Innovative Solutions for LTC Challenges in 2024

As we move full steam ahead through 2024, it’s evident that the long-term care industry faces unique challenges. Many are a direct result of or were exacerbated by the COVID-19 pandemic, while others might loom in the near future. It’s imperative that we, as an industry, uncover and develop new and innovative solutions to conquer these challenges, for the benefit of those we care for and those we employ alike.

Staffing issues are well-known, in addition to trouble with reimbursement, industry reputation, and more. In my role at Omnicare, my team and I are constantly keeping a pulse on what’s happening in the industry–not just with our own clients–to determine which challenges persist, which are on the horizon, and where and how we can make improvements to help facilities adapt. Here are some of the stand-out topics and solutions we’ve identified that decision-makers from facility managers to directors of pharmacy services should be thinking about.

Hiring and Retention

While some believe that staffing shortages came and went with the COVID-19 pandemic, the long-term care industry is still very much dealing with these struggles at “monumental” levels, according to a recent report published by the US Department of Health and Human Services (HHS),¹ noting high levels of burnout and frequent employee turnover.

In addition, the recent State of the Sector report by the American Health Care Association (AHCA)² notes of nearly 450 nursing home providers surveyed, two-thirds are concerned that escalating workforce challenges may force them to close their facility. More than 70% of nursing homes reported staffing levels lower than pre-pandemic, and 99% said they are hiring for open positions.

While the HHS report¹ uncovered some creative solutions used to retain staff, such as hiring bonuses and free meals, it also revealed that many nursing homes have used outside staffing agencies to fill gaps. This can have significant downsides including high costs, unreliability and unfamiliarity with systems and residents. Simply put, we must do more.

On my team, we’ve identified the value in offering virtual training to upskill our facility staff when it suits their availability. A shift from our on-site-only training approach, this method allows us to still provide timely updates to our staff through monthly webinars, podcasts, and more without inundating them with only in-person training that takes substantial time away from their priority, customer care.

Equipping staff with the training they need that is convenient in turn supports retention, and if facilities aren’t already leaning on technology for this, it’s something they should start to do.

In addition, we employ a network of 250 clinical consultant pharmacists who serve as local, dedicated, personal pharmacists and resources, offering an individualized approach to their facility’s needs. For example, we offer a medication pass optimization program where our clinical consultant pharmacists seek to streamline and simplify the medication pass for nurses to save time and reduce errors. Our clinical consultant pharmacists have become even more invaluable post-pandemic and serve as tremendous assets to assist facilities with challenges, lending support wherever needed. Access to a network of resources, like our clinical consultant pharmacists, are one of the benefits of partnering with a provider–and a great alternative to tapping a staffing agency for support.

Reimbursement

Similarly, poor reimbursement rates can often increase the burden on staff and facility leadership, and we’ve seen a shift at both the state and federal levels in how care is reimbursed.

It’s difficult to maintain appropriate levels of staffing without the proper resident and payment mix. Skilled nursing is a complex profession, and according to a recent Skilled Nursing News article, the complexity, in addition to financial pressure and poor reimbursement, has forced many nonprofit skilled nursing facilities to seek affiliation or potentially close.³ While for nursing homes, their struggles to attract and retain certain staff are directly tied to federal and state reimbursements that do not cover the cost of care in full.¹

If facility leadership can find a way to prioritize a balanced resident mix–focusing on cost containment and maximizing reimbursements–they’ll be able to optimize reimbursement without poorly impacting resident outcomes or staff bandwidth.

If a nonprofit facility seeks to partner with a provider, they’ll have more capital to use for strategic initiatives, access to innovative tools and technology, localized support and more. While higher federal reimbursement rates would be an ideal solution here, in the interim, a provider can help facilities make conscious efforts to shift their payor mix to be more sustainable–and no, that doesn’t always mean denying a resident admission if their needs are a bit more complex.

Long-Term Care Reputation

Arguably the most devastating impact from the COVID-19 pandemic was its toll on long-term care residents. According to the National Library of Medicine,⁴ as of August 15, 2021, there were a total of 634,179 COVID-19-related deaths in the US, with 21% of those estimated to make up deaths among nursing home residents. This also resulted in an increase in seniors wanting to age at home, with more than three-quarters of adults over 55 wanting to stay in their current home or community for as long as possible, according to an AARP survey.⁵

However, according to new research from NORC at the University of Chicago,⁶ older adults who live in senior housing communities actually live longer, receive more health care services, and benefit from greater rehabilitative and preventative care compared with their peers living in the greater community.

It’s important to acknowledge, though, that COVID-19 is still very much prevalent, and our residents are some of the most vulnerable. According to the Centers for Disease Control and Prevention,⁷ as of the week ending March 3, 2024, 42% of nursing home residents are up to date with their COVID-19 vaccines, while only 8% of nursing home staff are up to date. It’s crucial that we as an industry continue providing the necessary precautions to ensure we’re heading in the right direction. One of the ways in which I’ve seen our clients respond to this is by capitalizing on our on-site vaccination clinics for assisted living residents and staff where CVS pharmacists can vaccinate against not just COVID-19, but also flu, Prevnar, Pneumovax and Shingrix, right in the comfort of your own community. For our skilled nursing clients, we can also supply them with vaccines for facility staff to complete, and our clinical consultant pharmacists can also support administration.

To help recover the flawed perception of the industry, my team and I find it helpful to curate customer satisfaction surveys where we can learn what we’re doing well, but more importantly, where we need to continue evolving to meet the needs of this changed industry. This is a simple practice that I’d recommend all providers and independent facilities implement.

Demographic and Occupancy

In addition to the challenges already at hand, we must also prepare for those to come. While identifying the root of our ongoing problems is important, looking forward for solutions that match the changing industry is what will propel your community forward to meet resident needs.

According to an article published by NLM, in thirty years, the elderly population is expected to be twice what it is today. By 2030, the US will have more baby boomers than children–61 million people between the ages of 66 to 84, and 9 million people born prior to 1946.⁸

With a significant increase in the demographic comes an obvious increase in occupancy. In fact, senior living occupancy is on the rise and expected to reach 95 million by 2060, according to Grand View Research.⁹

But with current struggles in staffing and reimbursement, some facilities are closing, when, in reality, we need more to open. At my company, we’ve set a goal to grow our bed count this year, and I’d challenge all facilities and providers to do the same to prepare for the influx in occupancy to come.

The National Library of Medicine⁸ findings said it best: “the economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boomer children in the 1960s.” To prepare, the report stated:

1. Society needs to develop better payment and insurance systems
2. Take advantage of advances in medicine and behavioral health to keep our elderly healthy and active
3. Make care more accessible; and
4. Alter the cultural view of aging to ensure all ages are integrated into the fabric of community life.

Conclusion

It pays to have a trusted partner in your pocket, working with you to address these challenges and those to come. This year, my teams will continue striving to be the best in operational excellence and clinical expertise while delivering financial value for our partners. This means prioritizing value-based and individualized care and really leaning into technology and advancements in AI to continue learning and innovating. In clinical care, staff should always deliver the most customized care possible, and it’s up to facilities and providers to help lay the groundwork.

If your vendor isn’t ready to listen to the unique hurdles you face and adapt to offer solutions that meet the needs of the industry, my advice to you is that it may be time to explore alternative partners.

References

1. Lessons learned during the pandemic can help improve care in nursing homes. US Dept of HHS of Inspector General. Published February 2024. Accessed March 26, 2024. https://oig.hhs.gov/documents/evaluation/9808/OEI-02-20-00492.pdf
2. American Health Care Association. State of the nursing home sector: Survey of 441 nursing home providers highlights persistent staffing and economic crisis. March 2024. Accessed March 26, 2024. https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/AHCA%20State%20of%20the%20Sector%202024.pdf
3. Stulick A. Nursing home reimbursement pressure ‘flat out profound,’ necessitating innovative models. Skilled Nursing News. Published February 23, 2024. Accessed March 26, 2024. https://skillednursingnews.com/2024/02/nursing-home-reimbursement-pressure-flat-out-profound-necessitating-innovative-models
4. Cronin CJ, Evans WN. Nursing home quality, COVID-19 deaths, and excess mortality. J Health Econ. 2022;82:102592. doi:10.1016/j.jhealeco.2022
5. Binette J. Where we live, where we age: Trends in home and community preferences. AARP. Published November 18, 2021. Accessed March 26, 2024. https://www.aarp.org/pri/topics/livable-communities/housing/2021-home-community-preferences/
6. Senior housing residents live longer than counterparts living in the community. News release. National Investment Center for Seniors Housing & Care. Published March 5, 2024. Accessed March 26, 2024. https://www.nic.org/news-press/senior-housing-residents-live-longer-than-counterparts-living-in-the-community
7. Nursing home COVID-19 vaccination data dashboard. CDC. Accessed March 26, 2024. https://www.cdc.gov/nhsn/covid19/ltc-vaccination-dashboard.html
8. Knickman JR, Snell EK. The 2030 problem: Caring for aging baby boomers. Health Serv Res. 2002;37(4):849-84. doi:10.1034/j.1600-0560.2002.56.x
9. US assisted living facility market size, share & trends analysis report by age (more than 85, 75-84, 65-74, less than 65), region (West, South, Midwest), and segment forecasts, 2023 – 2030. Grand View Research. Accessed March 26, 2024. https://www.grandviewresearch.com/industry-analysis/us-assisted-living-facility-market