The changing face of resident care

Right now, a 65-year-old man is learning to live life after having major hip surgery. Although he finds himself in a long-term care facility, his stay will be short in nature. In a few days he’ll go back to what feels comfortable and natural—his home, but not without the help he needs to complete his healing.

A unique back-to-home program—provided by the facility where he experienced his short-term rehab—will ensure he gets back on his feet quickly, and safely.

Across the country, a registered nurse is told she is about to be in charge of admitting a high-acuity patient and she prepares what she needs to administer inotropes to treat congestive heart failure. Infusion therapy is something she had limited knowledge of when she first took her job at the LTC community, but now she is confident and ready because of the education she received from the operator’s pharmacy provider. Around the corner, a family is touring a local CCRC campus and decides this might be the place for their loved one to call home. Here, they decide, mom will be able to maintain her lifestyle, which includes a weekly pedicure, aquatic therapy and occasional Skype chats with her grandchildren. While mom needs the additional care, they don’t want her to sacrifice what she has come to enjoy.

Each of these scenarios happen every day in LTC communities across the country, and in their own way, tell the story of how the industry is adapting to remain competitive and financially secure. LTC providers are investing more heavily in short-term rehab as a way to recoup shrinking Medicare reimbursements while taking on higher-acuity cases in order to keep residents out of the hospital. Meanwhile, they are giving wellness amenities and programs higher priority as families evaluate facilities with a more discerning eye.

Communities are reshaping double occupancy spaces into private short-term rehab units to accommodate the growing demand of younger seniors who need temporary placement after surgery. Pharmacy providers are creating comprehensive support services to equip and educate LTC staff to better handle the complex cases coming through their doors. And nearly every LTC facility is treating wellness space, equipment and programs as a necessity rather than a novelty.

It’s a continual work in progress, but most LTC operators and their service providers say the investments and changes are necessary to meet the needs of the next generation.


Pharmacy services companies are evolving into an even more comprehensive support system for LTC providers as the demand to care for higher-acuity patients continues to rise.

About three years ago, Omnicare Inc.—the nation’s largest pharmacy services and consulting company for skilled nursing and assisted living facility providers—started seeing a significant change in one specific area of service: infusion therapy. While IV services are nothing new to long-term care, the breadth and level at which they were being required to offer it was quickly changing.

Nurses who were once only required to administer simple IVs for antibiotics and hydration were finding themselves faced with much more complex cases that involved intravenous feedings and end-of-life medications. As a result, SNFs and short-term rehab units are providing care today that was once only offered in a hospital setting.

LTC providers are onboard with the reason for the shift—an attempt to reduce healthcare costs and slash hospital readmission numbers—but not all of them are prepared to handle it.

“The worst thing that could happen is that a facility admits a patient with IV orders and then their nursing staff is not able to provide the care needed,” says Tim Webster, RPh., MBA, senior director of infusion services with Omnicare. “This would result in the patient being readmitted to the acute care setting.”

Omnicare services about 10,000 skilled nursing and AL facilities across the nation. The company found that many of these facilities could benefit from resources like infusion policies and procedures that are critical for successful management of residents who are receiving infusion therapy.

As a result, Omnicare has gone beyond simply providing the medications to offering support services that help educate and equip staff to properly administer them. Through its infusion support, Omnicare began working with communities both internally and externally to put in place the tools, procedures and education needed to walk their staff through the difficulty of taking care of higher-acuity patients.

Over time, its program has gained momentum. Those who use Omnicare’s infusion service have access to a wealth of resources including skilled worksheets for nurses, infusion drug reference cards (based on the top 10 IV drugs it dispenses) and an entire library of documents. In the past 11 months alone, Omnicare has trained 16,000 nurses in its infusion education classes.

Corinne Bishop, RN, CRRN, CRNI, national director of infusion nursing at Omnicare, says she has seen LTC providers move to hire a greater number of registered nurses than licensed practical nurses because they know they need RNs to manage the increasing complexity of admissions. Still, if a new RN or LPN is hired at one of the facilities and they don’t have experience with infusion therapy, they are encouraged to participate in one of Omnicare’s classes.

“The long-term care setting is much different from a hospital setting where a nurse has a greater support network from which to draw if she needs help with infusion therapy,” Bishop says. “Many times that RN or LPN may be the only licensed staff in that facility.”

The benefit of providing successful infusion therapy is beginning to touch all areas of long-term care. In the past six months, Omnicare has heard its customers express an interest to provide infusion therapy in the assisted living area. Many of these communities have residents who have temporarily been in skilled nursing and are ready to return to their independent lifestyle, but may still have two more weeks left of therapy.

Regardless of what area of LTC infusion therapy is offered, there’s no question a facility’s ability to provide the best care directly affects their bottom line. The ability to administer infusion drugs in the LTC arena plays a vital role in preventing a patient from having to return to the acute care setting—a top concern for referring hospitals. 

“What does this mean to a long-term care facility?” Webster says. “If I am a hospital and you are sending back all your patients because of poor clinical results, then I will stop referring to you. Hospitals are not going to refer patients to a LTC facility that cannot manage residents with infusion therapy needs because they may have other LTC facilities that are doing a better job.”

LTC providers are very much aware of this and are taking steps so they can be identified as a skilled facility that is capable and competent to provide the same quality of care that was provided in the hospital setting.


LTC providers are redefining themselves as they seek to grab more of the ever-increasing short-term rehabilitation market share.

Suddenly, amenities that offer the ability to interface with families through high-tech tools as well as state-of-the-art rehab equipment have become a top priority for communities. It’s a change CCRCs must make to stay attractive to younger and active rehab patients and a highly discerning field of referring hospitals.

For many industry suppliers, such as NuStep Inc., it’s a breath of fresh air. Executives at the Ann Arbor-based company still remember the first time they introduced the NuStep prototype at The American Association for Homes and Services for the Aging (now known as LeadingAge) national conference in 1993. NuStep—a manufacturer of recumbent cross trainers—was the only rehabilitation product there and its presence was somewhat of a mystery to many.

“At the time only a few communities were offering wellness programs and if we mentioned aerobic exercise to the leaders of CCRCs they would say, ‘What? Can you spell that for me?’ or ‘What does that mean?’” says Steve Sarns, NuStep’s vice president of sales and marketing. “It was a fun and exciting time as the industry was discovering what wellness programming meant and that it made sense and would enhance the quality of life of their residents.”

Today NuStep doesn’t have to spend as much time explaining the basics. Instead, it’s busy trying to keep up with the growing demand from communities that want to create the right infrastructure in both its wellness programs and short-term rehab units.

“Hospitals and doctors are looking at patient care more long-term,” Sarns says. “It used to be that they would have a sick-care approach: You fix the patient and get them out the door. But now they see wellness as long-term and doctors are looking to refer their patients to the best facilities.”

Thirty percent of NuStep’s business is now devoted to its “Rehab to Home” program. The program helps LTC communities transition short-term stay patients back home while maintaining a tailored rehabilitation program they can do on their own. The program has transformed the long-term effect on patients and helped them better stay on the road to recovery.

“We are seeing much more interest in our Rehab to Home program from both the individuals and their physician as short-term stays are on the rise,” Sarns said. “Rehab stays many times are only 30 days and the rehab programs need to continue at home to help minimize the risk of preventable readmissions to the hospitals. Readmissions are not in the best interest of either the individual’s health or the physician’s revenue and healthcare mission.”


Like NuStep, It’s Never 2 Late Founder Jack York has witnessed a shift in the priorities of LTC operators. It’s Never 2 Late offers computer systems that engage individuals while they are going through therapy. York says communities now look at wellness, brain fitness and rehab-related equipment as a necessity rather than a novelty.

“There’s always the financial piece that operators have to consider, but at the end of the day there has been a dramatic shift in families demanding that their mom or dad stay connected and engaged, both physically and cognitively,” says York, whose product allows individuals to Skype, email or play games while undergoing therapy.

Short-term rehab patients are typically 10 to 20 years younger than the traditional 86-year-old LTC resident. They are also less frail and used to a lifestyle that is busy, engaged and connected with the outside world. More than ever, those looking at facilities—whether they are families or referring hospitals—want to know those they are placing there will have the best possible equipment to keep them engaged and healthy.

“When you have to put your mom or dad in a retirement home it’s not an easy transition,” says Michele Reber, public relations director for HydroWorx. “No one wants to go to a retirement home unless it’s a place where the amenities are wonderful and people are happy there.”

HydroWorx’s underwater therapy machines are part of wellness, preventative care and rehab programs at many LTC communities. These communities see the benefit of water therapy to treat conditions such as swelling, arthritis and fibromyalgia, and know it adds to its cache of wellness services.


Meg Sutton, an interior designer with Direct Supply Aptura, says you only have to look at an LTC facility’s blueprints to see where its priorities lie. In the past five years, Sutton has increasingly helped operators transform double-occupancy skilled care rooms into private short-term rehab spaces. Those doing new construction have placed a high priority on wellness areas that not only focus on physical rehabilitation, but spa services.

Still, Sutton says communities need to be careful to maintain a balance in what they offer regardless of the latest market trends. “I think [short-term rehab] is important and will continue to be important, but what we have learned in the last nine months since the government cut funding and changed reimbursement rates is that operators are feeling the need to be balanced in what they offer,” Sutton said. “Short-term is important as the population ages and people want to stay in their home longer, but what other care services can providers offer to remain competitive?”

Julie Thompson is a freelance writer based in Dayton, Ohio.

Topics: Articles , Clinical , Executive Leadership , Facility management