“Right-Sizing” Nursing Care Settings in a Life Plan Community, a new brief from LeadingAge, is designed to help life plan communities make decisions about the “right size” of their Medicare-certified skilled nursing setting and their non-Medicare, long-term care setting.

These decisions “will depend on the unique circumstances of your life plan community, and must be based on a careful analysis of issues related to residents, payment/reimbursement, and operations,” says the brief.

An Evolution in Life Plan Communities

From their inception, life plan communities typically featured an assortment of independent living residences and a nursing home. The nursing home was largely intended for individuals who had initially moved into an independent residence but needed nursing home care when their health changed.

The rule of thumb for these young life plan communities was simple: You needed one nursing home bed for every 4 independent living residences on your campus.

Life plan communities have evolved since those early days, and so has that rule of thumb. As a result, many life plan communities are exploring challenging questions relating to the size of their nursing care settings.

3 Sets of Issues to Explore

The new brief presents a host of questions that a life plan community should consider when deciding whether to increase or decrease the size of its nursing settings, or eliminate them altogether. Those questions touch on:

• Issues involving residents, such as consumer preferences, contract provisions, resident mix, and census.
• Issues involving payment/reimbursement and other market issues like payment pressures, referral sources, competition, and the scope of assisted living regulation.
• Other operational issues, including state law requirements, age of the physical plant, staffing, and technology.

“There is no right decision for every life plan community, and no magic formula for the ‘right-size’ of your nursing settings,” concludes the brief. “Each life plan community must decide what is best, based on the preferences of current and prospective residents, its payment and reimbursement pressures, and its current operations.”