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Certificate of Need meeting touches on new type of care facility for seniors

JEFFERSON CITY, Mo. – The attendees of a Certificate of Need (CON) meeting discussed a new development in the healthcare industry Monday, one that could affect how senior citizens recover from surgical care.


According to longtime member of the Missouri Health Facilities Review Committee Rep. Caleb Jones, R-Columbia, the legislature may need to approve a new type of healthcare facility known as a transitional care facility (TCF), a burgeoning type of health care center separate from independent senior living communities, assisted living facilities (ALF) and skilled nursing facilities (SNF).

The development of TCFs currently mirrors the same way ALFs emerged in the 1990s. ALFs were a middle ground between living independently in a senior facility or neighborhood and confining oneself to a nursing home for more intensive care.

“It started out with basically independent living and skilled nursing facilities, and over time they realized that even people as they get older, they don’t need to be in a 24-hour care nursing home,” Jones says.

These ALFs provided certain amenities helpful for senior citizens, such as cooked meals, regulated prescriptions, and some nursing services among others, while not restricting independence as much as a traditional nursing home.

Now, a new niche has popped up in the market to fill in a new gap, according to Jones.

“Elderly people who are still in physically good shape have to get surgery to replace knees, hips, elbows, shoulders, back injuries, and their recovery takes longer than a younger person,” Jones says. “So this is creating a boutique cottage industry. Now, we have something completely different… The step between the hospital and wherever you’re going to end up is transitional care.”

“Whenever assisted living statutes came in to create this industry, we are now seeing a discussion and a realization that we need to do statutes for the [TCFs],” he says.

Jones says that TCFs have cropped up as a reconciliation of two truths in healthcare; that senior citizens have longer recovery rates after surgery and take up valuable bed space in a hospital and hospitals are trying to increase their turnover as quickly as possible to see more patients to provide more care and make more money. TCFs, such as the Landmark Hospital Transitional Recovery Centers in Columbia and Joplin, offer more attentive care for longer periods of time (the average stay at Landmark Columbia is 21 days) than traditional hospitals.

The reason for the burgeoning market has to do with a provision in the Affordable Care Act, colloquially known as Obamacare, that penalizes hospitals if they “excessively” readmit Medicare patients after 30 days for certain conditions by docking Medicare reimbursements paid to the hospital. It incentivizes hospitals to ensure quality care, but it makes it difficult for high turnaround, especially with older patients.

“By having a facility like a transitional hospital or transitional treatment facility they’re able to properly recover with the same intensive monitoring,” Jones says.

Unfortunately for the CON, TCFs are currently designated as SNFs instead of reflecting their unique status on the healthcare spectrum. This distinction matters a great deal because of main quantifier the committee looks at for facilities they certify: bed needs. If TCFs fall under the SNF category, they will be judged the same way by the committee for the number of beds they provide when the two types of facilities serve vastly different purposes.

The committee will next meet in approximately two months time.