As long-term care providers collectively brace for the Silver Tsunami’s local impact, there’s one organization that is doing a lot of the heavy lifting: The Health Care Association of New Jersey.
The local nonprofit trade group shoulders the responsibility of doing all the lobbying in Trenton for policies and handling the research needed by those providing nursing home care, assisted living, rehab and other long-term care services in New Jersey.
Six decades into being the industry’s local stalwart, they’re still finding more ways to pull their weight.
Andrew Aronson, CEO and president of Health Care Association of New Jersey, and Charles Larobis, director of the group’s clinical services, spoke to ROI-NJ about the work that’s ahead for them and their members.
ROI-NJ: From your perspective, and that of the long-term care providers you advocate on behalf of, what changes do you expect will come from rising numbers in the state’s elderly population?
Andrew Aronson: In long term care, particularly nursing homes, here’s how we’ve changed over the years: We treat people in place a lot more than we once did. If you go back 25 or 30 years ago, people got custodial care in a nursing home, and if they needed clinical services, they were transferred to a hospital. That no longer works.
Andrew Aronson
Because of growth of the (elderly) population, because of the way hospitals work, people need to be treated on-site at nursing homes. When we talk about new technologies or innovative plans and strategies, it’s generally been nursing homes talking about being far more clinical than they used to be, so that people can be treated on-site, without being discharged from the nursing home and admitted to a hospital. Same is true to a lesser extent in assisted living, which is going to be a little less clinical than a nursing home setting.
But, at least in New Jersey, assisted living facilities are allowed to provide pretty complex clinical care to residents, as long as they have the ability to provide that care. When we think about how providers in this field have reacted to what’s changing demographically – that’s the general theme.
Charles Larobis: This demographic shift – it’s what we call re-imagining health care. As part of that, we’re trying to provide the best coordination of services to meet residents where they are and provide top quality of care. That has meant changes such as medical-surgical units moving into skilled nursing facilities. With that, the competencies and training of staff need to also be on par with needs of the population. Skills and competency always need to be on the top of the food chain to make sure we have resources and services to improve outcomes for patients and keep them where they are. Being a nurse myself, we don’t want to miss anything.
Charles Larobis
So, what’s vital here is a very astute, head-to-toe assessment. Years ago, the strategy was, ‘When in doubt, send them out.’ We can’t do that.
We have to utilize proper assessments so we can care for our residents and improve their outcomes. And, hopefully, we’ll be reducing hospitalizations by identifying early changes in conditions. We have a lot of challenges in that, but we’re up for it.
ROI: What sort of innovations need to be folded into that re-imagination of care?
AA: In the old days, every time a nurse went rounding in a facility, the first thing he or she had to do when seeing a resident was take vitals as they did an assessment of the resident. Now, you have technology usually within the rooms that are 24/7 monitoring all those vitals for a resident – heart rate, oxygen levels, blood pressure.
All of the different things nurses had to do when walking into a room to see a resident now are at their fingertips, before even entering a room. They can use that data for predictive modeling and analytics to take a look and say, ‘There’s a resident in room 3, and that resident has these characteristics going on, so let’s prioritize getting in there to see them because there’s something that doesn’t look right.’ A lot of those remote monitoring and predictive analytics tools can be used to target interventions and prioritize who needs to be seen in a facility and when they need to be seen.”
CL: Technology is here to stay. And it’s important that operators choose the right technology system, as they’re not good for everyone if it’s not customized and suited to their needs. That being said, there’s a lot of options out there for AI-driven technologies that are helping to reduce falls, including smart lighting and VR headsets to identify risks for falls. Falls are a major issue for residents. Remote patient monitoring is also a big area. More and more of that is going to be vital.
Having physiologic monitoring, like some of the technology embedded in smart watches, is important, because it gives operators a better capacity to see the red flags. These can all be customized based on patients’ parameters, but tracking blood pressure trends is one example. Any deviation there can be flagged to help detect early changes in conditions.
There’s also technology that’s helping operators to be diligent in something like hand hygiene, making sure we’re doing control measures to prevent infection. All that comes with necessary staff training as well to get the most out of these tools.
ROI: What do you view as some of the biggest hurdles for long-term care providers tasked with meeting the demands of a ballooning elderly population?
CL: What I can think of right away is the workforce crisis that we’re in. I’m sure you’ve heard all about that, but especially on the caregiver and nursing side, what’s a big challenge is reallocating nurses to do these bedside assessments more often and taking care of more complex needs. If we can alleviate some tasks by automation, perhaps, to free up nurses from giving medications and have medication aid administered to them, that would allow us to free up clinicians for where they’re needed the most, which is in identifying those early changes in conditions and looking at red flags. Right now, we have some big restrictions in terms of manpower.
AA: There are regulatory barriers. Particularly with nursing homes, it’s a very regulated setting in terms of how they’re allowed to operate. Any time implementing new technology and changing the paradigm of how things are done, it creates problems because tech moves a lot faster than regulatory change. If you’re bound by regulation to act in a certain way, it takes away flexibility from providers to innovate and change the way they do things.
If we have a change that involves new technology, we have to bring those to regulatory agencies and show them what we’re doing, convince them it’s correct and wait for the regulatory change. The simple example in New Jersey: Other states have changed to allow what we call medtechs (or medical technologists). Those are specially trained CNAs (or certified nursing assistants) who give medications to residents, which then frees up nurses to do other things. Many states have gotten to the point of allowing medtechs in nursing homes, but not New Jersey, even though it’s allowed in assisted living in New Jersey.
The way our industry has changed, it’s certainly safe to give medication in this way, but regulations-wise, we haven’t completed that years-long process to allow this yet.
ROI: How do these two challenges, the workforce and the regulatory issues you alluded to, intermingle?
AA: There’s this constant push and pull between trying to innovate and make the best use of resources to provide better care while also having a regulatory system that’s pushing staffing mandates and staffing ratios – things that are going against the tide here demographically in New Jersey and the rest of the United States. The population of residents aged 85 and older is growing, and it’s growing faster than any other population, while the population of those at care-giving age is either staying stagnant or shrinking in some cases.
The reality is: The workforce shortage is not going to get better. It’s likely going to get worse. We have to be innovative to better care for people, frankly, with less caregivers. To do that, we have to become more efficient. That’s why we’re focused from an industry perspective on helping our providers use resources and innovate the best they can to care for as many people as they can, which means we’ll continue to advocate for those providers with regulatory agencies to make sure we’re all moving in the same direction.