Resident and family satisfaction is critical to retention and reputation for almost every senior living community. Just like no two communities are alike, however, no two residents have the same needs, creating unique challenges for communities.
According to new data from the Centers for Disease Control and Prevention, the number of adults aged more than 65 years who need help with personal care is on the rise. With an estimated 20% of the population reaching 65 years or older by 2030, the long-term care industry will grow significantly in the next 15 years. Although this “aging boom” provides the industry with great opportunity, a number of basic challenges must be resolved for assisted living communities to take advantage of this.
What may seem to be the most basic problems — billing and clinical support — still are considered the most complex by community leaders and staff. By partnering with a long-term care pharmacy that specializes in assisted living, however, communities can overcome these obstacles by using the pharmacy’s unique skills and services.
Medication billing can be one of the most frustrating and confusing areas for residents, their families and community staff, creating a feeling of dissatisfaction. From issues with pre-authorization and noncovered medications to the “donut hole” and 800 numbers, residents experience challenges when trying to resolve problems with their bills. Often, they look to the community staff for help, but this is simply not part of the community’s role or area of expertise. When staff members attempt to help resolve these issues, it takes valuable time away from resident care.
Many of the billing issues, however, could be resolved in advance if the resident’s pharmacy is proactive, removing this burden from the staff. For instance, residents often are prescribed medications not covered by their drug plans. Rather than work with a resident’s physician to resolve this, most pharmacies just fill the prescription, resulting in drugs billed at much higher costs. This creates confusion and frustration when the bill is received.
Moreover, during open enrollment each year, many residents reevaluate their Medicare prescription drug coverage (Part D) plans. Often, decisions to change coverage are made without assistance regarding the best plans available for their particular circumstances. Without an understanding about the timing of the coverage gap (also known as the donut hole), residents and their families often are surprised when they receive bills that are significantly higher than expected.
Regardless of the billing issue, residents and their families frequently musy access an 800 number to remedy the problem. This creates problems for both the residents and community staff. Residents are affected because they rarely are able to talk with the same representative and, therefore, do not have one person to advocate on their behalf. Additionally, lack of payment while waiting for a resolution could keep them from receiving their medications on a timely basis, putting their health and well-being at risk. If medications are not delivered to a resident on time, the community also could be at risk for noncompliance with state and federal regulations.
Assisted living communities are home to hundreds of residents, and each may have their own pharmacy, doctorand medication needs. Because residents are not required to use the same pharmacy due to the right-of-choice mandate, there is no consistency in the packaging or dosing of medications. This makes any existing med pass and med cart audits more time-consuming and difficult, increasing the chance of errors.
Many assisted living residents also arrive at a community with a medication profile that includes prescriptions from multiple physicians. This can potentially affect a resident’s safety, as no one person is responsible to conduct a drug regimen review to manage medications and identify possible adverse drug reactions or polypharmacy issues, a growing concern among the industry and elderly residents.
Additionally, keeping up with the educational needs of the staff can be challenging for communities. While they recognize that well-educated caregivers make fewer mistakes, facilities often experience a high level of staff turnover, so educational needs are ongoing and crucial. If the community is not engaged with a pharmacy that provides this ongoing training, it often has to outsource it, which can be expensive.
Finally, technology has become essential in the LTC setting and can play a tremendous role in the accuracy and efficiency of medication management. Starting with implementation, communities often struggle with selecting the right technology. With so many program options in the market, it’s challenging for communities to research and understand which systems are best to meet their immediate and future needs. Because numerous physicians, vendors and partners are involved in resident care, each with their own programs, communities may have to interface with as many as nine or 10 different systems. This requires staff members to learn how to use all of these offerings while also performing their regular job duties.
A pharmacy’s role
Many communities have found that, to overcome the challenges they face, they must work with an LTC pharmacy that specializes in assisted living and understands the extra level of support and service they need. The right pharmacy provider should be an integral partner in any community’s efforts to improve quality of resident care and decrease staff turnover.
One way to eliminate many of the problems is by establishing a relationship with a preferred pharmacy. Even this action, however, is not successful if the pharmacy selected does not provide the needed services to solve the billing and support issues.
So what should you expect from an LTC pharmacy?
A good assisted living pharmacy provider will get to know the community staff, the residents and their medication needs. Residents will feel confident knowing that when they have questions about billing or medications, they are talking with someone who is familiar with their individual situation, rather than having to contact a large call center and speak with a new person each time.
In regards to Part D plans, look for a pharmacy partner that meets with residents and their families annually to educate them about their various options and the coverage gap. The pharmacy should take an active role and notify residents when they are near the donut hole so that there are no surprises when the bill arrives. To further eliminate billing frustrations, a pharmacy should proactively identify noncovered medications when prescribed and work with the doctor to determine a covered option to keep costs low.
For clinical support issues, protocols should be in place to ensure that medication management is efficient and safe. Upon arrival of a new resident, the community should expect the pharmacy to conduct a drug regimen review of all medications to guarantee there will be no adverse reactions or polypharmacy issues. The pharmacy should then take the lead working with the facility staff members to review each resident’s medication profile on an ongoing basis or as new medications are added. Pharmacies also should conduct, as applicable, medication administration, med room, controlled substance and med cart audits regularly to increase staff efficiency and facilitate compliance.
The need for education is constant, but by working with a pharmacy that provides ongoing training and educational courses, communities will see fewer medication errors and staff members will become more confident, helping to decrease turnover. Look for a pharmacy that offers this ongoing, onsite education where the pharmacy’s nursing staff will train on the med pass and proper documentation to classes that qualify for continuing education units, including topics on Alzheimer’s disease, diabetes, falls prevention and more.
Additionally, a pharmacy that has technological knowledge and can help communities integrate technology into their workflow is also crucial. Communities need a pharmacy that can help staff members with their ongoing questions and needs, saving the community both time and money.
Although it’s important to remember that residents have the right of choice when it comes to their pharmacy provider, many do not understand the true value of working with the community’s preferred pharmacy. When a pharmacy can truly get to know the residents, it can tailor programs to meet individual needs. A pharmacy that provides the staff and residents with materials and educational programs explaining the many benefits of adopting the preferred partner will help increase the adoption rate.
Overall, working with the right LTC pharmacy can reduce resident costs, minimize billing complaints and help limit medication errors, leading to greater resident and staff happiness. The main goal for both the community and the pharmacy should be to get the right medications at the right time to residents administered by a professional staff that has been properly trained. A true working partnership between the community and the pharmacy is the only way to ensure resident well-being — and that means a more satisfied customer.
Rich Eakins is vice president of sales at Guardian Pharmacy, one of the largest long-term care pharmacy companies in the United States.