Senior Living
Articles
Managing Acuity Creep in Senior Living
June 16, 2024
There’s no question that senior living communities are seeing higher levels of acuity. But there is no clear answer about how to handle acuity creep. Gwen Wilburn, MBA, RN-BC, senior vice president of clinical operations at the Aspenwood Company and board member and president of AALNA’s Texas Chapter, discussed some multiple sides of acuity creep and how to manage this challenge successfully.
The Staffing Side
Staffing and acuity go hand in hand. “As acuity increases, we need the correct staffing ratios to provide the necessary care. To provide necessary staff training, we need to know who is in our communities and conduct accurate risk
assessments,” said Wilburn. When community leaders overestimate or misjudge their ability to care for residents with special needs, they may face increased callouts and turnover, as well as staff injuries. “It is important to conduct frequent evaluations,” she said, adding that staff should be encouraged to document and report additional services they need to provide and what training they need to be effective. She stressed, “If you don’t know what’s in your community, you can’t identify and provide the training and supports staff need.”
It also is important to have confidence in your teams. Wilburn said, “I think a lot of the frontline staff are very capable of learning about different disease processes, and they want to be empowered to take good care of these residents.” However, they can’t do this without appropriate training, supports, and tools, as well as a culture of open communication and mutual respect.
The Occupancy Side
By conducting an analysis of your residents and staffing plus a risk assessment, you get a better sense of what kinds of residents you can realistically care for. These analyses also can suggest what additional training and supports staff will benefit from and what special equipment and/or technology are necessary. While there often is pressure to increase census, risk assessments will help clarify the implications of accepting residents your facility isn’t equipped to manage.
Fear of losing hospital referrals can increase the urgency for facilities to take residents with higher acuity levels. This is one reason it’s important to have relationships with discharge planners at local hospitals. If they have a need for facility partners that can manage specific conditions, you can work with them – and outside practitioners and specialists – to address staffing, training, support, and equipment needs. One solution, Wilburn suggested, might be to establish a higher acuity wing or unit with higher staffing ratios and specially training nurses and other team members. It also may be possible to identify buildings within a large provider organization that are best prepared to care for higher acuity residents.
The Medication Side
Wilburn observed, “With more chronic conditions and higher acuity come a more complex medication regimen, so pharmacist reviews are more important than ever. The pharmacist can help the team understand how medications interact with each other, if it might be more beneficial to give certain medications at a different time, and if some drugs can be eliminated or dosages reduced, among other things.” The pharmacist also can communicate with prescribing physicians to help prevent adverse drug reactions/events and minimize polypharmacy.
Enabling Success on All Sides
The key is to manage acuity before it explodes, and you find yourself stretched in different directions. Get an honest assessment of what your current resident mix is, where you want/need to be, and what you need to get there. Get ahead of the curve on training and the implementation of any special equipment or technology you’ll need. “It boils down to really knowing your residents and making sure that you’re conducting frequent evaluations,” said Wilburn, adding that it’s also important to assess residents prior to admission to determine if their needs are a match for your capabilities.
At the same time, Wilburn suggested, “Encourage frontline associates to acknowledge when there’s a change of condition or an issue or situation they don’t feel equipped to deal with. It’s important to empower them to come to you with information and concerns.” It is also essential to have a rapport with families. They should be involved in care planning on an ongoing basis to help set realistic goals and expectations.
As people not only live longer but delay entry to senior living communities longer, they will continue to have more chronic conditions, comorbidities, and disabilities when they enter. By looking ahead and preparing now, the acuity creep will be more manageable for everyone.