South Florida Hospital News
Friday October 23, 2020

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May 2006 - Volume 2 - Issue 11


Trends in Long Term Care

When Hospital News Publisher Charles Felix asked me to write an occasional column on trends in long term care, I thought it a great way to continue our professionís dialogue with physicians and hospitals. We are all part of the same continuum of care and we share many of the same challenges.

Iím a Baby Boomer, but Iím also a second generation nursing home administrator. From my seat in the stands Iíve seen long term care evolve from the old "rest homes" to places where the patientsí complete medical, social and even spiritual needs are met. Today our patients are older, sicker, more frail and more medically complex than those we cared for in the 1960s. As the state moves to expand home- and community-based care options to allow the elderly to live longer at home, itís logical that tomorrowís nursing home population will be even older and sicker than todayís.

Major health policy changes are occurring right now at both the federal and state level that will profoundly affect the long term care system. They are manifestations of several trends that will continue into the coming years. Here are only three:

Residential vs. Medical

I get the biggest kick out of news stories about what nursing homes and assisted living facilities will look like when the time comes for the Baby Boomers to check into them. These nursing-home-of-the-future stories invariably describe a combination spa/wellness center/crash pad where Harleys are parked outside, right next to the Jacuzzis. Other stories say there wonít be any assisted living facilities in the future because all the elderly will be living it up aboard cruise ships circling the world.

I doubt tomorrowís long term care system will resemble the ones described in the stories, but itís already apparent there are moves away from the medical model we have today (and have had ever since the federal government embarked on a hospital-nursing home building program in 1954) and toward more of a social-residential model. Nursing homes in the future will still provide skilled 24-hour nursing care, but there will be much more of an emphasis on outcomes, what the patient wants and how best to meet his or her individual needs. Baby Boomers have always demanded quality products and meaningful choice among providers; thereís no reason to think they wonít continue to just because they have become old and frail.

Cost Control Spurs Innovation

This is a trend playing out right now in the form of Gov. Jeb Bushís "Florida Senior Care" Medicaid managed care plan. Under the plan, Medicaid-eligible seniors age 60+ will choose from various private HMOs or managed care organizations that will then coordinate and provide the array of services available. Pending federal and state legislative approval, pilot versions of the plan could begin this year in Pensacola and the Orlando-Melbourne area. Itís too early to tell whether this particular idea will work out, but the overarching goals of improving quality and managing burgeoning state health care costs will spur innovation and drive creative thinking for years to come.

Change and uncertainty is always scary for some, so look for a proceed-with-great-caution approach as new ideas are implemented and tested. Considering the stakes involved, this is the prudent way to go.

More Diverse Funding

Maybe Iím being overly optimistic, but watch for federal and state legislators to provide financial and/or tax incentives for people to purchase private long term care insurance and/or to take care of elderly family members at home. A purely taxpayer-funded system is barely sustainable now, both from a state budget perspective as well as from my perspective as a long term care provider. Having a more diverse payor mix is best for all. Also look for tightening of Medicaid eligibility requirements and increased penalties for those who game the system.

Many unanswered questions remain for long term care providers. Chief among them is whether ALFs and nursing homes can remain financially viable in the future environment. Our costs have steadily increased, but our funding has not kept pace. At the end of the day, if nursing homes and ALFs canít cover their costs, they will close their doors at the very time the Baby Boomers come knocking.

Bobby Rosenthal, President, 21st Century Health Group, Inc., can be reached at (305) 986-0389 or
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