The long-term care (LTC) setting is certainly facing its share of challenges as the healthcare industry continues to evolve. In the new year, providers who work in LTC will need to remain focused on new payment models, new technologies, and finding fresh ways to address staffing needs and employee retention issues.
The facilities that prove to be most effective and innovative in tackling these challenges will be well-positioned to thrive operationally, and will have the ability to provide the best in resident care.
Staffing and Retention
One of the primary challenges facing long-term care in 2017 is the need to be more effective in attracting and retaining skilled nurses. Stability in staffing and quality of care are directly connected.
Currently, the LTC setting is struggling to hire, develop, and retain top nursing talent, a fact that is compounded by a simultaneous shortage in overall staff.
Over the next 10 years, this shortage will intensify as waves of baby boomers begin retiring, because the simple fact is there are not enough Gen Xers (people born between 1960 and 1980) to take over the vacated positions. The need to attract Millennials (people born between 1981 and 1997) to LTC is a very real industry matter.
Overcoming a Negative Image
Unfortunately, LTC is not a preferred work environment for many younger nurses simply because it’s not viewed as a “trendy” employment role. Settings such as acute care and ambulatory care are seen as being more interesting to those currently pursuing their nursing degrees. This image problem is a real dilemma that the LTC sector must overcome.
Attracting & Retaining Students
These staffing-related challenges in LTC are causing the industry to take a serious look at how it proceeds over the next decade. In order to address staffing and retention issues amongst its nursing staff, two things must happen. The first involves putting a renewed and consistent focus upon attracting students and new graduates to the profession. Facilities that offer LTC services need to spend time at job fairs, making students and new grads aware of what the jobs entail. The patient population in this setting is more complex than most people realize, and LTC nurses require strong clinical and analytical skills.
Secondly, the LTC industry needs to take a deep look at how it retains its current employees. Once we have fleshed out what attracts LTC nurses to the job, we can work to enhance that for nurses who are thinking about entering the industry.
In addition, other healthcare settings (such as acute care) seem to have a deeper grasp than LTC does on offering new employees training, orientation and mentoring programs — something LTC should be instituting. We must examine more formalized mentoring programs so we can implement something similar in our institutions. In addition, we should begin to analyze how we can use technology and social media channels to attract and retain staff.
Last, people working in LTC need to be asking themselves about the ways we can alter job functions so that nurses can perform tasks they truly enjoy every day.
While not a new issue for the LTC professionals, emerging payment models have become an accelerated challenge. This involves learning the ins-and-outs of new mandatory bundled payment programs, such as The Comprehensive Care for Joint Replacement (CJR) model. Our nursing partners in the acute care setting are currently participating in these programs. If LTC does not get involved soon, we’re not going to have access to any of the available funds that are being offered, both now and in the future.
We need to establish partnerships with our acute care colleagues, and explore how we can be contributors in these alternate payment programs. If we don’t, we risk losing acute care discharges to the home health sector.
Currently, 30% of Medicare payments are now tied to quality metrics through alternative payment models. The U.S. Department of Health and Human Services (HHS) has been vocal about seeing up to 85% of payments coming out of alternative models by 2018. If the LTC sector doesn’t seriously examine these models, and figure out how it can participate and how it can get into partnerships with hospitals and accountable care organizations (ACOs), LTC is going to fall behind.
The LTC sector should also focus on the regulatory issues impacting the industry and the publicly reportable information available through health inspections, staffing numbers, and quality measures.
This information will impact a LTC facility’s ability to participate in new payment programs. For example, the LTC sector currently uses a Five-Star Quality Rating System. With that system, a long-term care facility is evaluated and assigned a rating of between one and five stars.
New payment models only look at homes with a rating of three stars or greater. If eventually 90% of all payment programs use alternative payment programs, that means LTC facilities that only rated between one and two stars will need to find other ways to maintain profitability and keep their doors open.
Our industry will also see consolidation through the changes brought about by alternative payment programs. We’ve already seen large chains sell off some of their underperforming homes. This type of activity is likely to continue in the overall marketplace. Long-term care organizations should focus on maintaining four- and five-star ratings, understanding how upcoming industry regulations will affect payments models, and anticipating how regulations will impact quality star ratings. This is a crucial element component for keeping your LTC facility in good financial health.
If an organization is performing poorly through quality measures, it should be proactive. Information about how to improve your facility’s quality rating is available online. A facility can simply download it and share it amongst staff members, who can then help improve the quality measurement rating.
If staffing is an issue, an organization must adjust its ratios and make sure it is reporting staff correctly – the recent changes to staffing data collection have made that a priority. Long-term care facilities shouldn’t hesitate to lean on vendor partners and consultants for help, or bring other LTC organizations together to chat about how new payment models will affect them. Work together to implement changes.
The technology focus in LTC over the last decade has been mostly centered on helping staff understand how information technology (IT) boosts facility efficiencies and performance, and helps facilities stay on top of regulations. As a result of this push, everyone understands the value of the electronic health record (EHR).
The next vital step is sharing the data that is gathered through an HER with local hospitals, and, if a resident is leaving LTC to go somewhere else, making sure the right patient information goes with them electronically. This step, however, is complicated.
Health information exchanges (HIE) that support the transition of data can be too expensive for facilities to use because of high enrollment charges or subscription fees. In addition, many do not have sustainable models. One LTC facility might only interact with two or three centers that pull this information together — so LTC facilities can have a hard time seeing the ROI that is supposed to come with sharing data this way (due to the expense).
Direct messaging, a form of secure email, is a more cost-effective alternative as long as systems can talk to each other; but not all EHRs will accept outside mail, requiring LTC facilities to log into multiple systems.
Ultimately, the true value in connected-care comes from being able to use that data to find better outcomes for a facility’s residents. Moving ahead, it is important that LTC finds ways to leverage technology to successfully link and share data with accountable care organizations and hospitals.
A constant in the LTC industry is change – it is inevitable. As we move towards 2017 and beyond, the long-term care industry must be innovative, agile, and adept at recognizing and addressing the key challenges it faces regarding staffing and retention, payment models, and technology. Only those facilities that are proactively tackling these challenges will be positioned to thrive in an ever-evolving healthcare environment.
Jayne Warwick is director, market insight for PointClickCare. PointClickcare is used by over 13,000 long-term care organizations across North America.