John O'Connor, VP, Associate Publisher, Editorial Director

There is continuing debate in long-term care about whether future success lies in upstream (increasingly healthcare focused) or downstream (increasingly service focused) services.

Compelling arguments can be made for either option. That being noted, some recent findings leave little doubt about which way the scrum is moving.

Earlier this month, the National Investment Center for Seniors Housing & Care released results from wave 41 of its ongoing and excellent Executive Survey Insights series. It includes feedback on a new question that asked respondents whether acuity levels among new residents are 1) rising, 2) declining, or 3) staying about the same.

The overwhelming response from skilled care, assisted living and independent living operators? Door number one.

Move-in acuity increased for 71% of the respondents with assisted living, and for more than 60% of respondents with memory care units and nursing care beds. Moreover, 41% of the responding independent living operators indicated acuity has gone up since the COVID-19 pandemic began two years ago.

As slam dunks go, these results shatter the backboard.

Not that residents arriving older and sicker is a new thing. Frankly, this trend has been many decades in the making. Nursing homes began largely as convalescent settings. Many early residents were there simply because they had no place else to go. That’s a far cry from the reality currently in place.

Now before you run out and build what amounts to a hospital without a surgical suite, there may be a couple of caveats to consider.

First, the sample size here is a bit small.

Second, staffing challenges may be playing a bit of an indirect role here. Many facilities are so stretched for workers they are actually restricting placement requests and only admitting certain types of residents. Care to guess which kind tends to generate the most revenue? If you said chose upstream and “higher acuity,” give yourself a pat on the back.

Still, it’s pretty clear what’s happening. Across the board, residents are arriving sicker than ever.

Take that nugget of information for what it’s worth. Ignore its larger implications at your own risk.

John O’Connor is editorial director for McKnight’s.