Trends: Senior housing and services grow more intertwined

[Editor’s note: As a prelude to its national conference, the National Investment Center for the Seniors Housing & Care Industry (NIC) shares a sneak-peek Q&A held with opening keynote speaker Thomas H. Lee, MD, chief medical officer at healthcare performance improvement firm Press Ganey Associates.]

Although it may be uncertain, the future of healthcare will have a dramatic impact on seniors housing as new innovations impact the way care is delivered. These crucial insights and others will be explored by Thomas H. Lee, MD, chief medical officer at healthcare performance improvement firm Press Ganey Associates, at the opening general session of the 24th NIC National Conference Oct. 1 to 3 in Chicago.

Lee (pictured, right) has more than three decades of experience as a practicing physician, researcher and health policy expert. He played a leadership role in the development and implementation of healthcare reform in Massachusetts, a precursor of the Affordable Care Act enacted by the U.S Congress in 2010. Lee also served as network president for Partners Healthcare System and CEO for Partners Community HealthCare, Inc., the integrated delivery system founded by Brigham and Women’s Hospital and Massachusetts General Hospital.

NIC recently interviewed Lee on his outlook for the industry, which he’ll share in detail at the NIC conference.

NIC: How does improving healthcare apply to seniors housing?

Lee: This is a very important question that hasn’t been posed by 98 percent of the healthcare community, but here’s how I’d frame it: Seniors are disproportionately the patients who are front and center in the healthcare system. If the real goal of healthcare is to meet the needs of patients, then you quickly come to understand that many of the activities that drive better health are outside of what we traditionally consider to be healthcare. That’s where housing becomes very important, along with food, education, employment and other basics. Those factors dwarf what I might do for patients in my office on Friday mornings.

NIC: What’s the biggest challenge facing organizations that care for seniors?

Lee: The challenge and the opportunity are to determine what actions will produce better health for seniors, but then knowing that no one organization can perform all those functions. What we need is real collaboration and integration of organizations that work with seniors, including healthcare providers and housing groups. Companies that can figure out how to work with other organizations in the chain of senior services will have a competitive advantage.

NIC: You talk about the integration of services. Can you cite some housing examples?

Lee: The Department of Veteran’s Affairs (VA) is not covered in glory these days, but it does some marvelous things we can all learn from. The VA doesn’t just provide healthcare; it also takes responsibility for housing veterans. The VA understands that housing is part of what it means to take care of people.

Another example is the Health Leads, a national program that trains college kids to work in emergency departments and health centers. The students advocate for the social needs of patients and connect them to the resources they need to stay healthy, such as housing. The healthcare providers don’t offer housing but partner with organizations that do. It’s a win-win for everyone.

NIC: What are the implications for private sector seniors housing companies?

Lee: If I were in the housing business, I’d be approaching large healthcare delivery systems to find ways to integrate our work. When a housing issue comes up with a patient, it would be nice for a healthcare provider to work out the problem systematically instead of panicking. Healthcare providers need partners in housing that can address the patient’s needs.

NIC: What are two healthcare trends that will impact seniors housing and care?

Lee: Baby boomers like me are becoming seniors and have transformed every institution they’ve touched. We can assume they’ll transform seniors housing, too. They want housing that meets their healthcare needs but also makes life worth living. They want it all. They’re going to vote with their feet and will move into places that can meet their needs.

The other big trend is that healthcare will be coordinated. The need for coordination of care is qualitatively different from 20 years ago because of the tremendous advances in medical science. There’s so much more we can do. For too many people nowadays, the healthcare experience is chaotic. Patients have always been afraid of their diseases and the treatments, and that’s still true today. But now there’s a third fear, namely that healthcare providers don’t have their act together. We need to have environments where teams can meet the needs of patients so they can have the peace of mind that care is coordinated. This will increasingly be what patients demand.

NIC: Much of your work is on quality of care and quality measurement. How will these concepts impact seniors housing?

Lee: The type of data and the way they are collected is changing. It’s a myth that seniors won’t participate in electronic data collection. My 87-year-old mother uses email. We’re also moving into a world where we’ll gather more information on how things are going for patients and what they’re worried about. These kind of data will be collected regularly on all patients, similar to how we take vital signs such as a heart rate or blood pressure reading. Information like this will be gathered at multiple points during an episode of care and not just when the incident is over.

The period of care is expanding to match the patient’s perceptions. For example, providers are following up with patients after a hospitalization and not just asking about their stay but also about the ease of the transition back home.

There are also more convenient and efficient ways to deliver care when an acute issue arises. For example, the need for residents to be transported by ambulance to an emergency department is a failure of the system. Patients hate it because it’s scary. It’s also expensive. Determining how often residents go to the emergency room by ambulance would be a useful measure to create incentives for improvement.

Overall, I think housing and care providers that can integrate data collection and quality measures into the lives of their residents and patients to improve care will have a competitive advantage.

NIC: Can you give an example?

Lee: Here in Boston, Hebrew SeniorLife runs a community with beautiful apartments, plus movies, exercise and everything else. The building offers primary care and has a kiosk where residents can input information about their well-being. I think this concept will spread and will eventually be available in all kinds of seniors housing settings.

NIC:  You talk a lot about efficiency of care. How does that apply to long-term or post-acute care settings?

Lee: The first goal of healthcare and housing is to meet the needs of the resident. The next objective is to do that efficiently. That’s why I talk about value. You can’t just consider cost, but it’s naive to talk about quality alone. Value is the right framework, and consolidation is an important strategy to improve value. In other words, don’t try to do everything everywhere. We can’t afford that. We need integration and consolidation of services to meet people’s needs. For example, a housing facility might have on-staff primary care but then build relationships with organizations that offer specialty care.

NIC:  You played a role in healthcare reform in Massachusetts. What are the implications for seniors housing and care as the government’s role evolves?

Lee: There’s still a lot to play out with healthcare reform, but the creation of accountable care organizations (ACOs) is transformative. The more forward-looking ones will be open to meeting with representatives of the housing industry as providers try to figure out how to keep people healthy. However, I think the seniors housing industry should take the imitative and reach out to the ACOs. The smart ones will sit down and talk.

NIC: What about skilled nursing facilities? How are they being impacted?

Lee: ACOs will play an important role. For example, the ACOs in Massachusetts are creating standards for nursing homes. If they don’t meet the standards, then the ACOs won’t give them business. Not every nursing home is ecstatic about this, but it does improve care by having clear expectations.

NIC: What would you like attendees to take away from your presentation at the NIC conference?

Lee: I’ll be talking about transparency. I recently wrote a blog post noting that healthcare providers like transparency for everyone except themselves because they can imagine the terrible things that would happen if their data were posted online. But the truth is that the arc of history is toward greater transparency, and the organizations that can use transparency to drive improvement will have a competitive advantage.

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