AHCA Board Chair Phil Scalo Plans to Harness 'The Power of We' | <p><img src="/Issues/2024/Spring/PublishingImages/Phil-Scalo.jpg" alt="Phil Scalo" class="ms-rtePosition-1" style="margin:5px;width:200px;height:200px;" />Long before Phil Scalo was a nursing home operator, he was an athlete. As a team captain, he developed the leadership philosophy that guides him today, a belief that the most important thing a leader can do is to ensure everyone is on the same page. <br></p><p>“The way you do that,” he explained, “is by knowing the people you’re working with and by making sure they understand what the standard is—and why you have that standard.”<br></p><p>This philosophy is why Scalo, now CEO of Bartley Healthcare in Jackson, N.J., always appreciates when his employees approach him with concerns. “It tells me that they know the standard and that they know that I’m going to listen to them,” he said. As the new chair of the board of directors of the American Health Care Association (AHCA), he plans to take the same approach to steering the organization into the future: setting high standards of excellence, listening to members’ concerns, and doing everything he can to keep them on the same page.</p><h3>‘The Power of We’</h3><p>Armed with a law degree from Rutgers University, where he’s currently a member of the board of trustees, Scalo got his start as a lawyer representing nursing homes. When a group of physicians he worked with suggested they build their own nursing home, he signed on to be the company’s attorney and ended up as a managing partner. <br></p><p>“It’s the old story: They wanted to build a nursing home because the ones in their area were not up to their standards,” he recalled. “One of the things my partner said at the time is that we wanted to make sure we do a good enough job that when my mother’s friends are ready for care, my mother is not embarrassed to send them to us.”<br></p><p>In a sense, this became Bartley Healthcare’s guiding perspective, the one that led it to become one of the leading providers in New Jersey. Since its founding in 1984, the company has received an AHCA/NCAL Silver National Quality Award, Best Practice Awards from the New Jersey Department of Health, five-star ratings, and numerous other accolades. As a senior partner, Scalo has stepped back from operations in the last few years to focus on his work with AHCA.<br></p><p>For all the ways the industry’s changed over the course of his career, he reflected, it’s also stayed the same. “There have been a series of existential threats that were going to destroy our business, and somehow we seem to manage those,” he said. “I call it ‘the power of we’: As long as the members stay together—and we usually do in times of crisis—we can weather any storm.”</p><h3>Turning Challenges into Opportunities</h3><p>As AHCA board chair, Scalo will focus on using that power to ensure both public and elected officials understand what the long term care profession does—and what it needs to be effective.<br>On the policy side, he’s pleased that legislators have a deeper appreciation of long term care than they had in the past. The open question is whether they continue providing the resources necessary to meet the moment. He sees promise in recent legislative support against minimum staffing rules, which would punish providers for not having employees they don’t have the means to hire. <br></p><p>“That’s a good example of where we’re taking what could be a crisis and turning it into a positive,” he said. “A lot of people on Capitol Hill are starting to understand, one, that staffing is an issue, and two, that in order for us to do what we need to do, there’s going to have to be reimbursement. I’m hoping that we can turn that challenge into a big opportunity to enhance the profession.”<br></p><p>Scalo recognizes that the profession’s reputation suffered during the pandemic—and it’s widely believed in the industry that this was due to politicians who needed a scapegoat. Still, he has little doubt that confidence will improve as more and more people interact with the profession. “If you’ve had family in a nursing home or an assisted living building, chances are you’ve had a good experience,” he said. <br></p><p>In his years running Bartley Healthcare, he’s come to believe a small shift can go a long way toward addressing doubts. “We’re trying to help families see the many benefits that come with nursing homes and the care provided within them. We look at it as moving into a new home. And when you think about the service we give, every family in this country has been affected by it, one way or another.”</p><h3>Working Collaboratively with Regulators and Each Other</h3><p>Scalo’s biggest priorities are growing AHCA/NCAL while keeping its membership on the same page. While this can be challenging—especially as membership becomes more regional, business structures evolve, and regulatory environments remain in constant flux—he’s confident that the benefits of a united front speak for themselves. <br></p><p>“It’s clear that in states where we have a higher percentage of membership, we do much better in reimbursement and much better on the regulatory side,” he said. “That’s the message I’m trying to bring: We are better together.”<br></p><p>He’s hopeful that as more and more people use long term care, there will be an increasing recognition of its value and the hard work of its employees. “The prospects for us going forward are very good from that perspective,” Scalo said. “I hope that we’re able to continue to convince the legislators on the state and national levels that our service needs the attention and the reimbursement that we deserve.</p><p>“If we can get the regulators to start thinking more collaboratively, the quality of what we do will increase,” he concluded. <br></p><p style="text-align:center;"><img src="/SiteCollectionImages/logos/ahca.jpg" alt="" style="margin:5px;" /><br></p> | 2024-03-11T04:00:00Z | <img alt="" src="/Issues/2024/Spring/PublishingImages/Phil-Scalo.jpg" style="BORDER:0px solid;" /> | Caregiving | As AHCA board chair, Scalo will focus on using that power to ensure both public and elected officials understand what the long term care profession does—and what it needs to be effective. |
NCAL Board Chair Mark Maxfield Is Excited for the Future of Assisted Living | <p><img src="/Issues/2024/Spring/PublishingImages/Mark-Maxfield.jpg" alt="Mark Maxfield" class="ms-rtePosition-1" style="margin:5px;width:200px;height:200px;" />Mark Maxfield brings a great deal of experience to his new role as chair of the board of directors of the National Center for Assisted Living (NCAL). Previously NCAL’s vice chair, he has also served on the board of the Idaho Health Care Association and the Community Care Advisory Council. He’s also the CEO and owner of The Cottages, an assisted living and memory care provider serving his home community of southwest Idaho. <br></p><p>Maxfield entered the industry almost 23 years ago after working as a social worker in group homes for boys. He made the switch thanks to his father, who called him one day and asked if he wanted to get into the assisted living business. “He said, ‘We’re going to take care of people like your grandpa,’” Maxfield recalled. It was a compelling pitch. He had been very close with his grandfather, who lived to 100 years old and, despite not needing the level of acute care provided in a skilled nursing facility, spent years living in one because there weren’t enough assisted living options in the area. “I thought, ‘Yeah, I would love to do a venture with my dad and to take care of people like Grandpa.’ So I moved my family back to Idaho.”<br></p><p>Maxfield and his father built The Cottages’ first location in a town called Emmett, on land that Maxfield’s grandfather had owned. More than two decades later, they operate communities across the region. As the company’s longtime CEO, Maxfield has watched the profession undergo considerable transformation. “Back then, it was all about building a product that you hoped would show interest for the elderly,” he said. “I have incredible staff that do a great job, but I probably spend more of my time, effort, and resources building them than I do in marketing and trying to find residents.”</p><h3>‘You Have to Be Present’</h3><p>What does it take to build incredible staff? For Maxfield, it’s a simple philosophy: People don’t want to be managed; they want to be led. Maxfield came to believe this even before The Cottages opened its first location, when he took a job as a caregiver. “I wanted to experience what it was like firsthand to be a caregiver,” he recalled. “If I was going to hire caregivers and lead them, I wanted to know what it is they do.”<br></p><p>Maxfield worked in the role for about six months, and it was an eye-opening look at the work it takes to keep the assisted living industry running. “It gave me a peek at what the day-to-day life is like for a caregiver and the things they deal with,” he said. “The joys of meeting people and talking with incredible souls, and then the lows of seeing them pass, saying goodbye to your friends, and everything in between, working late nights and double shifts. It really has given me incredible appreciation for what they do.”<br></p><p>Years later, he still believes in showing up on the front lines as often as he can, even if it’s not as often as he likes. “You have to be present,” he said. “I make myself available, not just to administrators, but to caregivers as well. They know who I am, and I do my best to know who they are. Same with the families. They need to know that the leaders of the company are present, and they listen, and they care.”</p><h3>Keeping AHCA/NCAL at the Forefront</h3><p>As NCAL board chair, Maxfield’s top priority is keeping the American Health Care Association (AHCA)/NCAL relevant, especially in a busy election year. “The aging of society is going to bring some very interesting challenges for us as providers and advocates for the elderly,” he said. “I want to make sure NCAL stays on the forefront and the minds of our legislators and the policymakers—not just for funding but to keep legislation in check.”<br></p><p>One key legislative concern is minimum staffing rules. “Some might say, ‘Oh, that’s just for skilled nursing.’ But what happens there trickles down to assisted living,” Maxfield explained. While he supports commonsense regulations, he hopes policymakers recognize that industry leaders know how to serve their residents. “Nobody wants to do a better job more than we do, nobody cares more about our residents than we do, and nobody cares more about our staff than we do,” he said. <br></p><p>Unfortunately, misconceptions about assisted living still run rampant among policymakers, even when it comes to basic matters of payment. “They think, ‘Oh, they have Medicare. That’ll pay for it,’” Maxfield said. “Medicare doesn’t pay for assisted living. That’s primarily private funds. Yes, there’s a Medicaid program, but depending on the state, it doesn’t pay as well. A lot of seniors are having a hard time affording quality care, or families are having to assist and supplement. Some families can do that, but some can’t.”<br></p><p>Fortunately, Maxfield knows the industry is in good hands. “I’d be foolish not to admit that 99 percent of the work happens by the AHCA and NCAL staff,” he said. “They’re legit, they’re competent, and they know what they’re doing.” To Maxfield, his responsibility is keeping the ship on the right course and ensuring AHCA/NCAL’s work has the impact it deserves. “It’s on me as board chair to keep our focus singular.”<br></p><p>He sees an exciting future for the industry, one where the coming wave of residents can choose from unprecedented options, whether in size, location, care model, or even lifestyle options. “I’m excited that now more than ever, we’re poised to take care of our residents in ways we never have before,” Maxfield concluded. “Which is good, because we’re going to see numbers like we’ve never seen before.” </p><p style="text-align:center;"><img src="/SiteCollectionImages/logos/ncal_large_color.jpg" alt="" style="margin:5px;width:250px;height:167px;" /><br></p> | 2024-03-11T04:00:00Z | <img alt="" src="/Issues/2024/Spring/PublishingImages/Mark-Maxfield.jpg" style="BORDER:0px solid;" /> | Assisted Living | Maxfield sees an exciting future for the industry, one where the coming wave of residents can choose from unprecedented options, whether in size, location, care model, or even lifestyle options. |
Happy Birthday, Provider! | <p style="text-align:center;"><img src="/Issues/2024/Spring/PublishingImages/happy-birthday1.jpg" alt="" style="margin:5px;width:727px;height:119px;" /> </p><p style="text-align:center;"><br></p><p style="text-align:left;"><span>The year 1974 was significant for many reasons.
President Richard Nixon resigned from office, and Gerald Ford became
commander in chief. The earliest forms of word processors hit the
market. The Miami Dolphins won the Super Bowl. Stephen King published
his first novel, <em>The Sting</em> won the Oscar for Best Picture, and <em>All in the Family</em> and <em>M*A*S*H</em> were among the top-rated TV shows. And <em>Provider</em>
published its first issue as the official publication of the American
Health Care Association and the National Center for Assisted Living
(AHCA/NCAL). </span><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><img src="/Issues/2024/Spring/PublishingImages/10-22.jpg" alt="" style="margin:5px;width:197px;height:265px;" />   <img src="/Issues/2024/Spring/PublishingImages/11-94.jpg" alt="" style="margin:5px;width:197px;height:266px;" />  <img src="/Issues/2024/Spring/PublishingImages/2-96.jpg" alt="" style="margin:5px;width:197px;height:266px;" /></p><p style="text-align:center;"><br></p><p>Today, the magazine has a readership of more than 52,000 owners, operators, clinicians, administrators, and others working in nursing facilities and assisted living communities across the country. But from day one, it established a voice for the industry that has strengthened and grown over the years. It remains the most highly read publication in this care sector, partly thanks to its online counterpart (providermagazine.com), which debuted in 2011. <em>Provider</em> continues to track the pulse of the industry and serves as the leading source of post-acute and long term care clinical and business news.<br></p><p><span><img src="/Issues/2024/Spring/PublishingImages/Steven-Chies.jpg" alt="Steve Chies" class="ms-rtePosition-1" style="margin:5px;width:150px;" /></span><em>Provider</em> has tracked and provided information and insights about new trends, regulations and legislation, and technology that have emerged over the years. The publication has also featured pioneers and leaders in the field. At the same time, some topics—such as staffing and the pursuit of quality care—have been ongoing staples.<br></p><p>As <em>Provider</em> celebrates its 50th anniversary, AHCA/NCAL members and friends paid tribute to a publication they consider a must-read.</p><h3>Memories and Opportunities Abound</h3><p>Steve Chies, MHA, LNHA (Mn), FACHCA, LHSE, president of North Cities Health Care, Inc., recalled, “One of my first contacts with AHCA on a national level was when I was asked to write an article about marketing in 1984. Since then, I’ve been interviewed numerous times, and I see the publication as a source of information we need as a sector to bring people together from a cultural standpoint.” <br></p><p><span><img src="/Issues/2024/Spring/PublishingImages/Shelly-Peterson.jpg" class="ms-rtePosition-2" alt="Shelly Peterson" style="margin:5px;width:150px;height:184px;" /></span>He continued, “I think <em>Provider</em> connects people to their colleagues. It’s a good place to check out the latest trends and ideas. The publication has a great history and tremendous potential for the future.” <br></p><p>Shelly Peterson, who recently retired as president of the North Dakota Long Term Care Association, said, “<em>Provider</em> was my go-to publication when I traveled. Airplane time was a great opportunity to catch up and read about new trends and people doing good work. It’s a trusted source of information and a good read. Provider is dependable and always there when I want to know what’s happening in our industry.”<br></p><p>In an ever-changing world, Peterson said, “that a magazine can stay relevant for 50 years is amazing. It has stayed on top of where the industry is and what has changed in the world. It has stood the test of time, and I can see it lasting another 50 years.”</p><p><br></p><p style="text-align:center;"><img src="/Issues/2024/Spring/PublishingImages/3-14.jpg" alt="" style="margin:5px;width:197px;height:266px;" />  <img src="/Issues/2024/Spring/PublishingImages/6-15.jpg" alt="" style="margin:5px;width:197px;height:266px;" />  <img src="/Issues/2024/Spring/PublishingImages/7-17.jpg" alt="" style="margin:5px;width:197px;height:266px;" /></p><p style="text-align:center;"><br></p><h3>Reading and Sharing</h3><p><img src="/Issues/2024/Spring/PublishingImages/Patti-Cullen.jpg" alt="Patti Cullen" class="ms-rtePosition-1" style="margin:5px;width:150px;" />Patti Cullen, former state executive of Care Providers of Minnesota, said, “I’ve been in this profession almost as long as <em>Provider</em>. I’ve been featured in the publication talking about topics like COVID-19 and regulatory changes. I read it the second it comes out. I would forward it to my team with little notes about different articles I thought were particularly important or interesting.” <br></p><p>For those individuals who are immersed in operations, Cullen said, “<em>Provider</em> plays a role in helping you think ahead and get topics on your radar. <em>Provider</em> hits on issues and provides a different take and unique perspective on things. For instance, as payment changes, it is helpful for us to learn not just from our state associations about what is going on with things like ACOs [accountable care organizations] and issues related to value-based care.” She added that she appreciates <em>Provider’s</em> online presence and the move to resources such as video clips and podcasts. “Ramping up the digital presence is so important,” she stressed. <br></p><p><span><img src="/Issues/2024/Spring/PublishingImages/Anna-Fisher.jpg" alt="Anna Fisher" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" /></span>There are a few keys Cullen sees to Provider’s staying power. “It’s a consistent presence even when there is turnover,” she said. At the same time, she noted, <em>Provider</em> remains topical, current, and fresh. Each issue has something new that others haven’t thought about, and it features new faces and unique insights. “Its variety keeps it fresh and timely. It hits all the buttons.”<br></p><p>Anna Fisher, CADDCT/CDP/CMDCP/CDSGF/QCP, a clinician and educator in Nebraska, offered a message directly to Provider: “Congratulations on 50 years of glorious writing! You have given us a platform to share our stories and embrace the knowledge and expertise from so many leaders and team members across the nation.”<br></p><p>She added, “In these opportunistic times, <em>Provider</em> is a venue that fosters connections, amplifies our voices, and the writers know just how to get to the heart of the conversation. I look forward to many more years of news, information, and insights.”</p><h3>A Lifeline in Challenging Times</h3><p><em><img src="/Issues/2024/Spring/PublishingImages/Debbie-Meade.jpg" alt="Debbie Meade" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Provider</em> is more than a tool, said Debbie Meade, co-chair of the Quality Cabinet and chief executive officer of Health Management in Georgia. It is a lifeline. “I was AHCA chair during the worst pandemic we have ever seen, and just having Provider as a communication tool that enabled us to reach out, provide comfort, and let people know they weren’t alone was so important,” she said. <br></p><p><em>Provider</em> also enabled AHCA leadership to share information and updates on clinical and research news, as well as regulatory guidance and changes. “In a time when we weren’t able to have one-on-one contact, Provider gave our members a place to go for reliable, current information and some form of relief in a very difficult time,” Meade said. <br></p><p>“It consistently provides essential communication to members that helps us prepare our businesses for the many challenges we’ve faced and work through them effectively,” said Meade. Particularly, smaller organizations and independent owners with small or no public policy staff depend on <em>Provider</em> for information, guidance, and updates on policy issues. <br></p><p>Meade has a message to <em>Provider</em>. She said, “Congratulations on a job well done. Please continue to be a beacon, a lifeline, and a positive force for our profession.”</p><p style="text-align:center;"><img src="/Issues/2024/Spring/PublishingImages/7-17.jpg" alt="" style="margin:5px;width:197px;height:266px;" />  <img src="/Issues/2024/Spring/PublishingImages/9-16.jpg" alt="" style="margin:5px;width:197px;height:266px;" /><br></p><p><br></p><h3>From the ‘80s to the Present: <em>Provider’s</em> Been There</h3><p><img src="/Issues/2024/Spring/PublishingImages/Mary-Ousley.jpg" alt="Mary Ousley" class="ms-rtePosition-1" style="margin:5px;width:150px;height:180px;" />Mary Ousley, chief strategy officer at PruittHealth, and Provider have had a connection since 1980 when Ousley first became a nursing center administrator. “We didn’t have the emails, alerts, online programming, and other technology we have today. <em>Provider</em> was one thing that inspired me to get more involved with the Kentucky state association and AHCA,” she said. <br></p><p>She remembers getting updates on challenging issues of the day via <em>Provider</em>. “Communications in Provider about these issues helped us see a better way to deal with them,” said Ousley, adding, “<em>Provider</em> has helped facilitate change again and again.” At the same time, she said, “<em>Provider</em> has always done an excellent job of keeping us informed about updates and changes to the regulatory and survey process. This is such a critical component of who we are.”<br></p><p>The magazine’s longevity doesn’t surprise Ousley. One key, she said, is its interdisciplinary approach. “You get information about HR [human resources] issues, clinical updates, regulatory and legislative news, and resources. When you look at all the components, there is something for everyone.”<br></p><p>Looking to the future, Ousley suggested that Provider “will continue to have a critical purpose in post-acute and long term care.” Whether readers access <em>Provider</em> online or count on print copies, she said, the publication will continue to keep people informed and updated. <br></p><p>She observed, “This is a critical time for post-acute and long term care. Our acuity has changed dramatically, and this is being recognized everywhere.” More than ever, administrators and their teams need reliable sources of information and guidance. <em>Provider</em> helps everyone see what AHCA/NCAL members do and the individuals they serve as having value and being worthy of dignity, respect, and quality care. </p><h3>Here’s to Another 50 Years!</h3><p>Ultimately, <em>Provider</em> plays a powerful role. It gives everyone who picks up a copy or accesses it online a window into the tremendous effort, passion, commitment, and creativity providers and their team put into caring for their residents every day. They get a unique perspective that is empowering and enlightening. This publication will continue that role in the months and years ahead. As the issues change and the industry evolves, <em>Provider</em> will be there for its readers. <br></p> | 2024-03-11T04:00:00Z | <img alt="" src="/Issues/2024/Spring/PublishingImages/birthday.jpg" style="BORDER:0px solid;" /> | Caregiving | Provider continues to track the pulse of the industry and serves as the leading source of post-acute and long term care clinical and business news. |
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 | 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 | 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 | 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 | 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. |