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New-generation software improves seniors management

A new generation of software developed specifically for the assisted living and seniors housing industry is supplanting the existing supply of applications originally developed for the healthcare platform and adapted to serve assisted living facilities.

"The majority of software applications out there today have been primarily nursing home-oriented tools and applications customized by individual operators," says David S. Schless, executive director of the American Seniors Housing Association (ASHA), an affiliate of the National Multi Housing Council, with more than 300 member firms from all sectors of the seniors housing industry.

According to Schless, the need for management software developed specifically for assisted living and seniors housing residences has become more of a pressing issue. Demand has risen, says Schless, for practical solutions that address the day-to-day needs of these facilities and incorporate care provisions, resident services, marketing, and management tasks that reflect the long-term resident care process. This demand is being driven by the accelerated growth of assisted living residences, which are outpacing the development of other segments of seniors housing, such as independent living and skilled nursing facilities.

According to recent surveys by ASHA, development of assisted living communities comprised as much as 54% of all seniors housing development. A joint study conducted by ASHA and Coopers & Lybrand L.L.P., The State of Seniors Housing 1997, projects that the present $15 billion assisted living market will expand to a $30 billion industry by the year 2000.

By the year 2020, the number of senior citizens who will need some form of daily assistance will double from the present total of 6.5 million.

The rapid pace of development, acquisition and investment, coupled with the strong demographic demand, have created a fast-paced environment of constant change that makes the role of managerial and operational software all the more crucial to a facility's success.

THE IN-HOUSE SOLUTION One innovative firm, Sun Health Care, a major developer of health care services and products, and its new assisted living entity, Sun Bridge, have taken things into their own hands. Dissatisfied with the available products on the market for managing assisted living facilities, Sun Bridge decided to develop their own software applications. The company partnered with Marktech Systems Inc., a 10-year-old healthcare software development firm, with headquarters in Minneapolis, to create a customized solution.

Essentially, their efforts have revolved around modifying and customizing Marktech's successful Montana Assisted Living System, a set of financial and clinical applications built around a robust and flexible relational database management system. Founded in 1988 by a group of former Honeywell Healthcare Information Systems executives, Marktech has systems for the full range of senior housing residences in some 500 installed sites in 28 states.

"Most of the software packages available had been designed for long-term care, hospitals, or rehab facilities," said Steve Lacy, Senior Business Analyst and primary MIS contact for Sun Bridge. "We wanted an integrated solution that allowed us to manage and track all of the data related to services and residents from one interrelated source that would be easy to access."

Tapping the vision and considerable industry experience of Sun Bridge executives, particularly Jerry Meyer and John Gonzalez, the development team assembled applications that would provide a single source of data entry into a unified database. This database tracks resident information through the whole process from initial inquiry through admission and residency.

"Information flows from department to department," explains Lacy, "and is available to every office within the facility. Because all of the information is housed in one place and is easily manipulated and output to reports, it's a great planning tool. Managers can see the whole picture, instead of small, isolated segments."

The software, as yet unnamed, has five components: client tracking, care management, accounts receivable, accounts payable and marketing.

According to Lacy, Sun Bridge's custom software improves communications among the various entities managing and running the facilities and promotes a team concept of working together.

"With less time rekeying data, which previously ran about 30 hours per week per building - and that's a conservative estimate - the staff has more time to spend on their key tasks and on planning," said Lacy.

The software was developed over a year and a half time period and involved a lot of Sun's experienced assisted living staff in the process. The software runs on the Windows NT platform, and Sun Bridge facilities are connected by WAN (Wide Area Network) over ISDN lines to the main Sun office in Albuquerque. This setup enables centralized management for all of the computer systems needs of the facilities.

"We'll soon be converting to a frame relay network to lower costs," said Lacy. "In addition, we're developing a company-wide intranet to post and share information."

Parent company Sun Health Care has been so pleased with the in-house software development process that they've established Sun Systems as a separate entity to develop custom applications for the company's other areas, such as pharmacy and long-term care. All of the applications will be built on the same model and run on the same platform.

AAHSA ENDORSES ACHIEVE'S PATHLINK(TM) SOFTWARE The American Association of Homes and Services for the Aging has officially endorsed a software product from Achieve Health Care Information Systems that serves companies in every facet of long-term care, according to Scott Parkin, a spokesman for AAHSA.

Achieve, based in Minneapolis, is one of the industry's leading developers of information systems software for the post-acute care market. It also provides consulting services. According to Chris Hawver, chief marketing officer for Achieve, the company serves between 3,400 and 4,000 clients nationwide, making it one of the largest providers of long-term care information services in the industry.

PathLinks software is modular and includes 23 different applications that are customizable to each facility's needs. Among the modules included are admission and census; clinical and financial pathways; care plans; clinical documentation; minimum data set; quality indicators; electronic submission; accounts receivable; general ledger; human resources; and acuity-based staff scheduling with specific and related applications to most components of long-term care services.

The software has been designed to facilitate the sharing of data between nursing homes, hospitals, retirement communities, assisted living centers, physicians, health services, and others in the long-term care spectrum of services. As part of the agreement between Achieve and AAHSA, the two organizations are creating an extensive database on long-term care procedures and outcomes and that will track - for the first time - cost, quality, outcomes in multiple service levels and locations for long-term care. This national databank will allow organizations to access analyses and benchmarking data on all assessments on a national, state, or regional basis.

According to Hawver, PathLinks integrates case management tools with clinical and financial tools. There are modules for referral management, consolidated billing and the ability to do assessments.

"Users can purchase and use the PathLinks components they need," said Hawver. "The software can be easily customized for each user so that they only view the screens necessary to their job."

Hawver says the company is focused on developing applications to meet the needs of the long-term care market and what he describes as the "large demand from the assisted living market."

Most of the needs they hear about focus on obtaining real-time information; being able to get snapshots of the health of the organization on a daily basis; an intuitive decision support system; broad user-defined capabilities; and the ability to zero in on key performance indicators. To meet that demand, Achieve has another 18 applications in the design process that will be coming out early next year.

SUPPORT IS KEY TO CARE'S STRATEGY As one of the major leaders in software services for the long-term care industry, CARE Computer Systems' VistaCARE product is used at more than 3,000 facilities across the nation. CARE, which has been serving the long-term care industry since 1969, places a premium on support. The company, based in Bellevue, Wash., maintains a high ratio of customer service staff to clients. It presently has a staff of over 85, all of whom have experience in healthcare administration, nursing, accounting, computing and medical records. To serve clients efficiently, there are 11 offices throughout the country with additional offices scheduled to open this year. Its product development staff includes more than 95 people.

Under its brand name VistaCARE, CARE provides clinical and financial software information systems to nearly every segment of the long-term care industry, including assisted living, skilled nursing homes, subacute, Continuing Care Retirement Communities, retirement homes and adult daycare. CARE software runs on PCs under DOS, Novell, Windows 3.11 and Windows 95 platforms. Pentiums with a minimum of 16 MB of RAM are recommended. In a typical year, CARE develops over 100 software enhancements which customers receive as a benefit of their annual software update service.

The VistaCARE product is a complete integrated system of focused modules, including: admit, discharge, transfer; resident management (MDS 2.0); case mix; care plan; physician orders; report writer; cost analysis: pre-screening; accounts receivable/billing; accounts payable; payroll; general ledger; resident trust; staff scheduling; bar code/ancillary tracking; and dietary management.

CARE also has a remote communications module that enables users to enter data and billing to multi-facility organizations. In addition to its core applications, CARE provides comprehensive training and installation services. Early in the process, the company meets with clients to develop an installation schedule and customize training to the needs of the client's personnel.

A NEW PLAYER EMERGES To meet the needs of the rapidly growing assisted living market, Briggs Corp., a firm with more than 50 years of experience in providing health care products, services, forms, and documentation systems, formed a new company, Briggs Technology, in 1997.

"We targeted the assisted living market because we found there were few software systems designed specifically to run assisted living facilities," said David Bolen, manager of technology products for Briggs Technology. "Most existing software were really nursing home programs modified slightly for assisted living use."

A year ago, Briggs launched Ariata(TM), its windows-based assisted living management software. According to Bolen, Ariata is the first software built from the ground up to manage assisted living facilities. The program was developed for Briggs by consultant Karl Corbett, president of Shasha Corp., and a number of assisted living facilities participated in the product's development.

Briggs acquired Ariata from Corbett late last year and added a new GUI (graphical user interface) and made the program more robust. The program runs exclusively on Windows 95 and Windows NT through Microsoft Access 97 and is tightly integrated with the Microsoft Office 97 suite of applications. All of the necessary functions for operating assisted living residences are built into the program, including general ledger and accounting; services and administration; maintenance, housekeeping, food service and central supply; resident services; social services; staff scheduling and tracking; resident wellness; and marketing.

The program is designed to be intuitive and easy to learn, allowing staff to get up and running quickly. Information in the system is updated constantly and allows managers to retrieve a current snapshot of facility operations and performance regularly. Ariata generates more than 200 reports detailing activities, vacancies, services and nearly every aspect of operations.

Some of the software's advanced features allow users to capture and review comprehensive cost data, provide staff and residents/family members with detailed billing reports; perform trend analysis derived from the statistics captured by the system, such as turnover rates, marketing leads, accidents, etc.; track marketing information and generate mailings without having to reenter data into the system.

Ariata is one of two programs recommended by the Assisted Living Federation of America (ALFA) for use by its members, according to spokesperson Whitney Redding, ALFA's director of public relations. The other software application is called *lpha, a relational database program developed by the research division of Hearthstone Alzheimer Care, an assisted living provider. Hearthstone developed *lpha under a grant from the National Institute of Aging. The company contracted with Advanced Information Management, a software developer with 20 years of experience in creating computer applications for providers of services to the elderly.

Constructed around a powerful relational database infrastructure, *lpha provides a complete integrated system to address management, service planning, operations, and marketing, including all of the functionalities offered by competing products.

SEEKING THE COMPETITIVE EDGE IN ASSISTED LIVING In 1997, Boston Financial, a diversified real estate investment firm based in Boston, launched a major foray into the assisted living market with the announced goal of owning 5,000 assisted living or congregate care units for its clients by 2001. A key component of Boston Financial's initiative was to hire Karen Anderson, formerly of Advantage Health Management Association, to direct the firm's assisted living program.

Today Anderson, who serves as vice president and director of senior living at Boston Financial, oversees a portfolio of approximately 200 communities, with two new ones in development. Boston Financial's management portfolio includes more than 1,200 seniors housing units, primarily within assisted living communities.

One of the major problems confronting Anderson was the lack of industry-specific management tools. The problem she faced is a systemic one that she says is industry-wide. At a major technology summit sponsored by the National Multi Housing Council and ASHA last January, Anderson gave a presentation on the difficulties in finding adequate software applications to meet the industry's needs and described the path Boston Financial has taken.

Working with software development firm Healthware Solutions, Inc., based in Baltimore, Md., Boston Financial has developed a software tool that addresses operational concerns and can be mapped across accounting systems. The software integrates outcome tracking, physical assessment, service plans, residential services, and the physical and health status of residents.

"Most of the software available was developed based on profiles and needs of frailer residents and were not residentially driven," said Anderson. "We wanted a system to help us devise plans to delay frailty, reduce falls and accidents, and enhance the social and personal aspects of residents' lives."

According to Anderson, choosing to develop their own application in-house was the fastest path to meet the organization's needs. Key functionalities built into the software are focused on a cost-benefits analysis model that would generate the data managers needs to show residents the cost-effectiveness of the facility and to help managers benchmark the performance of their facility against others on the market.

"It was essential to come up with a tool that direct care workers could use easily, that was simple and that enabled them to direct their attention to providing services," said Anderson. "The better we're able to explain to consumers the costs and benefits of our programs, the better they're able to make an informed decision about assisted living."

The program is Windows-based and is being beta tested this summer. It will include integrated accounting and management applications and tools for capturing data from scanners and bar-coding. Anderson says the program is not proprietary and will be made available to the industry.

"Our hope is that ultimately applications like ours, and efforts to develop accurate databases on assisted living performance, will improve the flow of information industry-wide to better enable investors, managers, owners, and consumers to evaluate the performance and efficacy of the assisted living communities on the market."

WHAT THE FUTURE HOLDS The good news for the assisted living industry is that more applications are emerging that address the specific needs and functions required to manage their facilities. As the industry matures, the software designed for the industry is evolving with it. The fast changing environment for technology poses significant challenges to industry professionals to keep pace with new developments and to make informed decisions regarding the technical direction of their management systems.

Users can expect to see continued evolution of the available products that expand applicable management components, streamline processes, and increase ease of use. With the industry driving rapidly toward a critical mass, you can expect to see more major software developers begin to enter the market to compete with existing companies. A lot of promising applications are also emerging from innovative approaches such as the efforts by Boston Financial and Sun Bridge to develop their own custom software.

"One significant trend developing is the move towards a three-tier architecture," said Hawver of Achieve. "By that I mean an architecture where business logic is separated from the database and user interface to produce simpler applications that can run on inexpensive hardware over networks from acentralized server."

According to Hawver, "The role of automation is to enhance productivity, not require you to modify your business operations to meet the needs of the software. Information is so dynamic and changes so quickly that technology is the only real way to get a handle on it. For assisted living providers, information is a strategic weapon for survival, growth, and profitability."

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