With so much focus, for so long on surviving COVID’s clinical and financial ravages, many long-term care operators have shifted to looking for strategies to help them thrive as the pandemic drags on — and flourish even more when it eventually ends.

A flurry of recent expert advice lays out possible game plans.

With so many uncertainties, it can be challenging to know where and when to invest. Hiring, compliance and technology modernization efforts are all crying out for attention.

For almost all providers, a return to any kind of normalcy will necessitate a review of what still works and what doesn’t.

Others have an eye on large-scale change. After all, if necessity is the mother of invention, she certainly delivered over the last 18-plus months.

“There have been a lot of really amazingly  innovative and inherently interesting ideas that have come out of this (COVID),” said John Kane, SNF team lead for the Centers for Medicare & Medicaid Services. “One of the big things over the next three to five years is facilities being open to critically analyzing and assessing their own practices. … COVID has demonstrated that the way we’ve been doing things has not been working. It took something like this, maybe, to reveal that.”

Kane was one of several speakers who tackled the question, “What is one thing to do now to prepare for the next three years in long-term care?” during the LTC Virtual Symposium hosted by long-term care software provider Simple LTC in late September.

He suggested using the post-vaccination era to get together with peers again, including those from other long-term care sectors, to discuss ongoing problems and potential solutions.

“Figure out how to fix it, whether it’s from a staffing perspective or financial, or whatever, talk to your peers and see what’s been working,” Kane said.

Other industry observers also have distinct thoughts on what operators should be doing now to ensure success in coming years.

Prepare for scrutiny and transparency

As Congress debates several nursing home-related bills, including the Nursing Home Improvement and Accountability Act, it’s clear that providers need to be prepared for increased regulatory scrutiny and calls for more transparency, said Jessica Curtis and Melissa Fedun, BSN, RN,  managing partners of the consulting firm Formation Healthcare.

One component of the Improvement and Accountability Act would expand the Special Focus Facility program to include up to 5% of all Medicare and Medicaid-funded facilities.

“Providers must stay abreast of where they stand in their state with regards to real-time regulatory survey performance and what their relative likelihood is to be selected as a special focus candidate or special focus facility based on those survey outcomes,” Fedun told McKnight’s. “The intense scrutiny on special focus facilities can lead to termination of provider agreements, referral issues, lack of financing and degraded marketing opportunities which can be devastating.”

With an ongoing push for increased regulatory oversight, providers also should be prepared for all levels of ownership, individual and organizational relationships, and operating brands to be clear and transparent to the public and all stakeholders.

“Owners should intimately understand their operating partners and their performance not just on financial metrics but clinical/regulatory outcomes as well,” Fedun said. “ They should consider the performance of operating partners’ entire group of facilities, not just the subset under their ownership, as systemic issues and struggles can quickly bleed over to affect performance across the board.”

Skill up

Geriatrician Michael Wasserman, M.D., past president of the California Association of Long-Term Care Medicine, told McKnight’s that facilities should focus on improving their leadership teams and the skills of managers including administrators, medical directors, directors of nursing, and infection preventionists.

“Whether it’s the government and the survey process making recommendations, QIOs coming in with training or in-services for staff, there are so many ways we bring information to nursing homes on how to do things,” Wasserman said. “Then we struggle to get them implemented, and those that are aren’t always sustainable.”

To make changes that last, Wasserman suggests operators hire and train administrators to use a consensus or servant leadership style that solicits and uses input from team members. That style has long been linked to higher quality and lower turnover.

Pair that leader with a strong medical director who is on site often and willing to partner with a full-time infection preventionist and director or nursing to create programming and necessary interventions, and you’ll find better clinical success.

Leadership is the glue that makes doing the right thing implementable and sustainable,” he said.

Invest in in-house clinical

“From the network perspective, one of the lessons learned from COVID in long-term care specifically was the need for better bed-side services and the lack thereof,” said Ian Strand, vice president of health plan development for Patient Pattern, a group of geriatric care providers using data and technology to improve care for frail populations. 

Without technology to help with vitals monitoring or a robust telehealth option, he said, “you put nurses in the situation where they are trying to manage a very frail, complex patient population.” 

He suggested facilities review their patient needs and invest in telehealth platforms or other technology that could help them in future outbreaks.

“There are going to be situations where you have to manage your patient population in place and meet their needs and deal with that in an environment where you might not be able to send everybody out to a specialist as you have in the past,” said Strand, who also spoke at the LTC Symposium.