Last week, I attended the MarcusEvans LTC and Senior Living CXO Summit in Los Angeles, where I delivered a keynote address on “Identifying and Repairing Communication Gaps in LTC.” It was a fascinating, energizing event, and not just because I was leaving the frigid temperatures of New York City to dine outdoors in Marina Del Rey.
Of course, I was all jazzed up to speak about my obsession, long-term care. Of the many communication gaps I mentioned that need repairing, the one that most people commented on afterward was the way we handle end-of-life care.
Perhaps the ample feedback reflected how we, as a country, are spending so much money on aggressive medical treatments that are unlikely to help those who are dying and that most people wouldn’t want if they knew what they entailed. Or perhaps it’s because the vast majority of the audience was not only professionals in the field but also had a relative in long-term care. They recognized the value of having a peaceful death both for the resident and for their family.
It was interesting to me that only a few of these C-suite attendees had heard of Atul Gawande, MD, whose recent book on end-of-life care, “Being Mortal: Medicine and What Matters in the End,” became the basis for a “Frontline” documentary that aired last week. Atul Gawande is all the rage in my circle.
I, on the other hand, was gobbling up new information about positioning care facilities to thrive over the long haul. The clinical and the financial sides of the business have a lot to teach each other.
One of the highlights for me was hearing Dr. Margaret Wylde of the ProMatura Group speak about what’s important to residents of senior living communities. I was so excited by her information that I leaped from my seat and shouted, “Yes! Yes! Right on, sister!” At least, that’s what I was doing on the inside, while my outside sat politely nodding in my gray business suit.
The gist of her message, which was backed up by impressive research funded by the American Seniors Housing Association, is that what contributes the most to the satisfaction of long-term care residents is not the next expensive amenity, but the feeling of being at home. The intangible stuff, like smiles and respect and relationships with staff and other residents. Yes, the aspects of care I talk about all the time. Senior bullying, she said, is being recognized as more and more of a problem. (For an example in the media, see Mean Girls in the Retirement Home).
Other points from the conference that stuck with me:
• Real leaders are focused not so much on how we are going to make payroll next week, but how we are going to make payroll in five and 10 years from now. The heads-in-beds mentality has got to go.
• In the future, there won’t be just a few options for care such as ALFs and SNFs and CCRCs, there will be a whole rainbow of options. We need to identify niches and adapt facilities to fill the niches. (As I jokingly explained to a civilian friend, we won’t just have facilities for retired actors or for the LGBT community, we’ll have places for retired LGBT actors.)
• In the effort to avoid hospitalizations, we need to think of ourselves not as post-acute care, but as pre-acute care. Partnering with home health providers and other outpatient resources, we can offer services that help people avoid the need to enter the hospital in the first place.
• Susie Mix of Mix Solutions made it clear that whether we like it or not, managed care is sweeping the country and we need to prepare for it. She emphasized the vital importance of having a case manager who is paying close attention to billable details. (I’ve been down this road in the mental health world. Managed care changes everything, especially reimbursement.)
• We need to advocate for ourselves so that when negative reports appear in the press, our organizations are responding by offering a more balanced perspective of long-term care.
Many of the ideas mentioned at the summit — from senior bullying to staff retention to reducing the use of psychotropic medication — are areas where input from mental health providers such as psychologists could be of great benefit. I look forward to more conversations not just between the clinical and the executive sides of the business, but also forums that bring mental health and medical health providers together with the execs to create solid LTC organizations that can meet the challenges of the future.
Eleanor Feldman Barbera, PhD, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. An author and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.