It’s Time to Rethink How—and Where—Healthcare is Delivered

As many as 85% of older adults have at least one chronic health condition, and 60% live with at least two chronic conditions. Too many of our seniors live alone, adding the serious risk of social isolation to their disease burden, a risk only increased by the COVID-19 pandemic. As many as 2 million Medicare beneficiaries are completely homebound, a number that also dramatically increased during the pandemic. For those who are homebound with complex medical needs, a small minority have access to medical care in the home. Seniors managing on their own face a daily threat of adverse risks, from loneliness to fall hazards, that a system focused on preventive care could address. We are not, however, there yet. But at Brookdale, we know that delivering effective healthcare to seniors means supporting seniors every day to help reduce the risk of serious illness. That’s why high-quality assisted living is an essential part of a value-based continuum of care.

To Brookdale, “Assisted Living” Means More Than Amenities

For decades, senior living communities have put hospitality, not healthcare, at the core of their service models. However, residents entering senior living communities today are trending older and have more chronic conditions to manage. At Brookdale, we conduct personalized assessments to determine whether we can manage not only the quality of a person’s daily life but also their clinical needs. That’s because treating chronic conditions effectively and maintaining the health of an at-risk population requires more than adhering to the “sick care” part of the system. True well-being requires holistic care. In addition to providing a healthy living environment, transportation, access to medical care and nutritious food, Brookdale helps residents achieve well-being in every area of life through our Optimum Life^® program. This was created to address the social determinants of health by educating our staff and residents about an overall focus on wellness, which involves active engagement in relationships and activities that support their spiritual, physical and emotional well-being.

Our approach to managing the health of the population we serve can help reduce unnecessary hospital readmissions and help senior patients live their healthiest lives possible. To manage chronic conditions, we do the following:

• Help residents adhere to physician-directed treatment plans, manage their medications and follow dietary recommendations and exercise guidelines, as well as support their social and behavioral needs.
• Provide opportunities for providers to round inside our community to see for themselves how their patients live day-to-day and close the continuum of care inside the patient’s home with us.
• Engage medication management programs with pharmacy partners to monitor interactions with medications and coordinate with providers outside our walls.
• Health and wellness directors regularly report changes in condition to care partners.

It’s through supporting and witnessing residents’ daily habits that we’re able to identify that something may have changed, and we can help get ahead of a decline in condition in partnership with their care team. In this way, we’re helping overcome access to care issues and the delays that social isolation may cause. 

In our HealthPlus^® communities, which exists in a number of our communities in Ohio, we expand our clinical capabilities with RN care management that helps bridge the gap of communication between the family and the physician. They know what the residents’ chronic conditions are and preventive care plans needed for that diagnosis, including next steps. Typically, with chronic conditions, patients aren’t scheduling proactive, preventive checkups; and because they may be seeing more specialists, there isn’t a strong role for the primary care provider. At many assisted living facilities, that role continues to be placed on the care partner. But at our Brookdale HealthPlus communities, an RN Care Manager manages care such that a resident with diabetes, for instance, has their annual podiatrist and eye exams scheduled in consultation with care partners and primary care providers, so that each resident has a proactive patient advocate, not just those whose families find the healthcare system easier to navigate.

Healthcare Versus Sick Care: Steps Toward Daily Wellness

For a senior who may have been living alone, moving between their bed and a chair with little interaction or stimulation from the outside world provides limited opportunity for healthy habits and daily wellness. A “sick-care moment” could be right around the corner.

The difference can be remarkable when they come to live at Brookdale. The relationships we foster in our communities can help create some of the greatest changes in a resident’s health and well-being. The Centers for Disease Control reports that social isolation significantly increases a person’s risk of premature death and contributes to a 50% increased risk of dementia. Among heart failure patients specifically, there’s a four-times increased risk of death for lonely and socially isolated adults. At Brookdale, they’re in an engaging community where they visit friends and participate in enjoyable activities that we help them identify and pursue. I was just talking to a gentleman whose mother recently came to live with us. He said, “I don’t even know who this person is, because she’s never in her apartment. She’s always out.”

Think about the term “assisted living.” It boils down to assisting someone with their daily living. We’re addressing social determinants of health beyond what even a 24-hour caregiver could provide, because that support isn’t all resting on one person’s shoulders. We’ve enabled a community of caregivers, including our community of residents, to support one another in their health and overcome social determinants they may have faced before they moved in with us. Once a resident is inside our care, it can be an easier and more equitable way of life that supports their health, without waiting for that “sick-care moment.” It’s where value-based healthcare happens daily, in moment-to-moment interactions that support and help improve outcomes.

It’s time for senior living communities to better distinguish “healthcare” from “sick care.” It’s time to reevaluate how we define the most effective roles we can play in helping to improve the health outcomes of senior adults. At Brookdale, we’ve found that it’s a daily choice of proactive care and everyday wellness.