State of the long-term care industry in 2018

The world of long-term care is changing in 2018, and this will impact the future of care in Central New York, as well as the future of Loretto. 

Dementia & memory care trends

The number of Americans age 65 and older living with memory loss, including Alzheimer’s and other dementia conditions, is projected to more than triple from 5.1 million in 2016 to 16 million in 2050. Close to 18 percent of that growth will be right here in New York state. Not only is dementia affecting more people, but it is also starting to impact younger people. For these reasons, a significant investment in memory care will be needed to ensure we have the appropriate professionals and the facilities for victims of this disease.

Telemedicine trends

The concern over rising health-care costs combined with technological advances are continuing to shape the industry in a unique way. Nationally, more than 20 percent of Medicare patients discharged to a skilled-nursing facility return to the hospital within 30 days. The federal government estimates this translates to $17 billion that could be saved with proper patient care. 

To help address these concerns and best leverage new technology, Loretto will be working to improve patient care and reduce readmission rates through the incorporation of telemedicine to enhance our rehabilitation services. This year, Loretto will be introducing TeliStat Restorative Care Units with portable monitors that track multiple health risks in real-time. Residents in our short-term rehabilitation program will receive an interactive telemedicine device that enables them to access physicians any time of day or night. 

Workforce development

There continues to be a shortage of the skilled nursing and other professional staff that are needed nationally, and in this region. Recruiting, training, employing, and supporting these individuals is a key area of focus for Loretto in 2018.

Loretto’s partnership with CenterState CEO’s Work Train initiative through the Health Train Industry Partnership creates local career opportunities in health care. We’ve hired more than 300 graduates of this program over the past three years with an 89 percent retention rate, higher than the industry standard of 50 percent to 60 percent. This demonstrates how the state of our industry can differ from region to region.

Impact of tax reform

Some of the most significant challenges we will face in 2018 and the near future come in the form of legislation. Tax reform passed, and despite congressional leadership calling for cuts to Medicare, the final version preserved several tax provisions, including the medical-expense deduction, which is promising. But House Speaker Paul Ryan has been vocal about making cuts to Medicare, saying, “This [Medicare] has been my thing for many, many years. I think it’s the biggest entitlement we’ve got to reform.”

However, tax reform is just one of many critical pieces of legislation that affects the services and programs we provide to individuals of all ages and income levels in Central New York. Residential facilities, like several of Loretto’s facilities, account for 42 percent of all Medicaid spending — so any changes there would have a significant negative impact on our people. And the number of people we are serving, as well as the number of years for which we serve them, is also growing. Residents coming into our facilities are now living with us for 10 even 20 years, which was not the model when Medicaid was introduced in the 1960s. Even those who may have saved for retirement and care in later years likely didn’t anticipate living to 90 or 100, and at some point, they will need Medicaid assistance.

Looking ahead

All of this means that 2018 is going to be a challenging year. We are likely to have fewer resources and potentially fewer referrals as more people are going home from the hospital. Additionally, we face increased demand for complex medical and behavioral care services, and subsequently the need to increase investments in IT infrastructure, staff training and benefits, and access to real-time critical business information. At the same time, however, there is potential for more resources and new opportunities over time in other areas.

Managed care, readmission measurement, and value-based payments are here to stay, no matter what happens with health-care reform efforts. But for managed care as the primary payer, the revenue cycle will be longer, so we will need to find ways to increase cash on hand.

While we sharpen our focus, we can’t lose sight of what’s ahead. We need to be creative in anticipating the needs of our community, particularly for home and community-based services and specialty care services.

We will continue to be active in these and other potential issues that threaten the care that our residents and program participants need. But we won’t let these challenges take our focus away from creating opportunities to secure the future of long-term care in Central New York.                         

Kim Townsend is president and CEO of Loretto, a nonprofit network of elder-care providers. It serves nearly 7,000 individuals annually in Central New York. Loretto employs 2,500 people and says it is the sixth largest employer in Central New York. It adds that it’s the fourth largest health-care provider in the region.