WELShift In the News - Article Detail


Moving Forward with Transitional and Integrated Services Report 3/26/2014 The Long-Term Services and Supports Providers’ Perspective...


Below is an excerpt from the report developed by the American Association of Homes and Services for the Aging (AAHSA) Transitions and Integrated Services Taskforce pages 19-21 . . .          . . . download full report .pdf


Senior Health and Housing Initiative For Transformation (SHIFT)


The “Senior Health and Housing Initiative For Transformation (SHIFT)” model was developed by Wesley Enhanced Living, a multi-site CCRC in suburban Philadelphia. This model uses incentives and places a person in the middle of the “process” in order to try to help someone earlier in life (possibly before their health conditions worsen) as opposed to PACE (which requires that a person be nursing home eligible). The program is designed to bring the Medicaid system into play if a CCRC client no longer has funds to pay for care. It’s a campus-bound program and has an admissions process similar to a regular CCRC. The SHIFT monthly fee would cover all services (as is the case with a Type A CCRC).


SHIFT is a concept that combines two existing and successful models. It employs the coordinated, integrated, at-risk approach inherent in the PACE model, which is a day-care based program for frail elderly, on a CCRC platform that provides multiple levels of care and housing. The purpose of the SHIFT model is to integrate the healthcare and housing needs of the elderly and provide a lower cost, higher quality residential care option for people who would not otherwise be able to afford the lifestyle provided through a CCRC. SHIFT aims to coordinate, and manage intensively, all acute, post-acute, and long- term care services for older adults within a CCRC setting. Since SHIFT receives capitated payments from Medicare and Medicaid, and assumes full risk for providing healthcare services, the incentive for the program is to manage the healthcare needs of the SHIFT population to maintain health status and residence in independent housing, to prevent or delay disability and to manage chronic conditions, and to delay/prevent the need for costly long-term care in an institutional setting.


The SHIFT program operates as a Type A CCRC. SHIFT, like all CCRCs, would seek to attract a relatively healthy population, before they became frail. In addition to operating as a CCRC, it also operates as an insurer and provider of Medicare and Medicaid health and long-term care benefits. As such, it assumes full risk for the healthcare, prescription drug and long-term care spending of its resident population.


CCRCs already address the housing, meals, assisted living, nursing, therapy and psycho-social needs of its residents. A typical PACE provider would provide nursing-like services, therapy, some psycho-social programs and physician services, but would not offer housing. Like a PACE provider, SHIFT would add physicians on staff and contract for acute care services when necessary.


To expand the SHIFT model to allow the middle class broader access to a CCRC environment, it is intended that the Medicaid program would contribute to an individual’s monthly and entrance fees on a shared basis. This contribution would not change based on the individual’s care needs, and could be based on an individual’s income and assets or perhaps only after all other resources have been exhausted, similar to a spend-down situation. The expected benefits of the program include the following:

  1. As a combination of two proven, existing models, SHIFT has the potential to obtain better outcomes at a lower cost.
  2. SHIFT operates an environment to promote “aging at home” and combat isolation, boredom and depression.
  3. SHIFT offers the potential of coordinating and integrating the delivery of care and services. As compared to hospital or physician-based coordination, which is conducted through infrequent interactions with the individual, the staff of a SHIFT program interacts daily with residents. Problems can be caught early, proper medication management and other follow-up procedures will be more likely to occur, and SHIFT staff can assist residents with complying with dietary, medication, physical activity and other guidelines. Finally, and most importantly, the purely medical and acute care prism through which this population has been traditionally viewed can be shifted to a more holistic, person-centered perspective.
  4. The PACE model has demonstrated an ability to “bend the frailty curve,” meaning that it is slowing down the onset of frailty with age. SHIFT, by intervening far earlier along the curve and therefore operating over a longer period, should be able to demonstrate an even stronger impact on the curve.
  5. The Medicaid program, by contributing to the capitated payment streams, would be capping its potential liability, thus saving it money. In fact, an independent study has estimated a 20 percent savings to Medicaid under the SHIFT program over a 10 year period compared to the same population under the current system.
  6. Through its design, SHIFT can provide access to the vast middle class who currently are unable to access many services that are available either to upper- income or, in some cases, lower-income individuals.
  7. By providing the critical mass of people within a concentrated locality, services can be delivered in a highly efficient and effective manner. SHIFT’s design offers the opportunity for the maximum amount and quality of services for the lowest possible cost.

The SHIFT design needs to be tested in order to prove it can deliver improved access and better outcomes for less money. The next steps for this program are to seek the waiver, or legislative authority, to combine the funding in the manner described, fully design the model and desired outcomes, locate potential sites, ultimately build and operate multiple SHIFT facilities, and assess the results. Eligibility requirements for the program also need to be determined. Currently, PACE programs cannot refuse an eligible client based on his or her diagnosis unless there is a safety risk. It is not yet known if this eligibility requirement could be extended to a CCRC platform.

. . . download full report .pdf