Acuity and ALFs

Skilled Nursing News reported the ongoing problem of assisted living facilities admitted residents they are not equipped to take care of because they need skilled care. In lieu of turning away adults with needs that extend beyond what assisted living facilities offer, the businessmen who run the facilities are now willing to accept adults they know will be neglected.

Mark Dubovick, the Executive Director and CEO of SelfHelp Home, explains that the model of an assisted living facility is evolving into one that essentially doubles as a nursing home. This newer model would allow facilities to accept more people and, thus, make more money.

This extended care would include assistance with activities of daily living, medications, and chronic conditions—all services that a skilled nursing home typically handles. Dubovick stated that, “You can provide staff training and the technologies to move forward, almost into that intermediate care model.”

The director failed to mention if the facility employees, who already tend to be underpaid and overworked, would become even more underpaid as they’re asked to function as skilled “intermediate” staff members than the basic assisted living they signed up to do.

One may wonder why skilled nursing facilities exist in the first place, if assisted living is working to offer the same services. However, EF Senior Care CEO and Partner, Mike Nickolaus seemed to explain this evolution as a pure business model, unconcerned with the wellbeing and needs of vulnerable adults. Nickalaus explains that because he works to “sell a product that people don’t want to buy,” he is pushing for this development to increase success in his business.

Much like other facility directors who work to fill every bed regardless of the eligibility of each resident, Nickalaus is forcing the evolution of assisted living to drive up profits. In fact, he, and other executives are even pressuring lawmakers and regulatory agencies to relax the regulations that are currently in place to ensure residents receive sufficient care. As Dubovick boldly stated, politicians and agencies need to “understand that this is the future.”

In the meantime, operators have already been shifting their care structures and bolstering care billing to drive up profits—this shift to the “new skilled nursing” facility is likely to increase revenue even further.

Dubovick further explains this concept as if he’s a guest businessman lecturing a class of finance students, stating, “…this really starts to drive which [assisted living providers] move up the chain and which are going to stay where they are.”

In this future model of “assisted living 2.0,” assisted living facilities are required to increase the number of licensed clinical staff on duty. The number of decent nursing talent available is already scarce, so another industry drawing on this pool will put assisted living facilities in direct competition with skilled nursing facilities looking to hire the same talent. Such an intense strain is likely to cause both facilities to hire less capable nurses.

To protect business executives overseeing this process, operators are designing “risk management programs” to address higher operating expenses and liability concerns (which are likely to be an issue, as operators look to endanger residents by making necessary care less available.)

With an insufficient number of capable staff on call, tragedies such as the fire in Fall River, Massachusetts that led to the death of 10 residents, will become common among the long-term care industry.