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Betsy Donovan
Senior VP & COO

Eskaton Senior Living
Northern California

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Seniors at the heart of Eskaton’s strategic partnership with PharMerica

It’s easy to see how a place like Northern California is so alluring, with its world-famous vineyards and Silicon Valley, the epicenter of technological innovation. For a half a century, Eskaton Senior Living has called this part of the country home, caring for millions in a myriad of settings from skilled to home to memory care to rehab and practically everything else in between.

In all, this mid-size care provider is likely less known for its unusual name than the words beneath its logo: “Transforming the Aging Experience.”

This bold claim is a big part of Eskaton’s DNA, and is why this Aging 2.0 member credits so much if its success to the strategic partnerships that have yielded such innovations as smart sensors that help reduce falls and universal tablets that connect residents and families while keeping caregivers highly productive and efficient. Other partnerships have resulted in the development of smart lighting that improves the quality of seniors’ lives while lowering energy bills, and a host of outside-the-box life enrichment programs aimed at enhancing the lives of older adults wherever they live; however the challenge remains in how to mitigate a problem that has long confounded senior care more than that in any other state – the lack of affordable housing.

Every single endeavor conducted under the auspices of Eskaton’s “Innovation Lab” has been borne out of the need to solve a problem or meet a profound challenge head-on. And nearly every partnership has yielded results exceeding expectations. Its partnership with one company to prevent falls using passive monitors ended up allowing caregivers to proactively detect conditions like urinary tract infections. And its partnership with K4 Connect to test a resident and family portal solution yielded a suite of smart home devices that eventually made caregivers’ pagers obsolete and supports resident socialization.

Chasing high technology

Eskaton is an avid believer in utilizing technology in aging services and senior living, and recognizes the value of new technologies and service models that bring wellness promotion, healthcare and connectedness to people in their homes, as noted in its recent white paper, “Transforming the Aging Experience.”

“We love to partner with other organizations that also have an interest and desire to meet these challenges,’ says Betsy Donovan, who oversees Eskaton’s entire operations as senior vice president and COO. “We try to keep our foot in the technology pond as much as we can through things like pilots and demonstration projects. We’re always looking to work with best-in-class companies on solutions, whether it’s a business we’re providing or not.”

This explains, in part, what Eskaton saw in PharMerica as its pharmacy services partner.

“Our long-term vision with technology is being on top of what is most current and valuable to those we serve – whether it’s residents or participants based on our various lines of business,” she adds. “Keeping current is always a challenge, and it requires us as a provider to be nimble enough to make the needed changes.”

“It’s been a very positive relationship. When things come up that we question, there’s always a resolution. We’ve been very happy.”

PharMerica’s high-tech solutions allow Eskaton to bring best-in-class pharmacy solutions like RX Now® to its 4 skilled nursing/rehab facilities while providing pharmacy services and consulting to its 9 assisted living and memory care communities. Eskaton’s growth in managing non-Eskaton sites allows for expansion of this expertise into additional SNF, AL, MC, CCRC communities, according to Donovan.

Part of Eskaton’s success also is being comfortable in its own skin, and knowing what it can and cannot do.
“Going forward, Eskaton’s focus is not necessarily building new places, but rather, partnering with others in and outside our space to find the best ways to manage what we have and grow, while ensuring we continually provide the best possible quality care and services to those we serve.,” she says.

For example, Eskaton has recently partnered with 2 CCRC communities in a management capacity since late 2016. “Sites like these can’t always have the resources to provide some of the innovative stuff larger organizations like Eskaton can do,” she says. Key among those resources is the innovative solutions PharMerica brings to the table as well as others. Being able to do so also helps to make Eskaton a more attractive management services provider to others, according to Donovan.

The rising bar of quality and MCOs

In the ever-evolving world of healthcare reform, Eskaton finds itself, like others, working closely with managed care organizations (MCOs), which are wielding greater power and influence in how public healthcare funds are spent. Quality care metrics are paramount.

“We absolutely value our partnerships with MCOs, and Kaiser is by far the largest one we work with,” says Donovan. “It’s paramount that we continuously demonstrate that we are providing the level of quality care that our patients deserve. This includes being able to show we are producing quality outcomes. We’re very much into monitoring, measuring, and providing dashboard results to demonstrate that, and this is an area where PharMerica has been extremely helpful.”

For example, RXNow helps to ensure Eskaton’s medications are always on-hand and not being delayed. And PharMerica’s Discharge RX program helps Eskaton to keep its readmission rates down.

The ability to access DischargeRx tools and resources will take on added significance as MCOs become more dominant and readmission rates become more integral to MCO partnerships.

“The intent of DischargeRx as we see it is residents’ medication needs are packaged up with a bow so when they leave our facility, they leave with very clear and explicit directions about their medications,” Donovan says. “We like that the meds are ordered before they go home so they do not have to order or wonder when their medications will arrive. It’s about having as smooth a transition as possible. Making sure those safety nets are in place is critical – regardless of where the resident is coming from or going to in the health care continuum.” The relationship between the SNF care team and PharMerica is critical to ensure a smooth hand-off.

The essence of the partnership is never more evident than every quarter, when PharMerica’s reps sit down across the table with Eskaton clinicians and managers to discuss the organization’s quarterly business reviews.
“Not long ago, we sat down and asked how we could get some qualitative and quantitative results from PharMerica to share with our MCOs,” says Donovan. “It’s those kinds of things that help us meet our mission of partnering. We know we do a great job but we have to prove it. That has been very positive with these narrowing networks that MCOs are going to work with.

“It’s getting smaller and smaller so you have to be best in class, which is what we want to be,” Donovan adds. “To us, that means anything we can do to pull in technology or systems that minimize the chance of error and that increases the chance of residents — while they’re with us and when they leave us — of being very successful in accessing their medications. We know when they leave skilled nursing and go home or leave the acute care and go home, the number one reason they come back is their medications are not being taken or set up appropriately.”

Assisted living and its drug expertise gap

Donovan isn’t alone in viewing the current long-term landscape as one of profound transition. Uncertainties abound over what it will look like in 10 years after the largest wave of baby boomers has come and gone.

One looming question mark is the role assisted living will play. For now, however, no one doubts the amount of building that’s underway.

“If there’s a piece of in-fill land in the greater Sacramento area, there’s an assisted living facility being built on it,” Donovan muses. “Everywhere you go, there seems to be a new facility popping up.”

Another certainty is that the level of acuity and need for clinical care will rise in assisted living, making it essential that providers like Eskaton have the capability of meeting the medication management needs of those residents.
“This is why a few years ago we folded PharMerica into our assisted living and memory care facilities,” she says. “It’s been a very positive relationship. When things come up that we question, there’s always a resolution. We’ve been very happy.”

Existing ALFs everywhere are in need of clinical pharmacy expertise as they take on more residents with chronic diseases and other ailments, according to Donovan. “Often, ALFs will use more of the smaller mom and pop pharmacies,” she says. “You’re not getting the breadth of industry knowledge, innovation and experience with them as you would with a company like PharMerica.”

A future both bright and cloudy?

Eskaton’s vision around technology is unmistakably optimistic and unapologetic. To forward-thinking and brave adopters like Eskaton, technology is the invisible caregiver who never quits or calls in sick, or the bookkeeper who never tires of confusing reimbursement rules. It is becoming the constant companion at each resident’s bedside, opening the door or ringing the phone of a loved one both far and near, day and night.

“We’re very much into monitoring, measuring, and providing dashboard results to demonstrate that, and this is an area where PharMerica has been extremely helpful.”

Technology is at the core of Eskaton’s future vision that is convinced of the powerful need for governments, businesses, nonprofits and consumers “to partner to truly transform the aging experience,” as it notes in its recent white paper. And as the provider humbly admits, the challenges it and its peers face “are too far-reaching for aging-services providers alone.”
In contrast to the bright future technology provides is the somewhat murky landscape of affordable housing – something that will undoubtedly pose serious challenges for senior living providers and the coming “age wave.” In places like California, where affordable housing has a serious deficit, providers like Eskaton are more than eager to find solutions through partnerships.

Eskaton was an early pioneer of affordable housing in the Sunshine State back in 1978, when it opened the President Thomas Jefferson Manor in Sacramento, which offered relatively low-cost, independent-living housing to seniors with restricted incomes. Today at several locations, Eskaton provides affordable housing with services funded by Section 8 rent subsidies from the Department of Housing and Urban Development. Many of these communities were developed in partnership with the local cities and counties that provided advocacy, support and, in some cases, funding.

One future potential partnership, according to Donovan, is PACE, or Programs for All-Inclusive Care for the Elderly, whose target population of low income, skilled nursing level residents is a perfect fit for senior housing providers like Eskaton, who currently supports Sutter PACE in one of its affordable housing communities. “We’re looking at this,” she says. ”What innovative strategies and partnerships can be sought to address the ever-growing needs of our low income seniors? That’s a big one!”

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