New Promotional Video for House Calls

We’ve recently added a new promotional video for House Calls.  Click on the following link and lets us know what you think.

Also, we continue to search for more doctors who would like to augment their office practice with a profitable 1/2 day per month working with House Calls.  If you are a doctor interested in this rewarding opportunity, please leave a comment or call Dr. Fuller at:  208-908-9962.

The 3 Highest Risk Medicines in Assisted Living Communities

High Risk MedicinesA data base sampling of 5 Boise Assisted Living (AL) communities indicates that of all the prescribed medicines that residents take, those for pain, depression, and anxiety are associated with the highest risk for failing health.  Residents taking any of these medications would benefit from a PRO-active approach of increased observation and supervision by all AL employees.

Here’s a 4 question test:  In YOUR Assisted Living Community…

  1. How many different prescribed medicines are taken by the average resident?
  2. What are the most common prescribed medicines taken by YOUR residents?
  3. What is the percentage of YOUR residents who take HIGH RISK medicines?
  4. If an employee suspects a resident as having an adverse reaction to a medication, what system do you have in place that will cause immediate intervention and prevent potential loss of that resident to an ER or hospital?

Let’s pretend we gave this test anonymously to the owner, administrator, marketer, nurse, and to 2 aides of YOUR AL.  I think you might agree that most of these 6 individuals would probably have to take their best guess for their answers.  And as a result, out of the 6 people who took the test, we would probably get 6 different guesses as answers for each question.

Here’s the problem with this very realistic scenario:  Guessing Costs Money.

Unfamiliarity with important healthcare facts about YOUR AL residents, and a passive approach to addressing their healthcare needs, leads to unnecessary resident turnover.  The ER, hospital, and nursing home are NOT acceptable answers to preventable and potentially treatable healthcare problems discovered in an AL.

Every AL has a large storehouse of healthcare and demographic information.  But this data base is so large and often so disorganized that a substantial amount of crucial and extremely useful knowledge remains hidden, never used.  This is knowledge that could help AL owners, administrators, and employees to improve resident health management , reduce resident turnover, and save thousands of dollars every month.

Data base analytics are an integral part of most successful industries.  This approach has not been widely adopted by ALs but has now become available.  Questions such as those above and many more are easily answered in real time. Sophisticated software allows important and actionable knowledge about each AL to be retrieved that will lead to improvements in residents’ healthcare and an AL’s bottom line.

Novel Ways of Using Your Data Base to Preserve Retirement Community Census

data baseQUESTION:  What is the most effective way to preserve census in a Retirement Community (AL, IL, or CCC)?

ANSWER:  Learn as much as you can about the #1 reason for losing residents, and then develop specific solutions.


Failing health far exceeds any other cause for losing residents in Retirement Communities.  The average resident takes 7.6 different prescription medications and has at least 2-3 or more chronic health conditions (CHCs), and this provides ample opportunity to lose a resident to the ER, hospital, or nursing home.  Proactive approaches aimed at stabilizing CHCs and reducing problems with medications have the most promise for keeping residents as healthy and functional as possible and thus preserving census.

Exploring a Community’s data base yields invaluable insight into maximizing residents’ health.  Doing so allows the creation of a HEALTH RISK PROFILE for every resident.  Combining the details of the residents’ CHCs, the medications they are prescribed, and some basic demographic information identifies residents as being either high, medium, or low risk for failing health.  If every resident is assigned to one of these Health Risk categories, then proactive approaches designed to counteract the threats in each category will offer residents their best chance at maximal health and independence.  This also increases their lifetime value to the community.

Here are 3 very relevant questions that can be answered only by a detailed analysis of a Community’s data base:

  1. How many CHCs does each of your residents currently have, and which ones pose the greatest risk for loss of independence?
    1. A PROACTIVE intervention program for residents with these specific CHCs will have the biggest impact in stabilizing health and improving resident retention.
  2. What is the average number of medications each of your residents take, and which classes of medicines pose the greatest risk for complications leading to loss of resident independence?
    1. A focused awareness and caregiver education of the most high risk medications will alert co-workers to be especially watchful for signs of side effects and declining health.
  3. Which resident demographics provide insights that may lead to improvements in marketing and the services you provide?
    1. Learning whether money is being spent marketing services that very few of residents actually use allows the reallocation of these funds to services having a broader appeal.

Our previous blog highlighted 5 CHCs that raise residents’ health risk and separate them from residents with lower risk CHCs.  Our next blog will identify higher risk vs. lower risk medications.  And a following blog will combine the information we have obtained from our analysis to suggest a Health Risk Profile for every resident that can be used to benefit every Retirement Community.

We believe that this type of methodical approach in the use of a Community’s data base offers a unique and creative opportunity for preserving census and increasing profitability.

“Separators” that Predict Health Related Attrition in Retirement Communities

SeparatorsTo preserve its census, a Retirement Community (Independent or Assisted Living) must proactively work to preserve the health of its residents.  Indeed, 92% of residents who leave Assisted Living Communities do so because of failing health.  [Reliable data for Independent Living Communities are not available].

Chronic Health Conditions (CHCs) are the leading cause of illness and death of seniors.  And seniors with multiple CHCs are 100 times more likely to have a preventable hospitalization than someone with no CHC.  All seniors in Retirement Communities have multiple CHCs, the 10 most common of which are:

  1. High Blood Pressure
  2. Alzheimer’s disease and other dementias
  3. Heart Disease
  4. Depression
  5. Arthritis
  6. Osteoporosis
  7. Diabetes
  8. COPD and allied conditions
  9. Cancer
  10. Stroke

But not all CHCs equally increase the risk of failing health.  Some conditions can be managed and remain stable for years, while others pose a much greater risk.  Analysis of the House Calls data base in Boise, Idaho has revealed 5 CHCs that separate the residents living independently from those living in Assisted Living Communities.

The most common Chronic Health Conditions in our data base are shown in the next figure:

Aggregate CHCs


By identifying those residents with any of the Chronic Health Conditions that are “Separators”, a community can then focus the attention of its employees on these residents so that everyone will be especially aware of any signs of declining health.  This will allow for early intervention that will stabilize a resident’s condition and thereby avoid losing the resident to an ER, hospital, or nursing home.

Kevin Williams wrote about the enormous value of a Retirement Community’s data base in a recent article in McKnight’s Long Term Care News.  He was right – this data base is golden.  And when combined with residents’ anonymous health information and then data mined, insights are revealed that will help preserve census by reducing health attrition.



Early Benefits of Analyzing Your Retirement Community’s Data Base

Data Mining - The FutureIn order to preserve census in Retirement Communities (Assisted and Independent Living), a detailed knowledge of the healthcare needs of every resident would be invaluable.  The importance of this knowledge cannot be over-emphasized, since the National Center for Assisted Living tells us that 92% of residents who move out of Assisted Living Communities (ALCs) do so for health reasons.

An understanding of Chronic Health Conditions (CHCs) will improve a Retirement Community’s ability to maintain the health of its residents.  Chronic Health Conditions are those that last a year or more and require ongoing medical attention and/or limit activities of daily living.  The most common CHCs are:

  1. High Blood Pressure
  2. Alzheimer’s disease and other dementias
  3. Heart Disease
  4. Depression
  5. Arthritis
  6. Osteoporosis
  7. Diabetes
  8. COPD and allied conditions
  9. Cancer
  10. Stroke

Chronic health conditions account for more than 75% of all healthcare spending in the US and are the driving force of healthcare for older people.  Eighty percent of independently living seniors have 1 CHC, and 50% have 2 or more according to the Centers for Disease Control.  At some point, the burden of CHCs overwhelms the ability of independently living seniors to care for themselves, so many seek Assisted Living.  At this point, the typical resident has at least 2-3 of the most common CHCs.

Assisted Living Communities are charged with addressing very complex healthcare issues in addition to the challenging responsibility of providing residential care that includes a wide variety of services and amenities.  The services that ultimately have the largest impact on resident retention, however, are healthcare services.

Data mining the known information about a Retirement Community’s residents can provide extremely valuable insight that can guide and assist healthcare management.  Our experience with data mining ALCs and ILCs (Independent Living Communities) of various sizes in Boise, Idaho has enabled us to:

  • Discover which CHCs are the most common in each specific ALC or ILC.
  • Establish a ‘health risk profile’ that is specific for each resident.
  • Based on the ‘health risk profile’, design interventions that may help preserve census by reducing health related attrition.
  • For ILCs, discover which CHCs pose the highest risk for losing a resident to an ALC, and then most importantly…what to do about it.
  • Gain insight on which residents nurses, aides, and other employees should focus their time and attention based on the health risk profile.
  • Compare the health risk profile of a specific ALC to national statistics.
  • Gain marketing insight based on the health risk profile of current residents of ALC’s and ILC’s.

Our next several blogs will show specific examples of the kinds of information retrieved by data mining Retirement Communities.  We will then demonstrate how this information can be used to create the health risk profiles discussed above.  We look forward to your feedback.

42 doctors for 55 residents??? What???!!!

FrustrationHouse Calls first exercise into data mining an Assisted Living Community (ALC) immediately found this:  a moderate sized ALC has a census 55 residents who are cared for by 42 different primary care physicians!  Nearly every resident has a different physician.  No doubt every ALC is in a similar situation.  And if you count the multiple office staff in each physician’s office who answer the phones and take messages, as well as the usual staff turnover, and also the physician’s call partners and their offices and staff, then this exasperated ALC nurse may literally have hundreds of medical personnel with whom to interact when performing or overseeing routine care for her residents.  And this is just one of her many duties!

No wonder a task as simple as getting an answer about a lab result, or a simple medication question, or getting a signature on a form, or especially getting a physician’s response to a resident’s acute medical complaint can consume the nurse’s attention for hours and sometimes days!

Years ago, hospitals found the solution for the inefficient and often times unacceptable care resulting from many physicians caring for many patients:  Hospitalists.  Most hospitals now hire a small group of physicians called Hospitalists to care for their in-patients.  Each Hospitalist generally provides most of the care for about 15 patients.  Nurses for the patients know exactly whom to call, and they get a prompt response from a physician who is knowledgeable and dedicated to this group of patients.  Hospital care has not only improved for the patient, it has also improved for the nurse.

ALCs would do well to take a lesson from the Hospitalist model.  Although it is neither necessary nor financially feasible for an ALC to hire a group of physicians, there is a way to vastly improve the current situation most ALCs are burdened with:  that is, having a glut of disconnected and unfocused medical personnel to sift through whenever a physician response is needed.

Data Mining Message

PARTNERSHIP.  ALCs must be proactive in reaching out and establishing a working partnership with just 1 or 2 local primary care physicians – that’s all that’s needed.  Physicians who would be willing to be the primary care providers for any resident voluntarily wanting to take advantage of their services.  Yes, a small financial investment by the ALC may be required to support the physician’s administrative costs required in developing a portion of his practice at the ALC.  But this investment is small and easily and quickly recovered by more efficient communication with physicians who are focused on YOUR residents, thus freeing your staff to attend to other activities.  Physician partnership also serves as an important market differentiator for current and prospective residents.  Residents and their families will feel comforted in knowing that your community has a special relationship with local physicians.  This is a partnership in which EVERYBODY WINS!


Critical Insight Revealed by Data Mining Your Retirement Community

data mineHave you ever considered “DATA MINING” your assisted living or independent living community?  That is, ‘going deep’ into all the information you have at your disposal about your residents – demographic, social, health…everything.  Your retirement community…every retirement community has a treasure trove of unused information about its residents that could be used to improve your business, your marketing, your services, and your amenities in ways that will positively impact your bottom line – census.  And these data are specific to YOU and YOUR COMMUNITY.  Unveiling this information by data mining, then organizing and analyzing it, and then finally comparing it to data from other communities as well as national data available in the literature, will reveal a specific profile, not only of your community as a whole, but also of every resident living in your community.

In the coming weeks, I will post blogs on the House Calls website that will chronicle our experience of data mining independent and assisted living communities in Boise, Idaho.  I will highlight the kinds of valuable information that is available to every retirement community and the recommendations that can positively impact performance and census.  I look forward to thoughtful feedback and provocative discussion.


A Physician in Every Home

Everybody knows that Bill Gates was crazy when he dreamed 35 years ago, “A computer in every home.” He was completely nuts, right?  Not possible, can’t be done, etc.  Yeah right…

But now how about, “A physician in every home.”  Crazy, not possible, can’t be done, right?

But I say, not only a physician in every home, but an entire healthcare team –  nurse practitioners, nurses, medical assistants, social workers, radiology, lab, EKG, all led by an active and engaged physician, IN EVERY HOME!

Is this just “pie in the sky”, wishful thinking, or worse…?

No to all of the above.  This can be done…NOW!  With the resources we currently have.  And it doesn’t depend on Medicare or insurance companies changing the way they reimburse (now THAT’S wishful thinking!).  And it doesn’t depend on some type of wild and ‘far out’ technology that hasn’t been invented yet.

What’s required is that we simply change our thinking.   We just “rearrange” the way we use our current resources, open our minds, and augment our business model to finally begin doing what we’ve always just assumed was impossible:  make our HOMES, not the doctor’s office, the primary site of healthcare delivery.  This is NOT IMPOSSIBLE!

We need to stop viewing ourselves as victims of a dysfunctional healthcare system, and we do this by taking control of healthcare delivery in our communities.

If we rearrange the way we use our existing resources even while keeping our existing system of reimbursement, we can bring an entire healthcare team to every home, apartment, and trailer.

All we have to do is change our thinking!


White Paper – Transcript of interview with Kevin Wiliams, president of

I was recently interviewed by Kevin Williams, the President of  Kevin was very interested in the House Calls unique model for bringing Primary Care Physicians profitably to Retirement Communities.  We had an informal discussion about the value of a service that will increase the lifetime value of residents and also promises to reduce health related attrition rates.

Click on the link below to read a transcript of our discussion.

Senior Marketing Interview

To learn more about Kevin and his very creative and insightful approach to senior marketing, please visit:

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,  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 (  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 (

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