Higher or deeper?

I don’t like labels in general, since they tend to limit our potential rather than extending it. But if the glove fits, wear it—and the past few years have become known for certain waves of culture change.

2012 was clearly the Year of CMS Initiatives, when the Medicare-governing agency finally drew lines in the sand about reducing preventable hospital admissions, reducing the shady uses of antipsychotic drugs in nursing homes and reducing the spread of infections. Knowing the bite of penalties would affect those who failed to meet the new goals, many long-term care (LTC) organizations took the opportunity to look hard at their operations, redesigning their clinical care processes and revamping staff workflows.

2013 saw the Quality Assurance and Performance Improvement (QAPI) initiatives take their first real roots in LTC, opening the eyes of owners, operators and caregivers to the idea that quality care delivery is not just a clinical issue, but also a true business aspect. Many organizations began adding new services to their portfolios, including memory care, adult day care and short-term rehabilitation, excited by the growing consumer possibilities in having a spectrum of services handy at the same location.

Back in January, I’d called 2014 the Year of Opportunity, and I stand by that. Mergers and acquisitions heated up in the first two quarters of 2014, and the LTC real estate market saw surges in new building for the first time in years. Early adopters of LTC technology, both clinical and business automation-based, are beginning to see the value of their investments. Continuing care retirement communities, or CCRCs, burgeoned in their elements, especially within the assisted living component, with some organizations creating a virtual soup-to-nuts community where every possible service is available, right on the campus. Meanwhile, some organizations decided to partner with home health agencies, adding that home-based care sector to their suite of offerings—a rarely seen crossing of the “invisible DMZ” between facility-based LTC business models and the “at home” care setting.

Midway through 2014, the LTC industry sits at another subtle crossroads, paved by multiple questions about the short-term and long-term future. Will the next movements in the business of delivering long-term and post-acute care be higher or deeper? As all savvy businesses know, what’s hot today is a good investment, but what will be hot tomorrow is a far better one.

Will the trends continue to pile on more and more services within a single location, or will the industry see a marked shift to service-based specialization? How will the differences between the for-profit and not-for-profit business models evolve?

An even bigger item: Will today’s fastest-growing care sector—memory care—be viewed as a specialization to be delivered within a dedicated center or facility, or will the new, higher goals of today’s memory care become an assumed part of every LTC  setting? Perhaps the days of “dementia wards” or “Alzheimer’s units” where X number of beds are designated for those with memory care needs are long gone already. LTC architect Amy Carpenter, AIA, LEEP AP, BD+C, one of this year’s Long-Term Living Leaders of Tomorrow, suggests that LTC building design trends are beginning to shift toward designing all LTC spaces with memory care in mind—creating memory-care-friendly design for all stages of housing, from independent living to hospice.

And perhaps the biggest question of all: How does the (rocketing) home healthcare industry sector fit into all this? Is home healthcare, in the end, a competitor or a partner? If a competitor, how will LTC businesses parlay the competition found in consumers’ wishes to “age in place”? If a partner, how will quality be monitored and assured?

How the LTC industry chooses to interpret and answer these weighty questions will form the next waves of culture change. What will 2014 be your “Year of”?

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.