Hospices expect to see substantial growth in the assisted living setting during 2020, followed by the skilled nursing setting. 

Hospice News in collaboration with Dallas-based tech company Homecare Homebase surveyed more than 300 industry professionals, including owners, executive leaders, managers and staff about the movement they expect to see in the hospice space during 2020.

About 36% responded that the assisted living setting would be their most significant avenue for expansion, followed by nursing or skilled nursing facilities at 33%. Hospitals and memory care facilities yielded the lowest percentages at 9% and 5%, respectively.

Demographic tailwinds and increased interest in assisted living among seniors are some of the driving factors.

“Currently, around one million Americans live in some type of senior living community, and that number is expected to double by the year 2030. To accommodate the savvier Baby Boomer population, who consistently chooses in-home or assisted living options over nursing facilities, the total number of assisted living facilities has grown over 15% in the last 15 years,” Catherine Dehlin, director of hospice and palliative services for the consulting firm Fazzi Associates, said. “Because the number of seniors is expected to more than double by the year 2060, the growth of assisted living communities will reach record numbers. Contracts between the assisted living community and the hospice are typically not required, opening the door for fair and unbiased patient choice of hospice provider.”

Patients’ private residences continue to be the most prevalent setting in which hospices provide care, at 55.7%, according to the National Hospice & Palliative Care Organization. This is followed by nursing facilities at 42.2%. The “nursing facilities” category includes assisted living facilities as well as skilled nursing facilities, other nursing facilities and routine home care days in a hospice inpatient unit. 

The assisted living setting is attractive to hospices because patients in those facilities tend to have longer lengths of stay than patients in homes,163 days compared to 111 days, or skilled nursing or non-skilled facilities at 103 days, Dehlin told Hospice News.

Lower costs associated with providing care in that setting also play a role.

“Labor costs are reduced when providing care in assisted living communities. Without driving or travel time in between client visits, hospice clinicians can be more productive and reduce labor and other costs, such as mileage reimbursement and travel time,” Dehlin said.

Hospices that have diversified services to engage patients further upstream also have the opportunity to provide palliative care in assisted living facilities. Data on the availability of community-based palliative care are limited, but according to the Center to Advance Palliative Care (CAPC) hospices comprise at least 50% of the providers of those services in the United States.

Interest in palliative care has been rising in recent years among health care providers, payers and policymakers, driven by the benefits to patients, the need to engage patients earlier in the course of their illnesses, and the potential cost savings from reduced hospitalizations, readmissions and emergency department visits.

“Palliative care is gonna be the fastest growing area of our industry for the next five plus years. Being able to position your program to meet the needs of those residents that have palliative needs and then transitioning them into hospice, when appropriate, is going to be very important,” said Michael Ferris, author and advisor for Healthcare Strategica. “Particularly, if the hospice is going to apply to be part of the Serious Illness Population model under Primary Care First, that will add to the value proposition that they have for assisted living. That’s something that all hospices should be looking at —how do we build a viable palliative program.”

The U.S. Centers for Medicare & Medicaid Services announced the Primary Care First initiative in April and will implement the models in phases beginning in January 2021, initially in 26 regions throughout the United States. Hospices and palliative care organizations are eligible to participate in the payment models provided they meet the program’s criteria. The program is designed to control costs, reduce avoidable hospitalizations and improve care coordination.

Eligible providers can choose to participate in one or both of two payment options under the program: A general payment option and a Seriously Ill Population payment option designed to serve patients with complex, chronic needs, through which providers focused on caring for that population would receive increased payments.

Hospices can begin to strategize ways to reach out to and partner with assisted living operators.

“The number one thing to look at with assisted living is what are their needs, and what are their problems, challenges and frustrations, and how do we line up our solutions to help them,” Ferris told Hospice News. “[Hospice] can keep their residents in their unit longer, which is a huge benefit to them. And at the same time, hospices can manage those patients and keep them from falling which keeps [assisted living facilities] from having reportable events, and just the fact that hospice is there will place less of a burden from those residents on the assisted living staff.”