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By David V. Hunter 

January 14, 2016


Connecticut is undergoing a permanent and historic transformation in its demographics - it is aging. Between 2010 and 2040, Connecticut’s population of people age 65 and older is projected to grow by 57%, with less than 2% growth for people age 20 to 64 during the same period[1]. Moreover, residents born in Connecticut today can expect to live to be 80.8 years old—the third highest life expectancy in the nation[2]. This unequalled long life, combined with firm increases in the number of older adults, has profound implications for everyone in Connecticut. In addition, the State of Connecticut has been actively engaged in rebalancing their Medicaid long-term care services from institutional settings such as skilled nursing centers, toward more emphasis on home-and community-based services and settings, for example, home care and adult day centers. The State has invested a significant amount of resources toward creating an environment where Medicaid recipients with a skilled nursing center level of care designation are aware of their options, including the opportunity to receive home and community based services (HCBS). In 2013, 56.6% of CT Medicaid recipients were utilizing HCBS and with State intervention it is predicted that by 2025, 75.1% of these individuals will be utilizing HCBS[3].  

At the federal level, provisions in the Accountable Care Act are addressing the impending rise in the senior population and particularly focusing on the utilization of health care and controlling those costs. The influx of an older population and the need to fund services has been addressed in some provisions of the Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act.  Together, this is known as the Affordable Care Act (ACA) which strives to achieve three goals:  improving the experience of care for individuals, improving the health of populations, and lowering per capita costs. In order to accomplish those goals, the existing payment models and health care delivery system are in a state of being reformed which in part, focuses on reducing the number of times seniors are readmitted to hospitals.  This one aspect has completely changed the dynamics between hospitals, skilled nursing centers and home care agencies, in which relationship building is essential in providing cost effective and excellent care.  The post-acute providers are no longer merely the next place for seniors to move, but are seen as part of the care process with emphasis on cost reduction with improved services.  Skilled nursing centers endeavoring to remain vital and successful must commit to innovations in service delivery, be comfortable with measuring and being measured for performance and working in a changing environment. In an effort to play a strong role in this changing environment, health care providers are compelled to form new associations through networking and relationship building, which includes sharing of information and metrics.

Long term and post-acute care is a critical aspect of every community, providing necessary services to millions of Americans.  As mentioned in the opening paragraph, our state and nation is aging, more and more individuals will need rehabilitative, short-term and long term care as they age.  Skilled Nursing Facilities are challenged to lead the way through the launching of new clinical programs, for example, performing intravenous therapy, pulmonary rehabilitation programs, and hospice programs that supports pain management.  Innovative rehabilitation modalities are being introduced, such as the Accelerated Care Plus, (ACP) which allows for specialized treatment plans using an ultra-sound machine, electric stimulation, diathermy, and bicycle machines.  This long term care model is also being challenged with the requirement to be innovative in promoting life-long learning experiences with the introduction of computer systems, such as iN2L[4], that promote individualized social and recreational activities for residents and clients.  Person centered care and services are becoming the norm in a field that is choked with regulation, and health care providers accustomed more to following rules than customer service as measured by satisfaction surveys versus regulatory inspections. 


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