CHRISTUS’ Changing Portfolio: 1/3 Non-Acute Care

Historically, CHRISTUS’ portfolio has been predominately focused on acute care, which are services provided in inpatient settings and require a hospital bed. However, because of the factors I outlined in the previous post, we believe this needs to change, and our portfolio must parallel our increased focus on non-acute care.

I believe that one of the most significant enhancements in non-acute care will involve advancements in technology, specifically long-distance monitoring. Through long-distance monitoring, health care providers can now examine nine different parameters of a person’s wellness: blood sugar, weight, blood pressure, urine pH, etc. We believe that number will increase to 26 - 30 parameters so that health care professionals will have a more accurate picture of a person’s health without requiring an office visit. By distance monitoring, patients can retain the best level of care possible without leaving their homes or staying in the most independent living option offered in a senior community.

In fact, distance monitoring is becoming so effective that in our independent living and assisted living campuses, we have applied for and obtained licenses to provide certified home care to their residents. Receiving these home care services and perhaps utilizing visits from a home health nurse enables seniors to live much longer in independent living situations, move into assisted living later, and perhaps never have the need to enter a nursing home.

In my last post, I also addressed the changes in the senior aging process and the large number of baby boomers who are reaching retirement age. In response, we are increasing our focus on palliative and hospice care programs as well as geriatric psychology programs, as we are seeing increased instances of depression in people living to 80 and 90 years old. Also, as people live longer, we are seeing new series of diseases in seniors that we previously would perhaps have only seen in a younger population. As we continue to see these types of diseases (most of which are propagated by environmental conditions, stress, dietary exposure, etc.), we will have to come up with new treatment modalities for older patients who will not opt for highly invasive treatments which have known high mortalities and morbidities.

For instance, I recently heard of an elderly man who developed colon carcinoma in his 80s. When I was in medical school, that was a disease of white males 40 years of age or younger. However, we are staying healthier, living longer, and are now prone to these diseases when we are older. The 80-year-old with colon carcinoma did not, understandably, opt for radical surgery. Instead, he chose minimal, non-invasive surgery, and immediately wanted to be enrolled in our hospice and palliative care program in his region. As a Catholic, faith-based organization, we pride ourselves in not only acute interventions and non-acute programs, but also every sophisticated and innovative palliative and end-of-life care.

Some people say that because boomers are aging and most health care is required later in life, health care are expenses going to rise. However, as discussed earlier, we are choosing not to build hospital beds for the elderly. Instead, we are depending on technology and changing attitudes to move as much care as possible into the most independent setting possible. And as you have heard, we’re so committed to this that we’re changing our entire portfolio.

It is our observation that already, every level of care after an inpatient hospital stay has been changed in some way. For instance, skilled nursing units are now doing what long term care used to do. This will change health care significantly, and we are hoping that this movement from acute (expensive and often invasive) to non-acute (less expensive and often non-invasive), may cause health care costs to decrease instead of increase. As we move toward becoming a more non-acute organization, we will do more of the following: acquiring distance monitoring systems, acquiring Visiting Nurse Associations, developing memory units so we can treat Alzheimer’s more effectively (instances of which will increase). Memory loss is a function of time, and we need more innovative ways to stimulate memory as patients age to be added to our inter-generational Alzheimer’s program in Utah, and our in-house animal programs in all of our senior campuses.

This inter-generational program pairs Alzheimer’s patients with children in daycare for 4-6 hours a day. Animals, including dogs, cats, birds and fish and plants placed into our senior facilities seem to foster companionship and provide enormous energy and stimulation for the residents. I believe that we will have a greater understanding of the mind in the next 10 years (much like our increase in understanding of the heart in the last 25 years). We still may not be able to cure diseases like Alzheimer’s, Parkinson’s, etc., but we may be able to stabilize them and mitigate the most serious side effects.

We recently acquired a senior care facility in the Dallas area and, like our international operations, especially in Mexico, is proving to be a great “learning-laboratory” for us to study and treat innovative models for senior wellness. Historically in the Mexican culture, children took care of parents as they aged. However, we are finding that elderly people in Mexico are considering alternatives so that they do not need to live with children unless they have no alternative, and children are looking for more stimulating environments for their parents. Also, in a recent trip to Japan, I discovered that country has a major issue in providing care for their elderly. They had a goal of funding long-term care for all aging people, and now they have a healthier elderly population who do not want to go to into a nursing home environment, and instead want to be in assisted or independent living facilities.

When we chose to shift our portfolio to focus more heavily on non-acute care to mirror changes in our culture, we signaled a shift in our own culture. Instead of seeing ourselves as a health care delivery system serving people, we must now move to seeing ourselves as an organization that serves people by delivering health care in the most appropriate setting to maintain wellness as long as possible. We now, at CHRISTUS Health, are in the people business.