Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
Interview with Gerald Hamilton, Owner of Bee Hive Homes
Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Gerald Hamilton, Owner of Bee Hive Homes in the 2017 AHCA Provider Lounge. Gerald discusses how his assisted living facilities are seeing a sicker, albeit better-informed resident pool. In order to manage the needs of his residents, Gerald is constantly looking into strategic partnerships to improve his facilities' offerings. Additionally, Gerald believes that keeping assisted living regulations at the state level encourages ingenuity among facilities in different states.
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Kris Mastrangelo: Good Afternoon we're here at the 68th Annual AHCA/NCAL convention in Las Vegas, Nevada at the Provider Lounge. We have Gerald Hamilton here with Bee Hive Homes. Gerald has multiple assisted living facilities in New Mexico and Nevada. We're so interested in how all the changes - regulatory and reimbursement - in the skilled sector are affecting your business positively or negatively and what have you been doing?
Gerald Hamilton: Well we're seeing what we saw years ago in the nursing home business. Acuity being pushed down to our level just like it did years ago in the nursing home business and so we're seeing people that are sicker and with more needs that are coming to assisted living. They're much more informed consumers and so they're making conscious choices. We have eighty/ eighty-five-year-old potential residents come to us often that have done some research on us and other assisted living facilities on the internet before they come in to see us and so they're much more informed than they have been in the past. They know what they want and they know the setting that they want to receive their care in so that's driving some changes for us that we need to respond to. And the reimbursement and regulatory changes at the SNF level are driving people to us and forcing us to look at partnerships. The states that I'm in - ACOs are not very prevalent yet but they're going to come our way and we need to be ready for that when it happens and be able to form strategic partnerships and give those partners the data that they need to make choices about whether they want to partner with me or another provider and how they can engage which providers best for them to join.
Kris: My experience has been vastly in the skilled nursing sector and hospitals, and in the assisted living what I found out about five years ago and I started to research it is that every state has different rules. So, from New Mexico to Nevada are the assisted living rules different or is there anything different about them?
Gerald: Yes, they are and it costs me more generally to do business in Nevada because of the regulations here requires some work, some different things. Just a couple of things that come to mind between Nevada and New Mexico's we've got to do some different things with background checks, tuberculosis screening for our employees, training for our employees. It’s a little bit more stringent here in Nevada. Each state’s a little bit different but I think that's the beauty of assisted living. I'm on the NCAL Board of Directors and one thing that we're really concerned with is making sure that we keep regulation in our sector at the state level and I think one reason that's really important is because that drives ingenuity, new ideas. We see different states doing different things to respond to the needs and if things work really well or if there's a great idea in one state we like to be able to transfer that to our state if you can and with a federal regulatory model that would be difficult if not impossible to do to take advantage of innovation that way.
Kris: That is incredibly powerful because I've asked a lot of individuals in the assisted-living sector to explain to me what the value would be and no one has ever said that that eloquently. I like that if different states have the platform or the canvas to be creative and innovative and you can learn from the other states that you saw that you're not confined to a federal oversight that where the adaptability would not occur, right?
Gerald: Well, we have the opportunity to be much more collaborative on a state to state level with our regulators. Where if we had that umbrella of federal regulations we wouldn't have that ability or that flexibility and I think that's driven some great ideas. Oregon is an example of a collaborative effort that's just gone on between the regulators and the people in the sector about how to drive quality, how to measure quality and that would not be able to happen if there was an overarching or a restrictive federal regulatory structure.
Kris: And some owners I have spoken to…they actually said that if assisted living - and again I'm from the SNF perspective, the skilled nursing facility - if they regulated the assisted living continuum that it would negatively affect…Would it negatively affect the census in the skilled nursing sector? I don't know the answer.
Gerald: I don't know I think even if we were to experience federal regulation it would be much less restrictive than it is in the nursing facilities so I think under that scenario it would be quite a while before we saw the flow of residents slow down from acute or skilled nursing to our field in assisted living.
Kris: So, I started in long term care in the early 90s and of course the patient population has dramatically changed from then. A large percentage of patients are going home, the length of stay is 21.3 days versus back then maybe 34 days or even higher. Do you see a different type of patient in assisted living today than you did 20 years ago are they the same?
Gerald: We do. We see them quicker, they are out of the hospital rather nursing home quicker and sicker. I think the reimbursement environment is driving that and I think people's choices are driving that too. It's not unusual anymore for somebody to come from an acute stay directly to assisted living and most states in the regulations have an understanding that in assisted living people can come and stay and age in place. And so, for example, my facilities, my communities most of the residents that leave us leave us when they pass away. They come to us at one level functioning. They start to decline. We bring in resources from outside to meet their needs if we're not able to under our license and they stay with us until they pass away and that's a real draw I think to our setting because people generally understand if they're pleased with the level of care they're getting and they like our setting, they can stay there and then they're never going to have to go somewhere else.
Kris: Ok, so I've got a couple questions on that. Is your occupancy up or down?
Gerald: At my communities it's up. We generally, mine again are small 15 rooms in each of my communities, and we generally run between 95 and 100 percent occupancy all the time.
Kris: And I read somewhere that the length of stay for the assisted living patient customer is about 2.5 years. Does that resonate with your community or from what you know nationally?
Gerald: Yeah that's pretty close to what we see. We've had residents obviously somebody that comes to us a very sick and they're on hospice, they may last a couple of weeks to a couple of months. But we've had residents come and stay with four and five years and so on average two or a little over two years I think is a pretty good number.
Kris: So, in my world as an occupational therapist I don't I don't know how to quantify that. So, say if you took out the hospice or the patients that are terminally ill and/or expected it's 2.5. Maybe it's not 2.5 - maybe that number is longer. Maybe 3 or 3.5 years. What is the reason why they would leave that setting?
Gerald: Yeah, like I said earlier most of the residents to leave my communities when they pass away. Although it's not unusual to have someone that has a sudden incident, a stroke or TIA and they’ll go and have a hospital stay, perhaps a rehab stay but almost always the customers that I've known if they end up in the hospital because of a situation like that they want to go back home and for them going back home means to my facility, my community.
Kris: And I guess my last question is - in understanding that space and by the way the differentiated state to state - what types of services can you provide for the viewers in an assisted living in those two states? Does home care come in, does therapy come in, do they bill under Part B or Part A or managed care? How does it happen?
Gerald: Sure. Generally, we provide ADL assistance only. That includes managing their medications, your showering, dressing, bathing, assistance with their meals, we prepare their meals for them. If they require anything more than that specifically any kind of skilled nursing service we can't provide that under our license but we make arrangements with a home health or hospice agency to bring in one of their people that can provide that service in our community. And so, it's not unusual anymore to have home health come in and a treat a resident for some skilled nursing services but also for some OT or some physical therapy to deal with a decline or post fall post-incident kind of thing and they can rehab them back to their former level in our setting without having them go to a skilled facility or hospital.
Kris: That's fantastic. Well our time is up, but we thank you for coming and learning about the assisted living and aging in place and the market and how it's changing and the influences. Thank you so much for coming.