| Report: Medicaid Falls Short on Costs of Care in Nursing Homes | <p><img src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" /></p><p>The Medicaid and CHIP Payment and Access Commission (MACPAC) <a href="https://www.macpac.gov/wp-content/uploads/2023/01/Estimates-of-Medicaid-Nursing-Facility-Payments-Relative-to-Costs-1-6-23.pdf" target="_blank">recently issue a brief</a> on Medicaid nursing home payments relative to the costs for care. The brief, which was highlighted last week at MACPAC's first public meeting of 2023, found Medicaid does not actually offset what it costs to care for residents. Based off payments from 2019, MACPAC found “the median Medicaid base payment rate in 2019 was 86 percent of reported facility costs."</p><p>But much has changed for nursing homes since 2019, as nursing home costs have skyrocketed over the last three years due to the COVID-19 pandemic. The personal protective equipment (PPE), testing, and staff needed to combat a multi-year public health crisis has cost nursing homes billions of dollars. In 2020 alone, <a href="https://d3dkdvqff0zqx.cloudfront.net/groups/ahca/attachments/protect%20access%20to%20long%20term%20care_ib.pdf" target="_blank">nursing homes spent $30 billion</a> on PPE and labor.</p><p>Labor costs are also increasing. As staffing shortages persist, a recent survey from the <a href="https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-Nursing-Home-Providers-Say-Workforce-and-Economic-Challenges-Persist.aspx" target="_blank">American Health Care Association (AHCA) found</a> that more than nine out of 10 nursing home providers have increased wages and offered bonuses to try and recruit and retain staff. Nearly 80 percent have turned to staffing agencies to adjust for shortages, which are often costly.</p><p>As costs continue to increase and inflation soars, Medicaid reimbursement rates are not keeping up. The same survey showed more than half of nursing homes are operating at a loss.</p><p>Another upcoming study, conducted by CliftonLarsonAllen LLP (CLA), highlights significant risks to nursing homes, including current and projected negative operating margins, the increasing cost of care, chronic issues such as underfunding and the workforce crisis, occupancy loss, and the threat of facility closures. <a href="https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/AHCA%20-%20State%20of%20Skilled%20Nursing%20Facility%20Industry%20-%20In-Depth%20Analysis%20on%20Increasing%20Costs%20and%20Local%20Impact.pdf" target="_blank">Hundreds of thousands of residents</a> are currently located in nursing homes that could be financially “at risk of closure."</p><p>The data in the MACPAC brief does not debate this underfunding. One table in the brief shows a breakdown on total facility costs per day along with Medicaid-covered costs. The average total costs per day per resident for all facilities is $293.36 per day, compared to the $243.61 for Medicaid-covered costs.</p><p>“We've been sounding the alarm on low Medicaid reimbursement rates for years," said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). “The majority of our nursing homes rely on Medicaid, but the system is flawed. We really need lawmakers to prioritize this issue and make significant investments to better support our nation's seniors and caregivers."</p><p>The brief also noted, “costs have historically been used to assess Medicaid nursing facility payments, but they are an imperfect measure of what facilities should be paid."</p><p>“The MACPAC brief notes the inconsistency in data for costs, which are ultimately used to determine Medicaid reimbursement rates for facilities," said AHCA/NCAL's senior vice president of quality, regulatory and clinical services Holly Harmon, RN. “Nursing homes are struggling to stay afloat because of inadequate funding. Without immediate action from Congress, these shortfalls could lead to more closures and leave our most vulnerable without the care they need."</p><img src="/Articles/PublishingImages/2023/AbbyBarreto.jpg" alt="Abby Barreto" class="ms-rtePosition-2" style="margin:5px;width:146px;height:184px;" /><p>MACPAC also added that “because nursing facilities serve a wide range of residents with different care needs, the costs of care for each resident is not the same." Sarah Schumann, vice president of operations at Brookside Inn in Colorado, strongly agrees.</p><p>“Each one of our residents is unique," said Schumann. “We provide specialized, one-on-one care to everyone who walks through our doors, and we need Medicaid reimbursements that fully cover the cost of care. We hope policymakers hear our calls for help and make improvements."</p><p><em>Editor's note: Children's Health Insurance Program (CHIP)</em></p><p><em>Abigail Barreto is senior director of public affairs at AHCA/NCAL.</em></p><p></p> | 2023-02-02T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER:0px solid;" /> | Medicare | MACPAC recently issue a brief on Medicaid nursing home payments relative to the costs for care. The brief found Medicaid does not actually offset what it costs to care for residents. |
| Increased Use of Telemedicine Brings Numerous Benefits for SNFs | <p><strong class="ms-rteForeColor-2" style="">ADVERTORIAL</strong></p><p><img src="/Articles/PublishingImages/2023/Kevin-Carpenter.jpg" alt="Kevin Carpenter, MD" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />As we move forward in 2023, it’s uplifting to see census returning to near pre-pandemic levels for many providers. Unfortunately, many of these same facilities are still experiencing staffing challenges and the daunting reality of higher-acuity residents. With over 50 percent of U.S. hospitals operating in the red, the trend to discharge patients from the acute setting faster and sicker will surely continue. </p><h3>An increase in acuity requires more physician access.</h3><p>Skilled nursing facilities (SNFs) are increasingly shouldering the responsibility of complex hospital discharges, which test staff capabilities and negatively affect quality scores. Some providers have welcomed a higher-acuity strategy as an opportunity to build census, but physician access for these patients remains limited. Newly admitted patients may not see a physician for an assessment on the first day, and long-term care residents may only see a physician once a month. Physician access differs vastly from the acute-care setting, where doctors can be at the bedside 24/7 when needed. <br></p><h3>Telemedicine is the only cost-effective means to increase access to physician services.</h3><p>If the pandemic had a silver lining, it was telemedicine. The U.S. Department of Health and Human Services reported a 63-fold increase in Medicare telehealth utilization in 2020. Better technology, the need for infection control, and regulatory changes in the Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded the opportunity to positively impact SNF outcomes. When deployed correctly, telemedicine is the most effective and affordable way to place a physician at the bedside 24 hours a day. Video-enabled virtual care provides the means to assess, manage, and treat changes in condition, in partnership with an attending nurse. It’s especially effective for nights and weekends. <br></p><h3>Today it’s about more, not less.</h3><p>Despite its promising potential, SNF telemedicine was initially met with a hefty dose of skepticism. Medical directors and attending physicians feared their billable encounters—or even their jobs—could be at risk. Nurses worried physicians would spend less time in the building. Providers worried about liability. And families assumed that telemedicine would replace in-person care for their loved ones.</p><p>Fortunately for long term and post-acute care residents, attitudes have shifted dramatically over the past few years. Today, there is broad and growing acknowledgment of telemedicine’s value and data to prove clinical efficacy and improved outcomes.<br></p><h3>Telemedicine assists in managing transfers to and from acute settings.</h3><p>One of the biggest challenges happens when residents need hospital-level services. Transfers at night create the most risk because understaffed emergency departments (EDs) don’t always prioritize SNF residents for treatment. We’ve seen a dramatic difference when an ED transfer workflow includes a tele-physician consult followed by direct communication from the tele-physician to the ED. When an engaged physician speaks directly to an ED physician to advocate on the patient’s behalf, the scenario for the patient changes. Telemedicine makes this possible, even overnight. The result is faster care, appropriate utilization, and less time in the hospital. We manage hundreds of ED transfers each month, and 39 percent of residents return to the SNF without hospital readmission. </p><p>Likewise, when patients arrive or return to the SNF, seeing a physician within a few hours can significantly improve the transition of care. Patients and families have shared how comforting it is to see a physician and have questions answered on day one. A video encounter can address medications, pain management, and a care plan to set the patient up for success until they can be seen in person by a physician. </p><h3>Integration makes a difference.</h3><p>SNF telemedicine is a two-way conversation initiated by a nurse at the bedside. Nurses use telemedicine more often when the process is easy, integrated into their existing workflow, and intuitive. Our partnership with PointClickCare makes telemedicine accessible directly in the patient chart, and utilization has skyrocketed. One regional organization saw a remarkable 300 percent increase in consultations—94 percent of which resulted in residents receiving treatment without having to leave their facility. </p><h3>Telemedicine has a positive impact on SNF operations.</h3><p>For SNFs, the return on investment from telemedicine shows up in myriad ways. Revenue is saved by reducing hospital readmissions and lost bed days. Administrative costs go down with uninterrupted care and fewer expenses tied to hospital transfers. Additional value accrues with improved quality scores, better hospital relationships, and more referrals through high-quality SNF networks. Additionally, numerous organizations see increased nursing satisfaction from this additional level of responsive support, even using their program to help recruit nurses. <br><br>Find out more about how Sound Physicians supports SNFs with telemedicine services. Visit <a href="http://www.soundphysicians.com/" target="_blank">soundphysicians.com</a>.<em><br></em></p><p><em>Brian Carpenter, MD, SFHM, is chief medical officer, telemedicine, for Sound Physicians.</em><br></p> | 2023-01-31T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2023/Kevin-Carpenter.jpg" style="BORDER:0px solid;" /> | Telemedicine | When deployed correctly, telemedicine is the most effective and affordable way to place a physician at the bedside 24 hours a day. |
| 3 Strategies to Prioritize Accounts Receivable Management | <p><img src="/Articles/PublishingImages/740%20x%20740/healthcare_finance.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />2022 was another big year of regulatory change and financial hurdles for the long term care industry. Long term care operators saw phased Patient Driven Payment Model (PDPM) cuts, the growth of managed care takebacks, and a major draft release of the Minimum Data Set (MDS) 3.0. That is a lot to digest, and this much change means even more research, training, and operational enhancements to make sure communities are accurately reimbursed for the care they provide.</p><p>However, there’s another financial threat that communities should be focusing on in 2023: aging accounts receivable (A/R).</p><p>Facilities across the country are sitting on millions of dollars in unpaid claims due to COVID-19 ripple effects, back-office staffing problems, and increased payor complexity. Operating costs are still up, and the census is still down, putting even more of a financial strain on the facility. Staffing struggles persist, despite raising salaries during the Great Resignation. The costs of clinical supplies, utilities, and resident meals are not decreasing even as inflation plateaus.</p><p>Accounts receivable should not be treated as the drop-off point in the revenue cycle, or the project to be worked on when you have 10 minutes to spare. A facility’s aging A/R is money earned through quality care; it is due to the facility, and it needs to be collected. </p><h3>Professionalize Your Facility’s A/R Management </h3><p>After working in the long term care industry for over 40 years and serving in various positions, such as business office manager, administrative roles, and consultant to the facility owner, here are three strategies I recommend to administrators. These strategies are relevant whether you have a centralized billing office or a one- to two-person team covering the whole back office.</p><h4>1. Review the aging report monthly, at a minimum. </h4><p>Billers should be reviewing the aging report daily. Administrators should review it once a month, at a minimum, to identify trends, determine process improvement priorities, and monitor performance. When reviewing the aging, focus on three key performance indicators: net collections, days sales outstanding, and A/R over 90 days. These metrics define A/R health, help to identify how much and how quickly money was collected, and what amount is at risk of not being collected. <br></p><h4>2. Prioritize claims and make sure the team has dedicated time to work on the A/R. </h4><p>Once the aging has been reviewed, prioritize the workload. There is only so much time in the day and working a single claim can take anywhere from five minutes to two hours or more. The objective is to collect as much money as efficiently as possible; strategizing and working claims systematically will assist with this process.</p><p>Start with claims aged at the timely filing limit to ensure minimal write offs. Secondly, prioritize new aging in the 30-, 60-, and 90-day columns. Lastly, prioritize based on business needs and trends. Remember, there are no unimportant claims; keep in mind how collections can be maximized for staff time and dollars spent. Prioritize the highest dollar claims, or a particular payer that is known to pay slowly. <br></p><h4>3. Champion fixing processes, not just correcting claims. </h4><p>Overstretched teams tend to focus on the immediate billing crisis, not the root cause. Like treating a patient’s symptoms without diagnosing the illness may result in temporary relief, the same problem will keep coming back. As a leader, start asking your team tougher questions during the monthly A/R reviews. What payers have the highest balances? Why? If unknown, what needs to be researched to find out? What is the root cause? Are the payers set up correctly in the A/R system? When was this last checked? Are claims escalated appropriately?</p><p>Consider an A/R assessment from an outside source. These assessments identify aging issues and provide recommendations for communities. Unsurprisingly, if a facility does not have the time or take the time to correct their upstream processes, the frustration will continue with no meaningful progress on the A/R and continued claim denials. <br></p><h3>Collect More with Help </h3><p>Another strategy to get back on track is to outsource your revenue cycle management (RCM) or to bring in a partner for an A/R clean-up. With the right partner, outsourcing RCM can increase collections up to 98 percent. An A/R clean-up will help you catch up on your aging while relieving your team to focus on current billing and broader process improvements. </p><p>The thought of hiring external experts for financial help may seem threatening to the team. They may feel someone is there to criticize and point out all the things they are doing wrong. But, reassuring and supplementing the team with an expert partner will assist with cash flow and getting claims paid, unlock staff time for other priorities, and stabilize the back office. </p><p><img src="/Articles/PublishingImages/2023/Kristy-Brown.jpg" alt="Kristy Brown" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />“Doing more with less” is a badge of honor in long term care, but our job as leaders is to put a strategy in place that will make our facilities and teams successful.</p><p>Creativity and a sense of partnership will help pave the way for the challenging financial times ahead. Take a closer look at your A/R processes and see what low-hanging-fruit improvements you can make. <br> <br><em>Kristy Brown is the director of skilled nursing facility financial services at Quality Healthcare Resources, an Assembly Health company. She has over 40 years of experience in the long term care industry and was recently recognized with a McKnight’s Long Term Care News Pinnacle Award.<br></em></p><p><em><br></em></p><p style="text-align:center;"><strong class="ms-rteForeColor-2" style="">Learn more:</strong></p><p style="text-align:center;"><em><a href="https://educate.ahcancal.org/RCM"><img src="/Articles/PublishingImages/2023/RCM%20Academy_promo.png" alt="" style="margin:5px;" /></a><br></em></p> | 2023-01-31T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2023/Kristy-Brown.jpg" style="BORDER:0px solid;" /> | Finance | A facility’s aging A/R is money earned through quality care; it is due to the facility, and it needs to be collected. |
| Nonprofit Organizations Help Grow the Long Term Care Workforce | <p><img src="/PublishingImages/Headshots/PaulBergeron.jpg" alt="Paul Bergeron" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />Nonprofit groups are stepping up their efforts to grow the nursing and long term care workforce through creative and uplifting programs that give candidates full-time jobs both during training and upon graduation.</p><p>The Jack and Nancy Dwyer Workforce Development Center, a 501(c)(3) nonprofit, works with other not-for-profits, partner workforce development organizations, and training partners to develop workers. Its students, called Dwyer Scholars, complete their training, participate in clinicals, and then take the Board of Nursing exam.</p><p>The program’s goal is to “help those who lack opportunity and aspire to pursue a career in the healthcare industry by removing barriers that prevent them from success,” Dwyer Workforce Development CEO Barb Clapp said. “Our mission is also to alleviate a severe healthcare workforce shortage and improve the lives of seniors.”</p><p>Dwyer Workforce Development’s goal is to help those who lack opportunity and remove barriers that prevent them from success by providing free certified nursing assistant (CNA) job training. Once certified, DWD places Dwyer Scholars into full-time positions through its network of long term care industry partners. In 2022 DWD, based in Baltimore, trained 286 scholars in Maryland; the program has a 95 percent stick rate.</p><p>DWD recently executed a $590 million acquisition of a Texas-based skilled-nursing-facility portfolio managed by Regency Integrated Health Services. With the acquisition, it transitioned the portfolio from a for-profit to a not-for-profit organization, which was the vision of entrepreneur Jack Dwyer to end systemic poverty and address the growing workforce crisis plaguing the health care industry.</p><p>“He wanted to fund the Texas program in perpetuity,” Clapp said. In Texas, DWD will train an additional 414 scholars and employs about 6,750.</p><h3>Set Up for Success on Day One</h3><p>As part of the training process, Dwyer Scholars are paired with case managers who work closely with them to identify career ladder goals to achieve over several years—keeping them on track for success. On a need basis, Dwyer Scholars are provided with wrap-around services, which include financial support for housing, childcare, transportation, and more, ensuring students are set up to succeed from day one.</p><p>“Our scholars could be single paycheck mothers, young people who have had enrichment programs in city schools but can’t afford pursuing a health care career in college, from foster homes, formerly in addictive treatments or recovering from domestic violence programs,” Clapp said. “If their child is sick and can’t go to school, they have no one to care for them. The case management support that we offer them makes the difference.”</p><p>In one case, a scholar had her child in daycare, but the daily training time period conflicted with the daycare schedule, so the case manager was able to get the scholar into training hours that fit her schedule.</p><p>“These are the types of conflicts that can happen to any adult who is just trying to get ahead,” Clapp said. DWD also uses an app as an incentive tool that rewards participants for active participation in the Dwyer Scholar program. </p><p>“They are encouraged to check in daily to let their case manager know how they are doing,” Clapp said. The scholar is rewarded for staying in the program at 3-, 6-, 9-month, and one-year intervals. “They get points and can cash the points in for gift cards and other needed items such as scrubs or work shoes.”</p><h3>MaineGeneral Offers Work While Students Train</h3><p>MaineGeneral Health has been operating its CNA Earn to Learn training program since 2018, offering four classes per year. More than 200 students have graduated from the program. By finding more trainers, in 2022, the number of classes MaineGeneral conducted doubled from four to eight.</p><p>To drive participation, MaineGeneral recruiters attend job fairs to engage with the community one-on-one. Recruiters also visit students at local schools, use social media platforms, engage local radio stations, and post on job sites. The program also recruits internally from non-clinical entry-level positions throughout its health system.</p><p>There are other CNA training programs in the state of Maine but Tarsha Rodrigue, Administrative Director at MaineGeneral Rehabilitation and Long Term Care, said Earn to Learn differentiates itself from the others because it hires its students into full-time positions.</p><p>Students’ time in class is supplemented with paid work hours serving in its skilled rehabilitation and long term care facilities. When not in clinical and class, the students are working as helpers in the facility, engaging with residents, participating in activities, and stocking and tidying rooms.</p><p>“This program has significantly helped in recruiting into the CNA role and beyond,” Rodrigue said. “We have graduates from this program who have continued to grow professionally and work in other areas of the organization.” Some are now medical assistants, CNA-medication technicians, phlebotomists, and registered nurses. <br></p><p>“Prior to the pandemic, this program assisted our long-term care facilities in eliminating agency and temporary labor,” Rodriguez said. “I am very proud of our CNA training program. We expect it to continue the success it has seen so far. This course is about so much more than meeting our staffing needs.”</p><h3>More Than Staffing, An Opportunity</h3><p>MaineGeneral holds a ceremony after each class graduates. There, at least one student shares with the group inspiring stories about how the class has given them a new opportunity, fulfilled a dream, or gave them a new purpose.</p><p>Aubrey Trout, a December 2022 graduate, got a late start on her career. “I decided that I would very much like to become a nurse, and at going on 40 years old, I should probably get a move on,” Trout said.</p><p>“However, at that point in time I would not have been able to afford paying for a CNA course, let alone nursing school. As I was searching for options that I could realistically consider, the MaineGeneral opportunity presented itself to me, so I seized it. I am now a CNA with intentions of becoming a registered nurse, and I feel like I have found the path I was looking for.” </p><p>She said the residents and the relationships she has developed with them over time makes it a rewarding career. “There is something profound and beautiful about having the trust of someone to do for them the things they cannot do for themselves,” Trout said. “I feel quite privileged to be in a position to provide that kind of care, and in a way that makes what is often times the remainder of someone’s life as comfortable and as meaningful as possible.”</p> | 2023-01-24T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0220_News2.jpg" style="BORDER:0px solid;" /> | Management | Nonprofit groups are stepping up their efforts to grow the nursing and long term care workforce through creative and uplifting programs that give candidates full-time jobs both during training and upon graduation. |
| Mock Surveys Are an Underused Tool in Assisted Living | <p><img src="/Articles/PublishingImages/2023/mocksurvey.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />It may seem strange to conduct a mock survey in an assisted living facility. For one, there’s no impact on 5-star ratings since those ratings don’t exist in assisted living.  Furthermore, citation fines aren’t as punitive or costly as they are for nursing homes. Even citation language is softer: nursing homes are “deficient” while assisted living facilities have “insufficiencies” in their care. <br></p><p>However, while CMS and state surveyors might not scrutinize assisted living to the same extent as nursing homes, quality of care is equally important in both settings. Mock surveys are one of the most underutilized tools to enhance care and manage litigation risk.</p><h3>Mock Surveys Alleviate Stress on Administrators </h3><p>I’ve worked in the long term care industry for four decades as an administrator, director of nursing, and assisted living regional operations director, so I know that caring for residents is at the heart of what we do. I’ve also seen that assisted living directors wear multiple hats every day: attending to resident and family concerns, filling in when staffing needs arise, dealing with employee concerns, and all sorts of other immediate “fires.” Assisted living directors simply don't have the time to take multiple days to conduct their own internal survey of operations to prepare for state surveyors.</p><p>That’s why partnering with a mock survey provider can be beneficial. Mock survey consultants are focused on one thing only: spending three to five dedicated days identifying a community’s opportunities for improvement and working with directors and staff to create action plans to address weaknesses and liabilities. </p><h3>Mock Surveys Are a Critical Liability Risk Management Tool </h3><p>Even without the impact on CMS ratings, assisted living facilities still need to consider their liability risk and how much of the risk the facility owns. While punitive fines do not exist as often in assisted living, the major risk is to be out of substantial compliance. For facilities that do not fully know their weaknesses and vulnerabilities, a mock survey is the perfect time to figure these out rather than during the actual state survey.</p><p>With our current staffing crisis, there seems to be turnover at every level, from resident care assistants to directors. With that amount of turnover, it is easy for staff to be unfamiliar—or worse, unaware—of policies and procedures to ensure resident safety. Assisted living communities can be held liable for inadequate hiring practices or negligence when staff are not trained or supervised, and incidents occur. Mock surveys provide an opportunity to have an outside consultant evaluate how well staff are trained and implement procedures that get all staff on the same page. </p><h3>Mock Surveys Are Important in a Post-COVID World</h3><p>We know that COVID has dramatically shifted the health care landscape. During the height of the pandemic, state surveys were paused or focused primarily on COVID management. With the advent of the vaccines, life has essentially returned to normal in assisted living and surveys have resumed as usual. However, the major change is the increased focus on infection control practices. To be frank, infection control practices were not stressed enough pre-pandemic since assisted living focused more on hospitality than on medical care. Now, we are seeing better outcomes for residents with medical issues like urinary tract infections or falls as we have more medical awareness and can take a more proactive approach to care. However, these efforts require staff training and formal procedures; initiatives that can be reviewed and addressed in a mock survey to ensure medical services are integrated optimally within the assisted living hospitality model.</p><h3>How Mock Surveys Can Specifically Help Assisted Living Communities </h3><p>As a former administrator myself, I know that assisted living leadership are worried all the time. The stress of knowing if you will have enough staff, whether residents are receiving all they need to age successfully, trying to optimize occupancy rates in a competitive environment, and negotiating rising costs for labor, food, and supplies is draining. That’s why I believe that one of the primary benefits of mock surveys is peace of mind and confidence. Mock surveys take the vital signs of the facility and help administrators prioritize what they need to be concerned about. Administrators are constantly putting out fires, and mock survey consultants help facilities identify the actual and hidden fires to help teams focus and prioritize. </p><p>After decades of performing mock surveys for long term care facilities, I know the difference mock surveys make. For new facilities or facilities with new administrators, a mock survey sets the team and facility up for success. I’ve also worked with some facilities for more than a decade, and mock surveys are a tool in their toolbox to decrease stress for administrators and drive effective operations. With a mock survey, I spend hours on-site being a resource for over-stressed administrators to identify vulnerabilities, both known and unknown, and help teams prioritize where to focus on quality improvement. </p><p>Everyone in our field has the same challenge: staffing. Year after year, I visit the same facility, and it’s rare that the same people are in charge. With constant turnover, assisted living facilities do not have the time for a brand-new director to spend multiple days getting up to speed and preparing for a survey. In contrast, as a mock survey consultant, I dedicate my time at each facility to over-prepare their staff for the survey. With a mock survey, I identify the vulnerabilities of the assisted living facility and establish systems that can be implemented easily, even when there is a revolving door of staff. I focus on the paperwork so administrators can work with the people. </p><p>There are limited organizations to call on for assistance with how policy changes affect a particular assisted living because there are no national regulations for assisted living. Not understanding how to implement new state policies puts facilities at risk for non-compliance citations. In my work, I use assisted living mock survey templates specific to each state. That way, as a consultant, I can ensure I know the regulations of each specific state, can speak to the specific trends happening in that geographic area, and can be a resource for a facility’s particular needs.</p><p><img src="/Articles/PublishingImages/2023/Leann%20Miller.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:175px;height:175px;" />Growing up, both of my grandmothers lived with me so all I’ve ever known is how to work with “old” people. And that’s a common refrain I hear from others in our industry: the commitment to helping people live out their later years in the best way possible. Our promise is to care for the residents in our communities. Being a faithful steward of that mission should drive us to seek solutions to provide the utmost quality of care. Participating in mock surveys is evidence of living that mission and being truly invested in the quality of your facility and serving your residents. <br><br><em>Leann Miller is a nurse consultant for Polaris Group. She has over 40 years of experience as a health care administrator and assisted living director. She holds a degree in Healthcare Administration, is a certified Dementia Specialist, and is certified in sub-acute care by the American College of Health Care Administrators.</em></p> | 2023-01-17T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2023/mocksurvey.jpg" style="BORDER:0px solid;" /> | Management;Assisted Living | Mock surveys are one of the most underutilized tools to enhance care and manage litigation risk. |
| 4 Ways to Reduce Fall Risk in the Most Vulnerable Hours | <p><span><span><span><img src="/Articles/PublishingImages/2023/Anne-Stankiewicz.jpg" class="ms-rtePosition-2" alt="Anne Stankiewicz" style="margin:5px;width:150px;height:150px;" /></span></span></span>Data shows that fall risk peaks between 6-9 pm and again from 3-6 am, when senior care staffing is reduced. What’s more, 50 percent of residents who fall overnight will have another overnight fall. These statistics become even more critical as they are applied to those living with Alzheimer’s and other forms of dementia—as the sun goes down, these residents are at even greater risk for falls as they experience sundowning, increased restlessness, anxiety, and disorientation—all of which can become more intense as the diseases progress.</p><p>Staffing shortages and burnout are posing an added risk for nighttime fall rates. According to a recent study by SafelyYou, nearly half (46 percent) of staff at senior living communities report that labor is a top challenge and 66 percent say these labor issues are leading to decreased quality of care. In fact, 85 percent of senior care executives found that falls significantly impact staff turnover. Given these combined issues, it has become critical for senior care providers to learn why falls are happening among their residents and how to prevent them.</p><p>Here are four ways senior care executives, nursing staff, and caregivers, can reduce fall risk for residents during the most vulnerable hours.</p><h3>1. Incorporate technology to ease the burden on residents, families, and communities.</h3><p>When the risk of falls increases during nighttime hours, the risk of ER visits increases as well. ER visits are not only feared for the resident’s sake, as they may become exposed to new illnesses, they are costly and anxiety-inducing for the families and care communities as well. Nighttime falls also require the added attention of multiple caregivers, adding to the staff’s workload and decreasing their ability to attend to other residents.</p><p><span><img src="/Articles/PublishingImages/740%20x%20740/fall_risk.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:150px;height:150px;" /><span></span></span>In 2022, nearly all senior care providers—93 percent—said in a SafelyYou survey that the right technology can significantly help prevent falls. Monitoring and notification systems are helping staff attend to resident needs nearly immediately. Artificial intelligence-enabled video technologies are decreasing resident falls by 40 percent and ER visits by 80 percent for some communities. Even more, adding technology that increases staff visibility and insight allows care communities to have straightforward and intelligent conversations with resident families around individual needs, such as: how their loved ones are sleeping, their comfort at nights, what is causing them to wake up, safety concerns in the bedroom, and possible improvements to the situation. Families are becoming increasingly more aware of these technologies (and requesting them), as they want to understand their loved ones’ individual needs and keep them safe.</p><p>By employing the right technology and significantly reducing falls, senior living communities could better support their staff, improve length of stay for residents, support resident families with clear insight and visibility, and cut on significant costs related to falls (estimated at $5,000 per resident fall with an injury). </p><h3>2. Know individual dementia behavior expressions and how they affect sleep.</h3><p>Everything from fatigue and hunger to pain, boredom, or depression can affect an individual’s sleep patterns. As simple as this sounds, making sure residents are surrounded by familiar objects and photos, and that they have ample opportunities for social engagement, can ward off restlessness and agitation that lead to increased falls as the sun goes down. Avoiding caffeine use and reducing stimulation at least 30 minutes before bed can also go a long way in ensuring proper sleep hygiene and fewer nighttime falls.</p><p>Even more, caregiver routines play a large role on residents’ sleep patterns and should be evaluated and discussed regularly. Pay attention to typical routines that could cause sleep disturbances, including the amount of time a resident is in bed during the day and night and patterns of interrupted sleep due to care cycles. As caregivers evaluate these practices, they should make necessary adjustments on an individual, case-by-case basis—as opposed to a one-size-fits-all approach for the community. </p><h3>3. Consider the sleep environment and potential interventions.</h3><p>There are several ways an environment can negatively affect an individual’s risk of falls at nighttime. With decreased light exposure and increased shadows, poor visibility can become a driver of falls. What’s more, any unfamiliarity with the environment can also make it easier for residents to become disoriented and fall.</p><p>Paying close attention to the environment is an important way to prevent falls. Is the resident continually waking up to check the thermostat because their room is too hot or too cold? Or does the resident regularly fall asleep with the lamp on, then wake hours later and attempt to turn it off during the night? Making small environmental changes, like installing amber lights in the room or reducing hallway light and noise can go a long way in preventing nighttime falls for those with Alzheimer’s and dementia. </p><h3>4. Be aware of disruptions to circadian rhythm. </h3><p>Disruption to circadian rhythm is often present even in preclinical stages of Alzheimer’s Disease. As many as 60-70 percent of individuals with dementia have sleep disturbances as melatonin production decreases and they experience increased wakeful periods at night. </p><p>There are several ways to counteract these disruptions to circadian rhythm. One simple way is to make sure residents are having enough exposure to natural light and ample opportunity to get outdoors for exercise. Using a light box can also help residents realign their natural sleep-wake patterns.</p><p><span><span></span></span>Preventing falls day or night is not a one-pronged solution. Fall prevention requires significant attention by care executives, quick and effective communication among nursing staff, and the support from families of residents as well. Understanding the risks and the solutions to prevent falls will not only help reduce falls among residents, but also provide the necessary support caregivers and nursing staff require. <br><br><span></span><em>Anne Stankiewicz is an occupational therapist with a clinical doctorate in geriatric practice and client success manager at SafelyYou. She is trained in Skills2Care<sup>Ⓡ</sup>, a behavioral problem-solving training program for dementia caregivers, and is a Certified Montessori for Dementia practitioner. </em></p><p><br></p><p><strong class="ms-rteForeColor-2">LEARN MORE:</strong><br></p><p><a href="https://ahcapublications.org/products/the-essential-falls-management-series-a-best-practice-approach-to-fall-prevention" target="_blank"><img src="/Articles/PublishingImages/2023/Falls.jpg" alt="The Essential Falls Management Series" style="margin:5px;width:200px;height:200px;" /></a><br></p> | 2023-01-11T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2023/Anne-Stankiewicz.jpg" style="BORDER:0px solid;" /> | Falls | It has become critical for senior care providers to learn why falls are happening among their residents and how to prevent them. |
| Long Term Care Industry Outlook for 2023 | <p>To kick off the new year, <em>Provider</em> magazine asked several industry leaders what they see as important trends or issues for the long term care industry in 2023. <br></p><h3><span class="ms-rteForeColor-8">Occupancy Levels</span><br></h3><p><img src="/PublishingImages/Headshots/MarkParkinson.jpg" alt="Mark Parkinson" class="ms-rtePosition-2" style="margin:5px;width:135px;height:163px;" /><strong>Mark Parkinson,</strong> president and CEO of AHCA/NCAL, said 2023 will finally be the year of census recovery for skilled nursing and assisted living providers. The industry will end the year near its pre-pandemic census levels, and because of favorable demographics, it will go up from there.</p><div><br></div><ul><li>John Pawlowski, managing director and head of Green Street’s Health Care sector, says that occupancy gains are delayed, but not permanently impaired. A continued moderation in supply, coupled with improved population growth among the 75 to 80+ age cohort will continue to support the recovery in the coming years.</li></ul><h3><span class="ms-rteForeColor-8">Technology</span></h3><ul><li>Dr. Kuljit Kapur, chief medical officer at Transitions, said that as medical practices become more automated with record keeping and information sharing among patients, doctors, providers, and insurance companies, the role of technology in healthcare has become critical to effective patient care. </li></ul><div><br></div><ul><li>Peter DeMangus, chief marketing officer, Solterra Companies, said technology will help to identify where the staff is spending their time and create better workflow strategies. </li></ul><div><br></div><ul><li>Chris Nall, chief technical officer of Coterie/Atria Senior Living, said implementing innovative and personalized technology features for residents is beneficial. <span>Coterie/Atria</span> has employed full-time digital innovation directors who assist with resident technology needs, including everything from setting up their smartphones to programming the technology in their residence.</li></ul><h3><span class="ms-rteForeColor-8">Precautions and Processes</span></h3><p><img src="/Issues/2022/NovDec/PublishingImages/DavidGifford.jpg" alt="David Gifford" class="ms-rtePosition-2" style="margin:5px;width:135px;height:169px;" /><strong>David Gifford, MD, MPH,</strong> chief medical officer at AHCA/NCAL, said that in 2023, providers will face an aggregate of little changes that could be overwhelming. Continued spread of multidrug-resistant organisms and COVID-19 will keep a focus on infection control practices and enhanced barrier precautions. There will be an increased demand for specialty services such as dialysis, mental health support, and opioid-use disorder treatment. Value-based purchasing will also be a focus with an expansion of state programs and CMS updates for Medicare.</p><div><br></div><div><strong><img src="/PublishingImages/Headshots/LBethea.jpg" class="ms-rtePosition-1" alt="LaShuan Bethea" style="margin:5px;width:135px;height:170px;" />LaShuan Bethea</strong>, executive director of NCAL, said that 2023 holds an exciting future for assisted living. Providers’ efforts to deliver the highest quality care and improve resident outcomes will continue, and an increase in education focused on caring for individuals with dementia and fall prevention is expected. There will be sustained focus on infection prevention and control, as well as emergency preparedness. Additionally, assisted living providers will begin to focus more on expanding access to low/middle income seniors to ensure they get the care they need in the right setting.</div><br><h3><br><span class="ms-rteForeColor-8"></span><span class="ms-rteForeColor-8"><br>Resident Services</span></h3><ul><li>Larry Nisenson, chief growth officer of Assured Allies, said that wellness programs will continue to play an increasing role for seniors as they are or are becoming more conscious of their overall health. </li></ul><div><br></div><ul><li>Zach Bowyer, MAI, MRICS, senior managing director, valuation and advisory, and head of living sectors, Cushman & Wakefield, said as demand increases over the next five years, there will be an increase in a la carte services, flexible or outsourced provider services, and other on-demand options for residents and operators.</li></ul><h3><span class="ms-rteForeColor-8">Reimbursement</span></h3><p><img src="/Issues/2022/NovDec/PublishingImages/MikeCheek.jpg" alt="Mike Cheek" class="ms-rtePosition-2" style="margin:5px;width:135px;height:174px;" /><strong>Mike Cheek,</strong> senior vice president for Reimbursement and Market Strategy at AHCA/NCAL, said that in 2023, providers can expect substantial changes to the federal Medicaid policy, including transitioning to PDPM-driven Medicaid payment systems. There will be an expansion of provider-led population health management models and strategies.</p><ul><li>Lynne Katzmann, founder and CEO of Juniper Communities, said that with regards to reimbursement, general inflationary pressures together with limited savings and higher care needs will mean shrinkage for operators—either in margins or potential market size with adequate resources for payment.</li></ul><h3><span class="ms-rteForeColor-8">Workforce</span></h3><ul><li>Aron Will, vice chairman, co-head senior housing, CBRE, said use of temporary labor is waning in senior housing communities as the labor market tightens up entering the current recession. The pendulum is swinging back in favor of the employer, and job security is starting to mean something again. </li></ul><div><br></div><ul><li>Lori Alford, co-founder and CEO at Avanti Senior Living, said that operators will deploy technology to improve efficiency and bring more streamlined communication with team members and families, adapting to a younger/newer generation’s demands and wants in the workforce. The industry will try to find ways for flexible staffing to mirror the “gig” workforce offerings.</li></ul><h3><span class="ms-rteForeColor-8">Facility Design</span></h3><ul><li>Johnny Dagher, principal and senior living practice leaders for Baker Barrios Architects, sees an increased trend in higher-quality, residential type finishes in senior housing intended to create a more comfortable experience for those to live in senior housing that feels less institutional. </li></ul><div><br></div><ul><li>David Banta, senior living practice leader and associate partner at architecture firm BKV Group, said that climate-resilient design in senior living properties is emerging and more operators will take climate resiliency into account during the design and construction phases, for example, HVAC systems that can handle temperature extremes. Onsite generators will emerge as a safeguard to minimize interruption and disruption from a weather-related power outage.</li></ul><p><em>Paul Bergeron is a freelance writer based in Herndon, Va. </em></p> | 2023-01-04T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/outlook.jpg" style="BORDER:0px solid;" /> | Caregiving | To kick off the new year, Provider magazine asked several industry leaders what they see as important trends or issues for the long term care industry in 2023. |