| Proactive Decisions about Expanding Services | <p style="text-align:center;"><img src="/Articles/PublishingImages/2026/expanding-services_207Primrose.jpg" class="ms-rtePosition-4" alt="" style="margin:5px;" /></p><p>Service expansion has become one of the most important strategic conversations in senior living and post-acute care. As resident expectations shift, acuity rises, and market pressures intensify, providers are being asked to do more with the campuses they already own.<br><br>In many cases, the opportunity is not to build new, but to rethink what already exists. Underused spaces, outdated layouts, and legacy service models can often be repositioned to support new care lines, stronger resident experiences, and better long-term performance.<br><br>The challenge is knowing which opportunities are worth pursuing. That requires a disciplined look at market realities, resident needs, operational readiness, and the physical environment itself.<br></p><h3>Begin with Market Demand</h3><p>Any decision to expand services should begin with understanding what the market needs. A market demand study can reveal key trends in demographics, referral patterns, competitor offerings, and unmet or unclear resident expectations.<img src="/Articles/PublishingImages/2026/expanding-services_125Hoff17.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:500px;height:320px;" /><br></p><p>Your market demand study will help answer practical questions. Is there rising demand for memory care? Are more consumers seeking lower-cost alternatives to skilled nursing? Is there growing interest in short-term rehabilitation, enhanced assisted living, or hospitality-based amenities?<br><br>In most cases, formal analysis is reinforced by internal indicators such as wait lists, repeated requests from families, or referral relationships that point to consistent and/or unmet demand. When providers ground expansion decisions in measurable need rather than assumptions, they reduce risk and improve the odds that your business strategy will succeed.<br></p><h3>Look Beyond the Wait List</h3><p>Resident need is not identical to market demand, and that distinction matters. A campus may be known for one care model, yet its resident population may increasingly require something different as people age in place and stay on campus longer.<br><br>Communities built around independent living may find growing need for assisted living, memory support, or more flexible post-acute options. Some organizations are also discovering that reducing traditional skilled care beds and transitioning certain areas to lower-acuity residential models can better match family expectations and resident independence goals.<br><br>This type of repositioning can also create environments that feel less institutional and more like home. A careful review of resident profiles, family feedback, care transitions, discharge patterns, and unmet requests can reveal whether the current service mix still fits the people being served.<br></p><h3>Test Operational Readiness</h3><p>Even when a market opportunity is clear, expansion only succeeds if the organization can support it operationally. Adding a new care line requires more than renovating a wing or updating finishes.<br><br>It may involve new staffing models, different clinical workflows, regulatory requirements, training expectations, technology needs, and revised programming. Leaders should ask whether the organization can recruit and retain the right team and whether current systems can support the added complexity.<br><br>Not every market gap should be pursued. In some cases, a modest enhancement such as a bistro, a wellness amenity, or a short-term stay offering may create value without overextending staffing or operations.<br></p><h3>Study the Building’s Potential</h3><p>The physical environment has a direct impact on whether a service expansion can succeed. Existing buildings must be evaluated for code compliance, life safety requirements, circulation, lighting, privacy, and the ability to support the intended level of care.<br><br>Physical feasibility is about more than compliance alone. It is also about creating spaces that support dignity, safety, staff efficiency, and quality of life while still feeling homelike.<br><br><img src="/Articles/PublishingImages/2026/expanding-services_Skaalen-CBRF-res-room-5.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:500px;height:334px;" />A strong example is the renovation of Magnolia Gardens at Skaalen Retirement Services, a specialized, memory care community-based residential facility on the Skaalen Retirement Services campus in Stoughton, Wisconsin. In this case, an outdated skilled care setting was transformed into a 16-unit community-based residential facility. Double rooms were converted into private rooms with full baths. Lighting and access control were improved, and walls were opened to bring more daylight into interior spaces.<br><br>The renovation also introduced centralized staff areas, a full cooking and serving kitchen, a bathing spa, laundry space, and dual-purpose cabinetry. In order to achieve the desired vision, an analysis of code required changes and how to accomplish them was critical to getting the project approved for the new license. The project shows how understanding building licensing requirements can result in thoughtful solutions that are realistic to existing conditions; it can reposition a building for a different, more relevant care model.<br><br>Existing conditions may limit the possibilities for re-purposing spaces—it is better to understand this up front as you begin planning to avoid headaches down the road.<br></p><h3>Build the Strategy Across Disciplines</h3><p>The most effective expansion efforts are rarely led by one department alone. They come from collaboration among leadership, nursing, facilities, operations, and frontline staff who understand how residents actually experience the campus.<br><br>In the Magnolia Gardens project, staff from multiple departments contributed insight that helped the design respond to real and honest irritations, unmet workflow needs, and challenges to serving residents well. That kind of input is not a nicety; it is a practical way to reduce risk and improve implementation which leads to a healthy business model and ultimately a better bottom line.<br><br>When organizations engage stakeholders early, they are more likely to identify hidden barriers, avoid costly redesigns, and create solutions that work in daily practice rather than only on paper. That is often the difference between a compelling concept and an executable strategy. Deliberate and careful planning can pay dividends for the owners and for the residents. Upfront planning is one of the most important indicators of future success. <br></p><h3>Turning Capacity Into Capability</h3><p>Service expansion should never be a reactive move based on empty square footage or competitive pressure. The strongest strategies emerge when leaders evaluate market demand, resident need, operational readiness, and physical feasibility together. When those factors align, campuses can evolve in ways that are strategic, financially sound, and mission aligned.<br><br><em>Jon Rynish is a senior project architect with with <a href="https://www.hoffman.net/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Hoffman Planning, Design & Construction, Inc.</a> and a Leadership in Energy and Environmental Design (LEED) accredited professional. He can be reached at <a href="mailto:jrynish@hoffman.net" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">jrynish@hoffman.net.</a></em><br><br><em>Mike Edwin is a senior consultant – senior living and religious markets with Hoffman Planning, Design & Construction, Inc. He can be reached at <a href="mailto:medwin@hoffman.net" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">medwin@hoffman.net. </a></em><br><br><em>Julie Heiberger is a senior project architect and the senior living market leader for with Hoffman Planning, Design & Construction, Inc. A member of the American Institute of Architects, the National Council of Architectural Review Boards, and the Board of Directors of the Society for the Advancement of Gerontological Environments, Julie can be reached at <a href="mailto:jheiberger@hoffman.net" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">jheiberger@hoffman.net</a>.</em></p><p style="text-align:center;"><em><img src="/Articles/PublishingImages/2026/Jon-Rynish.jpg" alt="Jon Rynish" style="margin:5px;" />     <img src="/Articles/PublishingImages/2026/Mike-Edwin.jpg" alt="Mike Edwin" style="margin:5px;" />     <img src="/Articles/PublishingImages/2026/Julie-Heiberger.jpg" alt="Julie Heiberger" style="margin:5px;" /></em></p><p style="text-align:center;"><em><br></em></p><p style="text-align:left;"><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#212121;">Provider<em> magazine includes information from a variety of sources, such as contributing experts. The views expressed by external contributors do not necessarily reflect the views of </em>Provider<em> magazine and AHCA/NCAL.</em><span class="Apple-converted-space"> </span></span><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#96607d;"><a href="/About/Pages/Submit-Article.aspx" target="_blank" title="https://www.providermagazine.com/About/Pages/Submit-Article.aspx" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" style="color:#96607d;margin-top:0px;margin-bottom:0px;"><span style="text-decoration:underline;"><em>Learn how to submit an article.</em></span></a></span><br></p> | 2026-06-18T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2026/Hoffman.jpg" style="BORDER:0px solid;" /> | Management | Jon Rynish, Mike Edwin, and Julie Heiberger | Service expansion has become one of the most important strategic conversations in senior living and post-acute care. As resident expectations shift, acuity rises, and market pressures intensify, providers are being asked to do more with the campuses they already own. |
| What Data Shows About Medication Risk in Long Term Care | <p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><p>Medication errors remain a persistent and costly challenge in post-acute and long term care (LTC). Estimates suggest that between 16 percent and 27 <span>percent</span> of residents experience a medication error, with as many as one in ten resulting in serious medical complications. Each year, adverse medication events contribute to approximately 800,000 preventable medication-related injuries and more than $4 billion in excess health care costs.</p><p><img src="/Articles/PublishingImages/2026/0626_Guardian.jpg" alt="GuardianShield" class="ms-rtePosition-2" style="margin:5px;width:350px;height:350px;" />The encouraging news is that nearly 40 <span>percent</span> of these adverse events are considered preventable. That raises two important questions for operators: Where are these risks happening? And are they being caught before they reach the resident?</p><p>Insights into these risks are increasingly informed by real-world clinical intervention data—captured as senior care pharmacists review, clarify, and adjust medication orders in the course of daily care delivery in LTC and senior living.</p><p>For many organizations, medication-related harm is still viewed through the lens of downstream events: a missed dose, a survey finding, or a hospitalization. But what this data shows is that most medication-related risk begins much earlier in the process, often during ordering, transitions of care, or routine therapy adjustments.</p><h3>Where Medication Risk Actually Occurs</h3><p>In 2025, Guardian pharmacists documented more than 102,000 clinical interventions, impacting nearly 76,000 residents across LTC, senior living, and other care settings.</p><p>Each intervention represents a potential medication-related issue identified and addressed before it reached the resident, providing a clear view of where risk is most likely to occur in everyday practice.</p><p>That visibility reveals seven key trends:<br></p><ol><li><strong>Ambiguous orders remain one of the most frequent risks</strong>. More than 25,000 pharmacist-led interventions involved order clarifications such as resolving incomplete, conflicting, or unclear orders before dispensing.</li><li><strong>Drug-drug and drug-disease interactions require ongoing oversight.</strong> Nearly 9,200 interventions identified therapies that increased the risk of adverse effects, toxicity, or the need for additional monitoring.</li><li><strong>Dosing issues continue to put older adults at risk.</strong> Approximately 9,100 interventions addressed doses that were too high, too low, or otherwise inappropriate based on the resident’s age, condition, or clinical profile, underscoring the importance of experienced senior care pharmacist oversight.</li><li><strong>Polypharmacy continues to be widespread in practice.</strong> Approximately 9,000 duplicate therapies were identified, highlighting the ongoing need for proactive medication reviews to reduce the downstream effects of overprescribing, especially for residents with complex medication regimens.</li><li><strong>Allergy-related risks still surface despite documentation. </strong>In over 7,300 instances, pharmacists intervened when medications were prescribed that conflicted with a resident’s documented allergies, requiring clarification, therapeutic substitution, or additional monitoring.</li><li><strong>Omissions in therapy continue to occur in practice.</strong> In more than 3,000 instances, pharmacists identified medications that were indicated but not prescribed, requiring follow-up to ensure appropriate therapy.</li><li><strong>Deprescribing remains an important part of medication management.</strong> Nearly 2,600 interventions involved potentially inappropriate or no longer beneficial medications that warranted discontinuation.</li></ol><h3>Where Transitions of Care Create Additional Risk</h3><p>One of the most consistent themes in clinical intervention data is the impact of care transitions. With frequent admissions and transitions, more than 62,000 medication reconciliations—comparing lists from various sources to determine the most accurate medication list—were required.</p><p>Admissions, hospital discharges, and internal level-of-care changes introduce new medication lists, new prescribers, and often incomplete or conflicting information. These transitions require rapid reconciliation and decision-making, frequently under time pressure.</p><p>Medication reconciliation is not a one-time task, but an ongoing process. Each transition creates an opportunity for discrepancies, omissions, or duplications that can affect resident safety and outcomes.</p><p>For post-acute care operators in particular, where shorter lengths of stay and higher acuity are the norm, these risks are amplified. Delays or inaccuracies during transitions can directly contribute to therapy interruptions, survey deficiencies, and hospital readmissions.</p><h3>The Role of Clinical Oversight in Preventing Harm</h3><p>The consistent theme across Guardian’s clinical intervention data is that medication risk is manageable, but only when it is actively monitored.</p><p>Clinical intervention represents the work that happens before a medication reaches the resident. It includes reviewing orders in the context of the resident’s full profile, identifying inconsistencies or risks, and collaborating with prescribers and care teams to resolve issues in real time.</p><p>In practice, this includes:<br></p><ul><li>Identifying potentially inappropriate or duplicate therapies before dispensing.</li><li>Adjusting doses based on resident-specific factors, such as age or medical condition.</li><li>Clarifying incomplete or conflicting orders.</li><li>Reconciling medication lists during care transitions.</li></ul><p>In 2025, these activities accounted for more than 35,000 pharmacist hours dedicated to clinical oversight and collaboration across Guardian’s network of more than 50 LTC pharmacies.</p><h3>From Individual Actions to System-Level Insight</h3><p>Beyond resolving individual issues, clinical intervention data provides operators with visibility into broader patterns of risk.</p><p>Tracking and categorizing interventions allows organizations to:<br></p><ul><li>Identify where medication risks are most likely to occur.</li><li>Understand trends tied to transitions of care or high-risk therapies.</li><li>Demonstrate proactive oversight during surveys and audits.</li><li>Support continuous improvement in medication management practices.</li></ul><p>This shifts medication safety from a reactive process to a measurable component of quality and risk management.</p><h3>What This Means for Operators</h3><p>Medication-related risk in LTC and senior living is not new, but the ability to measure and manage it at scale is.</p><p>For operators, the implication is clear: preventing harm requires more than policies and procedures. It requires consistent, real-time clinical oversight and visibility into where risks are occurring within their communities.</p><p>As staffing challenges, resident acuity, and regulatory expectations continue to increase, this level of insight becomes even more important. Reducing medication-related risk is not only a clinical priority. It directly impacts operational performance, staff workload, survey readiness, and resident outcomes.</p><p>Most medication-related harm is preventable, but only if it is identified and addressed before it impacts the resident.</p><p>To learn more about Guardian’s Clinical Intervention program and the GuardianShield suite of services, visit <a href="https://guardianpharmacy.com/guardianshield/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Guardian Pharmacy">guardianpharmacy.com/guardianshield</a>.</p><p><em><br></em></p><p><em><img src="/Articles/PublishingImages/2026/Bethany-Bramwell.jpg" alt="Bethany Bramwell" class="ms-rtePosition-2" style="margin:5px;" />Bethany Bramwell, RPh, BCGP is a board-certified geriatric pharmacist with 25 years of experience in senior care pharmacy. She currently serves as vice president at Guardian Pharmacy Services. </em></p><p><em>Guardian Pharmacy Services is one of the nation’s largest long term care pharmacy services companies. Through its locally‑based business model, Guardian partners with long-term care and senior living communities to deliver medications and a comprehensive suite of technology-enabled services designed to enhance care and improve clinical outcomes.</em></p><p><em><br></em></p><p><em><br></em></p> | 2026-06-11T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2026/0626_Guardian.jpg" style="BORDER:0px solid;" /> | Clinical | Bethany Bramwell, RPh, BCGP | For many organizations, medication-related harm is still viewed through the lens of downstream events: a missed dose, a survey finding, or a hospitalization. |
| 11 Steps to Improve Discharge Planning | <p><img src="/Articles/PublishingImages/740%20x%20740/dr-clipboard.jpg" class="ms-rtePosition-2" alt="doctor discharge" style="margin:5px;width:350px;height:350px;" />One aspect of nursing home operations that I have seen that could be
improved is discharge planning. It seems that once a discharge is being
initiated, we do that quickly in an effort to reduce workload. Discharge
planning represents many opportunities that many facilities do not take
advantage of in many different aspects. With that in mind, I would like
to offer or share the following points you may want to consider in your
discharge planning process.<br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">1.</strong> First, your interdisciplinary
team (IDT) should be conducting an IDT discharge meeting with the
resident and their responsible party ahead of the actual discharge date.
A specific date and time should be set ahead of time that everyone can
agree on. I also encouraged the IDT whenever possible to plan discharges
right after breakfast. Keep in mind that the business office bills for
date of admission but does not bill for day of discharge. Many
facilities wait until late into the afternoon to facilitate discharges.
When this happens, you are essentially providing free care throughout
that day. These expenses add up over time and include staff time, food,
supplies, rental equipment, etc. that you will not be able to bill. I
know in some cases this may not be possible, but our IDT would make
every effort to discharge residents after breakfast.<br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">2. </strong>Another
area that I would focus on is keeping a precise record of all rental
durable medical equipment (DME) that you are using to meet patient care
needs. I have seen many instances where accurate records are not
maintained and equipment gets lost or misplaced, which then you become
responsible for. I have walked by many resident rooms several days after
a discharge, and there is rental equipment still left in the room. All
rental equipment should be immediately removed from the room after a
discharge has occurred. From a financial standpoint, you are better off
purchasing this equipment rather than leasing. The lease costs will add
up considerably, and you can avoid this expense by purchasing this
equipment. <br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">3.</strong><span class="ms-rteForeColor-8"> </span>Before the resident leaves the facility, make sure
you have some boxes and plastic bags to pack up their belongings. Your
staff should be using a Resident Belongings Inventory to check off the
resident’s items that were brought in at admission. I would also highly
recommend purchasing a hotel luggage cart to transport the resident’s
belongings to their vehicle. <br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">4. </strong>For skilled nursing admissions, I
would recommend a follow-up call by the IDT within 30 days from the
date of discharge. In some situations where a resident may be struggling
at home and needs more care, you can bring that residents back into
your facility without a qualifying hospital stay and continue their
Medicare benefits unless they have been exhausted. I would also ask the
admission and business office to identify a secondary payer source for
short-term admissions in case their stay is longer than expected. This
should be done prior to or at admission. Your social services director,
therapy director or nurse case manager would be appropriate to follow
up.<br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">5.</strong> If you operate a skilled distinct care unit, it is very
important that long term care residents are not occupying these short
stay rooms. I would also encourage keeping private rooms open for
residents with highly complex care. Again, you do not want to tie up
your private and skilled beds with long term care residents. These beds
need to be available for skilled admissions.<br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">6.</strong> One aspect of
discharge planning that is vital in obtaining timely feedback from
residents who are in the process of being discharged is the completion
of a Resident Discharge Satisfaction Survey. I assign my social services
coordinator to initiate this survey during the IDT discharge meeting
with the resident and their family. This feedback evaluates the
resident’s overall stay and whether they would recommend others to your
facility. It also identifies any issues that could be resolved before
the resident leaves your facility. I would also double check to see that
there are no outstanding grievances that may still be unresolved.
Survey teams will ask to see your grievance logs so this should also be a
facility priority at discharge. This can also be a part of your QAPI
process. <a href="/Articles/Documents/discharge_survey_Trangsrud.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Resident Discharge Satisfaction Survey">Here is one example of a survey.</a> </p><p><strong class="ms-rteFontSize-3 ms-rteForeColor-8">7.
</strong> When your IDT meets to facilitate a discharge, make sure that a timely a
NOMNOC (Notice of Medicare Non-Coverage) is issued and signed by the
resident or responsible party. I have seen many instances where this was
not done and potentially puts the facility in a liable situation. This
means that the claim could be denied and the facility becomes
responsible for the cost of care for that resident for their entire
stay. Make sure you also have a trained back-up to assist with this
process. <br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">8.</strong><span class="ms-rteForeColor-8"> </span>From a marketing standpoint, I used a facility
newsletter to continue building on the relationship with discharged
residents. Facilities make significant efforts up front to build your
census, but keep in mind that many of the residents you discharge could
become repeat customers. It is vitally important to retain that
relationship that everyone has worked so hard to build. An electronic
quarterly newsletter is easy to do. At the time of admission, I would
ask for resident or family email addresses to build a list to use for
your facility communications. If you are looking to use resident
pictures or testimonials for marketing purposes, make sure you get the
required authorizations beforehand. These newsletters can also be sent
to other referral sources such as discharge planners, case managers,
social workers, and physicians. <br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">9.</strong> One thing to keep in mind,
especially with HMO and insurance payors, is that they will try to
discharge a resident too early, especially if they have Medicaid as a
back-up payor. If this happens, be prepared to file appeals on behalf of
the resident, especially if they are still receiving skilled services
during their stay. If you do not appeal, you will be paid at the
Medicaid rate while providing extensive nursing and therapy services.
You will need the resident’s approval to appeal any inappropriate or
early discharge. <br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">10.</strong> To facilitate a safe and appropriate IDT
discharge, I would also recommend a comprehensive discharge checklist to
ensure a smooth transition. Many long term care software programs have
discharge checklists that can be customized to your facility.<br><br><strong class="ms-rteFontSize-3 ms-rteForeColor-8">11.</strong>
Lastly, I would send the resident or responsible party a thank-you
letter for considering and choosing your facility for their care needs.
This is a good way to build more goodwill and further your relationship
with discharged residents and family members. <br><br><em><strong><img src="/Articles/PublishingImages/headshots/Mark-Trangsrud.jpg" alt="Mark Trangsrud" class="ms-rtePosition-2" style="margin:5px;" />Mark Trangsrud </strong>is
a retired skilled nursing home administrator with over 41 years of
experience. He has been licensed in 8 different states as a nursing home
administrator as well as serving on the South Dakota and Colorado
Health Care Association Boards. He can be reached at </em><a href="mailto:Metrangsrud57@msn.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="email Mark"><em>Metrangsrud57@msn.com</em></a><em>.</em></p><p><em><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#212121;"><br></span></em></p><p><em><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#212121;">Provider<em> magazine includes
information from a variety of sources, such as contributing experts.
The views expressed by external contributors do not necessarily reflect
the views of Provider magazine and AHCA/NCAL.<span class="Apple-converted-space"> </span></em></span><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#96607d;"><a href="/About/Pages/Submit-Article.aspx" target="_blank" title="https://www.providermagazine.com/About/Pages/Submit-Article.aspx" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" style="color:#96607d;margin-top:0px;margin-bottom:0px;"><em><span style="text-decoration:underline;">Learn how to submit an article.</span></em></a></span></em></p> | 2026-06-04T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/dr-clipboard.jpg" style="BORDER:0px solid;" /> | Caregiving | Mark Trangsrud | Improve nursing home discharge planning through better coordination, financial management, resident satisfaction, and follow-up care. |
| Telehealth That Works: Protecting the Progress We Make In Care | <p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><p style="text-align:center;"><img src="/Articles/PublishingImages/2026/iStock-1316204932.jpg" alt="" style="margin:5px;width:500px;height:333px;" /> </p><p>My mother is in long term care (LTC).</p><p>When I show up to work every day, I'm not working from theory. I know what it feels like to trust a facility with someone you love. I know what families are watching for. After more than 30 years in health care, from the emergency department to community-based care to where I sit now, I also know how often the system makes that trust harder to earn than it needs to be.</p><p>The core challenges haven't changed much, even as our technology has improved.</p><p>Coordination of care, collaboration among the providers delivering it, and communication of what's happening and when.</p><p>Three things that sound straightforward until you're managing a resident with several chronic conditions, a multitude of specialists adding orders, and a call light going off at 2 a.m. when there’s no clinician in the building.</p><p>That's the reality most skilled nursing teams are navigating, and it's the reality Lumina Care addresses on a daily basis.</p><h3>When Facilities Require the Most Assistance </h3><p>Overnight hours often leave skilled nursing facilities (SNFs) most exposed. There are fewer staff, clinical support can be limited, and the response we see too often is to transfer the resident to the ER.</p><p>This occurs not because it’s the best clinical decision, but because an overnight provider might not know the resident or have access to their complete medical picture.</p><p>The residents most affected are also the most complex. The average LTC resident is managing five to seven chronic conditions. Many are seeing multiple specialists: cardiology, pulmonology, behavioral health, wound care, etc., each with their own care plan. In rare instances, these care plans are well coordinated and well communicated.</p><p>When there is an acute change overnight, on-site staff do their best to deliver coordinated care, but it’s a challenge. </p><h3>What Telehealth Can Actually Do</h3><p>There are still skeptics, and I understand why. "Telehealth" gets used loosely, and passive remote monitoring (data collection and flashy apps with no real-time clinical response) isn't the same thing as delivering actual care via telehealth.</p><p>This distinction matters.</p><p>Telehealth means a clinician on the other end of a screen who can conduct a visual assessment, respond to an acute need, adjust a care plan, and document directly into an electronic medical record (EMR). It means having someone available when a patient needs clinical care and then sharing the information amongst providers.</p><p>I think about a major winter storm we navigated not long ago. Providers couldn't physically get into facilities, but phone lines were up, Wi-Fi was working, and we were there—remotely.</p><p>We managed acute needs, monitored residents, and kept facility teams from worrying about transfers that would have been a logistical nightmare. Telehealth didn’t replace anyone. It made vital care delivery possible during a weather emergency.  </p><h3>The Outcomes That Earned Our Confidence</h3><p>We're careful about the claims we make. What I can tell you is what we've seen and documented.</p><p></p><p>In a SNF partnership with a multi-state operator running our After-Hours Telehealth and Transitional Care Management programs, we saw hospitalization rates among facilities come in under 2 percent That means 98 <span>percent</span> of patients were safely treated in place.</p><p>For context, the industry average for SNF hospitalizations without this kind of coverage runs around 20 <span>percent</span></p><p>On the transitional care side, readmission rates dropped by 50 <span>percent</span> within five months, and we’re continuing to work with each facility on an individual level to improve our coordination even more</p><p><br></p><p style="text-align:center;"><img src="/Articles/PublishingImages/2026/Lumina_AHTH_Graph_v01.png" alt="Chart: Hospitalization Rates with AHTH" style="margin:5px;width:450px;height:450px;" /> </p><p> <br>Those numbers reflect something we've come to believe deeply: continuity across settings is what determines whether the progress a resident makes in a facility holds.</p><p>The transition home isn't the finish line. It's the moment that requires the most coordination, the most follow-through, and frankly, the most investment in everything the clinical team worked so hard to build.</p><h3>What Being Part of the Team Actually Looks Like</h3><p>Every Lumina Care partnership begins with a clinical facility assessment. We sit down with leadership at both the corporate and building levels to understand how we can collaborate to assist in care delivery in each facility. That assessment shapes every care plan we develop, so that when we place an order after hours, it can be fulfilled on site. We understand the facility’s capabilities and verify our plans of care align with capabilities and the resident’s goals of care.</p><p>We also work on the operations side to make sure our clinicians have full visibility across EMRs. The EMR access allows our teams to review existing care plans, specialist notes, prior hospitalizations, and goals of care before interacting with any resident. We enter orders directly and have daily follow-up reports that are delivered to the facility and the primary care provider. This way, we’re confident everyone involved in a resident’s care delivery is in the loop.</p><p>Our Lumina360 dashboard gives facility leaders a real view of their residents. At a glance, they can easily see action items that need attention, simplifying compliance and care management.</p><p>I'm often asked whether we're there to replace anyone. The answer is no, and I mean that plainly. We're an additional set of eyes. We are here to help!</p><p>Lumina Care’s goal is to be an extension of the care team, treat residents in their home when able, help primary care providers with their patients, and assist with safe transitions home. Long term care is full of amazing people. We don’t want to replace the people who know the residents and facilities, we simply want to collaborate to assist in necessary care delivery.</p><h3>The Organizations That Will Lead</h3><p>When I think about where skilled nursing is heading, I keep coming back to something simple: the organizations that will continue to thrive will be the ones willing to ask hard questions about how care is delivered and then act on the answers.</p><p>That's especially true in rural areas, where a facility's ability to offer specialty care can come down to geography as much as resources. Telehealth changes that equation without requiring a complete overhaul of staffing or operations.</p><p>My mother is in long term care. </p><p>The people caring for her are working hard and deserve every tool available to do that well. So does everyone else in care delivery, and Lumina Care is here to help with that!<br><br><em><strong>Laura Geiger</strong> is the Chief Medical Officer at Lumina Care. </em><br><br><em>Lumina Care provides virtual clinical care and operational support to skilled nursing and long term care facilities across the country. Programs include After-Hours Telehealth, Chronic Care Management, Behavioral Health Integration, Collaborative Care Model, Telepsychiatry, Talk Therapy, Transitional Care Management, and the Lumina360 Care Analysis Dashboard.</em><br><br>Learn more at <a href="https://www.luminacare.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Lumina Care">LuminaCare.com</a>.</p><p><br class="ms-rteFontSize-1"></p><p><span class="ms-rteFontSize-1">updated: 6.10.2026</span></p> | 2026-06-03T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/telehealth_woman.jpg" width="740" style="BORDER:0px solid;" /> | Caregiving | Laura Geiger | The biggest challenges in skilled nursing care are not technology gaps, but care coordination, provider collaboration, and communication—especially during overnight hours when staffing and clinical support are limited. |