by Dwain Hebda
Gone is the institutional feel of nursing homes, modern enterprises look and feel like a destination resort.
Superior Health and Rehab, all of one week old, stands like a beacon on the edge of Conway. If you didn’t see the large stone sign out front, you’d swear it was a boutique hotel. Walking into the foyer does nothing to change your mind; it’s only when you get a few strides down the wide, inviting hallway that you start to see hints of where you are.
“The year is 2019,” gently reminds one display before listing the day, month and date. The placard is subtle, and there are several. A few more steps and you see the nurses’ station, which you expect, and a bright, comfortable gathering area in front of a fireplace, which you do not.
Just down from the family game room and the library stands another door with a patriotic display, reminding residents to vote for the community council. Such elected entities are required by law in order to give residents a voice in the care and amenities they receive. That goes for Superior too, even though the place is so new, they don’t have enough residents to fill the offices.
But arguably the most impressive part of the new nursing home is the therapy room, which takes up a large footprint on the second floor. This isn’t the only place in town offering physical, occupational and speech therapy – there are two hospitals in Conway, an acclaimed physical therapy program at the University of Central Arkansas and many ancillary health care options. But it’s hard to imagine Superior’s setup not being ranked among the best, both in square footage and appointments.
Your short tour completed, your head spins trying to put what you’ve seen into context. Is Superior merely a unicorn in the skilled care market or does it represent the future of nursing homes, even in a poor, rural state such as Arkansas? In Northwest Arkansas, sure; in Little Rock or Hot Springs, definitely. But what about White Hall? Or Helena? Or Piggott? Or one of the dozens of other small communities where people are poorer and enter nursing home sicker? Could this model be sustainable in these places?
That’s exactly the idea, says Michael Morton, whose Fort Smith-based company owns a conglomerate of more than 40 nursing homes in Arkansas, including Superior Health and Rehab. A veteran of the industry, he’s seen such a fundamental shift in consumer demands it’s redefining the entire model of senior care.
“The biggest thing people don’t realize is, in a lot of skilled care facilities, like mine, over 50 percent of the people who come in go home,” he says. “The federal government has changed it to where you can come in and if you have a hip fracture or something, you can have your operation, go into a nursing home and get two or three weeks of therapy and then have home health follow up with you a little bit. In the old traditional style of nursing homes, when somebody came in, they never left until they died.”
This new era of nursing home optimization has seen other changes as well, particularly in the area of medical care and training. Rachel Bunch, executive director of the Arkansas Health Care Association, says this has been the primary challenge for individual operators as well as the industry statewide.
“As we see the acuity level of the patients that we take care of continue to rise, then the skill level of the employees that we have working with those patients has to rise and match that,” she says. “We have to keep the training up and provide the nursing education to make sure that the nurses that are in the facilities are trained to work with that geriatric population.”
Bunch admitted Superior was a unique example of care and amenities but was quick to point out nursing homes across the state are taking strides to modernize their facilities and improve programs and services. Considering that not long ago the standard nursing home model featured communal bathrooms and a shower room that served an entire floor one patient at a time, there’s been major progress. This is particularly true regarding training, which is delivered both by the association and by individual facilities.
“Nursing schools have become more complex; they prepare nurses to take care of more complex patients, but they may not get a lot of extra training in geriatrics,” Bunch says. “Or they might get a basic education on dementia, but that education is not going to include the long-term care regulations. So, the industry-specific regulations are taught onsite which is where we come in.”
Many facilities are beginning to offer in-room refrigerators and flexible meal plans, in addition to traditional dining services as a market-driven strategy to stay ahead of their competitors. As counter-intuitive as it may seem to offer options instead of providing a guaranteed revenue stream with set meals given the waves of Baby Boomers crashing daily onto the shores of their golden years, nursing homes, as an industry, have been in trouble for some time.
In December, Skilled Nursing News reported the average median operating margin for such facilities nationwide was zero, thereby forcing operators to find other sources of revenue just to stay afloat (and resulting in a mounting number of industry casualties that didn’t.) The magazine thus predicted facilities will begin to reach into different categories of care. In addition to therapy services such as those at Superior, skilled nursing facilities are dabbling in providing home health care, behavioral therapies or substance abuse treatment. There’s also a trend for facilities to work together thereby spreading out costs and boosting services.
Bunch says Arkansas is no exception; while not all operators in the state have the money or the motivation to go as over the top as Morton’s Conway facility, most are reaching out to their peer nursing homes to discover new types of programs to offer. These range from the relatively simple – a staff baseball game, cookouts, a game room – to the truly unique such as a facility in Malvern recently granting residents’ requests to form a gun club, with target practice supervised by local police.
While all of that is important from a quality of life aspect, it’s what’s going on behind the scenes that very often gets overlooked, Morton says. Staff training programs and disaster action plans aren’t exciting until you need them, as with the recent floods that swept the state.
“One thing that our association does is we hold different types of training for every aspect of a nursing home,” he says. “From nursing to housekeeping to dietary. And one of those that you probably wouldn’t think of is emergency management. Remember the Great Flood of 2019? Remember the levee that broke at Dardanelle? Did you read in the paper or see on the news the 100 residents who had to be rescued?
“No, you didn’t; and the reason you didn’t is because it was my nursing home, and we had been trained by our association on exactly what to do. We evacuated them in advance, and we didn’t call the National Guard or anybody. We had been trained on what to do, and we set about it very quietly and methodically. And no one even knew it.”