If you own or operate a Skilled Nursing Center, you certainly must be preparing clinically and administratively for Managed Long Term Care (MLTC). However, you may not yet be planning for changes to your Buildings' Infrastructure that might be necessary to support the inevitable changes in your case mix.

Under MLTC, Accountable Care Organizations (ACO's) such as hospitals and group medical practices will have a very large say in who your residents are. Direct discharges from Emergency Rooms and Doctor's offices will become the norm. In order to maintain their referral base, nursing centers will be forced to accept many more "Heavy Care" sub-acute residents.

A heavier case mix puts a heavier burden on your building and its infrastructure. Is your building ready? For example, are you in a position to accept respiratory residents? Even if these residents are not ventilator dependent, having piped medical gases such as oxygen and suction will make care delivery more efficient.

Another area of focus should be your bathing rooms. A higher volume of "younger" sub-acute residents will increase tub room use. What is the right ratio of tubs vs. showers? Are there enough fixtures? Would shower chairs be an option? Is there sufficient space to add a recumbent tub for respiratory residents? We have found that a larger tub room footprint is needed to allow fixtures to be adapted to changes in case mix while also providing needed space for storage of lifts, scales and other large equipment.