To address the demographics, successful AL providers are changing their care and service visions and finding new ways to meet residents' needs. A primary way to complement an AL program is to develop relationships with other service providers, including home health agencies, adult day care centers, durable medical equipment companies, therapy providers, case managers and specialty physicians, such as consulting psychiatrists.

To establish a preferred provider relationship, AL providers should consider an organization's care and service philosophy, flexibility, accessibility, quick response and interest in open communication.

HHA Case Study

Since attracting and retaining AL residents who require skilled nursing care or need ongoing homemaker services may be cost-prohibitive, AL providers may consider developing a relationship with a home health agency. Instead of using their own staff, many AL providers have turned to HHAs to provide care. Models for this service arrangement vary according to each state's licensing requirements and marketplace. We've observed several models, but the following one has achieved success.

The AL provider, a residential facility serving older adults who require assistance with ADLs, wanted to meet the needs of aging residents who require more services. The provider reviewed the costs and procedures for obtaining and operating its own HHA license and determined that it would be too costly and outside the scope of its experience. The provider then decided to develop a relationship with an existing HHA.

The AL provider interviewed several HHAs, exploring each agency's:

.understanding and experience in providing care in a residential environment and/or assisted living setting

..philosophy regarding resident choice and risk assessment

.ability to consistently meet needs with trained staff

.use of outside pool staff to meet needs

.reputation in the marketplace and with referral sources

.willingness to work with the assisted living care staff

.willingness to present a seamless service program to residents and their families.

The AL provider ultimately selected a local hospital's HHA affiliate as a preferred provider. The two entities established a contract describing the relationship and the responsibilities of both parties. The contract stated that the AL provider would pay the HHA a nominal monthly fee to provide assessment services for pre-admission and re-admission following a hospital stay. In exchange, the HHA agreed to provide monthly wellness clinics, resident education and weekly office hours. The AL provider also agreed to provide office space, telephone support and access to standard office equipment.

To address resident and family member concerns, the AL provider presented the services with the preferred provider as seamless and easily accessible. First, the AL provider discussed the service expansion and introduced the home health nurse to residents and their families. The AL provider presented the HHA as a preferred provider, not as a sole service provider, reinforcing that residents could still choose other providers for care. Following the meeting, family members and residents discussed fees and service options with the home health nurse and the AL provider.

Then the home health nurse completed a personal assessment on the participating residents and established a service plan to meet their needs. A key benefit to all parties was that the resident remained in the AL residence for a longer period of time.

Within one year, over half of all residents used the combined AL and HHA services. Today, the HHA staffs the building 16 hours a day and provides staff 24 hours a day as needed. Weekly meetings between the AL and HHA staff keep information flowing to meet resident needs.

By establishing the preferred provider relationship with the HHA, the AL provider learned to integrate care and service philosophies of the two organizations, conduct general orientation for all providers in the building, schedule and conduct weekly care meetings for providers, include the home health staff in holiday parties and special events, seek ways to build a team approach to care for the whole person.

Adult Day Care Case Study

AL providers may also consider forming relationships with adult day care centers. For example, an AL provider was concerned about meeting the needs of residents with dementia and memory loss. The provider considered developing an enhanced activities program, but decided the number of residents who required this service was insufficient to cover the cost. Thus, the AL provider approached a local adult day care center and initiated discussion about pooling resources.

The AL provider had a large unfilled activity space in its building. The adult day care provider's facility, located in a local church basement, wasn't ideal for its clients. To address each organization's issues, they developed an agreement: The AL provider would lease the activity space to the adult day care provider. In turn, the AL provider would prepare and deliver meals to the adult day care clients. The agreement also offered AL residents priority admission and a small daily discount to the adult day program.

When the AL provider introduced the adult day care program, three residents immediately accessed the service. Their families appreciated the adult day program's structured environment and convenience. During the operation's first year, more residents used the day care program. Some attended the program for a few hours a week and others went daily. The adult day care program still served community-based participants at the new site.

An added plus to this arrangement was that the community-based participants became more comfortable with the AL program. When it was necessary to move, several of the community participants opted to move to the AL residence.

Through this relationship, the AL provider learned that: adult day care complements AL, access to adult day care allows some residents with memory loss to remain in the ALF longer, provider communication is crucial for continuity of care, adult day care can increase new resident admissions.

Other Service Options

HHAs and adult day care providers aren't the only entities that can complement an AL provider's program. Other beneficial contractual arrangements may be made with durable medical equipment companies, therapy providers, case managers and specialty physicians.

Moraine Byrne is senior vice president of marketing, Health Dimensions Group, Denver. Dr. Kathleen M. Griffin is national director, post-acute and senior services, Health Dimensions Group and president/CEO of Valley Consultants Inc., Scottsdale, Ariz. She also serves on ADVANCE's editorial board.