Spring Hills Senior Communities is proud to share this article as seen on SeniorsHousingBusiness.com
The assisted living industry has excelled at helping society rethink how we care for the elderly. But one area where the industry itself needs rethinking is its approach to technology.
Too many assisted living communities operate in a technological backwater. Years after the Internet and email have become ubiquitous and mandatory, many communities stubbornly remain pen-and-paper-based. They’re concerned that going “high-tech” will only alienate and overwhelm the staff.
While even the least expensive motels offer Wi-Fi, many assisted living communities do not, fearful of the expense needed for those few residents that might be interested in connecting.
Increasingly, going high-tech is no longer an option. It’s not a case of simply providing a perk for residents, but rather becoming a necessity to stay financially viable.
That’s because the model of the assisted living industry is changing, moving from a social framework with a medical conscience to a medical model with a social conscience.
Referral networks force the issue
The Affordable Care Act has mandated hospitals and doctors’ groups switch from paper to electronic health records, or EHRs. Faced with financial penalties from Medicare when incurring excessive patient readmissions, hospitals are increasingly looking for partners that can help them keep their costs down by practicing preventive rather than acute care.
While there is no such requirement for the assisted living industry, organizations that are not able to share comprehensive, verifiable information on patients that at a minimum has been recorded electronically will start to find themselves shut out of the referral network.
The Healthcare Information and Management Systems Society (HIMSS), a not-for-profit organization focused on better health through information technology, defines an EHR as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.”
A holistic approach to healthcare
EMRs, or electronic medical records, on the other hand, are generally thought of as the health record of an individual as it pertains to one single healthcare institution.
In advocating for a technology-centric approach, LeadingAge, a Washington, D.C.-based association of not-for-profit providers of services for the elderly, imagines a world where EHRs would be “at the center of this technology-enabled approach to health care,” it said in its State of Technology report.
“Such homes would feature health and wellness technologies that allow caregivers and healthcare providers to monitor the occupants’ ability to carry out activities of daily living,” according to LeadingAge.
“These technologies would also facilitate the collection of important health information that could help older people take proactive steps to maintain their own health and control their care; give informal caregivers an objective assessment of an older relative’s ability to live independently; help professional caregivers coordinate, dispatch and track the delivery of needed care and services; and allow health care providers to identify early onset of disease, prescribe appropriate interventions and monitor the efficacy of those interventions,” writes LeadingAge.
The average age that an individual enters an independent living community has risen over the last 25 years from the late 70s to the mid-80s, according to David Schless, president of the American Seniors Housing Association. With the typical age of assisted living residents being even older, “residents have more diseases and take more medications,” says Travis Palmquist, vice president and general manager senior living for Mississauga, Ontario-based PointClickCare, a provider of workflow software for the assisted living industry. “Without coordinated medical records, staff can miss documenting important events that can impact health.”
Hospitals are beginning to put together preferred provider networks. By coordinating care and communication with doctors and assisted living facilities, hospitals can avoid patients bouncing back to a hospital every time they have a fever spike.
“All hospitals track readmissions,” says Craig Patnode, CEO of Minnetonka, Minn.-based Eldermark, another provider of EMR and workflow software. “If you’re not connected to the hospital electronically and share data with them, you won’t get referrals. Why would they give a community referrals if they don’t practice under a care model?”
“Hospitals are looking at assisted living communities and asking, ‘How are you taking care of this resident?’ We use electronic medical records to predict a trend, so when residents become ill we can prevent re-hospitalization,” says Lesa Scott, vice president of resident services and program development for Spring Hills Senior Living in Edison, N.J.
Early adopters overcome challenges
That’s what Life Care Services realized when it decided to switch from its paper-based system of record keeping to an EMR product provided by Yardi Systems for its network of managed assisted living homes.
“Government regulations won’t directly affect us, but the more we can demonstrate that our care is standardized, and we can pull information from our system to give to local hospitals, the more likely they are to partner with us,” says Susan Adams, Life Care Services’ EMR director, based in Des Moines. “That’s important to our bottom line.”
Integrating the system into Life Care Services’ communities has taken 90 days on average. What’s the biggest challenge? With a lean staff thanks to a population that does not require that much care, the company has been hard pressed to have enough trained individuals to teach others how to use the EMR system. And that’s complicated by a high employee turnover rate.
EMR systems can also help communities capture the costs associated with “service creep,” care for which they often now don’t bill. “If an 80-year old pulls the cord twenty times per day and an aide has to visit the resident, you need to track that for both reimbursement and record keeping,” says Patnode.
While EMRs may be an obvious solution to more accurately tracking resident health and coordinating care with other providers, the implementation of such a system is not. Assisted living communities face significant obstacles in switching their pen-and-paper based medical records to an electronic version.
First, there’s cost. For EHR systems to be effective, they need to be available to all caregivers, both in the office and those on the floor, entering medical conditions in a tablet or smartphone. That requires a reliable and fast Wi-Fi network that is of hospital-grade quality and can cost $20,000 or more, notes Palmquist. Such a system can add several dollars per day per resident to costs, which then needs to be passed on.
“We spent hundreds of thousands of dollars to upgrade our Wi-Fi,” says Scott of Spring Hills Senior Living, a user of electronic medical records from PointClickCare. “Going in, we didn’t realize we needed to do that.”
An added benefit: While Wi-Fi may not be needed for today’s elderly population, “baby boomers will demand it,” says Adams of Life Care Services. “I wouldn’t move into a community that didn’t have the technology I was used to using.”
Staying the course pays off
High staff turnover means that continuous training and retraining is necessary, a problem that should diminish once new hires enter a community having already been trained to use an EMR system in a previous place of employment.
Change is hard, especially one as fundamental as introducing technology to a formerly analog world.
“Organizations are slow to change,” says Tom McDermott, vice president of sales for multifamily and senior living organizations at Santa Barbara, Calif.-based Yardi. “Most people would rather get a root canal than change software.”
Jim Altrichter, senior vice president for risk management at Milestone Retirement Communities in Vancouver, Wash., decided to switch to an EMR system offered by Eldermark. It took him three weeks to get the staff trained to use it. All training was done remotely, via teleconferences, which were held with the trainer three times per week for three weeks. “The benefits outweighed the training obstacles,” emphasizes Altrichter.
Scott of Spring Hills Senior Living knew it was important to minimize any anxiety her staff might feel switching to an unknown and technology-based tool.
To minimize the pain, Scott created a number of short training manuals, each customized for a particular job category. “I didn’t want people to feel intimidated by reading information that didn’t pertain to them,” she says.
Scott assigned key staff the role of “super-trainer,” tasked with training the next level of employees. “People got really excited. They came to me saying, ‘I do not know how to use technology.’ But they caught on very quickly.”
For many communities, technology is not a priority. Operators wear multiple hats, says McDermott, and naturally struggle with prioritizing their strategies.
“Everyone’s running hard,” says Patnode. “The team at a community must be committed to making this work. And funding is often a big obstacle.”
Too many operators do not set aside a certain sum for technology, and as a result it becomes an afterthought and unexpected expense, say industry observers.
Switching to EMRs “is disruptive,” adds Palmquist. “Make no mistake, when you bring in EMR, you’re changing the way people work.”
To smooth the transition, various EMR suppliers offer no-cost digitization of existing paper records, live webinars and continuous training to help new hires.
Some EMR systems still require records to be printed and physically transferred to a hospital via paper or PDF. That’s how Spring Hills Senior Living operates. Once a resident is sent to a hospital, a medical record “face sheet” is printed out that goes immediately to hospital personnel.
While HIPAA requirements must be met in storing records that is not an obstacle, according to the major EMR suppliers.
To help conform to HIPAA rules, “make sure you have good data security in cloud storage and tight internal processes,” advises McDermott of Yardi. “Use static, rather than dynamic, IP addresses to prevent access to records from outside the building.”
A psychological adjustment
Implementing an EMR system requires not only technological change, but more importantly a psychological one as well.
“This is change management,” says Palmquist. “Other markets have moved to electronic health records because they had the regulatory gun put to their heads. But with assisted living, it’s the Wild West. People need to get their heads around that they’re now in the healthcare business.”
Despite the fits and starts, Adams of Life Care Services has no regrets. “I’d absolutely do this again,” she says. “I don’t know how we ever got by without it. EMRs are a great tool to capture discrete data that allows us to do evidence-based work, enabling us to prove that we gave this care and why.”
This article originally appeared on Senior Housing Business. For more information, please visit www.seniorhousingbusiness.com.
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