Eric Mendel, CEO, Avenir Healthcare Group

For nearly two decades, Eric Mendel has been challenging the status quo of health care. In 2015, Eric set out to improve the state of long-term care, a long-underserved component of the continuum. With that, the Avenir Healthcare Group was formed. His philosophy of “treat everyone as you want to be treated” is apparent in every aspect of the continuum.

Through the Vision Series, Eric Mendel shares his vision for the aging health system of tomorrow with an emphasis on consumer influence. He explains how skilled nursing providers are navigating the staffing crisis using new technology and innovative hiring practices. He also talks about the current challenges and opportunities in providing better quality of care to aging Americans, as well as what SNFs are doing to tackle them.

Describe your vision for a health care system that truly is equipped to serve the aging population in America.

I think the health care system needs to be consumer-driven, which is the impetus for our health care system’s strength. It should be built around the desires of the consumer, rather than the industry, or the history of the industry.

If you could change one thing about the current experience aging Americans face, what would it be and why?

There aren’t enough services for individuals with dementia or Alzheimer’s disease who can’t afford the private pay space. I’ve been seeing a lot of people struggle to place their mother, father, grandmother or grandfather with dementia or Alzheimer’s disease. In our system, you can get into private pay memory care if you have eight or $10,000 a month. But a model for affordable or low income memory care does not currently exist.

We’re building one of the first facilities in the country specializing in that population and that socioeconomic group, and I think that’s a big deal. A lot of people are stuck in skilled nursing facilities who otherwise wouldn’t be there if there was an affordable memory care component for people on Medicaid.

What can individual care providers do to better facilitate care transitions for the aging population?

Care providers need to understand that they should treat their patients the way that they would want to be treated. I think if they do that, there’ll be an increase in the satisfaction of care in the United States.

Who should be responsible for overseeing continuity of care?

Typically, the case manager in a specific level of care should oversee continuity. I think you’ll see more long-term care providers offer services throughout the continuum to facilitate those transitions. You will likely see more providers embracing home care, skilled nursing, assisted living and memory care. If it’s one system, it’s easier to transition. Historically, most providers have not offered all of those components. In the continuum, I think you’ll see that change moving into the future.

What do you think is the biggest opportunity for providers of housing and care for the aging population in 2022?

I think they need to provide consumer-driven care throughout the continuum, and to [provide] the lines of service that will help individuals transition from one level of service to another.

What role does technology play in allowing individuals to age well?

Remote patient monitoring and other technologies such as fall sensors will continue to grow moving forward. Technology is also improving inside the individual’s home. I think people will be able to age in place and delay entering an assisted living independent living or a skilled nursing facility. You’re going to see more and more technology that helps people stay in their homes

What technology developments excite you most in how they’re addressing age-related challenges?

I cannot stress the importance of remote patient monitoring and its impending growth over the next couple of years. It’s unbelievable how much information providers can gather about patient needs. Addressing the patient or resident’s needs is much quicker when technology is involved.

What’s the single biggest hurdle to achieving better care for the aging population?

Government funding or increases in Medicaid reimbursement is a big one. Unfortunately, state Medicaid reimbursements are really low in our system. On the federal level, Medicare reimbursements are a bit better, but I think states need to bump up their Medicaid rates because many states are paying less than the core staff taking care of the patient in the right way.

How can individuals set themselves up for success in navigating today’s system for the aging population?

If a provider is ahead of the curve, gives the patient what they want and maintains a high standard for quality of care, they already have the secret to success.

How are things going in terms of staffing and what’s been going on just generally, on the SNF side?

The SNF side is interesting. As for my facilities, the short-term Medicare census is back to pre-COVID levels. I think the long-term census is not there yet because there were so many deaths across the country. That’s been challenging. I’m still very bullish on the space, especially in markets where there’s a high barrier to entry.

COVID wasn’t that bad, financially, for a lot of providers because there were many government subsidies. This year has been more challenging because the PPP and CARES Act funds are drying up. Census is still not back so it’s difficult, especially when you factor in the state of staffing. There has been a lot of price gouging by the staffing agencies, adding insult to injury.

Many agencies are taking staff from the nursing homes, paying them a couple of bucks more, and when the nursing home is really short-staffed, they’re leasing the employee back at a much higher rate. You’ll likely see medium and large providers doing more of their own recruiting instead of relying on staffing agencies. Still, I’m bullish on the industry. It’s very hard to take care of a person in their home when they get to a certain level of acuity. I think technology is going to help with that. If you take a look at New York, for example, it’s almost impossible to build a skilled nursing facility. Even if they lifted the CON moratorium, it’s almost impossible because land costs are astronomical, on top of the approval process. You’re talking about years, yet in New York, the occupancy is the highest in the country.

We are seeing upwards of 96% occupancy around the state, so you can imagine what’s going to happen with the aging population in 10 to 15 years.

Have you heard of skilled nursing facilities or providers, in general, creating their own staffing agencies because that’s something we’re starting to hear a little bit more.

Yes, I think every provider that’s not a mom-and-pop shop will focus much more on doing their own recruitment. Pre-COVID, it worked. You didn’t need the staff in your company doing the recruiting, and it was a good value for the provider, so they didn’t even think about it. With all this price gouging today, people are looking at their bottom line and getting a sense that things are looking up. Look how we’re doing? We’re not doing well because staffing costs have gone up 20%, 30%.

It’s not as bad in New York and New Jersey where I provide services, but I’ve been hearing stories of rural counties that are much worse off because they can’t get anybody to come. Industry-wide, people are thinking to themselves, “Why do we need these staffing agencies? It’s not rocket science what they’re doing. Let’s spend more time on recruitment. We’d rather pay higher wages to the caregivers rather than the agency.”

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