cultural traditions often influence how families manage aging, caregiving, and end-of-life decisions. Thus, we must prioritize culturally competent care and develop policies that promote health equity for older adults across all racial, ethnic, and cultural groups. A resident is much more likely to trust a provider who respects their culture, values, and practices. </p><h3>Challenges in Meeting Diverse Needs</h3><p>Racial disparities can lead to several challenges: cultural incompetence, implicit or unconscious biases, a lack of trust because residents may feel less comfortable with care staff who do not share their cultural background, and health disparities. Studies have shown that Black residents often receive lower quality care than white residents, especially in the areas of pain management, pharmaceutical intervention, and end-of-life care.<sup>2</sup> Here are some other challenges:<br></p><ul><li>Language barriers: Residents may struggle to communicate symptoms, understand diagnoses, or follow treatment plans. </li><li>Health literacy: Residents may misunderstand medical instructions, refuse preventive care, or manage chronic conditions poorly. </li><li>Cultural misunderstandings: Differences in beliefs about health, health practices, or even values may give a false impression of residents’ needs or behaviors. </li><li>Implicit or explicit biases: Biases can greatly affect clinical decision making and interactions with residents. </li></ul><h3>Barriers to Accessing Care for Underserved Populations</h3><p>Underserved populations, based on socioeconomic status, race, ethnicity, and geography, face significant barriers when accessing health care, contributing to persistent health disparities. Tackling health equity helps shrink these disparities and improves public health across the board for everyone. Barriers may include the following:<br></p><ul><li>Social determinants of health: Unstable housing, poverty, insufficient food, and lack of education directly impact health, and potentially access to care. </li><li>Financial barriers: Lack of insurance or being underinsured combined with high out-of-pocket costs makes health care unaffordable and discourages individuals from seeking care. </li><li>Geographic barriers: Underserved urban or rural areas may have only a few health care facilities and providers, and lack of transportation further restricts access. </li><li>Systemic barriers: Complicated health care systems and lengthy wait times can deter care-seeking. </li></ul><h3>Role of Caregivers and Strategies for Improving Cultural Competence and Equity</h3><p>Ensuring fair and equal access to quality care for all residents requires addressing both systemic barriers and individual needs. Providers must recognize factors such as income, housing, transportation, and lack of food and collaborate with community resources to address these challenges. They should ensure that residents with physical disabilities have accessibility and those in rural or underserved areas know how to leverage telehealth. They can track health outcomes using demographics to identify gaps in care and use the data to guide quality-improvement initiatives. In addition, they can involve residents in care planning to make sure treatments meet both their preferences and their needs. <br></p><p>Increasing racial diversity in health care workers will lead to more culturally competent care naturally and can aid in better health care outcomes with lower mortality rates for underserved populations. However, a health care team, whether diverse or not, needs cultural competence training to collaborate effectively and address the needs of residents. Training helps providers avoid misunderstandings and recognize implicit biases and stereotyping. It also improves the ability to tailor care to meet each resident’s unique needs and thus increases satisfaction. Education opportunities should be ongoing and incorporated through workshops, webinars, and professional development opportunities. <br></p><p>Training programs should include these elements:<br></p><ul><li>Cultural awareness training to help providers recognize their own biases and understand how cultural differences impact health care interactions.</li><li>Communication skills that focus on techniques for surmounting language barriers, such as using interpreters and culturally appropriate communication styles.</li><li>Diversity education to provide insights into the health beliefs, traditions, and needs of various cultural groups.</li><li>Role playing or case studies to offer practical real-world scenarios to apply cultural competence concepts in clinical practice.</li><li>A health-equity focus to emphasize addressing barriers and social determinants of health.</li></ul><h3>Conclusion</h3><p>By understanding and respecting cultural differences, using simplified communication and visual aids, and providing clear, culturally appropriate materials, health care providers can better address health disparities and improve resident outcomes. Strategies such as staff training, tracking and addressing gaps in health outcomes, interpretation services, and inclusive care practices help build an environment where all residents feel understood and valued. Cultural competence and health equity can help reduce the number of preventable health conditions and hospital readmissions, and their associated costs, benefiting both residents and facilities.</p><h4><img src="/Issues/2025/Spring/PublishingImages/Lauren-Stenson.jpg" class="ms-rtePosition-2" alt="Lauren Stenson" style="margin:5px;" />References<br>1. Centers for Medicare & Medicaid Services. (2024). <em>State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities.</em> <a href="https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf</a> <br>2. Schoenthaler, A., & Williams, N. (2022). Looking beneath the surface: racial bias in the treatment and management of pain. <em>JAMA Network Open 5(6): e2216281.</em> <a href="https://doi.org/10.1001/jamanetworkopen.2022.16281" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://doi.org/10.1001/jamanetworkopen.2022.16281 </a></h4><p><em>Lauren Stenson, MSN, RN, CNDLTC, QCP, DNS-CT, is a curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).<br></em></p><p style="text-align:center;"><em><br></em></p><p style="text-align:center;"><em><img src="/SiteCollectionImages/logos/AAPACN.jpg" alt="" style="margin:5px;width:100px;height:28px;" /><br></em></p>	The growing diversity of the aging population puts a focus on increasing cultural competence and reducing health disparities.	2025-03-10T04:00:00Z	<img alt="" src="/Issues/2025/Spring/PublishingImages/caregiving-2.jpg" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
Leadership Helps Quality Award Applicants Deliver Excellence	https://www.providermagazine.com/Issues/2025/Spring/Pages/Leadership-Helps-Quality-Award-Applicants-Deliver-Excellence.aspx	Leadership Helps Quality Award Applicants Deliver Excellence	<p><img src="/Issues/2025/Spring/PublishingImages/QA.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />For long term care organizations, the AHCA/NCAL Quality Award journey is like running a marathon. It takes some training and a while to hit your stride. It takes planning and pacing. However, ultimately, it’s well worth the effort, and mile after mile, applicants and award recipients alike gain quality improvement tools, knowledge, and strategies that make their organizations and their teams stronger, more effective, and more resilient. </p><h3>Examiners Attest: Leadership Matters</h3><p>Each year, hundreds of long term care professionals are selected to serve as examiners of the Quality Award’s Silver and Gold-level applications. They gain a keen understanding of what it takes for facilities to achieve excellence. Key to the Quality Award Program is leadership on the part of the applicants, say examiners, who keep organizations moving forward and help them over the hurdles they may encounter along the way. This leadership really starts and ends with communication and teamwork. <br></p><p>“Leadership plays an important role by creating a shared vision and better employee engagement,” said Brooke Francis, executive director at CommuniCare Health Services in West Virginia and a Silver examiner, adding, “It improves communication, engagement, and overall productivity.” <br></p><p>Allan Engelauf, Gold examiner and administrator of Vista Pacifica Convalescent in California, observed, “Leadership really begins with clearly defining the organization’s vision, mission, and values and how they will be realized and communicated to staff, customers, and partners.” <br></p><p><img src="/Issues/2025/Spring/PublishingImages/Greg-Leoce.jpg" alt="Greg Leoce, RN" class="ms-rtePosition-1" style="margin:5px;" />For applicant facilities, successful leaders are the eyes and ears of their organizations. As Gold examiner Gregory Leoce, RN, DNP, NHA, LHRM, RAC-CT, vice president of clinical services at Facility Support Company in Florida, “Being a leader in an organization requires you to understand all parts of the operations and your people and bring them all together to reach a common goal.” <br></p><p>Leadership requires flexibility and the ability to admit where there are gaps or issues. “Just because we have done something for a very long time doesn’t necessarily mean that’s the way we should keep doing it,” said Robin Nicholson, executive director at Holly Residential Care Center and director of quality for Ohana Ventures in addition to serving as a Silver Quality Award examiner. <br></p><p>She added that leaders are efficient time managers as well. “I’ve learned through the Quality Award process the importance of every action I spend my time on having purpose and driving the organization to the results we are trying to achieve. The most limited resources we have are time and energy, and they are too valuable to waste.” She noted “The role of leadership in an applicant organization is huge. It’s like the bow that ties everything together and makes sure everything is aligned and shares the most significant vision.”<br></p><p>Examiners go through rigorous training, and many start out as applicants and award recipients themselves. Therefore, they know the process and the importance of leadership in successfully going through the awards process. They experienced for themselves the value of the Quality Award journey and are passionate about helping others on their quality improvement path. <br></p><p>“Being an examiner enables me to uphold the standards of the Quality Award Program,” said Engelauf. As a Gold Award recipient, he noted, “Selecting other recipients is an honor, and it’s a great opportunity to help other providers in their quality improvement efforts.” <br></p><p>Leoce was introduced to the Quality Awards program in 2011 and became an examiner a few years later. He said, “I just really enjoy the program. I love the Baldrige criteria and what they can do for skilled nursing facilities and the quality improvement process.”<br></p><p>Francis, who is not only an examiner but has been through the Bronze and Silver application processes multiple times, said, “I did find it a little bit intimidating at first, but it’s become very near and dear to my heart.” </p><p>Nicholson, who became an examiner in 2024, saw the awards as groundbreaking when she first heard about them. “I wasn’t an administrator then, but I knew it was something that I wanted to try to pursue with a community once I got into that administrator role,” she said. Through her efforts, her current organization has so far pursued and received the Bronze and Silver awards. Nicholson takes her role as an examiner seriously, saying, “We have the opportunity to share feedback with applicants to help them look at their approaches and processes in a different way so they can achieve the award and move forward in their quality improvement journey.”</p><h3>Resident and Staff Recognition Take Center Stage</h3><p>Some of the highest performing Quality Award applicants have similar focuses on how they value residents and staff. For example, Engelauf said, “We went to a building last year that had some unique employee recognition processes, including a daily meeting between shifts where team members can recognize their peers. It really creates a culture of respect and teamwork in the building.” <br></p><p><img src="/Issues/2025/Spring/PublishingImages/Brooke-Francis.jpg" alt="Brooke Francis" class="ms-rtePosition-2" style="margin:5px;" />Francis said, “There was one organization that I went to for a site visit where they actually had purchased a house that was right next to the facility, and they used it to house employees who were perhaps staying over to work double shifts or who needed a place to stay temporarily because of something that had happened in their lives.” At another facility, they dedicated a room as a cafeteria with meals for staff. <br></p><p>Facilities implementing innovative ideas like these serve as a role model for others nationwide, said Leoce. He added, “It also makes a difference when organizations not only survey employees but take their input seriously and act on it.” <br></p><p>Francis said, “I’ve seen other organizations where every morning the whole team goes out and greets every resident and every employee. I think that makes a big difference when your residents and employees alike feel recognized and valued.”</p><h3>“Aha” Moments and Eye-Opening Innovations</h3><p>Early in his involvement with the Quality Awards, when he was an applicant, Leoce had an “aha” moment when he realized that successful quality improvement was aligned with the Baldrige Criteria, on which the award program is based. These criteria are organized into seven categories: leadership, strategy, customers, measurement/analysis/knowledge management, workforce, operations, and results. These elements enable health care organizations to achieve and maintain high levels of safety, loyalty, and positive outcomes. Leoce said, “It’s quite common in the skilled nursing industry that few people have had exposure to the Baldrige Criteria or know a whole lot about them. When they get into the program and learn more, they realize how effective they can be in process improvement.”<br></p><p>Nicholson said, “One approach that our company has taken is to identify Administrator in Training (AIT) candidates and grow them alongside experienced administrators who are actively pursuing various levels of the Quality Awards. We’ve been able to not only teach the role of the administrator but also approach this training from a Baldrige perspective early on. It’s like being baptized in a culture of quality, allowing our organization to produce next generation leaders who can lean on a skillset of process, evaluation, and improvement skills that will help them be a better leader, no matter what job they end up in throughout their career.” <br></p><p>She added, “This last year, we have internally grown three AIT candidates who trained under three different administrators who were award recipients and active applicants for this next award cycle. Over the course of a year, all three of these AITs participated in the Quality Award process.”</p><h3>Lessons Learned; Innovations Uncovered</h3><p>Examiners learn much from their efforts, as well as their own Quality Award journeys. Among their insights:<br></p><ul><li>“Rather than just submitting an interesting narrative, some applicants will use charts, graphs, and flow charts that really help the examiners see the flow of their progress,” said Engelauf. These can paint an illuminating picture of their quality improvement efforts and their results. </li><li>Facilities that reach the Gold Award level have staff, including front line caregivers—who can speak to quality improvement. This is part of a culture that is embedded throughout the building, </li><li>said Leoce.</li><li>The Quality Award Program has become something like the Oscars for long-term care. As Leoce said, “It’s one of the most prestigious awards to get in the industry. People know the awards take a lot of work to achieve, but they are willing to put in the effort and are quite proud to receive the award.” It’s much more than just a plaque on the wall, he stressed, noting that award recipients showcase their achievement and celebrate it with residents, families, and staff. </li><li>Nicholson noted that she is seeing more facilities celebrating diversity among residents and the workforce. “We are celebrating different heritages and cultures, and this provides such an opportunity for us to widen our perspective in terms of what makes us unique,” she said.</li><li>As facilities go through the award application process, they are going to see where there are gaps and areas where they are not performing as well as they could. This should not discourage people; instead, it presents opportunities. Nicholson offered, “Don’t get caught up in the negative and forget to celebrate the positive, and vice versa. You have to look at your data in a way that lets you analyze your performance over time. You should take a 30,000-foot view to see how and where you’ve improved and where there are additional opportunities for improvement.” </li></ul><p>The Quality Award Program is structured in a way that lets applicants see their progress and clearly envision where they want to go and how they will get there. Francis said, “You start your journey with the Bronze, which enables you to recognize where you’re going. I’m not saying it’s a cake walk, but it’s a basic and practical first step on your journey.” <br></p><p>The path becomes even clearer as applicants pursue the Silver Award. “When we were headed for the Silver, I started compiling raw data, and I could see opportunities to put processes in action that we need to achieve greater quality and better resident and staff safety and satisfaction,” she observed, adding, “As you develop action plans, you’re able to see successes and how you are progressing.” At the same time, she said, “Throughout the process you have to look at things critically and recognize your flaws and imperfections—both as a leader and an organization.”</p><h3>It’s About the Journey . . . As Well As the Destination</h3><p>While receiving a Bronze, Silver, or Gold Quality Award is the ultimate goal, there is much to be gained by going through the application process. As Engelauf said, “It’s quite rewarding and reinforcing to put down on paper what you are doing and having this documentation of what you’re doing right and your efforts at quality improvement.” It is important to share this information with the whole team, he stressed, and to give them some ownership in the process.<br></p><p><img src="/Issues/2025/Spring/PublishingImages/Nicholson.jpg" alt="Robin Nicholson" class="ms-rtePosition-1" style="margin:5px;" />Even in organizations that have a strong track record of quality, the Quality Award journey is productive. Nicholson noted, “I run a facility that has a focus on traumatic brain injury, which is a unique demographic within long term care. We were doing well, but the Quality Award process enabled us to really lay the groundwork for a systems approach. We had the opportunity for a team of people that already seemed to really have buy-in and wanted to strive for that level of excellence but could benefit from a strong systems approach.” <br></p><p>Of course, even after an organization receives the Gold Award, their journey isn’t over. There is a need, said Engelauf, to routinely look at your processes, evaluate and analyze data, and evaluate your efforts as part of continuous quality improvement. Leoce added, “Quality improvement efforts should never stop. There are always going to be opportunities for quality improvement, but once you have good processes in place and have engaged the Baldrige Criteria, you are better equipped to address the gaps and get over any hurdles you encounter.”<br></p><p><img src="/Articles/PublishingImages/headshots/JoanneKaldy.jpg" alt="Joanne Kaldy" class="ms-rtePosition-2" style="margin:5px;width:175px;height:219px;" />The Quality Award journey is “truly a rewarding experience,” said Engelauf, adding, “Once you go through the process as a leader, you’re better able to help your teams navigate the challenges that come.” <br></p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em><br></p>	Quality Award examiners have a front-row seat to see how leadership is critical in the application process.	2025-02-10T05:00:00Z	<img alt="" src="/Issues/2025/Spring/PublishingImages/QA.jpg" style="BORDER:0px solid;" />	Quality Awards	Quality Awards
Trends in Hospital Referrals to SNFs	https://www.providermagazine.com/Issues/2025/Spring/Pages/Trends-in-Hospital-Referrals-to-SNFs.aspx	Trends in Hospital Referrals to SNFs	<p><img src="/Issues/2025/Spring/PublishingImages/BTN%20PrvSpr25.jpg" alt="" style="margin:5px;" /></p>	With many SNFs having to limit admissions, hospitals continue to have challenges with discharging patients to receive post-acute care.	2025-03-10T04:00:00Z	<img alt="" src="/Issues/2025/Spring/PublishingImages/BTN.jpg" style="BORDER:0px solid;" />	Readmissions	By the Numbers

Finding Solutions for the Booming Long Term Care Population

https://www.providermagazine.com/Issues/2025/Spring/Pages/Finding-Solutions-for-the-Booming-Long-Term-Care-Population.aspx

Finding Solutions for the Booming Long Term Care Population

<img src="/Issues/2025/Spring/PublishingImages/Silver-Tsunami.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Every day 10,000 baby boomers turn 65, according to U.S. Census data. The baby boomer generation began turning 65 in 2011 and will continue to add 10,000 each day through 2030. The number of older adults will more than double over the next several decades to top 88 million people and represent over 20 percent of the population by 2050, according to a 2019 report from AARP. This silver tsunami of aging individuals will have a ripple effect through U.S. society, impacting industries across the nation. One of the most affected sectors will be the long term care profession. This rapid increase in older adults will create challenges and opportunities for the long term care profession over the next few decades. In addition to having more older individuals, people are living longer—between 2022 and 2040, the number of people who are 85 or older will more than double, according to the “Aging in the United States” report to Congress in May 2024. <h3>Demand for Senior Care Facilities</h3>The long term care profession has been aware of this coming demographic shift for years and will need to provide solutions in several main areas. First and foremost is availability. Demand strongly outpaces supply and will continue to widen as the baby boomers age. This demand is a business opportunity for those operating senior living, assisted living, and skilled nursing facilities. In addition to expanding and modernizing facilities, new locations will need to be built and staffed. This has led to innovation in construction methods to meet the rising need for space. Tino Popescu, vice president of clinical services at Maplewood Senior Living, said some states, such as Texas, California, and Florida, may each need more than 250 new nursing homes by 2030 to maintain current population-to-nursing-home ratios. <img src="/Issues/2025/Spring/PublishingImages/Tino-Popscu.jpg" alt="Tino Popescu" class="ms-rtePosition-2" style="margin:5px;" />“However, staffing shortages, rising labor costs, and high construction expenses constrain growth,” Popescu said. “New development remains slow, and acquisitions are focused on smaller, distressed assets. Federal policy shifts—particularly in Medicaid reimbursement—will be critical in shaping investment strategies.” “The industry has been trying to solve this by creating less expensive construction,” Zach Bowyer, MAI, MRICS, executive managing director, Cushman & Wakefield, said. “For example, hotel conversions can reduce real estate costs.” Developers sense the need to move quickly and efficiently in building structures to serve this population, according to BKV Group’s Senior Housing Practice Leader, Grant Warner. “Some are shifting toward prototype construction that saves time and money,” said Warner. “Some are also focusing on much-deserved areas such as suburbs, exurbs, rural communities, and urban areas.” Others are developing pre-fabricated housing solutions to save time and money. Despite increased demand, growth in new senior housing options is at one of the lowest levels in recent history, according to Anne Hill, senior vice president of Bayview, PACE, which provides financing for senior living and long-term care facilities. Like other commercial real estate segments, construction starts have slowed significantly nationwide due to the more expensive financing environment and elevated construction and labor costs. Doug King, vice president emeritus, health care at Project Management Advisors, Inc., said he is confident that existing assisted living communities will be able to scale up, as renovating existing housing stock doesn’t require significant adaptation to become an effective assisted living community. “The need for skilled nursing facilities is another, more complex matter,” King said. “These licensed rooms have technology and other health care features such as telemetry, medical gases, nurse calls, patient lifts, and provisions for patient safety, such as handrails, that are not found in the typical multifamily residential structure.”<h3>Affordability Remains a Primary Challenge</h3>With middle-income seniors projected to double by 2029, over half of this segment will not have adequate finances to afford conventional senior living and care, according to Bowyer. “When you look at housing affordability in the middle markets, half the population can’t afford it,” he said. “We need more solutions on the horizon for the middle market, which is made up of folks who will have a fixed income that doesn't align with some of the more luxurious options, such as teachers, firefighters, skilled trade workers,” according to Shannon Arnold, president, Kara Casa. The number of unpaid caregivers (such as family and/or friends) will on average decrease over the next five years, resulting in the increased need for paid caregiving in an appropriate long term care setting such as assisted living, according to a 2024 article from the National Council on Aging (NCOA). Over 15 million (or roughly one in three) older adults aged 65 and older are economically insecure, with incomes below 200 percent of the Federal Poverty Level said NCOA. Unfortunately, many seniors must spend down their assets in order to qualify for Medicaid to have their long term care covered. (Medicare does not cover long term care.) To qualify for Medicaid, most states require that you demonstrate that you require skilled nursing level care. Not everyone who needs long term care necessarily needs 24/7 support and may have their needs better met in a setting like assisted living. One option is to make assisted living a more affordable option to meet the changing needs of a growing elderly population. Assisted living communities that are 100 percent Medicaid are often built in areas specifically to serve low-income residents. To offer affordable assisted living exclusively requires an entirely different business model and vigorously looking for loans and programs to stay viable. This includes HUD loans, low-income tax credits, and USDA multifamily housing direct loans. Public-private partnerships are needed to identify opportunities and facilitate grant programs or other financing options. <img src="/PublishingImages/Headshots/LBethea.jpg" alt="LaShuan Bethea" class="ms-rtePosition-1" style="margin:5px;width:186px;height:233px;" />Research shows that some seniors will need more affordable assisted living options, as fewer resources and fewer family caregivers will impact the need for and ability to access assisted living care. But the path to getting there faces obstacles. “There are many challenges that need to be addressed in order for assisted living providers to be able to deliver more affordable care options,” said National Center for Assisted Living Executive Director LaShuan Bethea. “How long term care is currently financed, Medicaid underfunding, and essential public-private partnerships—these all need to be considered as we face an increasing senior population that will depend on the high-quality care offered in assisted living sooner than we realize.” <h3>Managing Multiple Conditions</h3>One result of a longer lifespan is that those in the 80+ demographic are also experiencing more health issues. Popescu said it is estimated that 90 percent of adults over age 65 experience one or more chronic conditions requiring specific treatments and medical care. This need to manage multiple conditions has led to an increase in innovations in technology. Technology use has exploded in the long term care profession in the past few decades and will be a critical part of caring for the silver tsunami. Innovations in monitoring and care practices have allowed skilled nursing residents to avoid hospital visits and continue to be managed in the facility. Electronic health records, interoperability, telehealth, and cybersecurity developments have helped move paper records into the electronic age, allowing for greater collaboration and communication, particularly in moving between care locations and physicians. Artificial intelligence is one of the most exciting areas of technology in long term care right now. Whether AI is helping to optimize the use of staff time, monitoring residents to reduce falls, providing companions or enrichment activities, AI is finding its way into the industry in a myriad of ways. “We not only have a rapidly growing number of elders in this demographic group, but many are not aging in healthy ways,” Banta said. “There is tremendous growth in dementia and co-morbidities that will require a vast expansion of acute care resources and housing in this country.” <img src="/PublishingImages/Headshots/DavidGifford_2022.jpg" alt="David Gifford, MD" class="ms-rtePosition-1" style="margin:5px;" />Greater research and development in treatment methods for conditions such as dementia are experiencing greater uptake as well. An estimated 6.9 million Americans age 65 and older are living with Alzheimer’s dementia as of 2024, according to Popescu. This number could potentially grow to 13.8 million by 2060 without medical breakthroughs. Alzheimer’s remains the fifth-leading cause of death among Americans age 65 and older. As a sector, “We have a good history of caring for residents with advanced dementia,” said David Gifford, chief medical officer at AHCA/NCAL. New, neurology-forward approaches to care have shown great promise in helping those with dementia manage these conditions better. <img src="/PublishingImages/Headshots/PaulBergeron.jpg" alt="Paul Bergeron" class="ms-rtePosition-2" style="margin:5px;width:185px;height:185px;" />While the silver tsunami brings challenges with higher numbers of seniors living longer and with more conditions, long term care as a profession is poised to tackle those challenges. New thinking, compassion, and technology—combined with investment, regulatory support, and a focus on workforce—will see the long term care segment growing well into the future. Paul Bergeron is a freelance writer based in Herndon, VA.

The first in an article series about the challenges and opportunities the silver tsunami will bring to long term care in the United States.

2025-02-28T05:00:00Z

Assisted Living;Caregiving

Special Feature

Paul Bergeron

52

1

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People On The Move

Senior Vice President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=136	Senior Vice President	<img alt="Michael Bassett, AHCA/NCAL" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Spring/potm_mike-bassett.jpg" style="BORDER:0px solid;" />	Michael Bassett	American Health Care Association/National Center for Assisted Living
Chief Executive Officer	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=137	Chief Executive Officer	<img alt="David Parker, Ciena Healthcare" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Spring/potm_david-parker.jpg" style="BORDER:0px solid;" />	David Parker	Ciena Healthcare
Executive Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=138	Executive Director	<img alt="Jennifer Evans, Juniper Communities" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Spring/potm_jennifer-evans.jpg" style="BORDER:0px solid;" />	Jennifer Evans	Juniper Communities
Vibrant Life Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=139	Vibrant Life Director	<img alt="Samantha Huggins" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Spring/potm_Samanthan-Higgins.jpg" style="BORDER:0px solid;" />	Samantha Huggins	Sage Valley Senior Living
Building Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=140	Building Director	<img alt="Joseph Gutierrez, Sage Valley Senior Living" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Spring/potm_Joseph-Gutierrez.jpg" style="BORDER:0px solid;" />	Joseph Gutierrez	Sage Valley Senior Living

Spring 2025

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People On The Move

‭(Hidden)‬ Stories of Care