About 20 years ago, assisted living and other forms of seniors housing evolved specifically to create a nonmedical residential care option for frail older adults. And yet today, a growing number of seniors housing organizations are disrupting the traditional senior living concept by explicitly integrating healthcare into their service offerings.
This trend fits with broader societal shifts: technological acceleration, consumerism and health and wellness. American consumers increasingly want flexibility and individualization in all of their service platforms, including health and housing. Meeting the full spectrum of seniors’ needs will help maintain, protect and preserve the active lives today’s older Americans want.
The good news is that integrating health and housing delivers bottom-line results to seniors housing operators. In fact, an independent analysis of Juniper Communities’ Connect4Life model, which integrates onsite primary care, pharmacy and lab services with social supports and residential care, shows a potential cost savings of up to $15.3 billion for Medicare in hospital inpatient spending (or $4,500 per beneficiary) if applied nationally to a frail population of Medicare beneficiaries similar to Juniper’s resident population.
Integrated health and seniors housing is a team sport
Integration is creating a care delivery system that relies on in-person and technological communication protocols to unify the medical and seniors housing operations. For the resident, it feels like a combination of 24-7 Marcus Welby-like doctoring with a stand-in adult daughter who has the responsibility and the incentive to help.
The critical component is a primary care doctor or nurse practitioner equipped with mobile diagnostic, laboratory and pharmaceutical tools that enable her to monitor and address changes in condition before they lead to an emergency. But also integral to the team are the housing and support services; the aides, LPNs and medical service coordinators (called “medical concierges” in Juniper Community’s Connect4Life model) who function as the system eyes and ears. They stay in constant digital contact with each other and the primary care practitioner. As the housing team supports the functional needs of residents, they also are flagging issues for the medical team and sharing information about individual resident needs.
This team then works together to prevent unnecessary and expensive healthcare utilization, such as polypharmacy, hospitalizations and ED visits, and it relieves family members of shouldering healthcare management duties alone.
In the nearly four years that Juniper Communities has been offering Connect4Life, integration has added value to the organization in three key ways:
1. It increases length of stay.
Since Juniper implemented Connect4Life, the team has seen residents’ average length of stay increase by one month.
Juniper has found that one of the greatest benefits to a seniors housing organization — and to residents —is the delay in move-out or death that occurs because of the improvements in health and functioning that come from the person-centered care that integrated care delivers and the avoidance of hospitalizations that so often lead to long-term nursing home placement or earlier death.
2. It gives consumers what they want.
Juniper’s brand is enhanced by its offering.
Happy customers translate into strong word-of-mouth marketing. Friends and family are the biggest source of move-ins at Juniper.
The Connect4Life program addresses the primary complaint of adult daughters that too much of healthcare coordination and management falls on them — even when they are paying top-tier senior living rates. As one daughter said: “My parents are in the top one percent. We’re paying $60,000 a year. Why am I managing everything?”
3. It gives referral sources what they want.
Juniper recently was sought out for preferred-provider status by Geisinger Health System in Pennsylvania, one of the most sophisticated population health management systems in the country. This status has boosted referrals, especially from area skilled nursing facilities.
On a day-to-day level, increased attention to care transitions and engagement with hospital staff leads to a better working relationship with hospital case managers and discharge planners. In turn, they develop lasting impressions of the higher-quality resident care and are more likely to refer.
On a system level, your referral sources — hospitals, doctors and managed care plans — are looking to reduce expensive healthcare utilization such as preventable hospital admissions and readmissions.
Anne Tumlinson Innovations conducted a study comparing the hospitalization rate of Juniper residents with a benchmark population of similarly frail Medicare beneficiaries and found a statistically significant difference between the benchmark population’s inpatient hospitalization rate of 0.65 and the Juniper reported rate of 0.30. This translates into about $5 million in savings on inpatient spending for Juniper’s resident population and about $12 billion in total Medicare savings if you apply Juniper’s annual per capita savings of $3,640 to the 3.4 million frail Medicare beneficiaries ATI identified as being most similar to the Juniper resident population.
Get more details about the ATI study here.
What integrated care is not
Integrated care does not mean hiring and paying doctors out of your operating budget. Medicare will pay nurse practitioners and doctors fee-for-service to make house calls and perform chronic care management.
Integrating healthcare into housing does not medical-ize assisted living. Primary care practitioners visit residents in an on-site clinic or in their apartments, but otherwise the integration is invisible to residents and their families. In fact, integrated care supports the social model by fostering well-being, which gives people the ability to engage in their lives and enjoy the programs and environment that good hospitality provides.
We should be aiming for giving people the best life we can, and silo-ed healthcare is never good for anyone, regardless of how lovely their living environment is.
More investment among health and seniors housing providers is needed to support such healthcare integration. As Juniper’s experience shows, those who innovate in this manner will be rewarded.
Anne Tumlinson, CEO of Anne Tumlinson Innovations, has more than two decades of research and consulting experience in post-acute and long-term care financing and delivery. She also is the founder of Daughterhood, a website providing information for consumers navigating the health and elder care systems on behalf of their parents.
Lynne Katzmann, Ph.D., is founder and president of Bloomfield, NJ-based Juniper Communities, which invests in, develops and manages senior living and long term care communities. The company has 22 properties in four states and more than 1,600 employees. Juniper had more than $70 million in revenues in 2016.
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