The Nursing Home in 2021: What Lies Ahead

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By Joel Landau

Buffeted by the coronavirus pandemic and faced by an ongoing influx of Baby Boomers, skilled nursing facilities are quickly approaching their day of reckoning. Or, more likely, several of them.

“I think that we’re moving into a decade of disruption, quite honestly,” Beth Mace, chief economist for the National Investment Center for Seniors Housing & Care (NIC), told the Senior Housing News webinar.

She made that statement on Jan. 15, 2020, just five days before the first case of COVID-19 was reported in the U.S. In other words, the factor she was most taking into account in regards to senior care was the graying of America — how 10,000 Baby Boomers will be turning 65 every day for the next decade, and how every Baby Boomer (i.e., one of every five Americans) will be over that age by 2030. Five years later, more Americans will be over 65 than under 18; there will be 76.7 in the latter demographic, 78 million in the former. Moreover, it is expected that by 2060, 23 percent of the population — some 95 million Americans — will be over 65.

In other words, the oncoming challenge to the healthcare system in general and senior care in particular has been apparent for quite some time, as has the necessity for reinvention. But then came the pandemic, presenting yet another challenge (and a dire one at that) to eldercare. The populations of skilled nursing facilities were found to be particularly vulnerable to the virus, necessitating changes in real time. Some of them will no doubt turn out to be longer-lasting.

Bill Thomas, a geriatrician and leader of the movement toward smaller senior facilities, is well aware of that. He put it this way to the Senior Housing News in March 2020, when the grim realities of the pandemic first became apparent:

“We’re going to put our heads down, we’re going to focus on protecting the elders and doing a great job with the staff and getting them the equipment they need and riding this out — but it’s flipping the game board. And after you flip the game board, you have to reset the pieces. That’s where senior living is going to be for the next three to five years — just figuring out how to set the pieces, set up a new game (with) new assumptions, new players, new landscape.”

What can be said with certainty is that the landscape is forever changed — that we will see more of the smaller facilities that Green has pioneered, and more people who want to age in place. And wherever seniors reside, tech’s impact will be felt. That has always been the case here at The Allure Group, a network of six New York City-based skilled nursing facilities, and is now true throughout the industry as well.

Here are the ways in which tech is altering SNFs:

Care

Even before the pandemic exacerbated the problem, there were dire warnings about staffing shortfalls among healthcare professionals. One study concluded that there will be a shortage of between 124,000 and 160,000 full-time physicians in the U.S. by 2025, and a shortage of over 500,000 registered nurses by 2030. When you couple that with the rising number of patients, both because of the pandemic and because of the number of Baby Boomers who will be in need of care, the situation appears very bleak indeed.

Technology can, however, help to bridge the gap. Whether seniors are residents in skilled nursing facilities or not, they stand to benefit from tech like telehealth platforms and wearables. The latter enables them to monitor their own vital signs, while the former makes possible virtual visits with healthcare professionals. 

For those residing in SNFs, remote patient monitoring systems like EarlySense essentially allow overburdened workers to be in multiple places at once. These sensors, an Allure staple, are placed under pillows or mattresses and track vitals as well as patients’ movements. In addition, there is hand-held technology like that which is provided by Vis a Vis Health. Also available at Allure, this device allows patients and healthcare professionals to stay in touch even after discharge.

Communications

A 2015 study suggested that social isolation is as harmful as smoking 15 cigarettes a day and other experts agree that it greatly increases one’s chances of a premature death — that among other things it leads to higher incidences of heart disease, depression and cognitive issues. Those concerns have only been heightened during the pandemic, as lockdowns and social distancing have become the norm.

But again, there are certain technologies that have shown themselves to be useful in combatting this issue, whether residents are in skilled nursing facilities or not. Apps like Skype, Zoom or Facetime, which can be accessed via smartphone or tablets — like those placed at all 1,400 bedsides in The Allure Group’s six facilities — enable residents to stay in touch with their loved ones.

Community

As mentioned, an increasing number of those 65 and over prefer to age in place. They stand to benefit from things like virtual assistants, smart pillboxes and apps like Uber and Lyft, the latter of which will allow them to travel to places they might not otherwise have been able to access. In addition, shopping apps will allow them to meet whatever needs they might have.

And to bring things full circle, there are Thomas’ ideas about the way skilled nursing facilities might look in the future. In 2003 he founded the Green House Project, which  as mentioned is geared toward smaller senior facilities; there are now 300 such facilities, in 32 states. 

Thomas is also a proponent of the multi-ability, mullti-generational inclusive concept (“MAGIC”), as well as something called Minka, which involves the construction of prefabricated homes that have the necessary tech to allow seniors to live on their own.

Clearly, however, there is more than one way to deal with the challenges facing skilled nursing facilities. Clearly there is still a place for larger facilities, albeit those that are led by forward-thinking leaders who understand that change is very much in order, and innovation is critical to meeting those challenges.

Joel Landau is founder and chairman of The Allure Group, a network of six New York City-based skilled nursing facilities. He has served as a member or an advisor on a number of boards and committees, including the Medicaid Managed Care Advisory Review Panel (MCCARP), NYS DOH Preventative Health and Health Services Block Grant, NYS DOH Task Force on Long Term Care Financing, and the Brooklyn Chamber of Commerce.

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