James M. Berklan

Maybe all that skilled nursing providers need to counteract anemic or slipping census numbers is to say they’ve become a continuing care retirement community. 

Re-label a few halls or wings as assisted living and independent living, give them new coats of paint and ride an evolving trend of sorts.

That’s how pure skilled nursing operators could at least give the appearance they’re not losing the battle for resident, family and investment attention. The textbook on this could be written on CCRCs’ evolving experiences.

General community needs may have only inched up in recent years, on average, but the proportion of those requiring more intense services has clearly grown most among the AL population, according to an AV Powell analysis of more than 360,000 residents’ experiences over the last 30 years.

It’s not that the overall intensity of healthcare may be increasing; it’s that residents are lingering longer in AL units, Powell analysts explained.

The same overall community profile perhaps, but a different label on the wing or unit where more complicated services are taking place.

Statistical analysis presented by top nose counters with AV Powell actuaries detailed their findings at the LeadingAge national meeting this week.

Rather than moving residents from one building or location to the next, a shift has been instead bringing the services to the client. CCRC residents don’t want to move and are flexing their spending muscles on enhanced AL services to prove it. In order to keep the beds warm, and census at more desirable levels, provider executives might need to bend more in this direction.

Assisted living has attracted more attention over the last 10 years. Average skilled nursing utilization, meanwhile, has lagged in almost mirror-like fashion.

“We’ve seen [potential skilled nursing] move-ins stay out of higher care longer, and use more assisted living,” confirmed AV Powell consulting actuary Coleman Naughton. “There’s a higher level of people needing services in assisted living than skilled nursing. The mix is changing.”

As a result, CCRC operators are investing even more in healthcare resources for their AL neighborhoods.

So the conundrum continues: Try to add services where the residents already are (meaning AL wings or buildings) or push the people closer to existing programs and materials? The trend — and customers’ obvious sentiment — is leaning more and more toward the first scenario.

Chalk up another strong vote for the “aging in place” movement. But there are still numerous factors to heed to oversee it correctly.

Powell himself cautioned that community operators must be careful to target only the types of residents they can handle given their experience and workforce capabilities.

While it would be foolish not to jump on a wave of offering more robust services in assisted and independent living settings, it would be even more risky to recruit higher-needs residents without being able to safely serve them.

Anyone wondering why can contact their local plaintiffs’ bar for a quick answer.

James M. Berklan is the Executive Editor of McKnight’s Long-Term Care News.