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Higher or deeper?

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I don’t like labels in general, since they tend to limit our potential rather than extending it. But if the glove fits, wear it—and the past few years have become known for certain waves of culture change.

2012 was clearly the Year of CMS Initiatives, when the Medicare-governing agency finally drew lines in the sand about reducing preventable hospital admissions, reducing the shady uses of antipsychotic drugs in nursing homes and reducing the spread of infections. Knowing the bite of penalties would affect those who failed to meet the new goals, many long-term care (LTC) organizations took the opportunity to look hard at their operations, redesigning their clinical care processes and revamping staff workflows.

2013 saw the Quality Assurance and Performance Improvement (QAPI) initiatives take their first real roots in LTC, opening the eyes of owners, operators and caregivers to the idea that quality care delivery is not just a clinical issue, but also a true business aspect. Many organizations began adding new services to their portfolios, including memory care, adult day care and short-term rehabilitation, excited by the growing consumer possibilities in having a spectrum of services handy at the same location.

Back in January, I’d called 2014 the Year of Opportunity, and I stand by that. Mergers and acquisitions heated up in the first two quarters of 2014, and the LTC real estate market saw surges in new building for the first time in years. Early adopters of LTC technology, both clinical and business automation-based, are beginning to see the value of their investments. Continuing care retirement communities, or CCRCs, burgeoned in their elements, especially within the assisted living component, with some organizations creating a virtual soup-to-nuts community where every possible service is available, right on the campus. Meanwhile, some organizations decided to partner with home health agencies, adding that home-based care sector to their suite of offerings—a rarely seen crossing of the “invisible DMZ” between facility-based LTC business models and the “at home” care setting.

Midway through 2014, the LTC industry sits at another subtle crossroads, paved by multiple questions about the short-term and long-term future. Will the next movements in the business of delivering long-term and post-acute care be higher or deeper? As all savvy businesses know, what’s hot today is a good investment, but what will be hot tomorrow is a far better one.

Will the trends continue to pile on more and more services within a single location, or will the industry see a marked shift to service-based specialization? How will the differences between the for-profit and not-for-profit business models evolve?


Pamela Tabar


Pamela Tabar



Pamela Tabar is editor-in-chief of I Advance Senior Care. She has worked as a writer...



While I understand that your editorial regarding the year of opportunity was "business" oriented, when I hear the term culture change, I think about the actual care that we deliver. Our system of care delivery is a specific culture with assumptions made regarding the population that is being treated.

Since I am a clinician, I see the vast canyon between my personal culture and that of the long term care system. I am technically a baby boomer. I have had cardiac surgery, I will need joint replacement, and in the future I will need assistance with care.

I am also a Doctorally prepared Nurse Practitioner very used to driving my own ship.

What I am seeing in the culture of assisted living, long term care, and rehabilitative care is that the "resident, patient, renter" is forced to change their personal culture in order to participate with these long term care systems. That is unacceptable.

Many excellent care givers and facilities are saying that the "regulatory environment" is what drives those rules.

Then it is time to change the regulatory environment. And to do that, we need lifstyle research that will help us shape systems and facilities where care is truly assisted and not comandeered by an expensive monolith.

I do appreciate your editorial. I am concerned that I never hear the voice of the patient.