Disability Insurance Benefits Attract and Retain Employees | <p><img src="/Articles/PublishingImages/740%20x%20740/staff_happy.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Nursing homes are a vital part of the health care system, and many people need to turn to nursing homes to provide specialized care later in life. </p><p>However, the health care system has been strained in recent years. As such, there is a <a href="/Issues/2023/Summer/Pages/Advancing-Policies-That-Support-Real-Workforce-Solutions.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">shortage of skilled health care workers</a> in the field, including in nursing homes. It becomes incumbent upon those managing nursing homes to find ways to attract and retain skilled nursing home employees in order to properly care for patients while successfully securing the longevity of the facility to continue providing care to those who may need it for years to come.</p><p>Nursing home operators can create a culture of care to attract employees who are in high demand. Offering a comprehensive and fair compensation package is crucial to attracting and retaining skilled employees. Owners and managers of a nursing home should review their compensation offerings frequently to ensure they remain competitive as an employer and retain skilled workers.</p><p>Compensation is not limited to regular earnings; it may include other benefits such as (but not limited to) paid leave, medical benefits, support for medical licensing, and insurance plans including private disability insurance. Not only do these compensation packages allow skilled nursing home workers to afford necessities but benefits like those stemming from disability insurance provide an income safety net and financial peace of mind should the employee become disabled.</p><h3>Working in a Nursing Home Comes with Occupational Risk</h3><p>Working in any medical care setting comes with some risk of illness or injury as workers are exposed to contagious diseases and potential injuries on the job caused by repetitive actions. Some of these conditions can become disabling. While workers' compensation benefits may provide some financial relief to the disabled worker in some cases, private disability insurance benefits are an important part of providing financial security for a disabled employee. Long-term disability insurance benefits are particularly important to disabled workers who are out of work for several months or years.</p><p>Nursing homes may come with significant occupational risk of illness or injury. The health care workers, physicians, and nurses who work in nursing homes see patients regularly, and as these patients live there full-time, there is no option to send sick patients home. The spread of disease can harm medical professionals working in nursing homes. This was observed frequently during the COVID-19 pandemic.</p><p>The physical injury risk to nursing home workers is also increased. Residents of nursing homes often need assistance with ambulation and mobility. Even with <a href="/Articles/Pages/The-Quality-of-Your-Care-Is-Connected-to-the-Competency-of-Your-Staff.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">trained medical staff</a> overseeing these activities, accidents do happen. Residents can be startled or fatigued during mobility or transfer activities that are part of their care, during which time employees can be injured from a fall or sudden shift of weight or movement.</p><p>If a resident falls in the nursing home and needs assistance, this can increase the risk of injury to the assisting employee. Even occupational therapists or physical therapists who have extensive training in safely ambulating patients can be injured in an accident.  </p><h3>Disability Insurance Benefits Offer Employees Peace of Mind</h3><p>With a heightened risk of contracting illness or suffering an injury in the workplace, many skilled nursing home employees may be concerned about the possibility their illness or injury might prevent them from working. Of course, illness or injury can happen outside the workplace as well, and offering a way for employees to prepare for the unexpected is a sound, compassionate business decision.</p><p>One way to invest in your employees and provide peace of mind should they become unable to work is by offering long-term disability insurance plans. This can be done in a number of ways. For example, the employer can offer group disability insurance benefits, including long-term and short-term disability insurance coverage. In some instances, the employer will pay a portion or all of the disability insurance premiums for the employee. As a business, the nursing home should consult with a business advisor or tax professional to assess how to structure disability insurance offerings to employees to ensure a sound business decision is made and to ensure that tax implications are appropriately considered.</p><h3>Adding Disability Insurance Coverage Through Private Disability Policies </h3><p>Not every business can offer the full range of disability insurance benefits to its employees. The premiums may be too high for the business, or the staff size may be too small. If offering group disability insurance is not practical, or the offering is limited in some way, the employer can still offer some options to employees. The nursing home could include an allowance or partial reimbursement for employees to secure private disability insurance coverage.</p><p>Private or individual disability insurance benefits allow individuals to contract for coverage or add policy riders that may not be offered within the standard group policy framework. This allows the employee to obtain the disability insurance coverage that will best suit their needs, which is especially important for medical professionals who may face challenges securing disability insurance coverage after the onset of a disability. </p><p>As with other benefit decisions, offering an allowance or reimbursement for disability insurance premiums to employees should be discussed with a business advisor to make the best possible decision in the current health care environment to protect the nursing home, its employees, and its patients.</p><p><img src="/Articles/PublishingImages/2024/Dominick-LaGravinese.jpg" alt="Dominick LaGravinese" class="ms-rtePosition-2" style="margin:5px;width:145px;height:178px;" />Ultimately, nursing home management can play a significant role in retaining skilled employees and promoting a successful and healthy facility through a comprehensive benefits plan that includes disability insurance benefits for employees.</p><p><em>Dominick V. LaGravinese Jr. is an associate at the disability insurance law firm <a href="https://www.seltzerlegal.com/attorneys/dominick-lagravinese/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">Seltzer & Associates.</a> He graduated from Ave Maria School of Law in Naples, Florida, with a Juris Doctor degree. He is a licensed attorney in the states of Florida and Pennsylvania.</em><br></p> | 2024-03-05T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/staff_happy.jpg" width="1056" style="BORDER:0px solid;" /> | Workforce | Dominick LaGravinese | Nursing home operators can create a culture of care to attract employees who are in high demand. Offering a comprehensive and fair compensation package is crucial to attracting and retaining skilled employees. |
Embrace the Future of Infection Control: Join the National Infection Prevention Forum | <p><img src="/Articles/PublishingImages/740%20x%20740/0920_News2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:190px;height:190px;" />In today’s rapidly evolving health care landscape, the significance of effective infection prevention in long term care is paramount. Recognizing this, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) launched the <a href="https://www.ahcancal.org/Quality/Clinical-Practice/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">National Infection Prevention Forum (NIPF)</a> in early 2023, supported by a grant from the Centers for Disease Control (CDC)/Project Firstline. The forum has attracted over 1,100 dedicated infection preventionists from diverse long term care organizations across the United States in its inaugural year, marking a significant stride in our collective journey to elevate health care standards.</p><h3>A Unique Platform for Collaboration and Learning</h3><p>The NIPF distinguishes itself through its collaborative and dynamic nature. It provides a space where infection preventionists in long term care settings can ask critical questions, exchange innovative insights, and learn from both peers and esteemed experts in infection control. Witnessing the rapid, informed responses to inquiries, often bolstered by evidence-based citations, underscores the forum's commitment to factual and practical knowledge-sharing. This vibrant interchange not only provides immediate answers but also fosters an environment for continuous learning and professional development.</p><h3>Expertise and Guidance at Your Service</h3><p>A key feature of the NIPF is the involvement of a rotating panel of infection control experts from the Association for Professionals in Infection Control and Epidemiology (APIC). These seasoned professionals monitor discussions, offering timely assistance and enriching conversations with their expertise. Additionally, the forum provides a unique opportunity to escalate complex queries to CDC experts, ensuring members receive clear advice.</p><h3>Expanding Horizons with New Initiatives in 2024</h3><p>Looking ahead to 2024, the NIPF is excited to introduce several new features designed to further support infection prevention work and offer a robust networking hub for professionals.<br></p><ul><li><strong>Hot Topics:</strong> Stay abreast of current issues with concise one-page briefs, tackling topics like dual vaccine administration and the utilization of vaccine information sheets.</li><li><strong>Clinical-Based Scenarios:</strong> Engage with interactive multiple-choice questions to enhance clinical decision-making skills, complemented by comprehensive insights from subject matter experts.</li><li><strong>Tips to Help You: </strong>Access quick-reference resources designed in response to common citation issues, providing practical tips to elevate care quality and prepare for state surveys.</li></ul><p></p><p></p><h3>Empowering Through Knowledge Sharing and Community Building</h3><p></p><p>In the coming months, NIPF members can anticipate:<br></p><ul><li><strong>Educational Video Interviews:</strong> Gain perspectives from experienced infection preventionists and interdisciplinary team members, showcasing the integral role of infection prevention in team-based, person-centered care practices.</li><li><strong>Ask the CDC Expert Thread:</strong> Utilize this direct line to CDC professionals for clarifications and insights on complex topics.</li></ul><h3>Your Participation Matters</h3><p><img src="/PublishingImages/Headshots/DavidGifford_2022.jpg" alt="David Gifford, MD" class="ms-rtePosition-2" style="margin:5px;" />NIPF is more than a forum. It's a community where every voice is valued, and every question can lead to new understanding and improved practices. We invite you to join this thriving network of infection preventionists committed to advancing infection control in long term care. Whether sharing your expertise, seeking answers, or engaging in rich discussions, your involvement is crucial to our collective success.</p><p>Visit <a href="https://www.ahcancal.org/NIPF" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">ahcancal.org/NIPF</a> or contact <a href="mailto:ltc-nipfhelp@ahca.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">ltc-nipfhelp@ahca.org</a> to learn more about joining.  <br><br><em>David Gifford, M.D., M.P.H., is the chief medical officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).</em><br></p> | 2024-02-29T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0920_News2.jpg" style="BORDER:0px solid;" /> | Infection Control | David Gifford, M.D., M.P.H. | NIPF is more than a forum. It's a community where every voice is valued, and every question can lead to new understanding and improved practices. |
Surviving the Financial Whirlpool | <p><img src="/Articles/PublishingImages/740%20x%20740/whirlpool.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The most effective way to survive a whirlpool is to not get caught in the whirlpool in the first place. The mistake that kayakers and canoers make is that they believe that they can pass over the edge of vortex and not get pulled in. </p><p>But it happens so quickly that you can’t escape. It’s hard to say where the outer edge of the current is. If we use the whirlpool analogy, in the senior care river, the general edge is a financial one. It is the energy drain that pulls you under.</p><p>The financial strains will generally impact staffing and safety in quick succession. In response, institutions will do all they can to reduce the largest single financial variable: payroll. </p><p><strong>The Constant Spinning of the Revolving Door of the Employee Entrance Starts the Whirlpool.</strong> While a quick fix is reducing the headcount, this rarely can be a sustainable strategy. Running the smallest possible staffing model results in shift fatigue, which then shows up as work injuries and burn-out. In dementia care units, residents who are faced with a new caretaker on a constant basis are more likely to display aggressive behaviors putting the replacement caretaker at an increased risk of resident violence-based injury.</p><p>How can you tell if this is happening at your facility? The information is tracked by your workers’ compensation carrier or third-party administrator can give you the answer. Your broker can also give you insights as to whether the number of assaults at your facilities outpaces the industry.</p><p>What about your turnover rate? When someone quits, what does it cost in overtime costs? How about the costs associated with finding a replacement employee and training that employee? Is your organization developing a reputation as a place skilled professionals should avoid? The revolving door to the employee’s entrance creates the swirl that starts the whirlpool that ends with a reputation that begs for investigations by state and federal authorities and litigation by families of those in the facility.</p><p>The speed of the downward pull of employee attrition is further accelerated by minimizing safety initiatives. Staff shortages too often result in a lack of time resources to require and provide anything beyond the minimal safety training. This in turn brings the employees back around the downward whirlpool where the lack of training results in injuries, that results in shortages in headcount, that results in burnout. </p><p><strong>The Heaviest Object Sinks the Fastest and Creates the Greatest Downward Pull.</strong> When I perform risk assessments at a care facility, I am not privy to the organization’s finances. I do not have to be. Just as someone can look at all the dents on a car to determine that the driver is probably unsafe, care facilities have their telltale signs. Signs might include an inadequate number of Hoyer and bariatric patient lifts on each floor, hallways lined with lifts and beds with signs stating that the equipment is out of service awaiting repair, or a storage area littered with broken equipment. About now, employee exhaustion is setting in, and the fight to get out of swirling water is starting to fail. </p><p><strong>The Smallest, Deepest Swirls Are the Most Powerful Killers.</strong> The deeper you are drawn into a whirlpool, the less your chances of survival. Perhaps it is the additional financial strain of increased insurance costs due to the claim history from too many work-related injuries or slip-and-fall claims due to inadequate maintenance of the facility. Perhaps it is the nonrenewal of your malpractice coverage (errors and omissions) that is proving to be the tight swirl of water. Perhaps it is the state regulatory body or the Centers for Medicare & Medicaid Services showing up at your door due to a complaint. Maybe it is the sheriff serving you with a lawsuit or possibly being the lead story on the nightly news. </p><p><a href="http://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/SNF%20Survey%20Mid-Year%202023.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">The 2023 AHCA Mid-Year State of the Nursing Home Industry report</a> highlights that the two stressors for nursing homes are staffing and financial pressures. New proposed federal mandates will add to the downward pressure, which already has many nursing homes fearing for their ability to survive at the current pace.</p><p>The most common approach to survival seems to be reducing the number of beds or services. In doing so, does it successfully reduce the expenses, or does it have an equal or greater reduction in cashflow? H.L. Menken observed that, “for every complex problem there is an answer that is clear, simple, and wrong.” As we look at the current crisis in the industry, a solution that screams out is reducing the bed count. By doing so, you can reduce the headcount. Since workers’ compensation is based in part on payroll, the reduction in payroll will result in a reduction in premiums.</p><p>Clear, simple, and wrong.</p><p>If the reduction in payroll results in a straining of the workforce, the increase in the frequency and severity of your work-related claims history will increase the insurance rate, the amount paid per $100 of payroll. Your savings may not be proportionate to the payroll savings. A reduction in the bed count may reduce the number of people visiting the facility daily, but you still have to provide the same number of slip mats, the same number of housekeepers, and the same expenses of security, fire, and property maintenance activities. Even if you close off a wing or two of your facilities, you will still have to maintain them and, frankly, you will not see much, if any, savings in property insurance without expert guidance.</p><p><img src="/Articles/PublishingImages/2024/Jeff-Marshall.jpg" alt="Jeff Marshall" class="ms-rtePosition-2" style="margin:5px;" />In kayaking and canoeing we learn that the three best ways to avoid death by whirlpool is to, first and foremost, avoid the whirlpool. Second, keep your boat from capsizing, and third, always wear your personal flotation device. For our industry, little is different. Perform real root-cause analysis to identify those issues that are pulling you into the whirlpool so that you can avoid them. Understand the forces that are trying to capsize your vessel and provide everyone in the boat with proper safety equipment and training.<br><br><em>Jeff Marshall is a kayaker and a risk and claims consultant for care providers, carriers, and third-party administrators focusing on nursing homes and assisted living facilities. He can be reached at <a href="mailto:IManageRisk4U@gmail.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">IManageRisk4U@gmail.com</a>.</em><br></p> | 2024-02-27T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/whirlpool.jpg" style="BORDER:0px solid;" /> | Caregiving | Jeff Marshall | The best ways to avoid death by whirlpool is to perform real root-cause analysis to identify those issues that are pulling you into the whirlpool so that you can avoid them. Understand the forces that are trying to capsize your vessel and provide everyone in the boat with proper safety equipment and training. |
Deficiencies at F742: Emerging Trends in the Enforcement of New Regulations | <p>In our <a href="/Articles/Pages/Deficiencies-at-F699-Emerging-Trends-in-the-Enforcement-of-New-Regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">last article,</a> we explored emerging patterns in deficiencies at F699. In this article, we explore trends in deficiencies at F742. The relationship between citations at F699 and F742 is important because many of the citations given at F699 could have resulted in additional citations at F742. Recall that guidelines at F699 instruct surveyors to explore additional F-tags if concerns are found at F699, including tag F742. Identifying a deficiency at F699 may be related to being cited at F742. In fact, if a facility is cited at F699, there is roughly a 41 percent chance that the facility will also be cited at F742. Hence the importance of considering emerging trends in deficiencies at F742.</p><p>Like the <a href="/Articles/Pages/Deficiencies-at-F699-Emerging-Trends-in-the-Enforcement-of-New-Regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">first article</a> in this series, we will discuss deficiencies obtained by SNFs in the CMS database in general terms, and specific deficiency instances with precise details (as outlined in the facility’s CMS-2567) will not be used/described as this could inadvertently lead to the identification of the facilities that received deficiencies. As the intention of this article is to learn about deficiency patterns and develop strategies to achieve and maintain compliance, the more general approach was felt to be the most useful. Again, for those readers who would like greater details, download <em>Full Texts of 2567 Statements of Deficiencies</em> directly from the CMS website and feel free to explore deficiencies in your area of interest.  </p><h3>F742: Treatment/Services for Mental/Psychosocial Concerns</h3><p>This regulation, along with its investigative protocol and deficiency categorization (guidance to surveyors on how to cite deficiencies), which became effective in October 2022, requires that:</p><ul><li>§483.40(b) Based on the comprehensive assessment of a resident, the facility must ensure that—§483.40(b)(1) A resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder, receives appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being.1</li></ul><h3>Patterns and Causes of Deficiencies at F742</h3><p>From 2022 and 2023, Missouri skilled nursing facilities received the highest number of deficiency citations at F742 (57 facilities in the state received deficiency citations), followed by Ohio (41 citations), Illinois (31 citations), Colorado (30 citations), and Pennsylvania (25 citations). It is unknown why these state facilities received the most deficiencies. More time is needed to learn about the reasons for these patterns of deficiency. </p><p>Vicarious learning is useful when it comes to survey deficiencies—that is, learning about the reasons for deficiencies in other facilities enables us to examine the practices, polices, and procedures in our own facility. <br><a href="/Articles/Documents/2024/Table%201%20Deficiencies-F7422.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img class="ms-asset-icon ms-rtePosition-4" src="/_layouts/images/icpdf.png" alt="" />Table 1</a> lists a broad description of issues that were identified on the CMS 2567 for each facility that received deficiencies at F742, along with some thoughts about potential ways to prevent deficiencies. </p><h3 style="text-align:center;"><img src="/Articles/PublishingImages/2024/Table%201%20Deficiencies-F742.jpg" alt="" style="margin:5px;" /><img src="/Articles/PublishingImages/2024/Table%201%20Deficiencies-F7422.jpg" alt="" style="margin:5px;" /><br></h3><h3>Implications for Older Adults with Mental Health Issues</h3><p><span><em><img src="/Articles/PublishingImages/2024/Timothy-Legg.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" /></em></span>The emerging patterns of deficiencies for both 699 and F742 are resulting in conversations among some owners/operators of skilled nursing facilities considering whether they will admit residents with histories of trauma or mental health needs, especially those facilities in mental health provider deserts (defined as geographic locations where there is a paucity of mental health providers). Still, other high-performing nursing homes may decide not to admit residents with behavioral health issues because of the potential impact on survey outcomes and the Five-Star Quality Rating System. While this may sound far-fetched, a 2018 study concluded just that—residents who had been diagnosed with depression or anxiety had lower access to five-star nursing homes when compared to no behavioral health diagnoses.2 These disparities were not limited to patients with serious mental illness but were also associated with patients who had substance abuse—a problem that continues to worsen in America.  <em><br></em></p><p><em>Timothy Legg is a board-certified gerontological and psychiatric/mental health nurse practitioner, licensed psychologist, licensed professional counselor, and state-licensed/nationally certified nursing home administrator. In addition to his private practice, he provides direct care and services to older adults in nursing homes as well as consultative services to nursing homes in Pennsylvania. Legg is an approved directed in-service provider by the Pennsylvania Department of Health. </em><br></p><div class="ms-rteElement-QuoteSpeaker">References<br>1.    United States Department of Health and Human Services. (2023). Revisions to State Operations Manual (SOM), Appendix PP. <a href="https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/R211SOMA.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/R211SOMA.pdf</a> <br>2.    Temkin-Greener, H., Campbell, L., Cai, X., Hasselberg, M. J., & Li, Y. (2018). Are post-acute patients with behavioral health disorders admitted to lower-quality nursing homes? American Journal of Geriatric Psychiatry, 26(6), 643-654. <br>3.    Stahl, S. (2021a). <em>Stahl’s essential psychopharmacology (5th ed).</em> Cambridge. <br>4.    Stahl, S. (2021b). <em>Stahl’s essential psychopharmacology prescriber’s guide (7th ed.). </em>Cambridge. <br></div> | 2024-02-15T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/computer.jpg" style="BORDER:0px solid;" /> | Clinical | Timothy Legg | Vicarious learning is useful when it comes to survey deficiencies—that is, learning about the reasons for deficiencies in other facilities enables us to examine the practices, polices, and procedures in our own facility. |