Redesigned long-term care communities that serve single types of residents — and a payment system that differentiates and reimburses accordingly — would improve care for older adults and benefit providers, according to Vince Mor, Ph.D., professor of health services, policy and practice and the Florence Pirce Grant University Professor in the Brown University School of Public Health.

“We may want to think about restructuring or rethinking the notion of separating post-acute care from residential long-term care, at least in some instances,” he said.

Older adults currently living in assisted living could be combined with traditional skilled nursing patients in a new, combined payment category, Mor said.

“Someone has got to make that decision, and it’s probably a good time, in general, for the United States to think about retrofitting or altering the physical plant of [communities],” he said. “How to do that in a way that is fiscally viable … is a real challenge.”

During the National Association for the Support of Long Term Care’s 2021 Legislative & Regulatory Conference, Mor questioned whether the current long-term care model is sustainable given design weaknesses revealed by the pandemic.

Long-term care facilities built in the 1960s and 1970s, he noted, served residents whose lives started in the 1800s. A new generation has “different expectations, different quality standards, different policy requirements and different preferences,” he said. “That means [operators] are going to have to respond in some way to that new world.”

The key to quality care for long-term care residents who need social support more than medical intervention may be in private rooms and smaller, Green House-style facilities, Mor said. Their small residential groupings and staff assignments were associated with lower COVID-19 risk.

These smaller facilities would have different missions, regulatory structures and quality metrics than buildings where post-acute care is provided, he added. But Mor acknowledged that separating out residents who have medically complex needs from those who need end-of-life or long-term care for chronic care won’t be easy unless policymakers tackle the costs of infrastructure and reimbursement.

This article appears in the June 2021 print issue as part of FocusOn: Design.