Perspectives: Will People Return to Senior Care Facilities After the Pandemic? (Part II)

Ryan Iwamoto, president and founder, 24 Hour Home Care

We’re pleased to bring you two more perspectives on how the pandemic has shaped the senior care industry, and what it means for the industry’s future. (You can check out Part I of our series here.)

Steve Carr is director of sales and business development at Centers Health Care, a premier group of skilled nursing, rehabilitation, and senior care services in New York, New Jersey, and Rhode Island.

Ryan Iwamoto is president and founder of 24 Hour Home Care. 24 Hour Home Care provides senior and disability in-home care through its 16 locations in California, Arizona, and Dallas.

Because COVID-19 has spread so quickly through nursing homes, it’s eroded family and resident trust in some facilities. What do you think senior care facilities will need to do to rebuild that trust during and after the pandemic?

Carr: The pandemic has shined a light into what, at least from the news reporting, was perceived to be a bad situation. We see that every day, both at the hospital level and in skilled nursing. I think all healthcare providers will need to highlight how they’re managing infection control and what they’re doing to keep staff and patients safe.

In the long run, we’ll need to educate the public about the role we in the skilled nursing sector play in the healthcare system. Recovery and rehabilitation occur in skilled nursing. This was true prior to the pandemic and will remain true as we overcome this challenge. I think it’s our responsibility to ramp up education around what we’re doing to manage outbreak and infection control, but also the role that we play.

Do you think we’ll see a restructuring of the senior care industry, whether that means physically redesigning facilities or adopting new policies and procedures?

Carr: I think policies and procedures have already begun to take shape as we’ve accrued intel from the early pandemic, and there’s been movement in the policy and procedure world around infection control and PPE supply chain and testing.

I don’t see a dramatic restructuring from the physical plan perspective. With over 15,000 nursing homes in the country, most of which have more than just private rooms, I don’t see that changing any time in the near future.

I think the definition of facilities and the role they play will change. We had COVID-dedicated facilities that allowed us to isolate patients in specific centers. That will continue. I think in the long run there will be facilities that specialize in long-term care and a subset that specializes in rehabilitation and post-acute care. I do think the levels of care will return after pandemic, and hospital care, skilled nursing, independent living, and home health care will continue on.

Once COVID-19 is better controlled or even eliminated, do you think that people will quickly return to senior care facilities? How might the pandemic have changed how families evaluate facilities when seeking out care for a loved one?

Carr: The recovery that we face will not be quick, in my opinion. That said, it will occur because skilled nursing facilities will play a major role in our nursing system. COVID will pass but other diseases that impact so many will not. COPD, end stage renal disease, and heart disease will require skilled nursing.

When choosing facilities, patients will think about who has the best track record, the best outcomes, and what centers offer a high level of quality that’s needed to care for a condition. Out of all the alternatives that exist, patients and families will always ask, “What’s best for my situation.” Facilities that can demonstrate that will gain that confidence.

Iwamoto: I think there will always be a need for skilled nursing facilities. However, we are going to see a growing shift toward sending patients directly home through hospital-to-home programs. CMS has been creating strategies to enhance hospital capacity amid the COVID-19 surge.

In March, CMS announced the “Hospital Without Walls” initiatives, which loosen up restrictions to provide services within their four walls. In November of last year, they expanded it to include the Acute Hospital Care At Home program to create even more flexibilities to treat patients at home. The program was created to further models of at-home hospital care that have been piloted and been successful prior. Six systems are a part of this program as of now. These include: Brigham and Women’s Hospital and Massachusetts General Hospital in Massachusetts; Huntsman Cancer Institute in Utah; Mount Sinai Health System in New York; Presbyterian Healthcare Services in New Mexico; and UnityPoint Health in Iowa.

Are there any other systemic changes that you predict the senior care industry will see as a result of the pandemic?

Carr: I think definitely the focus on the fundamentals around infection control, supply chain, and the ability to rapidly test at scale will become normal. I think the emergence of telehealth will live long beyond the pandemic. I would include the use of telehealth in skilled nursing as part of that.

I think the biggest difference will be the funding mechanism, and how the federal and state governments learn to be better prepared to find funding mechanisms that are sustainable. These mechanisms will need to help with shortfalls. Whether it’s staffing or supply chains, or all those things that will require funding, my hope is in the long term everything will be reliably funded.

Iwamoto: We are going to see further momentum shift toward patients going to the home after the hospital. Home care has made significant contributions to the post-acute care continuum. COVID-19 has just put a bigger spotlight on home care and confirmed an already valuable service for our healthcare system. We are also seeing health care financial leaders viewing home care as a key area of investment for the future.

According to a survey from BDO, an accounting & consulting firm, 59% of CFOs at US health organizations with revenues ranging from $250 million to $3 billion that were surveyed identified home care as a priority investment, COVID-19 being the big driver of this. And as the country continues to fight the surges, the demand for home-based care and services will continue to grow.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.