Use of electronic medical/health records was up 5% from the past two years to an 80% adoption rate across all operations, whereas point of care documentation technology remained around 76%. Automatic fall detectors were up 12% to an adoption rate of 36%. (The only category that slipped was traditional personal emergency response systems, which fell about 5% to 73%.)

In other categories:

• Access control/wander management systems were up 7% to about 77%.
• Telehealth/remote patient monitoring jumped 15% to an adoption rate of about 21%. 
• Telecare/telemonitoring jumped 12% to about 19%.
• Physical exercise and rehabilitation technologies’ adoption increased roughly 3% to 63%.
• Medication monitoring technology increased 5% to almost 45%. 
• Care management and coordination, a new category added this year, was adopted by 55% of the largest providers.

Even so, tech adoption lags the rate outside the senior living sector. “While there are exceptions, by and large, senior living organizations are not at the forefront of technology adoption,” says Travis Palmquist, vice president and general manager for PointClickCare’s senior living division. “While there is a multitude of potential ‘new’ technologies that could have an impact on the lives of seniors, most providers are wrestling with how to integrate those technologies into their business in a thoughtful and productive manner.”

When McKnight’s Senior Living asked leading tech companies what the latest most impactful tech is, most said it had to do with data.

Not surprising, interoperability is the big buzzword now as providers all kinds scramble to integrate EHR with payers and provider partners. “Employing interoperability, leading post-acute care organizations are able to manage critical areas across multiple facilities — quality of care, procurement, reimbursement and even regulatory compliance,” says Cheryl Field, chief product officer of Prime Care Technologies.

No single challenge confounds Move-N-Software’s clients more than electronic documentation, according to Rita Burgett, president. The most vexing issue they wrestle with among “state, insurance and family overseers” is connecting all those episodic and encounter dots.

“When caregivers need all documentation surrounding one specific incident, they must still wade through months and months of resident charting trying to tie together all the related charting for any given incident,” says Burgett, whose company has developed a solution called “resident care threading” to save time and provide better care.

Palmquist believes electronic medication administration records and point-of-care technology have had the biggest effect on senior living providers today. eMAR allows providers to manage the complexity of medication delivery, whereas PoC helps automate the delivery of services and/or care the cornerstone of resident- centered care today, he adds.

Trisha Cole, COO of Medtelligent, and Dan Roberge, president of Maintenance Care, a provider of facility maintenance software for senior living, assert that “smart” technologies such as voice-activated assistants are beginning to show great promise for facilitating greater resident engagement.

ARE NON-SNFS UNIQUE?

In its recent forward-looking report on evaluating business models for technology-enabled long-term services and supports, LeadingAge’s Center for Aging Services Technologies posed the provocative question, “What Kind of World Do We Want?” Among the various things such as EHR, eMAR, telehealth and broadband was the over-arching statement that residents of “the future will view technology as a resource that supports human interaction but does not replace it.”

So how does that make assisted living communities different from nursing homes?

“Technology use and adoption in non-skilled senior living settings is much different that in nursing homes because the makeup of the staff and their education level is less predictable,” Cole asserts. “Assisted living communities do not necessarily need a nurse on staff in many states, and often times a nurse is more technology-savvy given his or her level of education and is capable of leading and training staff on new technology solutions.”

Pondering that, consider what experts say ALFs and other settings are most interested in today.

A big one is anything that streamlines caregiving.

“Automation in workflow and process have to be at the forefront with assisted living operators due to the lack of care staff in comparison to skilled nursing facilities,” Roberge says. “Anything that allows the resident to communicate, or for the limited staff to automate their day today, has to be at the top of their list.”

Cole agrees, particularly with “smart” tech that accommodates and adapts to staffing levels. Although Cole believes “companies are looking for tools to help them determine the exact amount of labor needed for specific acuity level of their residents at any given time,” she also asserts a complete solution has yet to emerge.

Unlike nursing homes, assisted living communities find asset management as critical as anything, according to Palmquist. Moreover, “the lack of federal regulatory oversight leads to more complexity and risk of inconsistency.”

In some respects, non-skilled senior care providers hunger more for tech tools that add business intel and analytics muscle, says Cole, adding, “Previously the interest was in ‘data’ and collecting data, but companies have now realized that having pure data is difficult to sort through and analyze.”

Finally, like everyone in the business of senior living, there’s plenty of room to innovate in resident and staff engagement and connectedness technology. No one seems to get enough of it yet. Recent research found that subjective feelings of loneliness can increase the risk of death by anywhere from 26% to 45%, a fact not lost on CAST, which is refreshing it various tools for social connectedness and engagement technologies, according to Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and CAST’s executive director.

To some, tech needs are the same across every part of the LTC spectrum. It’s the end game that’s different.

“For a SNF, quality of care is critical to nearly every aspect of their business, whereas for assisted living, it’s more of a marketing play,” Field says. “That is, pick us because we provide high-quality healthcare on site.’”

In assisted living environments, so much of tech adoption is resident-driven.

“One thing that assisted living may see more quickly than nursing homes is the adoption of technology from their residents,” says Deb Woods, vice president of product management for Relias. “The aging population is becoming more technology-savvy.”

ACUITY CHALLENGES

As the acuity level of assisted living populations rises as expected in the coming years, owners may benefit from the tech savvy battle-tested counterparts on the SNF side, say observers.

As Wood observes, “Utilizing the data from EHRs and resident-owned technology, assisted living organizations will be able to respond more quickly and effectively to changes in condition that may warrant higher levels of care.”

Kristen Hanich, a research analyst for Parks Associates, says her firm’s research data shows that 76% of consumers aged 40 and older living in U.S. broadband households expect to live in their own homes when they turn 80, “even though it may not be safe or feasible for many to do so. Many of the most at-risk and vulnerable may have no other viable option than to remain in their homes simply because of cost.” And so, she adds, assisted living communities can use technology as a cost savings measure, “but there is a big question mark as to whether or not the facilities that provide service to the most vulnerable aging Americans will have the funding or knowledge to implement the necessary technology.”

Providing the most effective resident-centric memory care programs takes a sophisticated and multi-pronged approach that marries robust staff education and interdisciplinary collaboration with activities and technology-based applications that tap residents’ unique histories, interests and strengths.

“All residents, even those in end stages of cognitive decline, can become more engaged and fulfilled, and they deserve to live in communities that are committed to providing that,” notes Kathy Greene, the senior vice president of programs and services integration for Silverado.

Experts agree the efforts will pay big dividends by improving resident quality of life and giving operators a healthy competitive advantage by helping residents at even the most advanced stages of dementia age in place longer. Improved resident engagement also can help prevent elopement and falls triggered by agitation and confusion, as well as isolation and subsequent depression.

Despite growing awareness surrounding memory care programming, some operators still aren’t spending enough time each day to reach residents with dementia in meaningful ways, says Charles DeVilmorin, the CEO of Linked Senior.

“On average, residents get only 11 minutes of activity a day, and the people who need it most tend to get it the least,” he says.

Misconceptions surrounding dementia are often to blame. Because those with dementia often have shorter attention spans, some mistakenly assume a few minutes of activities is adequate when, in reality, it is possible to engage them longer with more creative, person-centric approaches. This underscores the need to keep targeted staff education at the core of memory care programming.

“Staff education needs to be ongoing and not just something that happens during an annual inservice,” says Kelly Carney, Ph.D., ABPP, CMC, the corporate director of memory care services at Acts Retirement Life Communities. Although some online training or traditional teaching approaches can be beneficial, especially when introducing employees to dementia basics, she stressed the value of more robust, hands-on training that lets staff apply what they learned.

Also essential is interdisciplinary collaboration that draws valuable insight about each resident from various members of the care team. This can be especially helpful for difficult-to-reach residents by allowing staff members to pool their knowledge in an effort to improve care and planning. A recreation coordinator, for example, can share important details about a resident’s history and current interests, and nursing aides can offer insights into a resident’s routines or any perceived changes, whereas a mental health provider can provide cognitive screening to determine resident strengths and deficits, Carney says.

“Our care philosophy is, no matter how advanced a person is with this condition, that person is still in there, and it’s our job to reach them in a meaningful way. It may be through a pet visit or another activity of particular interest to that resident,” Carney says. “The more information we have, the better we can meet those unique residents’ needs.”

Silverado communities also engage residents through high-touch, purpose-driven programming. Resident volunteer programs allow individuals in early and even more advanced stages of dementia to give back to their communities. Resident in earlier stages of dementia have volunteered offsite by feeding the homeless and serving the local Humane Society, for example, whereas those experiencing greater cognitive decline can volunteer for their onsite communities by making floral arrangements, baking cupcakes or sanding and staining signage for Silverado events, Greene says. Since Silverado began tracking volunteer hours six months ago, volunteers logged a combined 4,000 hours across 14 communities, and volunteers are being recognized and rewarded for their service.

CLUB APPEAL

Resident clubs also keep memory care residents engaged and enriched. Cooking, gardening and travel clubs are just a few that are available to residents, and themed clubs provide a positive sensory experience for residents with even end-stage dementia. The Good Fellas Club for men, for example, involves placing warm towels and shaving cream on men, and allowing them to smell cigars, while the seasonal Wedding Club might include flower petals, veils and residents’ own wedding photos to allow for sensory-based reminiscing. Residents with end-stage dementia who cannot verbalize their experiences still participate in the Travel Club at the sensory level. If Italy is the country of focus, residents can smell the simmering sauce, enjoy Italian music and even feel pasta between their fingers, Greene says.

Innovative, intuitive and flexible technologies can further promote resident engagement and enrichment, and some can help slow the progression of cognitive decline. Carefully selected solutions also can help caregivers stay better connected to their mission, which can increase employee satisfaction and reduce turnover – both of which can lead to more engaged and acclimated residents.

“Engagement technology is an innovative approach that provides older adults options that inspire autonomy, freedom from boredom, and opportunities for social integration and interactions,” says Juliet Kerlin, director of research and program partnerships for It’s Never 2 Late.

Person-based technology allows senior living residents with diverse backgrounds and personal histories to stay engaged by allowing activities and rehabilitation professionals to focus on their resident interests, needs and strengths while encouraging self expression, creativity and personal development, she adds.

“Residents undergoing cognitive decline often lack opportunities for success, which are essential in improving self esteem, enhancing confidence and reducing isolation,” Kerlin continues. “Engagement technology allows senior living professionals to improve resident quality of life and care by focusing on their remaining strengths instead of relying on the labels we have so often relied on in the past.” Equally important, it allows senior living professionals to embrace the belief that wellbeing encompasses all the dimensions of personhood – mind, body and spirit.

Technology also can help build deeper connections between caregivers, residents and family members, says Ted Teele, CEO of Touchtown Inc. “Imagine working with a family member to build a biography on the resident so a caregiver can bring up that information quickly on a tablet, computer or phone. The caregiver can then easily start conversations with the resident about their hobbies, interests or even where they went to school to bring up fond memories.” Touchtown Community Apps are customized application modules that help those in their communities stay engaged with services and programs. The apps can include brain fitness games that can be played on computers, smart phones or tablets and can help preserve cognitive ability, according to Teele.

Older technologies still can offer significant value — and without breaking the budget. Acts Retirement Life Communities still uses the Wii gaming system to enhance motor skills and let residents participate safely in formerly loved activities, such as bowling or tennis. The communities also have added iPods to their toolbox to deliver resident-specific playlists that already have proven successful with residents with dementia.

Sometimes, residents may appear disengaged and uninterested, when diminished hearing is to blame. To overcome this challenge, Silverado recently began renting senior-focused wireless headphone systems from Eversound to amplify sound to its residents.

For senior living communities dealing with the challenges of hiring, retaining, scheduling and training a qualified workforce, it’s true that things have pretty much stayed the same. It is still tough to find and keep workers in a market where fast food and retail merchants are competing for the same job applicants.

Yet there are new ideas, tools and systems to ease the burden of staff management available to organizations willing to embrace them. In that sense, the more things change, the more they can.

Any solutions for a senior living industry faced with an imposing labor situation are certainly welcome, says Mark Woodka, CEO at OnShift.

“Low unemployment, high turnover and a workforce shortage have led to a record number of open positions in senior care — this has made it harder to find qualified people today than any time in recent history,” he says. “With turnover rates at 50% or more across the industry, providers need to have a continuous flow of candidates readily available. At the same time, they need to make sure they’re doing everything they can to retain the employees they have.”

Market research points to a looming workforce shortage, Woodka says, but he maintains that data can be deceiving.

“The workforce shortage is here, it’s real and it’s challenging providers – today,” he says. “The shortage has made it very difficult for providers to operate, especially in markets where the supply is minimal given historically low unemployment rates.”

To be sure, as the labor market continues to tighten, finding qualified help has gotten more challenging, says Jan Wilson, director of learning designs and outcomes for Relias.

“Many operators are forced to offer premiums to secure qualified candidates,” she says. “Another interesting wrinkle is that most workers are expecting personal development as a determinant in making their decision to come on board with an organization. So if recruiters and managers aren’t leading with this type of benefit, good people could be lost before they even get to the latter stages of the hiring process.”

Despite the labor shortage, some professionals are having the opposite problem — finding a position in a senior living community.

“Our biggest challenge is actually finding work for all the dietitians we have in our network,” says Heidi Williams, marketing communications manager for Dietitians on Demand. “Administrators don’t anticipate needing a temporary dietitian, so it’s not a service they’re actively researching. Sites will often have one dietitian, so when that person is suddenly gone, they’re not sure where to turn, and the need becomes extremely urgent. In the case of an unexpected extended absence, such as family medical leave, maternity leave, vacancy, census increase or any other reason, we can typically get a temporary dietitian to cover within an average of nine days.”

ATTRACTING CANDIDATES

Using the wealth of digital communications available, provider organizations have more forums for recruitment than ever before. Social media are an effective means for extending beyond traditional job boards for promoting job openings, says Jon Forknell, vice president and general manager for Atlas Business Solutions.

“It is a cost-effective way to fill open jobs by reaching targeted individuals in a specific geography,” he says. “Employee referral programs are a great way to find new hires. They can help identify qualified people who typically stay longer than other employees.”

Simplifying the application process is another way to remove potential hiring obstacles, Woodka says.

“I have heard time and again that organizations lose applicants if it takes more than two minutes to apply online,” he says. “Recruiters are also rethinking how they connect with applicants, so they don’t lose them in the process. Consistent communication is key.”

In today’s connected society, job candidates are doing extensive online research on potential workplaces, so it would serve providers well to promote their attributes on the internet, Woodka says.

“More providers are investing in a strong online presence that highlights their values, people and culture to differentiate themselves,” he says. “Providers who are building up their brand and expanding their digital footprint are more successful than those who don’t, especially with the younger generation, who comprise the largest portion of the workforce.”

Employers also need to understand what job applicants are looking for in terms of shift flexibility, career development, wellness programs and other perks, Woodka says.

“In many cases, a standard eight-hour shift doesn’t work for potential applicants,” he says. “I am seeing more and more providers get creative with their shifts, offering more flexibility with shorter shifts or those outside standard shift times. In addition, providers are now revisiting their employee programs and benefits to not only attract new hires, but to retain their current staff.”

TRAINING CONCEPTS

The best way to retain employees is to offer a substantial orientation and training program, Wilson says.

“Most operators are starting to really examine their onboarding processes and practices with an eye toward retention, particularly their orientation programs,” she says. “In the past, orientation programs were viewed as simply a means to teach an established process: ‘Do this, this and that.’”

Providers need to conduct extensive review of their programs, which Wilson contends present too much information in too little time, with a lack of emphasis on real-world settings.

“Little if any time was spent on how all the concepts taught fit together from the lens of the customer,” she says. “Consequently, existing orientation programs did not prepare new hires for the world they would face — with real co-workers and clients — for which they are being asked to provide care. This is increasingly seen as being a contributor to turnover.”

Training programs also need to be analyzed for operational effectiveness, instead of relying on providing job instruction to staff while they are on the floor, Wilson says.

“More effort is being spent on getting new hires ready to face the real world of work with more collaboration between learning and operations, the inclusion of real-world scenarios and the addition of more critical thinking skills and more client-facing instruction,” she says. “Operators are seeing the benefit of enlisting all staff in the customer experience. This helps turnover by preparing new workers with a realistic set of expectations of their role in providing care for the whole person.”

SCHEDULING TOOLS

If there is one place where technology has made a significant improvement in staffing operations, it’s with scheduling — a process that can get enormously complicated, says Michele McFadden, vice president of product management and strategy for SmartLinx Solutions.

“When we talk about employee burnout and turnover in the long-term care industry, we often think of the front-line staff,” she says. “However, schedulers have one of the most difficult jobs in the industry. Thanks to technology, a single scheduler can comfortably juggle call-outs, no-shows, PTO, different positions, shifts, departments and even facilities.”

Manual schedule-making can be “a huge jigsaw puzzle with many pieces missing,” McFadden says. “Today, technology enables schedulers to put the right people in the right slots, automatically adjusting schedules to census levels. Modern systems allow schedulers to review totals by PPD or hours. Intuitive consoles alert users when they are under or over their ideal schedule, allowing users to predict compliance and overtime issues before they become problematic.”

Intelligent platforms enable schedulers to quickly post open shifts, automatically excluding staffers who will incur overtime, McFadden says.

Moreover, she maintains that adding outside agencies and their employees is no longer the headache it once was.

Q: What policy issues is LeadingAge focused on right now?

A: LeadingAge is watching with great interest immigration reform and what occurs there from a workforce standpoint. I think that affects everybody across the board. How are we going to find enough caregivers for this next 10-year push that we’re going to see in terms of demand for our services?

LeadingAge has not developed a policy statement per se on that as of yet but obviously is keenly interested in attracting highly qualified individuals from perhaps outside the United States to fill some of these vacant job postings across the country.

We’re also interested in the model we move toward nationally around Medicaid. LeadingAge, the American Health Care Association/National Center for Assisted Living and many other organizations were successful in getting the health bills blocked that essentially block-granted the Medicaid program, but I don’t think that fight’s over, so we’ll continue to watch that.

It’s very difficult for us as providers to be sitting here, hearing the words, “This funding needs to be cut” or “This needs to be removed” when we all know it’s actually the opposite. Instead of cutting one dollar in funding to fifty cents, we need to increase that one dollar in funding to two dollars.

The fiscal responsibility of the U.S. government to take care of its most vulnerable citizens first is going to be a high priority for LeadingAge, whether that be on the affordable housing side, assisted living, skilled nursing or home- and community-based services. All of those waterfronts need to be protected and shored up over the next decade, and it’s going to take a lot of heavy lifting to do that.

Q: What are your thoughts on the Centers for Medicare & Medicaid Services’ new approach to “encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency and promote transparency and accountability,” in the words of Administrator Seema Verma?

A: We would be very appreciative of any, and I underscore any, flexibility within the programs that are available through the federal government, whether that be Medicaid or Medicare, as it refers to how we pay for long-term services and supports.

In terms of LTSS financing, we need to provide a mechanism for all Americans to pay into the system and for the government to pay more into the system for future catastrophic long-term care needs. It’s a strategy that is going to be necessary, both for providers to stay in business and for the general public to be taken care of in the manner that we’re used to receiving in this country in LTSS.

Such communities outranked nursing homes (7%) but came in behind hospitals (27%), private families (26%) and home healthcare agencies (22%) in the “​Caregiver Trend Report” released by myCNAjobs. The report shares data collected in a December survey of 1,555 caregivers and a pay analysis of more than 1 million caregivers nationwide.

Other healthcare organizations aren’t the only competitors for senior living workers, of course.

For instance, 10% of caregivers surveyed said they had interviewed with Amazon, which operates 214 facilities around the United States and is opening more, according to the report. The company’s average pay is 30% higher than traditional retailers that offer pay that competes with senior living, the authors said.

And pay isn’t the only aspect of a job that attracts and keeps workers; working conditions and benefits hold sway, too, as the study indicates. Eighty percent of participating caregivers said they would prefer to work for one company if they could get the hours they want — and that it is easier to get preferred hours working in a retail setting or fast food restaurant. And 68% of caregivers said they would choose having access to a 401(k) program versus paid vacation time from their employers.

Senior living operators will want to address any perceived shortcomings quickly, the report suggests: 65% of caregivers said they always are looking for a better job, with 97% of caregivers being open to other job opportunities at any given time.

myCNAjobs, a Healthcare Research LLC Co., offers a suite of tools designed to help operators recruit caregivers, resident aides, CNAs and dietary workers. The report provides access to state-level and Zip code-level wage data as well as additional information. To download the full report, click here.

The quarter saw 70 acquisitions, down 5% from the 74 seen in the previous quarter, according to preliminary data. The decline in acquisitions compared with the same quarter of the previous year was even steeper, at 25%.

Several sellers postponed closings until this year in the hopes that their capital gains would be taxed at a lower rate, Irving Levin said.

The dollar volume of acquisitions also declined significantly, from $2.56 billion to $1.85 billion, or 28%, from the third to fourth quarter, according to Irving Levin. The year-over-year decline was even greater, a 71% difference from the $6.47 billion seen in the fourth quarter of 2016.

“Since the second quarter of 2017, when two transactions brought that quarter’s total to an unusual $9.7 billion, the market has been mostly dominated by smaller acquisitions,” said Steve Monroe of Irving Levin Associates.

Only six transactions had disclosed prices of more than $100 million, according to Irving Levin. The largest was Mainstreet Health Investment’s acquisition of Care Investment Trust for $425 million, announced in November.

Silicon Valley start-up company Voyage announced Wednesday that it has launched the second test of its self-driving taxi service at a 55+ retirement community.

The effort at The Villages in Florida follows the launch the service in October at a San Jose, CA, community called The Villages Golf and Country Club.

“Whether it’s helping those with Parkinson’s, Alzheimer’s, vision impairment or just those who want to get around with less friction, we’ve seen first-hand the positive impact autonomous transportation can have for seniors,” Voyage CEO Oliver Cameron wrote in an announcement posted on the company’s website. “With Voyage’s successful deployment at the 4,000-resident Villages in San Jose, we are now energized to tackle the challenges of a city-scale community and beyond.”

The company currently is recruiting riders and said it plans to expand the availability of the program in the coming months.

The Villages is located in Sumter County, FL, which the U.S. Census Bureau said had the highest median age in the country in 2017. In 2016, the bureau said that The Villages metropolitan area, west of Orlando, FL, and named for the retirement community, was the nation’s fastest-growing metro area for the third consecutive year.

Cameron said the door-to-door taxi service will be available to all 125,000 residents of The Villages when it is fully operational. Users, who will summon cars with an app, will be able to travel anywhere within the 40 square miles of the community.

“And boy are there places to go!” Cameron wrote. The Villages, he said, has more than 100 dining options, eight large grocery stores, golf courses, 7.8 million square feet of commercial and retail buildings, three movie theaters, more than 80 tennis courts, a 297-bed regional hospital and a charter school for the children of staff members.

Cameron said that residents of the community have shown “enthusiastic” and “overwhelming” support for the initiative. He recognized state Sen. Jeff Brandes for helping to pass legislation in 2016 that enabled fully driverless vehicles on Florida roads.

Voyage will partner in the effort with Carmera, which is mapping all 750 miles of road within The Villages and will provide continuous updates of data to the self-driving cars.