Zachary Cattell is president of the Indiana Health Care Association, a trade organization for the long-term care and assisted living community. Cattell has been with the association for more than seven years and has been president for more than two years. Prior to that he was an attorney focusing on health policy and law. He offered these comments on the progress in long-term care in Indiana.
QUESTION: What improvements in Indiana’s long-term health care have you seen in recent years?
CATTELL: The IHCA focuses on improvements in the quality of care for the long-term care profession and on how providers can continue to improve the outcome patients receive. In 2017 there were specific initiatives that happened that were positive. One thing is a program being run by Indiana University School of Medicine called Optimistic. It's a collaborative clinical model to pair nursing facilities with advance practice nurses and a full clinical team to address chronic diseases to reduce unnecessary hospitalizations and to help residents meet their goals of care. This is one of seven pilot programs around country that the federal government is funding at the Centers for Medicare and Medicaid Services.
We've seen outstanding results at nursing facilities. In the first phase those nursing facilities have reduced the risk of avoidable hospitalizations by 33 percent. They've reduced relative spending for those patients by nearly 25 percent per resident and produced a net savings to the Medicare program. It's all being done with high patient satisfaction, and it’s really about listening to the goals of the residents and doing advanced care planning.
We're serving a geriatric population that has chronic diseases, and we have to be sure we're doing what’s right by their goals. The first phase took four years to get these results and I think it will be a clinical model going forward, but it is too early to tell. Also, great strides are being demonstrated through award recognition programs. Our national trade association sponsors two quality programs, and we have more and more nursing facilities demonstrating by rigorous criteria that they are improving quality through objective third party measurements.
The Quality Initiative is an annual program that looks at specific measures of clinical quality that focuses on that year. It is looking at the present health care needs of patients and measuring providers' performance. The Quality Award Initiative is based on the Baldrige criteria. That is a rigorous system many industries use that sets measurable targets, organizes strategies to meet those and measures the results along the way and then changes the strategy based on the actual data produced. We have more and more nursing facilities qualifying with high marks in this program that leads to better clinical outcomes.
QUESTION: Where do you think the Region excels in this field?
CATTELL: We have lot of members in the Region that participate in these programs.
QUESTION: What is the Region and the state in most need of and how can you help it attain that?
CATTELL: Our biggest need is workforce. The workforce for health care generally but specifically in long-term care is about as challenged as it's been in a generation or more. Some of our members are human resource professionals, who have been doing it for 25 to 30 years, and they've never seen a market like this. There's not enough nurses across the state for all types of health care settings. If you think about the workforce in our world, we're not a manufacturing or retail environment or we're not fixing a meal.
We’re taking care of people. In this health care space, the challenge is improving quality of care, yet we have a difficult time finding enough qualified workers and keeping them because it is such a competitive environment. Working in long-term care and assisted living is some of the most challenging work in all of health care. It’s all over the country, but changing the dynamic is something we're working on. We put together a career ladder website, carefortheaging.org. People are finding careers in long-term care through that website. We are doing a pilot project in Indianapolis that we hope to spread around the state using the Department of Labor apprenticeship program for certified nurse’s aides. Also, we're launching an online certified nurse's aide program to increase the volume of individuals that can be trained.
We also are doing relationship building, connecting our members with educational institutions, both in K-12 and higher education. We're working with Ivy Tech on creating a long-term care certificate program where local employers work with local educators to make sure there are enough people in the education pipeline that can end up in the workforce.
QUESTION: Where do you expect to see the biggest growth in health care in the future? The biggest potential problems?
CATTELL: The workforce will be a significant problem for years to come. The biggest growth in continuum of care is in long-term services and support, and it is going to be in home and community based settings. Those are things like assisted living, home health care and personal service agencies. The whole goal is people desire to be closer to home when they are getting health care. Nursing facilities' services are an extremely important part of that, but there will be more needing care.
The boomer retirement rate is said to be 10,000 people a day. Just because people retire doesn’t mean they are going to use post-acute care services. Eventually they will need it, and we will be ready to care for those individuals in the place they choose and government approves. About 85 percent are paid by the government. Medicare is 20 and Medicaid is 65. This is care in the nursing facility side. The government sets policy on who gets service and for how long. There are a lot of different policies about benefits and payment methodology that the government is changing, and it is changing rapidly, which is a big challenge for providers to keep up with.
QUESTION: What do you see as the future of long-term health care in Indiana and the Region?
CATTELL: The regulatory environment is always challenging. There are opportunities, but keeping up with the changes in regulations is always a challenge. The goal is better patient centered care, and we will continue to focus on that goal.
QUESTION: Is there anything you can do to help the Region prosper?
CATTELL: Northwest Indiana is an integral part of the state and big share of population, so all these changes are as important in Northwest Indiana as anywhere else in the state. In Indiana, I feel we are well-positioned. There are a lot of nursing homes in Indiana and a lot of excess capacity, so I'm not worried about a shortage of space for the future population. There are a lot of perceptions about the nursing facility sector that are unfortunately perpetuated. People are afraid of the unknown. We’re happy to speak with families and policymakers about what long-term care really is.