Cross-training: Providing care across continuum
Cross-training: Providing care across continuum
Vertical integration could be the answer
When asked why a company would start a public/private venture for integrating various pieces of the health care pie into one location, Carl Rowe, PharmD, managing member of Integrated Care Communities in Marino Valley, CA, has a ready answer: "Three observations: the demographic tidal wave of elderly, the fragmentation in the long term care continuum, and the increased acuity of the post hospital patient." A quarter century of experience in the health care field leads him to believe that the only way parts of the health care industry will survive is by linking together.
Ground broke this summer on what Rowe hopes will be a model. On a large campus that already houses 364-bed county hospital will be a day care center catering both to well children, and sick and disabled children. There will be outpatient rehabilitation, a wellness center, adult day health care, a skilled nursing facility, and a home health agency. The bulk of the operation will be up and running next summer. The remaining pieces will come on line in 2001. Eventually, there will be further additions, including a medical building, a post office, a hotel, retail space, and a residential care facility for acute psychiatric patients.
"The subtext of this concept is that hospitals are suffering from increased competition, fluctuating staff, and decreasing censuses," says Rowe. "Hospitals that survive will have to focus on efficiency, on increasing market share, and on increasing their sphere of influence." One way to do that is to create vertical integration — merge into networks, form alliances, and start partnerships that provide for both patients and payers a complete continuum of care.
First, ask for input
Integrated Care Communities started by talking to local government agencies, such as the Office on Aging, to find out what health care needs were not being met and what was not being utilized to the fullest potential. "We talked to the Riverside (CA) Child Day Care Consortium and asked their desires. We spoke with local community colleges so that we could use the site for a variety for training — both nurses, and allied health professionals such as certified nursing assistants, aides, and licensed vocational nurses."
Nurses said one of their biggest peeves is providing care for a high-acuity patient, and then having no knowledge of the final outcome once the patient is discharged to another facility or to home care. "We asked if they would like to follow patients through the continuum of care," Rowe says. "They thought this was a great idea; and because of our operational agreement with the hospital, we can do that."
The ability to share resources is one of the biggest strengths of the proposed facility, Rowe says. "Because we are on the same grounds, a nurse could leave the hospital with the patient, go to the skilled nursing facility, follow through rehab, and then into home care. We would cover for that nurse, and exchange him or her for one of ours who was not currently busy."
Having a pool of nurses, technicians, and students could help hospitals keep costs down. "They don’t pay them if the census is down, yet the nurses continue to have work. We level out the fluctuating staffing patterns." The same philosophy could also apply to other services that can be shared, such as lab and X-ray facilities and staff.
To make the resource sharing work, Rowe says there will have to be some cross training (for more on cross-training programs, see related story on p. 97). He says his company will provide training in geriatric nursing for those who want it, and those nurses and other staff will become the core of the shared pool. "Most nurses like having variety, and this will be something new to many of them," says Rowe. "We think we will be able to attract a pretty good pool. The training is new, different, easy to get to; the hospital is encouraging them to do it, and it’s free."
Rowe’s message is simple: "Be open to new concepts in terms of cross-referral and shared utilization of resources. Proximity is the take-home message. If you have extra land, look at it and weigh building a parking garage against creating something that helps to create a real continuum of care. You’ll get more rewards for the latter."
He recommends that facilities interested in forging the kind of partnerships that will allow resource sharing talk to government and volunteer agencies in their communities. The local Office on Aging will have information on what kinds of services are needed and what parts of the post-hospital market are underutilized.
Rowe also suggests querying staff to see how they feel about resource sharing. He says he would be surprised if they weren’t excited by the idea, but cautions that, in any case, don’t leave them out of the discussions.
"There is a window of opportunity before the baby boomers swell the ranks of the chronic geriatric population," says Rowe. "If you have underutilized resources and see a need for vertical integration, then this is a practical approach to reaching those goals."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.