Skilled Nursing Facilities (SNF)

For a Chief Medical Officer, what role does technology play? Recently there was an opportunity to query executives in senior care, including Dr. Arif Nazir, Chief Medical Officer, Signature HealthCARE, who was asked about the technology impact on long-term care jobs.   The insights quoted here could be generalized, not just to Skilled Nursing Facilities, but to all types of care delivery – and are particularly notable in the context of last week’s New York Times article: "How Tech Can Turn Doctors into Clerical Workers.” As Dr. Nazir notes, it’s not just doctors who can be frustrated by over-emphasis on technology. Here are the questions and few observations about the work and the workers:

Largest city in the US shows a path for an aging society.  New York has long been a host and leader in supporting older adults, from being a WHO Age Friendly City, to acknowledging the presence of Naturally Occurring Retirement Communities (NORCs) starting in 1994, to being the home of the first Virtual Senior Center (VSC). In addition, technology leadership initiatives have been offered via SelfHelp in Queens, and Senior Planet, a technology exploration center that offers tech training for adults 60+. So many people aging, many needing the skills to find and keep jobs. So they utilize services like OATS and Senior Planet, or senior centers, training in libraries, carrier stores and online sites like AARP TeK Academy.  

Nursing home avoidance continues for both investors and care recipients. You might have read about investors cutting back on nursing home investment within ‘healthcare’ REITS.  CMS and Medicare are reimbursing less for ever-shorter nursing home stays, ending their multi-year ‘billion dollar pie eating’ wave of investment.  Note that the biggest chains of skilled nursing facilities (SNFs) like Signature Health Care (which has a web URL signaling LTC -- LongTerm Care) Revolution) – what might that revolution be?  Consider the consumer’s first encounter with the industries for health care, long-term care (LTC), skilled nursing facility (SNF), nursing home, or post-acute facility. This terminology morass mirrors the reimbursement patterns of government agencies, which, in turn, drive investment language, behavior and labeling.

Nursing home avoidance – the home care wave fits the profile.  So we know that tech-enabled home care has received several infusions of cash lately.  Whether this is an anomaly -- once new-age firms realize that home care consists of difficult and backbreaking labor – or signals a trend, remains to be seen.  The apparent bloom of the home care business opportunity appears to be the inverse of the business gloom in senior housing, as noted in these Chapter 11 filings. These businesses are failing at the same time as nursing home bed capacity is anticipated to become constrained.   As AARP has endlessly repeated, 90% of older adults want to remain in their own homes. Or maybe it is 87%.  But regardless of intent, most will stay because they can’t afford anything else.  

Are individuals who need care where they should and can be? You may have noticed last week. There were four articles and press announcements within just a few days – sourced separately that belong together. No insurance or government program is all that transparent or straightforward, but policy and practice variations across states seem to have one victim – the person who needs care.  They ability to obtain that care at home (or in the right setting) depends on the state you live in and what the policy, practices, and costs in that state. Genworth’s newly-updated report is revealing about long-term care costs in multiple settings and categories.