As the assisted living industry increasingly serves an overall resident population with higher-acuity health needs than in the past, and as acute and post-acute providers look for ways to address regulatory challenges that affect their bottom lines, senior living operators are working to educate healthcare professionals and consumers about what they have to offer.
Since 2010, the University of Massachusetts Medical School has offered a Chief Resident Immersion Training Program in the Care of Older Adults. The voluntary, three-day retreat, nicknamed CRIT, is designed to ensure that physicians nearing the end of their formal training “have knowledge and experience and training in the principles of good geriatric care,” according to Jerry Gurwitz, M.D., chief of the school’s division of geriatric medicine and executive director of the Meyers Primary Care Institute.
This year, for the first time, two area assisted living professionals were invited to observe the small-group discussions, mini-lectures and individual mentoring sessions, joining 19 residents as well as case managers, pharmacists, nurses, nurse practitioners and physicians from various specialties, including geriatrics, in late April and early May.
“The Massachusetts Assisted Living Facilities Association is seeking to expand its reach into broader educational programs,” explained Deborah Wollner, RN, a member of Mass-ALFA’s Resident Care Committee and senior resident care director at Sunrise Senior Living. Wollner, who is responsible for educating nurses and managers about state regulations and helping prepare for surveys at 13 Sunrise communities in Massachusetts and Maine, is helping Mass-ALFA evaluate whether one of those programs should be the CRIT program.
“I participated in small, interdisciplinary group discussions centered around a case study that followed a frail individual from a critical medical event through discharge,” she said. “There were also presentations on issues that affect frail elders, including delirium and discharge planning, and on leadership and training skills.”
The chief residents already have chosen medical specialties, so the CRIT program (2016 participants pictured here) isn’t meant to turn them into full-time geriatricians, Gurwitz said. But the chief residents “have oversight and influence on a large number of individuals who report to them and train under them, including residents who are earlier in their careers as well as medical students,” he said. “The goal is that they’ll influence many people below them.”
In the future, if Mass-ALFA decides to support the program, Gurwitz said, representatives from assisted living could play a larger role in the CRIT program.
Also representing assisted living at the event was Marla Prestone, a nurse who is director of assisted living at Briarwood continuing care retirement community in Worcester, MA. Regardless of Mass-ALFA’s decision about the CRIT program, member communities already are working to educate current and future healthcare professionals as well as consumers about assisted living in other ways.
Briarwood, for instance, also participates in the UMass Medical School’s “geriatrics interstitial,” a mandatory one-day program for third-year medical students, said Prestone (pictured here at the 2016 CRIT program). In the morning, students participate in small-group discussions about falls; incontinence; medication safety; dementia, delirium and depression; financing medical care for older adults; transitions of care; or community resources. Then, in the afternoon, the students visit Briarwood and other local assisted living settings and spend one-on-one time with residents, assessing cognition and function. Afterward, they discuss their experiences with faculty members and assisted living community staff.
“I’ll tell them about assisted living, what we provide, what we see most of, the problems with residents — falls or things like that — and how we’re dealing with it,” Prestone said.
“The focus is to have them understand and see older adult patients in a different context,” Gurwitz said. “Seeing older patients in the hospital is a far different experience than seeing an older person where they actually live and function.”
Programs such as CRIT and the geriatrics interstitial also help healthcare professionals better understand assisted living and how it differs from skilled nursing, Wollner said.
“I think many doctors are simply unaware of assisted living and the broad range of services that some, like Sunrise, can provide,” Wollner said. “Doctors may think that patients need around-the-clock skilled care when they really need personal care and coordination.”
Spreading the message in other ways
Sunrise is getting the word out in other ways, too.
Jessica Phaup, vice president of referral development at Sunrise, works to educate professionals at acute-care hospitals, skilled nursing centers, home health agencies and other settings about what assisted living can offer.
“We’re trying to help them understand that by living in assisted living, or specifically, at Sunrise Senior Living, we can help stabilize their patients through the care and services we provide, to help prevent readmissions or help stabilize someone with, for example, diabetes or chronic obstructive pulmonary disease or congestive heart failure,” she said. Some healthcare professionals are surprised that people who have diabetes or dementia can be served at an assisted living community, Phaup said.
Hospitals and post-acute providers have concerns about readmission penalties, reimbursement changes, value-based purchasing and alternative payment models, she noted. The ways in which assisted living can help vary by state, Phaup said, but “we’re working on educating professionals … on what it is that we can do at Sunrise, from a capabilities and services perspective, to help with some of the challenges that some of our friends in skilled nursing and hospitals are facing right now.”
Sharon Beeby, an area manager of business development for Sunrise who helps support six of the company’s communities in the Detroit area, also works with healthcare professionals. “Every day I could be talking to physicians, social workers, nurses, physical therapists, case managers, discharge planners — a whole host of professionals who, for some reason during the day, might have a conversation with a senior who could be appropriate for assisted living,” she said.
Beeby educates them on what Sunrise has to offer and also tries to think of ways she can work with these professionals to educate consumers that assisted living is private pay and might be more appropriate than skilled nursing for someone who needs a lower level of care. “We’re trying to find anyone and everyone who touches the life of a senior to start having these conversations earlier versus later,” Beeby said.