Dr. Chirag Patel has been in practice in the area of internal medicine and geriatric care for nearly 30 years. During the past decade, Patel has focused on providing primary medical care in senior living communities. He’s noticed some notable changes in the field in that time.
“The industry is growing, and its care needs have increased too” said Patel, who is CEO of Hansa Medical Groupe (HMG). “We’ve seen that the industry has realized more that what they’re doing is not just hospitality – it’s also medical care. Those entities that are fully scoped on hospitality understand now that the medical care component is here to stay, especially with the challenges that are coming with the increase of seniors requiring care, and it’s only going to get more important.”
HMG has a team of doctors and nurse practitioners that visit communities and provide care on site. Patel said the team currently provides services to approximately 120 communities and the company is experiencing high demand from senior living operators interested in partnering with HMG.
Patel said he spends time educating operators, REITs and others in the industry about what he sees as the evolving needs in the industry. Preventive primary care is powerful, Patel said. For instance, HMG has reduced ER visits by about 60% in the buildings where they work and the length of stay for its clients is approximately 12 months longer than the industry standard in assisted living and about nine months longer in memory care.
“For many years, the industry has been more hospitality-based, but I can see that shifting and I think operators will have to keep converting to the care side – I don’t think it’s avoidable,” Patel said.
Neurological conditions are a prominent and telling area where attentive medical care can make a pointed difference, Patel said. In their work, HMG providers frequently encounter assisted living residents who are experiencing cognitive decline that affects their quality of life but does not rise to the level of needing memory care. And, in some cases, those residents would benefit from a memory care setting but are avoiding it because of the financial requirements of it.
“We’ve noticed a lot of neurological need not just in memory care, but also in assisted living, and now, actually, it’s trending into independent living” Patel said.
Patel said HMG providers spend much of their time working with residents who have various neurological conditions, including dementia, that lead to other medical problems, such as anxiety, depression and behavioral issues. HMG focuses on these conditions from a neurological standpoint rather than a psychiatric one, Patel said.
“What I’ve found in senior living is that a lot of the psychiatric issues like depression or anxiety or even behavioral changes are not just related to a pure psychiatric condition or diagnosis – it’s more related to a neurological diagnosis,” Patel said.
As a result, Patel and his team focus “upstream” on the cognitive or neurological problem and tailor care to address it as a way of treating a resident’s anxiety, depression or other “downstream” struggle. Meanwhile, HMG also added a psychiatric component to its care to ensure that the primary care services and psychiatric care work in alignment.
Patel said getting a resident into the proper care level and environment can be a challenge in senior living with several factors coming into play.
“I think the sales and marketing teams will responsibly suggest to a family that memory care might be a better option when that’s the case, but the concern then becomes memory care costs a lot more than assisted living and then assisted living costs a lot more than independent living,” Patel said. “I’m sure there’s a balancing act in many cases when they’re trying to accommodate the budget of a family and also what the care needs are. Sometimes it may be okay to put someone with very mild cognitive decline in independent living or assisted living for the time being, but that could change at any time, and then they shift over from independent living to assisted living or from assisted living to memory care in the future. As an industry, we’re trying to accommodate all facets of someone moving into senior living, not just the care, but also the budget and other factors that the team at the buildings have to go through with the families or the loved ones of the residents.”
Patel said HMG strives to help community team members, residents, and families when weighing those decisions.
“When we are involved in the care of a resident that’s living in independent living, and they slowly start showing signs of further care needs and maybe their time to decline is now turning into dementia, we’re assessing those patients on a consistent basis, and communicating with the families,” Patel said.
HMG’s background as medical care providers helps build trust with families and understand the clear, logical reasons for suggesting a change, Patel said.
“It’s easier to convince a family that it’s time for their loved one to move to memory care because we’re coming from a clinical approach,” he said. “Sometimes when the approach is from the sales team, the families might feel it’s not just a clinical reason, even though oftentimes that blends together. That messaging just resonates with families when it comes from a clinical source.”
Patel said consistent attention is critical to caring for residents with cognitive issues. For instance, HMG typically sees a memory care resident on a monthly basis, which Patel said is much more frequently than people with those conditions typically see primary care physicians. Part of the reason for that close attention is to help avoid costly ER visits and hospitalizations that can be prevented with that level of attention. That frequency of care visits also provides better support to operator teams.
“If we stave off complications, slow down the deterioration of a resident and help with communication with the family, that indirectly makes the nursing director’s job at the building easier, and that’s become a positive side effect for the operators,” Patel said. “Nursing director and executive director is a really difficult job to do – it encompasses a lot of time and effort, and that sometimes can lead to burnout. So if my team can go in and ease up that pressure by taking some of the load of the care component for the resident, we’ve seen that the turnover is reduced in the buildings that we are involved in.”
Looking ahead, Patel said the primary care needs in senior living are only going to intensify.
“Senior living is obviously growing, and there are two components to that – one is the real estate and the other is personnel. We will need more memory care locations. We will need more assisted living locations than we have currently to house the folks that are coming of age in the next 10 to 15 years,” Patel said. “But there’s also the personnel. You can build a building, but you still need the staff to run it. There will be an increased need for doctors and nurses and nurse practitioners, CNAs and all caregivers. All of those folks will be needed exponentially as the number of seniors increase and come on board.”
Particularly in memory care, Patel expects major growth awaits ahead.
“We already know that people are living longer, and people are focusing more on their health – more on preventative health and wellness,” Patel said. “And doctors and nurse practitioners are focusing on preventing problems, and that also increases lifespan. When your lifespan increases, it will mean an increase in more folks with cognitive decline or dementia, and we’re going to need to be ready for that.”
