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Keeping Pace with Aging Customers

Nursing homes evolve new services — and new profit centers — to keep pace with customers who are living longer, staying more active and demanding personalized services.

Resident Jane Nicholson gets one-on-one attention from Gina Oliver, a certified occupational therapy assistant in Florence.

Resident Jane Nicholson gets one-on-one attention from Gina Oliver, a certified occupational therapy assistant in Florence.

Improved healthcare and longer life spans have made it possible for people to stay active longer and to have higher expectations than those of previous generations. Not content to sit in a rocking chair once they hit a certain milestone, these individuals want to live active, social, fulfilling lives well beyond their 80th or 90th birthdays.  

In the long-term care industry, those changing expectations represent new business opportunities. In addition to traditional long-term care services, many nursing homes now offer short-term rehabilitation, home health services, in-patient hospice and respite care to relieve in-home caregivers. 

“Thirty or 40 years ago, the average nursing home resident walked into the nursing home with a bottle of aspirin in one hand and a suitcase in the other, deciding to live out their days there,” says John Matson, communications director at the Alabama Nursing Home Association. “Now, most are brought in by ambulance and may not be able to walk or talk on their own. People are just living longer, healthier, more active lives.” 

Rather than waiting to care only for the patients who need a nursing home as a final option, many long-term care facilities are expanding their services to meet other needs of the aging population. By offering more services, these nursing homes are not just adding revenue and diversifying their revenue streams; they are also securing vital places in their communities by meeting the needs of local residents. 

Josh Kilpatrick, PT director at the Florence facility. 

Photos by Abraham Rowe

Rehab Services

Mitchell-Hollingsworth Nursing and Rehabilitation Center in Florence started providing short-term rehabilitation services about 12 years ago, using 20 beds from the nursing home’s total of 222. 

In 2004, when Administrator Brian Scheri arrived, he took an additional eight beds from the nursing home and added them to the rehab unit, choosing rooms that were located at the far corner of the building to create a separate entrance for the rehab center, “so somebody who’s 67 and just had knee surgery never has to walk through the nursing home,” Scheri says. 

With the added beds and separate entrance, Mitchell-Hollingsworth’s rehab patient caseload increased in just a year from about 12 per day to about 30 per day. Based on those results, leaders decided to invest more than $500,000 to build a new rehab gym connected to the unit. The state-of-the-art gym has been a selling point for the center and paid for itself within a few years. The center now has 38 beds for short-term rehab patients and a waiting list to fill them. 

“It’s been a good decision, because, if you look at the number of occupied beds in nursing homes over the past 10 years, they’re declining,” Scheri says. “We have 222 beds here, and we’ve got to do something with them. There was a market for rehab here, so we’re still meeting the needs of our community.” 

NHS Management, which manages several nursing home facilities in Alabama, is also focusing on expanding rehab services. In some facilities, the company is using space directly connected to existing long-term care facilities, and, in other locations, NHS is establishing freestanding, dedicated short-term recovery facilities with specialized services and amenities, says John Burchfield, vice president and director of Alabama operations. 

The company recently completed construction of a new rehab facility at Valley View Health and Rehabilitation LLC, in Madison County. Restore at Valley View is situated in a 25,000-square-foot wing, with a 4,000-square-foot therapy gym, and a dedicated dining area and in-suite dining. The facility houses 56 private rooms and two semi-private rooms. 

Currently under construction, the Aspire Physical Recovery Center–Hoover will open at the end of 2014. The freestanding center covers 85,000 square feet and will have 118 total beds and 78 private rooms. “Aspire is designed to provide short-term, in-house physical recovery,” Burchfield says. “It also will provide luxury amenities, including spa services, chef-prepared culinary experiences, concierge services and more.”

Long-term care facilities, such as Aspire in Hoover, have upped their game. This new facility is slated to open late in 2014.

Photo by Cary Norton

Personal Care Services

In addition to expanding rehab facilities to meet community needs, nursing homes also are adding more personal care services — services that cater to an individual’s medical or lifestyle needs. 

At Oak Trace Care and Rehabilitation Center in Bessemer, a new Music and Memory program is helping to improve the quality of life for long-term care patients. Through a grant from the Jefferson County Ombudsman’s Office, six staff members were trained and have become certified music and memory specialists. They use technology, such as iPods, to bring individually selected music to residents. With the help of local student volunteers, each resident completes a music inventory questionnaire that asks questions such as what year were you born and what year did you turn 16, to help staff and volunteers determine the types of music that were popular during the resident’s youth.

As a result of the music and memory program, “We have seen those who have dementia taken back to a happier time,” says Trina Vines, administrator at Oak Trace. “We have watched one gentleman use his iPod daily, and one of our folks who goes to dialysis was initially resistant to the music, and, now that he has been listening to his iPod, he takes it to dialysis and keeps it in his room and charges it himself. Overall, our use of anti-psychotic medications has continued to decrease, and we believe the music and memory program is a part of that.”

At Westside Terrace and Rehab First in Dothan, staff has embraced the philosophy of person-directed care, which “encourages both the older adults and their caregivers to freely express choices and to practice self-determination in meaningful ways in every aspect of their daily lives,” says Administrator Kristie Hughes. “Values that are essential to this philosophy include choice, dignity, respect, self-determination and purposeful living.” 

By allowing residents more freedom of choice and creating an environment where staff members accommodate seniors’ preferences, rather than the seniors having to conform to facility schedules and patterns, Westside Terrace has gained a competitive advantage. For instance, Westside Terrace has an average 96 percent occupancy rate, which exceeds both the state and national averages. In addition, the facility has a long-term care waiting list. “Our revenue is obviously census-driven, so the combination of a great occupancy rate, and people wanting to stay here with us, results in financial success,” Hughes says. 

In addition, Westside Terrace has documented great satisfaction among its customers. Annual survey results show an improvement in customer satisfaction from 89 percent in 2006 to 98 percent in 2014. 

But the changes aren’t over yet. “Many in this business refer to culture change and person-directed care as a journey, not a destination,” Hughes says. “We have found that to be true and continue to identify ways that we can improve the delivery of the services we provide. We enlist the help of our residents to make decisions about the changes they would like to see. In nursing homes, consistent customer satisfaction is, in itself, the most rewarding accomplishment.”

Nancy Mann Jackson is a freelance writer for Business Alabama. She lives in Huntsville.

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