As the long-term care continuum has gained prominence as a preferred rehabilitation site for post-hospital care, skilled nursing facilities have seized the initiative and created post-surgical rehab units for discharged hospital patients. Although senior living communities largely haven’t developed the infrastructure for short-term rehab on the same scale, signs that they exist are becoming more interested and involved in serving these patients.
With the acuity shift in long-term care driving patients from hospitals to the long-term care sector, rehab is no stranger to assisted living. These communities have long been welcoming residents in need of clinical rehab services. Rehab just hasn’t been part of assisted living’s identity as it has for skilled nursing.
But David Tate, chief strategy officer for Reliant Rehab, says rehab is indeed becoming more associated with senior living.
“It is common for senior living operators to promote the availability of onsite therapy services,” he says. “Whether in a small skilled nursing unit, memory care unit or in a dedicated outpatient therapy gym, therapy services are increasingly available to senior living residents. For senior living communities without dedicated therapy space, an approved therapy facility may offer ‘off-premises’ services in a patient’s room. Home health is another provider commonly offering therapy services to residents of senior living communities.”
Although short-term rehab infrastructure may not yet be universal in senior living, Tate says it is more commonplace to see senior living communities with dedicated therapy gyms that occupy prominent locations and can be accessed by residents and potential residents.
“Short-term rehabilitation provides senior living residents an opportunity to receive therapy services in an ideal environment for restoring optimal functional abilities,” Tate says. “While the convenience of onsite outpatient therapy is a definite plus, the more important advantage is receiving functional rehabilitation services in the actual home environment.”
The clinical dynamic
Rockland Berg, architect and principal with the Dallas-based architectural firm three, has witnessed the acuity shift and rehab migration trend over the course of decades. If skilled nursing has owned the rehab component, it is because the facilities have a more clinical focus (and image) than senior living, he says.
“It’s because skilled nursing has been closely identified with hospital environments and institutional settings, and it’s a highly regulated environment,” Berg says.
“Also, skilled nursing in the past seemed to be a competitor for the hospital environment, but that fundamentally changed about 10 to 15 years ago as hospitals needed to shed patients as required by new regulations.”
Even so, post-acute care and senior living are evolving in their identities, approaches to care and overall environments and are gaining more influence over public policy, so the migration of rehab into assisted living is a natural result of that evolution, Berg says.
“Today, we’re seeing operators getting more creative with licensing regulators, so that they can provide better care in less restrictive environments,” he says. “I think certain states are no longer requiring skilled nursing as part of the continuum, such as Arizona, I believe, and that will continue to change the dynamic.”
Nevertheless, senior living is a different care setting and faces an alternate process of adopting rehab.
“They are less institutional, less encumbered by regulation, and potentially less expensive to the resident,” he says. “All these qualities make it very different to add short-term rehab, and it aligns well with the dynamics of today’s senior living environments.”
The EdenHill experience
Five years ago when EdenHill of New Braunfels, TX, cut the ribbon on its Fischer Rehabilitation Center, industry observers may have considered it to be a novel approach for a continuing care retirement community.
As the local newspaper reported in 2014, EdenHill management decided that a CCRC should provide rehab “to ensure that continuity of care.”
The center has made services accessible throughout the New Braunfels’ community, including wellness and fall prevention as primary objectives. Therapists have developed programs to assess and improve residents’ mobility, balance, safety, strength, cognition and swallowing abilities.
Among the center’s rehab and clinical services are post-surgical recovery, wound care, pain management, cardiac and orthopedic programming, incontinence management, and programs about cognitive and physical impairments.
Berg is familiar with EdenHill — three designed the 2015 renovation and expansion — and holds it up an example of forward thinking in senior living.
“They strategically reduced their skilled nursing complement, replacing it with contemporary assisted living and memory care and a robust PT/OT component to improve services and drive revenue,” he says.
The rehab strategy
As the rehab migration continues to gain momentum in senior living, Berg says it has come at the expense of skilled nursing in the communities that offer it.
For-profit and nonprofit designations also make a difference, he says.
“I would like to stress that all of the for-profit senior living providers we know or that are working with our firm have ceased to provide skilled nursing as an option, and they now stop at memory care,” Berg says.
“As for the not-for-profits we see, they are cutting down their skilled nursing offerings. As a means to satisfy opportunities for short-term rehab, they are now providing solutions in these hybrid environments that are licensed under assisted living. As this is taking place, the footprints for physical therapy and occupational therapy are enlarging, sometimes doubling what they have provided in the past,” he adds.
To be a viable part of the post-acute rehab network, senior living communities have to establish strong relationships with hospitals and referring clinicians. Berg says that is happening.
“Some communities are strategically locating in close proximity to the hospital output environments and tailoring their physical therapy and occupational therapy services to align with prospective residents’ needs,” he says. “In fact, we see that they are actually advertising their affinity to the larger community with these healthcare networks.”
If there is reluctance among senior living communities to accommodate short-term rehab, Berg hasn’t seen it.
“I can’t say that I have,” he says. “We’ve found that most of the operators see it as a need to be filled, an economic opportunity and an opportunity to market to a new group of prospective residents who might not have considered their community otherwise. Some of those potential residents are even younger and staying in their communities longer.”