4 Key Software Tools for Skilled Nursing Facilites

Smart use of software tools can improve many aspects of operations in skilled nursing facilities. Administrators, physicians, and staff can streamline communication, management tasks, and decision making. Residents and their families can experience better interactions with caregivers, closer communication with each other, and higher quality of care overall.

The first key to success with software tools is to select the appropriate tools for each specific usage. Different stakeholders will benefit from the use of software in specific ways. When considering software solutions, keep in mind that quality healthcare requires a blend of time-honored low-tech caring with cutting edge modern innovations. For example, there’s no substitute for a physician or nurse spending time talking face to face with a resident and their family. 

However, you can (and should) use technology to help make the caregiver’s day as efficient as possible, so that they actually have time to sit and talk with your residents. With that in mind, here are four software tools that have been particularly beneficial for caregivers in our group and for facilities where we work.

1. HIPAA-Compliant Messaging & Communication App

A HIPAA-compliant messaging app becomes a central hub where your nurses, doctors, therapists, managers, administrators, and all staff in your facility are all able to communicate in one place. Their functionality is quite similar to Slack or other business chat apps, albeit with the added layer of HIPAA compliance, and the attendant business associate agreement between the software provider and your facility.

In facilities that don’t use such a tool, we have observed that important messages and information often slip through the gaps, impacting resident care. But once everyone starts using these tools, systems function more smoothly, and messages rarely get lost or misinterpreted.

We’ve had a good experience with a software called hucu.ai. We have actually helped a number of facilities start to use this app as a communication hub for their staff and administrators, with the added bonus that it makes communicating and coordinating with our group much easier. Some other similar software products (that we haven’t used) include zinc.it, Qliq, and Notifyd. New options appear in this space frequently.

2. Frailty Tool

A frailty tool is a dynamic algorithm that incorporates a wide variety of data points about each patient to predict the level of care the patient is likely to need. The software looks at the resident’s diagnoses, demographic information, vitals, and other kinds of relevant data. The software uses this information to evaluate the patient on a “frailty index.” In simple terms, the frailty index allows you to evaluate the overall health of each patient, irrespective of their age or other superficial factors. 

We’ve found the software is quite useful in predicting which patients are likely to need significant attention, which in turn leads to better care by helping us to focus resources and attention where they’re most needed. Among other benefits, this can significantly reduce the chances the patient will return to the hospital. The tool can also help to identify which patients have the potential to be compensated at a higher level based on PDPM criteria. The frailty index itself is developed based on extensive research into the characteristics of frailty, such as these studies.

The frailty tool we use is Patient Pattern. In our experience, Patient Pattern is extremely useful Although we expect frailty tools to become a standard across the SNF industry, we’re not aware of any other software that performs the same function

3. Advance Care Planning Database

Advance care planning requires having an in-depth conversation with each resident about their goals, expectations, and intentions for their care, taking into account various possibilities and potential outcomes. It requires asking hard questions to create advance directives for different scenarios. For example, “If your heart stops, do you want caregivers to attempt resuscitation?” Or, “If your breathing stops, do you want to be put on a ventilator?” Advance care planning is often emotionally taxing for patients and their families, and the last thing they want is to have to have such conversations repeatedly, or worse yet, to have their wishes disregarded through either miscommunication or simple ignorance on the part of their caregivers.

The purpose of an advance care planning database is to create a record of each patient’s goals, intentions, and wishes for their care, and to make that record accessible to all of their various care providers. That way, if a patient leaves your facility and goes to another facility, or to a hospital, their new caregivers will also have access to their advance care directives. This saves the patients and their families from having repeated conversations about advance care planning, or from receiving care that doesn’t align with their wishes.

Although it’s not yet required, we expect advance care planning to become a standard across the SNF industry. The current requirement to have a POLST form on file is a step in that direction. However, creating a record of the resident’s intentions in an advance care planning database helps ensure that their intentions are not merely recorded, but also easily accessible to their caregivers. We’ve found AD Vault to be a very effective advance care planning database, primarily because it’s the most widely adopted system, and therefore the most accessible for caregivers across different facilities. There are many other database tools available, such as Iris Health Care, Honor My Decisions, Vynca Health, Wiser Care, and others. Some of these focus on a particular niche or functionality, and may be a more viable solution in certain situations. However, accessibility and wide adoption is critical to the success of an advance care planning database. Patients often come into facilities in emergency situations, and if doctors and caregivers don’t have easy access to the patient’s directives when needed, the directives may not be followed.

Among its other benefits, advance care planning can lead to significant cost savings for both facilities and payers. Accountable care organizations, Medicare Advantage plans, and other payers are beginning to push facilities and caregivers to make advance care planning a standard part of their process. Beyond honoring the patient’s wishes, advance care planning also has potential to reduce health care costs, since end of life care administered contrary to the patient’s directives contributes to the high percentage of medicare costs related to end of life care overall.

In many facilities, our physicians and nurse practitioners assist the facility social workers with certain patient intake processes, including the standard POLST forms, as well as an advance care planning form in AD Vault. While many skilled nursing facilities have robust and reliable intake processes, we’ve found that even in the best facilities the social workers are sometimes stretched thin, especially so during the COVID-19 era. In many cases, we’ve found it’s beneficial for our staff to have an in-depth advance care planning discussion with residents.

4. Family Communication App

This one is actually on our own to-do list, as we haven’t used it ourselves, nor have any facilities where we work. A family communication app is a tool to give quick updates to family members on the status of their loved ones. In the course of caring for residents, SNF staff make simple notes in the app, and the family sees messages such as “Mom ate breakfast today,” “Mom walked 100 feet with the walker,” and so forth. Some of our colleagues report their facilities have reduced the number of complaints in their facility to almost zero, simply by keeping families better informed. 

Whether or not a facility uses a family communication app, this concept provides a useful lesson for SNF administrators and staff. Often, when families are dissatisfied, the issues could be resolved merely through improved communication. Unfortunately, many facilities don’t prioritize communication, and as a result families may become needlessly upset, sometimes even to the point of filing formal complaints with regulatory agencies.

Next Steps

Our team certainly doesn’t promote technology for its own sake. Rather, we take technological solutions as a means to facilitate quality healthcare. The tools listed above perform two key functions:

1. Enable rapid communication between staff, administrators, and other stakeholders
2. Provide easy access to vital information in a timely manner

Again, good healthcare requires a blend of old-fashioned caring and face-to-face time with patients, while utilizing modern technologies in their proper place. Often, the place of technology is to remove the busy work, to make the work day more efficient, and to help a facility distribute resources wisely and efficiently, which ultimately allows physicians, nurses, and staff to spend valuable time face-to-face with residents and their families.