Long-term care providers are at a crossroads, according to “The Changing Dynamics of Dependent Care” panel presentation at SFCS By Design 2023. Increasing regulatory demands, static reimbursement rates, never-ending paperwork requirements, staffing issues, and a negative perception of nursing homes post-COVID have all conspired to create a difficult environment for skilled nursing care units to navigate.

Such was the consensus of panelists Dina Capek, Director of Health & Residential Services at Royal Oaks in Arizona; Frank Mandy, Vice President of Development & Planning with Kendal Corporation in Delaware; Amy Carpenter, Principal with SFCS and Vernon Feather, Managing Principal with SFCS.

For older adults, especially baby-boomers, a shared room with an institutional feel is now unacceptable, and many senior living communities are making big changes to adapt to these demands. By converting skilled nursing units into assisted living and memory care households, communities are still able to provide the care residents need while upgrading their living environments.  

“That’s what their residents wanted,” said Mandy.  

Kendal Corporation partnered with the San Francisco Zen Center to build its newest life plan community, Enso Village, which offers amenities such as a tearoom, hydrotherapy spa, and Zendo. Skilled nursing services are available from organizations nearby, when most needed and for a shorter duration.  

At Royal Oaks in Arizona, Capek’s team discovered that the shift from the highly regulated skilled care units to less restrictive memory care and assisted living allowed staff to focus, “more on care and less on administrative tasks.”

Other innovations included working with licensing bureaus, training CNAs to become caregivers, partnering with physicians and other healthcare providers, and involving residents with the proposed changes. The result: residents enjoyed private rooms and suites, regardless of their level of care; expanded use of Medicare benefits; elevated levels of services offered in wellcare centers staffed with full-time RNs; new medication management assistance, and regular wellness checks in an environment that Capek describes as “complete supportive living.”  

Royal Oaks also saw significant cost-savings, especially in areas of staffing and administration.  

When converting skilled nursing units to single occupancy assisted living, Feather said, designers need to ensure each unit includes a private accessible shower, ample space to safely maneuver walkers and wheelchairs throughout the unit, and have ample space to install a kitchenette.  

Even changes such as enlarging exterior windows to allow for more sunlight and better views can improve the resident experience. Feather also recommended that communities should be designed to ensure easy transitions to different levels of care.

Carpenter cautioned, though, that reducing or eliminating skilled nursing units is ultimately a mission-driven decision. “If you are already the nursing home of choice in your community and you’re providing a high level of care very successfully, it makes sense to keep doing it,” she advised.  

A need for skilled-nursing will remain, healthcare occupancy regulations continue to evolve, and these types of conversions may end up widening the income divide by excluding seniors who cannot afford private pay options.  

Still, the desires of older adults are clear. Quoting residents, Capek said, “I want to be in my own space, and I want to have my own things around me. I want to know that someone is always there when and if I need help. I want to feel respected. I want to have purpose. I want to do what I still can do, and I want to feel safe and comfortable.”