Are you holding a full house?

Companies that develop assisted living facilities have become the darlings of Wall Street. There are many factors driving this growth. First, demographics are changing and the senior population is growing worldwide. Second, advances in medical technology afford longevity. Third, consumers are taking better care of themselves. Fourth, economics and reimbursement issues are encouraging a greater emphasis on ambulatory settings, as they are less costly. Fifth, and maybe most importantly, assisted living provides an alternative in many cases to traditional medical institutions such as the nursing home.

Although assisted living can be considered part of the post-acute care continuum (broadly defined), it is operationally very different from skilled nursing or subacute care. To start with, its population functions at a higher physical level, with most residents able to ambulate or move around independently. This level of functioning dictates everything from the type and skill set of personnel to the design of the structure. Another difference is that consumers often choose to go to an assisted living facility with the idea of residing there for the rest of their lives. Surely this is not the same attitude of those entering a hospital or even, in many cases, a nursing home.

Probably the greatest difference between assisted living and its post-acute siblings, though, is reimbursement. Even though many states are evaluating legislation that would provide payment for assisted living, currently there are few third-party payers in this field. Residents and their families generally are responsible for payment for assisted living services, which can be costly.

Assuming, however, that an assisted living operator has defined, through good market research, a population of age- and income-qualified potential customers who might be interested in a convenient assisted living resource, one of the next major challenges is finding referral sources. Here is where the entire post-acute care continuum (also broadly defined) comes into play.

Those assisted living centers that are part of a corporation that includes various levels of care understand very well the referral role that skilled nursing/subacute facilities can play. Their primary goal is to restore residents/patients to their highest level of functioning, and options range from retaining them in the nursing home, sending them home, possibly with an order for home health services, or discharging to less intensive residential care. Managed care and Medicare are creating an environment that motivates providers to transition residents/patients rapidly to the least costly and (hopefully) most practically functional level of care. Not only are skilled nursing/subacute providers natural allies and referral sources in this, but formal collaboration with independent living facilities may play a key role, as well, in garnering referrals.

Case managers, those working independently or for insurance plans, are some of the best referral sources. These professionals are knowledgeable about conditions that could result in someone's requiring assisted living. What is also pertinent is that they often have this information well before the need for assisted living becomes a reality. They are always interested in saving the plan money by keeping the client out of a medical setting and are especially trained as patient advocates.

Home health agencies probably are already providing some service to your facility, and they offer a link to potential clients in the community. These nurses and therapists are acquainted with the physical problems of those in the community. Because they work in the client's home, they often become close to the family and learn of their varied needs. And don't overlook physicians themselves, who often provide a key part of the "assistance" in assisted living. One shouldn't rely solely, though, on the healthcare system's many components to channel referrals to the special post-acute level of assisted living. For example, local clergy are often personally close to members of their churches and temples, and are involved in many important family decisions. Become involved in the community - attend Chamber of Commerce meetings, the Rotary Club, etc. Get to know attorneys, accountants, trust and estate administrators, large and small employers, and managers of senior centers, social clubs, area agencies on aging, and disability organizations.

Last but not least, ask your staff. That's right, the people you go to lunch with, who run the office, maintain the building, work in dietary, care for the resident - the people you count on day in and day out. Recently, an assisted living administrator asked me if I could suggest some new referral sources, as he felt he had exhausted his list. I asked him to arrange for me to meet with his personnel a few times. During these meetings we did some communication exercises and I developed a questionnaire. After surveying the 26 staff members, I handed him the names of over 250 new sources. It was one of those easily overlooked "obvious" solutions.

You may have others. If so, let me know at the address below. Here's to a "full house" for many assisted living operators in 1998.