A Healthcare Team Without Doctors…Really???

There are 624,434 U.S. physicians (AHRQ, 2010), but only 0.6% of them would ever consider entering an Assisted Living Community (ALC) to provide on-site care.  There are more than 36,000 ALCs in the US caring for over 1 million fragile older adults (ALFA 2011), but you are literally more likely to be struck by lightning than to ever see a doctor walk through the doors of any of these communities!

The first ALC began in 1981 to care for the Founder’s mother who was in her early 60s (The History of Assisted Living, www.assistedlivinghistory.com).  These Communities were originally promoted to provide a supportive, primarily non-medical living environment to bridge the gap between independent living and the nursing home.  But the landscape for ALCs has dramatically changed since their inception.

The average age of an ALC resident is now 87 years (Harris-Wallace et al, 2011, Seniors Housing & Care Journal).  Thirty-seven percent of residents receive assistance with 3 or more activities of daily living (NCAL 2012), greater than half of the residents have 2 or more chronic medical conditions and are taking multiple medications having a variety of potential side effects, and 42% have at least some degree of memory impairment or dementia (NCAL 2012).

ALCs are no longer predominantly non-medical communities.  They have high acuity residents, and this will only intensify in the future due to a very competitive market as well as resident expectations to age in place and experience the progression of chronic medical conditions in one setting that provides ongoing care and monitoring.

In other words, times have changed.  But the problem is…our thinking hasn’t!  Our thinking is stuck back in the 1980s and hasn’t kept pace with the changing demands and expectations residents impose on ALCs.  The healthcare team that provides medical oversight of residents in ALCs is led either by non-medically trained administrators or by nurses with additional support from aides and assistants.  But there is a glaring omission:  WHERE ARE THE DOCTORS???

Just as in the 1980s, we keep hauling our residents off-site all over town to a variety of doctor’s offices just to get their basic primary care needs met.  But this isn’t the 1980s any longer!  These residents are 20 years older, much more fragile on average, and all these off-site trips are incredibly stressful not only on the residents but also their families as well as the ALCs and their employees.  We can and must do better!

It is no longer appropriate to be thinking as we did in the 1980s and have predominantly off-site physician care.  And it is no longer acceptable to have the supervisory medical team not include a fully engaged physician who provides on-site care.

ALCs and physicians MUST come together and meet the demand of caring for high acuity patients in the community setting.  The direction of modern healthcare delivery is TOWARD THE COMMUNITY to proactively keep people as healthy as possible at home and AWAY FROM HIGH COST INSTITUTIONS that only care for patients reactively after they become ill.  This reversal in the direction of healthcare delivery falls right in the laps of ALCs, and the pressure to care for higher acuity residents will therefore only increase.  This also means that on-site care by physicians offered to ALL residents should no longer be a luxury but MUST be a REALITY.

There are a few innovative healthcare models now available that encourage ALCs and physicians to each put “skin in the game” and come together as PARTNERS (http://housecalls-llc.com/articles/physicians-must-partner-with-retirement-communities-and-heres-why).  To meet the new demands that confront this partnership is surprisingly easy and not intimidating and can happen overnight.  The biggest obstacle is in our thinking:  WE MUST THINK DIFFERENTLY (http://housecalls-llc.com/articles/think-the-same-stay-the-same-think-differently-and-thrive/).

If we think differently…if we bring physicians and ALCs together as partners, we will discover that EVERYBODY  WINS!


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