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4 Key Factors in Evaluating an On-Demand Staffing Platform
<p><img src="/Articles/PublishingImages/740%20x%20740/staff_1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" /><strong class="ms-rteForeColor-2" style="">ADVERTORIAL</strong></p><p>Are you struggling to find nursing staff for your facility? You’re not alone. The national nursing shortage continues to be a major challenge. This is especially true for the long term care sector, where nurses and nursing assistants provide the majority of care. According to AHCA/NCAL’s latest survey: <br></p><ul><li>95% of nursing homes are having a difficult time finding staff</li><li>More than half are limiting admissions.</li><li>72% are concerned about having to close their facility.</li></ul><p>Understandably, health care providers want their own staff. But sometimes, outside help is needed. Temporary staffing firms play a critical role in meeting nurse staffing needs, and today, this vital industry is in transition. Traditional staffing companies, which often work on a small scale using manual, time-consuming processes, are being displaced by a new generation of digital staffing platforms that can connect providers to a vastly larger network of clinicians.</p><p>Just as Amazon has transformed how we shop, these new staffing platforms make it quick and easy to find exactly what you need. If you’ve not yet made the switch, you should know that all platforms are not the same. Here are some of the key factors to consider when evaluating a potential platform staffing partner. </p><h3>Price Transparency</h3><p>With cost concerns top of mind for most communities, it’s critical to know how you will be charged for platform services. Some platforms charge you for each shift that is filled. The cost includes the nurse’s pay plus the platform’s marginal fee for facilitating the work. Others may add a flat fee to use the platform or impose minimum use requirements. These additional fees can add up. Make sure you review closely what fees are a part of the platform.</p><p>The advantage of platforms is their tremendous efficiency. Watch out for platforms that want to charge you for “cool features” you don’t want or need. Review the fee structure closely to ensure you get a cost-effective solution that meets your needs and works for your budget. </p><h3>Risk Management</h3><p>One significant difference between staffing platforms is how they classify their workers. There are generally two options. Some hire nursing staff as their own W-2 employees, covering taxes, workers’ compensation insurance, unemployment, and other employer responsibilities. This is consistent with long-standing practice in health care, and reflects the highly-regulated, supervised work environment.</p><p>In contrast, a few of the newer platforms send clinicians to you as “independent contractors.” Their model is based on the premise that because they are only matching clinicians with providers, they are not an employer and bear no responsibility for the worker. This model is a big change for our industry, as it puts health care providers, clinicians, and patients at risk.</p><p>Under the Department of Labor rules, health care providers that rely on temporary staff can be considered a joint employer of those workers. Because W-2 platforms are operating as employers and handling employer-related responsibilities, the risk for your community is much lower. </p><h3>Customer Service</h3><p>You may be eager to leverage the speed, scale, and efficiency that platform staffing provides, but worry about one thing: what if I need to talk with a person? This is another issue to consider, as some platforms rely almost entirely on technology-based communications. Got a question? Send a message to the chat box. Others augment their technology with customer support teams that are available to answer your calls and talk through whatever issue you may be having. Before you sign on the dotted line, ask who your contact will be and whether you can expect to talk with a member of their team when needed. </p><h3>Readiness to Respond</h3><p>When choosing a platform, a final factor to keep in mind is whether they are set up for immediate response to your needs. Ask how many clinicians they have available on the platform, what their average fill rate is in your area, and how quickly most shifts are filled. Because they are digital platforms, they should have this type of data readily available. The answer will give you a good indication of just how quickly they can provide the help you need. </p><p>With more than 30 years in health care staffing, I have seen just how powerful platform staffing can be. For decades, I supported clients the “old school” way. In 2016, we launched Gale as the first platform for our industry. Today, Gale Healthcare has more than 70,000 W-2 clinicians on our platform who are available to meet our partners’ temporary staffing needs. We have no minimum use requirements or hidden fees, and no charge if you want to hire one of our staff for your permanent team. We also have a highly responsive customer support team that is available to you 24/7, 365 days a year.</p><p>At the end of the day, we know that nurse staffing is still a people business. With Gale, you get the power of technology, plus a great team that is available to provide whatever support you need. </p><p>Find out why so many health care providers choose Gale. Contact us <a href="https://info.galehealthcaresolutions.com/facility-landing-page?utm_source=facility-trades&utm_medium=mcknights-ltc&utm_campaign=december-weekly-round-up&utm_term=lets-talk" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">here</a> to learn more about how we can provide an efficient, flexible, high-quality solution to your staffing challenges.</p><p><em>Tony Braswell is president and founder of Gale Healthcare, a leading staffing platform for the post-acute health care industry. </em><br><span><br></span></p><h4 class="ms-rteElement-H4B">The First in Platform-Based Staffing<br>●    The nation’s largest per diem nursing workforce for the post-acute health care industry.<br>●    Absolute price transparency—set your own rates and no hidden fees. <br>●    W-2 nursing staff.<br>●    Open shifts filled in seconds! <br>●    24/7/365 customer service. </h4><p><br></p><p style="text-align:center;"><img src="/Articles/PublishingImages/2023/gale.png" alt="" style="margin:5px;width:180px;height:76px;" /><br></p>
<img alt="" src="/Articles/PublishingImages/740%20x%20740/staff_1.jpg" style="BORDER:0px solid;" />
Understandably, health care providers want their own staff. But sometimes, outside help is needed. Temporary staffing firms play a critical role in meeting nurse staffing needs, and today, this vital industry is in transition.
Opportunities Abound with LTC-Focused ACO Model
<p><img src="/Articles/PublishingImages/740%20x%20740/senior_nurse_1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:140px;" />As providers adapt to changing dynamics in care and payment models, Fred Bentley, MPP, MPH, managing director, ATI Advisory, said, “There are some very real opportunities for providers to partner with accountable care organizations (ACOs).” Speaking about “From Threat to Opportunity: The LTC-Focused ACO Model” at the 2023 AHCA/NCAL Convention and Expo, Bentley talked about some of these opportunities as well as some pitfalls to avoid.</p><p>While ACOs and value-based care are certainly not new, there is a new urgency for providers to understand them and their role in post-acute and long term care. The Centers for Medicare & Medicaid Services (CMS) has announced a goal of all Medicare beneficiaries being involved in a value-based care model by 2030.</p><p>The world of value-based care can seem like multiple puzzle pieces that are challenging to put together. Bentley offered a few basics to pull the pieces together. First of all, he noted that primary care is at the center, with entities accountable for efficiency, quality, and associated costs of care delivered for a population of patients. Fee-for-service (FFS) beneficiaries are assigned to ACOs based on where they receive primary care. This alignment can happen prospectively or retrospectively based on who was seen. ACOs, he said, receive FFS payments throughout the year and then receive their bonus at the end of the year after the reconciliation process.</p><p>The goal, he said, is to keep costs below benchmark. “Annual spending targets are based on historical and geographic spending patterns,” Bentley said, adding, “Participants generate bonuses—or penalties—based on actual spending relative to predetermined targets. Providers still receive regular fee-for-service reimbursements throughout the year.” However, he added, “If your spending exceeds the benchmark, you may be on the hook for penalties. This is a typical model.”</p><h3>The Alphabet Soup of ACOs</h3><p>There are several types of ACOs, Bentley noted, but he focused on two. First, he said, there is the Medicare Shared Savings Program (MMSP) ACO. This has all the hallmarks of a traditional ACO, he said. “This is a lower risk-lower reward model and the most common form of ACO you will encounter. It has essentially been around since 2012, yet we are just starting to see it in long term care.” He noted that one challenge is that this model is rooted in primary care. So, Bentley said, unless you own a primary care practice, you may have a hard time participating in this model. However, he added that this is starting to change. Today, he said, there are a few different MSSP ACOs getting involved in long term care.</p><p>The hallmark of these types of ACOs include voluntary provider participation, provider accountability for efficiency and quality, payment incentives to improve care and slow cost growth, performance measurement to ensure optimum care delivery, and defined patient population (assigned or enrolled). The care delivery design involves access and continuity, care management, comprehensive coordination, and patient and caregiver engagement.</p><p>Bentley then talked about the REACH ACO model, which is both high risk and high reward. “This is for providers who don’t have or need training wheels. This is not for the faint of heart.” However, he noted that there are flexibilities such as they can apply for a three-day waiver so you can do direct admissions. This model targets the high-needs population—the most expensive, clinically complex Medicare beneficiaries. Starting next year, CMS will allow beneficiaries who have 90 days of home health or who have been in a nursing home for 45 days to apply for this track. “These are long term care residents—the sickest of the sick. That is an important development in the ACO space,” said Bentley. </p><p>To be part of a REACH ACO, providers must agree to participate in the model and contribute to the REACH ACO’s goals, and they can participate as either a “participant provider” or a “preferred provider.” Participant providers are used to align beneficiaries to the ACO. They are required to accept payment from the ACO through their negotiated payment arrangement with the ACO, continue to submit claims to Medicare, and accept claims reduction. A preferred provider can contract with the REACH ACO, accepting payments from it through a negotiated payment arrangement. They will continue to submit claims to Medicare, but they aren’t used to align beneficiaries to the ACO.</p><p>It is well documented, Bentley noted, that when a typical ACO launches, and they are looking for savings, “They look to you. It’s low-hanging fruit to divert patients away from skilled nursing facilities (SNFs) or shorten their SNF stays to reduce spending.” To connect effectively with ACOs, he suggested, “The easiest way to shift your mindset is to think about the two different resident populations you manage. ACOs have been going after short-stay post-acute business, but your long-stay population is where there are interesting opportunities.” There is a lot of spending involved for these long stays, so there are “meaningful opportunities to eliminate some of that spend. If you can reduce hospitalizations, emergency department visits, specialist visits, etc,,” Bentley said, noting that there are a growing number of organizations getting into this space and looking to set up ACOs and partners with SNFs.</p><h3>Finding the Right Fit</h3><p>It is important for providers to know what they have in terms of capabilities, outcomes, and resources and what type of ACO might be the best fit for them. Toward that end, they should consider evaluating potential partners’ core competencies regarding electronic connectivity, patient engagement, clinical operations, business operations, network development, and data and analytics. “Operators also need to assess ACOs’ experience, track record, and cultural fit,” Bentley said.</p><p>This all may sound complicated and like a lot of work at a time when staffing and other challenges continue. However, Bentley noted that are numerous benefits of an ACO-SNF partnership. For instance, multiple studies of ACO performance have determined that ACOs achieve savings by driving down SNF utilization. Elsewhere, some ACOs can negotiate and manage FFS payments for providers, including SNFs; and there are many examples of ACOs offering discounted rates to SNFs to be part of their network.  One “absolute benefit” of working with an ACO, Bentley said, is access to more clinical data and resources. These are incredibly valuable, he said, and can help reduce staff burden and improve care coordination.</p><p>“You can earn performance incentives. If the ACO achieves their share of savings and you hit certain performance targets, you get a portion of savings,” Bentley said. “You can use this money to bump salaries, hire new staff, or other efforts. That is one way you benefit financially.” However, he noted, “For a variety of reasons, the anticipated increase in referrals often does not materialize for SNFs.”</p><p>An ACO could set performance benchmarks and “ask you to have more skin in the game, though this generally doesn’t happen,” Bentley said. However, he stressed that the ACO has to generate savings to have shared savings. “If they hit their targets and you hit yours, you qualify for bonus payments.” The most common target is hospitalizations. He said, ACOs want everyone laser-focused on preventing hospitalizations because they are one of the most expensive cost centers.</p><p>Providers need to weigh the strategic, financial, and clinical value of an ACO partnership against the potential downsides. Ultimately, however, “accountability is coming,” said Bentley. Post-acute and long term care organizations that resist the call of ACOs will still be held accountable by CMS. It behooves every provider to position themselves to take on accountable care partners and start incorporating a value-based care mindset into every aspect of daily work.</p><p><img src="/Issues/2023/Spring/PublishingImages/JoanneKaldy.jpg" alt="Joanne Kaldy" class="ms-rtePosition-1" style="margin:5px;width:175px;height:219px;" />Bentley said, “Getting into risk-based care without taking a lot of risk can help you manage patients effectively while keeping the costs of care down. This is fundamental to doing well in value-based care.”</p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em><br></p>
<img alt="" height="519" src="/Articles/PublishingImages/740%20x%20740/senior_nurse_1.jpg" width="740" style="BORDER:0px solid;" />
While ACOs and value-based care are certainly not new, there is a new urgency for providers to understand them and their role in post-acute and long term care.
Artificial Intelligence Helps Meet the Changing Needs of the Aging Population
<p><img src="/Articles/PublishingImages/740%20x%20740/senior_computer1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />One of the most pressing issues societies worldwide must confront is adapting to the changing needs of older adults as the global population continues to age. Thanks to the rapid advancements in technology—particularly in the realm of artificial intelligence (AI)—we're in the midst of a transformative era where AI's capabilities intersect with the new digital approach to senior care.</p><p>From addressing social isolation head-on to cultivating digital environments tailored to seniors, AI offers innovative solutions that significantly enhance the quality of life for older adults. Let's discuss these solutions in greater detail.</p><h3>Reducing Social Isolation</h3><p>The aging process inevitably results in a number of physical limitations and health concerns that can restrict a resident's ability to engage in social activities. This gradual withdrawal from social interactions can lead to feelings of loneliness, depression, and even cognitive decline. As societies become more digitally connected, the paradox of social isolation becomes even more profound, with seniors feeling left behind in an increasingly interconnected world.</p><p>Artificial intelligence helps to reduce social isolation by giving seniors access to virtual companions that provide constant camaraderie to older adults. These companions are not just programmed to provide information or perform tasks; they are designed to engage in meaningful conversations, share stories, and offer emotional support. Through advanced natural language processing, machine learning algorithms, and neural networks, these companions can simulate genuine human-like interactions.</p><p>But the potential of AI goes beyond individual companionship. AI algorithms can also facilitate the creation of online communities tailored to older adults' interests. Imagine a platform where seniors can connect with peers who share similar hobbies, passions, and experiences. Through AI-driven matchmaking, these platforms can recommend potential friends and group activities, fostering a sense of belonging and community. Virtual events, discussion forums, and support groups can transcend physical limitations, enabling seniors to build meaningful relationships.</p><h3>Creating Digital Environments Where Older Adults Can Thrive</h3><p>One of the primary barriers preventing older adults from fully embracing technology is the complexity of user interfaces. AI bridges this gap by enabling intuitive, user-centric design principles. Voice commands, gesture recognition, and simplified navigation can replace intricate touch interfaces, making digital interactions more intuitive and accessible to those with limited technical experience.</p><p>AI-driven health monitoring systems have the potential to revolutionize health care for the elderly. Smart devices equipped with AI can continuously monitor vital signs, detect anomalies, and even predict potential health risks. For instance, a wearable device could detect irregular heartbeats and alert medical professionals in real time. Machine learning algorithms can analyze data trends to provide personalized health recommendations, empowering older adults to make informed decisions about their well-being.</p><p>Cognitive decline is one of the most prominent disorders senior care centers have to specialize in for the well-being of their residents. AI-powered applications provide cognitive assistance by offering memory prompts, reminders for daily activities, and assisting with financial management. These tools, designed with empathy and understanding, can help seniors maintain their independence while managing the challenges associated with memory loss. Through continuous learning and adaptation, these AI applications can evolve alongside their users, offering tailored support.</p><h3>Enhancing Independent Living</h3><p>AI-enabled smart home technologies hold immense potential in enhancing the quality of life for older adults. Sensors and smart devices can monitor daily activities within the home environment, such as cooking, medication intake, and movement patterns. When irregularities are detected, AI systems can send alerts to caregivers or emergency services. Furthermore, smart homes can adjust settings like lighting, temperature, and security based on individual preferences, providing a seamless and comfortable living experience.</p><p>For older adults with limited mobility, AI-driven mobility solutions offer a new level of independence. Self-driving cars equipped with AI can safely transport seniors to appointments, social gatherings, and recreational activities. These vehicles are designed with user-friendly interfaces, making them accessible to individuals who might not be comfortable with traditional driving technology. Moreover, AI-powered mobility aids, such as exoskeletons and smart walking assistants, can help older adults maintain mobility and balance, preventing falls and improving overall quality of life.</p><h3>Holistic Mental and Emotional Well-being</h3><p>AI technologies can provide continuous emotional support and mental health monitoring for older adults. Chatbots equipped with empathetic algorithms can engage in conversations that promote positive emotional well-being. These virtual companions can lend an empathetic ear, offering a space for seniors to express their thoughts and feelings. Additionally, AI can detect patterns indicative of mental health challenges, enabling timely interventions by mental health professionals and caregivers.</p><p>Cognitive decline is a common concern among the elderly, but AI-powered entertainment platforms can help mitigate its effects. These platforms offer personalized content that stimulates cognitive functions. Virtual reality experiences, brain-training games, and interactive storytelling applications provide engaging activities that promote mental agility and creativity. Through regular use, these applications can contribute to maintaining cognitive vitality.</p><h3>Ethical Considerations and Human-Centric Approach</h3><p><img src="/Articles/PublishingImages/2023/MelissaPowell.png" alt="Melissa Powell" class="ms-rtePosition-2" style="margin:5px;" />As we embrace AI to address the needs of the aging population, it is crucial to maintain a human-centric approach. Ethical considerations should guide the development and deployment of AI technologies for seniors. Privacy, data security, and consent must be at the forefront of these innovations, ensuring that older adults' dignity and autonomy are respected. Transparent communication about how AI is being used and the benefits it provides is essential to foster trust between seniors, caregivers, and technology developers.</p><p>It is possible for advanced technology and human connection to coexist harmoniously, enriching the lives of older adults around the world.<br><br><em>Melissa Powell is the COO of Genesis Healthcare, a network of 250 facilities across 22 states.</em><br></p>
<img alt="" src="/Articles/PublishingImages/740%20x%20740/senior_computer1.jpg" style="BORDER:0px solid;" />
One of the most pressing issues societies worldwide must confront is adapting to the changing needs of older adults as the global population continues to age.
Bridging the Health Care Literacy Gap
<p>Recent trends in workplace dynamics have underlined the importance of health care literacy, posing a pressing challenge for long term and post-acute care companies. <br>A 2023 Health Care Literacy Report from Optavise identified four key challenges, including: <br></p><ul><li>knowledge gaps among employees in specific industries.</li><li>reduced direct involvement of HR in benefits education. </li><li>increased reliance on digital tools and social media for benefits communication. </li><li>growing dissatisfaction with benefits due to misunderstanding their scope and function.</li></ul><p>To address these challenges, here are some potential strategies:  <br><strong>1. Intensify Benefits Education:</strong> Employ a benefits expert to provide employee education and help bridge the knowledge gap. Regularly scheduled workshops, one-on-one consultations, and Q&A sessions can be effective. For employees who cannot leave their workstations, on-site sessions or webinars can be organized.  <br><strong>2. Leverage Technology But Keep It Personal: </strong>Digital tools should complement—not replace—personal interactions. Online tools can be used for initial information dissemination, while detailed queries and doubts can be addressed in individual consultations.<br><strong>3. Encourage Proactive Health Care Practices:</strong> Employers can encourage employees to use preventive care benefits, ensuring timely health check-ups and reducing the need for urgent care.  <br><strong>4. Enable Informed Decisions:</strong> Employees should be equipped to make informed decisions about their health care. This includes understanding how to review their coverage each year, compare prices for care and medications, and check their bills for inaccuracies. <br><strong>5. Targeted Communication:</strong> Tailor communication efforts to address the <br>needs of different employee demographics. Younger employees, those earning less, or those in industries with higher knowledge gaps may need more focused educational efforts.  </p><p>Addressing the health care literacy gap among employees is a formidable task, but doing so can lead to better health outcomes, increased satisfaction, and cost savings for both employees and employers. <br></p><p><img src="/Issues/2023/Fall/PublishingImages/Compass.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />At Compass Total Benefit Solutions, we leverage the latest technology and the resources of established industry partners to offer affordable, PPACA-compliant plans, but with the educational support to ensure your employees’ needs are addressed wherever and whenever necessary.<br></p><p>For more information about working with Compass Total Benefit Solutions, email Nick Cianci at <a href="mailto:firstname.lastname@example.org" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">email@example.com</a> or call him directly at (860) 416-5333.</p>
<img alt="" src="/Issues/2023/Fall/PublishingImages/Compass.jpg" style="BORDER:0px solid;" />
Recent trends in workplace dynamics have underlined the importance of health care literacy, posing a pressing challenge for long term and post-acute care companies.
Creating Workplace Flexibility in the Health Care Industry
<h3>Envy as an Idea Incubator</h3><p><img src="/Articles/PublishingImages/740%20x%20740/staff_2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Sometime in the year 2020, I developed a case of freeness envy, or perhaps flexibly loathing. I work at St. John’s Health Care Corporation, an innovative leader in skilled nursing and senior life in western New York. During the pandemic, because of the high-risk industry we work in, some of our employees opted to leave the workforce while the rest of us came to work in person every day. I’d read all these wonderful stories of people who were working from home, and they’d comment about how much they were saving on commuting and how productive they were. They would gloat that they were safer than most everyone because they never had to leave their house.</p><p>To compound this, we began losing some employees who took other jobs because they could work remotely or have more flexibility than we offered. The few employees we lost, coupled with the uplifting stories of people working from home, encouraged us to review our employment practices.</p><p>Flexible schedules and remote work are somewhat limited in the health care business. You can’t decide whether to pass medications to someone remotely or at a time that works best for you, or provide them with meals on days and times that work around your pickleball court times. Many of our jobs require presence at work on a rather fixed schedule, but the senior living industry does have some flexibility options available.</p><h3>Parting with Traditional Notions of Equity, Observation, and Power</h3><p>I’ve heard HR people state many times that you have to treat everyone the same when it comes to flexible schedules. If you can’t offer flexibility to clinical folks, don’t offer it to other staff. I’ve never bought into this concept. Managing differences is part of the fun of working in HR, and there’s no reason differences can’t also apply to remote work.</p><p>Another mindset we have to overcome is the question of the effectiveness of remote workers. Is work getting done if you don’t witness it happening? There’s a school of thought that productivity decreases when people work remotely. The thinking goes that you’ll lose valuable team collaboration and idea sharing. There’s also some thought that remote workers are stealing from the company by cutting their grass or scrolling through their social media on your dime.</p><p>However, others think remote workers are more productive because they face fewer distractions and spend less time commuting and more time working. I don’t know the truth of how remote work impacts productivity, but I do know that a remote worker is far more productive than an unfilled position.</p><p>There’s a final concept we need to come to terms with, and that’s who is driving the rules of work. Who has the authority and power? As anyone who has been to a restaurant or tried to hire a contractor knows, work is very different than it was four years ago. There’s a critical worker shortage in most every field.</p><p>I’ve had a number of people tell me that applicants treat us like we need them more than they need us, and there’s a reason for that: It’s because we need them more than they need us. We’re in a job market like no other, so as an employer, you need to give up the notion that you set all the rules. There are too many choices out there, so you have to negotiate salary and incentivize them with flexibility offerings if you want to have a solid workforce.</p><h3>Flexibility Is Largely Free, So Use It</h3><p>Half of our HR team works not only remote, but from other states. Is this situation ideal in every way? Of course not, but it works. In the modern world of work, think about the number of times you communicate with people in the office. How many of those discussions are in person, compared to conversations over email, text, or the phone? Our experience after a few years is that most people have no idea someone isn’t in the office, because when they need support, they typically call, email, or text us; they don’t come to our office in person. Our classic HR teams are all day workers Monday through Friday, and the bulk of our workforce is here during other hours, so interactions typically aren’t face-to-face anyway. When you send a message and get a response, you don’t care where the response came from. </p><p>We’ve had no HR turnover for three years, and flexibly is a large part of the reason. If you had the resources to do a labor productivity time study, would you conclude that remote work is as effective as work in the office? Maybe or maybe not, but I’m certain that an experienced team working partially remote with no turnover is much more productive than a team trying to bring new people up to speed due to 50 percent turnover.</p><p>When it comes to equity for people who can’t work remotely or flex their schedules, we try our very best to offer them perks during this very difficult labor market. In New York, clinical employees are paid state-funded bonuses, but office staff are excluded. We also adjust market pay rates for some jobs and not others. If you share your rationale, most employees are able to understand the concept of doing the best you can with individual circumstances.</p><p>I’ve found that there is some pain associated with managing differences and explaining them, but I try to keep it in perspective. Keep in mind that giving one person job flexibility doesn’t take anything away from another employee and is largely free—and free is good.</p><h3>Discovering Work Flexibility BSchedules </h3><p>There are many kinds of flexibility that can be offered beyond what people typically think of, such as a customized start/end time or work location. Part of the reason we value schedule flexibility is that it reduces the stress of getting life activities done. At St. John’s, we’ve implemented several benefits that help people in fixed work schedules get more flexibility in their lives.</p><p>One of these is a way to get physician visits remotely or while at work. We partner with a company that employees or their families can call to get help with the same kinds of issues for which you would visit a primary care physician or an urgent care facility. This helps employees and their families in a way that doesn’t require taking time off work or interfering with their personal lives on days off. </p><p>We’ve also tried to build in some pay flexibility to the best of our ability using a payroll app, which allows employees to get paid when they want after working, for a very small service charge. In effect, an employee can work today and get paid tomorrow. This offering has had a positive impact on our staff benefits. </p><h3>Flexible Connections</h3><p>I’ve found that our younger employees don’t use a phone to speak to people, don’t read email, and prefer not to have meetings, so we’ve tried to meet people where they are by communicating to them through text messaging and phone apps. We’re trying to be flexible and share information with them so they can view our messages in a time and manner that works best for them.</p><p>Another way we’re trying to connect with people where they are is by using newer digital technology to target prospective employees. We target prospects by using demographic information to reach their social media accounts. Online job advertisements are of course valuable, but we have more success using digital media.</p><p><img src="/Articles/PublishingImages/2023/DeanMoore.jpg" alt="Dean Moore" class="ms-rtePosition-2" style="margin:5px;" />The world of employment has changed very dramatically in recent years, and concepts that applied a short time ago may not work any longer. Workplace flexibility will result in better productivity and staff engagement. By boosting your employees’ productivity and ensuring they’re committed and happy, you’re automatically increasing the level of patient care your facility provides. In years to come, attracting and retaining quality health care staff will be even more vital, with staffing shortages predicted to increase amid an aging population. Flexibility results in a win-win situation. <br><br><em>Dean Moore is vice president of work/life at St. John’s, a full-service senior care provider with options that range from independent living to skilled nursing and hospice in Rochester, New York. He has been in the human resources industry for more than 30 years. </em><br></p>
<img alt="" src="/Articles/PublishingImages/740%20x%20740/staff_2.jpg" style="BORDER:0px solid;" />
Flexible schedules and remote work are somewhat limited in the health care business.
What Providers Should Know About the Employee Retention Credit Moratorium
<p><span class="ms-rteForeColor-2"><strong>ADVERTORIAL</strong></span></p><p><img src="/Articles/PublishingImages/740%20x%20740/Legal_3.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />On September 14, 2023, the IRS announced a processing moratorium (not a filing moratorium) on newly filed Employee Retention Credit (ERC) claims, projected to last until at least the end of 2023. Understandably, many long term care facilities (LTCFs) have questions and concerns about what the moratorium is and how it impacts ERC claims—filed or unfiled. Let’s take a look at how we arrived here and our recommendations for LTCFs at all stages of the process.   </p><h3>Why Is Processing in Time-Out?</h3><p>Briefly, the ERC is a refundable payroll tax credit for businesses, including LTCFs, that retained employees and were affected during the COVID-19 pandemic. While it is only available to eligible employers for certain periods in 2020 and 2021, businesses may still have time to claim the ERC retroactively. It’s important to recognize that the ERC is complex, but when properly claimed, we have seen firsthand how it has been a lifeline for thousands of LTCFs around the nation.</p><p>Undoubtedly, when the ERC was implemented in early 2020, all kinds of businesses and the IRS were being impacted by the pandemic in numerous ways. Businesses were failing and jobs were at stake. But it’s easy to forget that the IRS was also confronting the direct effects of the pandemic in its own operations and among its own personnel.</p><p>Moreover, the IRS was charged with not only administering ERC, but also issuing rounds of Economic Impact Payments, and managing business as usual (amplified by a noticeable uptick in anxious taxpayer communications). Considering these circumstances in conjunction with the ERC’s complex nature, it is not surprising that the IRS, tax professionals, and business owners were all generally late in the game to recognize the full scope of the benefits of the ERC.</p><p>By January 2023, however, millions of ERC claims had been filed, and the IRS believed it had seen enough fraudulent claims and unscrupulous “ERC mills” to warrant heightened scrutiny. Concurrently, the IRS increased its enforcement efforts directed at fraudulent claims and issued a flurry of new warnings about potential scams and bad actors. In the summer of 2023, the IRS shifted a significant portion of its resources to clear the ERC backlog (at that time, approximately 800,000 claims) so that it could more carefully scrutinize the incoming claims. </p><p>Of course, a ticking clock adds pressure on both sides. While employers—especially those who are only now learning about the credit—may feel a time crunch to review the complex credit with a trustworthy preparer and get everything filed within those limits, the IRS undoubtedly fears the time remaining is long enough to exponentially increase the number of fraudulent filings. Under current law, employers may only file amended returns to claim ERC for 2020 periods until April 15, 2024. For 2021 periods, employers have until April 15, 2025. Significantly, excluding the 3rd and 4th quarters of 2021, those same deadlines apply to the IRS’s ability to assess additional tax for a potential erroneous ERC claim. For the 3rd and 4th quarters of 2021, the IRS may assess until April 15, 2027. </p><p>All of the above brought us to the moratorium.  According to the IRS:</p><p dir="ltr" style="text-align:left;"><em>IRS Commissioner Danny Werfel ordered the immediate moratorium, beginning [September 14, 2023], to run through at least Dec. 31 following growing concerns inside the tax agency, from tax professionals as well as media reports that a substantial share of new claims from the aging program are ineligible and increasingly putting businesses at financial risk by being pressured and scammed by aggressive promoters and marketing.</em><sup><em>1</em></sup></p><p dir="ltr" style="text-align:left;">The IRS clarified in its moratorium announcement that it is continuing to process ERC claims filed before the moratorium (but at a slower pace than before), but the processing of newly filed claims is halted until at least the end of the year.</p><h3>What Should LTCFs Do Now?</h3><p dir="ltr" style="text-align:left;">It’s important to remember that you may still file for the ERC, but depending on your circumstances, we recommend the following courses of action:<br></p><ul><li><strong>LTCFs Waiting for Payment.</strong> For LTCFs that filed an ERC claim, or claims, before the moratorium, the IRS will continue to process the claim(s). Due to intensified compliance scrutiny, those LTCFs should anticipate a slower processing pace. </li><li><strong>L</strong><strong>TCFs Considering Filing.</strong> There are still many LTCFs that may be eligible for ERC relief. With less than 6 months remaining to file for 2020 ERC claims, it’s imperative that LTCFs consult with a trusted tax professional as soon as possible. LCTFs must be careful to avoid abusive tax promoters and “ERC mills.” Every ERC claim must be aligned with the statute and guidelines—it’s a complex analysis which can result in serious IRS complications if mishandled.</li><li><strong>Concerned LTCF Filers.</strong> LTCFs that have already filed but are concerned about their claims for any reason, should seek guidance from a trusted tax professional. Just this month, the IRS issued details of its ERC Withdrawal Process. The process permits certain filers to withdraw claims as if they never filed them at all, avoiding both penalties and interest. For instance, many early filers didn’t have the benefit of later IRS clarification regarding supply chain issues. Now is the time to reflect with a professional on the basis of the claim.</li><li><strong>LTCFs and Erroneous Payments.</strong> If an LTCF believes that it received an ERC payment in error, the IRS has announced that a settlement program is forthcoming. While we wait for details, we can only note that it will allow a business to repay an ERC claim and potentially avoid penalties and further unwanted action. </li><li><strong>Prepare and Substantiate.</strong> The IRS is clear that during the moratorium, many filers should expect to receive requests for substantiation to back up elements of their claim. Unfortunately, we are aware of the fact that many of the companies preparing ERC claims for LTCFs neglected to assist with this part of the process. For instance, government orders were not compiled and attached to a memorandum that detailed the basis of the claim. LTCFs should consult with a trustworthy professional now, prepare for IRS information requests, and ensure that they have the necessary documentation readily available.</li></ul><h3>Conclusion</h3><p><img src="/Articles/PublishingImages/2023/MaryLundstedt.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" />Remember, there is less than 6 months left to file for the ERC for 2020. Whether you are just now learning about ERC or have already filed a claim and feel like a second look is prudent, we urge you to engage an experienced tax professional to examine your claim. The moratorium reinforces the need for a trustworthy tax professional, equipped with industry specific knowledge, to be involved at all stages of the process. </p><p>If your LTCF has any ERC needs, contact our team at (410) 863-3575 or <a href="https://askfrost.com/contact" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">schedule a confidential consultation today.</a></p><p><em>Mary Lundstedt, Esq., is director of legal analysis at Frost Law. She is based out of Annapolis, Md., and can be reached at <a href="mailto:Mary.Lundstedt@AskFrost.com" data-feathr-click-track="true" data-feathr-link-aids="["60b7cbf17788425491b2d083"]" target="_blank">Mary.Lundstedt@AskFrost.com</a>. </em><br></p><h4>Reference<br>1. IR-2023-169 (Sept. 14, 2023).<br></h4>
<img alt="" src="/Articles/PublishingImages/740%20x%20740/Legal_3.jpg" style="BORDER:0px solid;" />
Many long term care facilities (LTCFs) have questions and concerns about what the moratorium is and how it impacts ERC claims—filed or unfiled.
Addressing Social Isolation in Long Term Care
<p><img src="/Articles/PublishingImages/740%20x%20740/lonely-senior.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Social isolation is a critical social determinant of health that can significantly impact an individual's physical and mental well-being. Social determinants of health are the social and economic conditions in which people live, work, and age, and they can have a profound influence on a person's overall health outcomes. Social isolation refers to a lack of meaningful social connections and engagement with others, which can manifest in various ways, such as limited social networks, minimal social support, or a lack of participation in social activities.</p><p>This is particularly relevant with the addition of social isolation to the MDS v1.18.11 that was implemented on October 1, 2023. Social isolation can be subtle in long term care residents, but its impact is significant on the nursing home population.</p><p>These impacted areas include:<br></p><ul><li><strong>Mental Health:</strong> Social isolation is strongly linked to mental health problems, including depression, anxiety, and loneliness. Prolonged social isolation can lead to feelings of loneliness and despair, contributing to poor mental health outcomes. It can also exacerbate existing mental health conditions.</li></ul><ul><li><strong>Physical Health:</strong> Social isolation can have adverse effects on physical health. People who are socially isolated may be more likely to engage in unhealthy behaviors like poor diet, lack of exercise, and substance abuse, which can increase the risk of chronic conditions such as obesity, heart disease, and diabetes.</li></ul><ul><li><strong>Health Behaviors:</strong> Social connections play a role in influencing health-related behaviors. People who have strong social networks are more likely to engage in healthy behaviors, such as regular exercise and a balanced diet. In contrast, social isolation may lead to the adoption of unhealthy habits.</li></ul><ul><li><strong>Stress and Coping:</strong> Social isolation can increase stress levels. Without a support system to turn to during challenging times, individuals may experience chronic stress, which can contribute to a range of health issues, including cardiovascular problems and weakened immune function.</li></ul><ul><li><strong>Quality of Life: </strong>Social isolation can reduce an individual's overall quality of life. Loneliness and a lack of social engagement can lead to a decreased sense of well-being and life satisfaction.</li></ul><p>Addressing social isolation among nursing home residents is particularly important as they are often at a higher risk of experiencing loneliness and isolation due to factors such as physical limitations, health conditions, and the institutional setting. Here are some ways to address social isolation in nursing home residents:</p><p>Regular Social Activities:<br></p><ul><li>Facilities should offer a variety of social activities such as group games, arts and crafts, music therapy, and book clubs.</li><li>These activities can provide opportunities for residents to interact, share experiences, and form friendships.</li></ul><p>Intergenerational Programs:<br></p><ul><li>Establish partnerships with local schools or organizations to bring young people into the facility for activities or visits.</li><li>Interactions with children and young adults can bring joy and companionship to residents.</li></ul><p>One-on-One Visits:<br></p><ul><li>Ensure that residents receive regular one-on-one visits from staff or volunteers.</li><li>These visits can provide individualized attention and reduce feelings of loneliness.</li></ul><p>Family Involvement:<br></p><ul><li>Encourage family members to visit regularly and participate in resident activities.</li><li>Families can play a crucial role in providing emotional support and companionship.</li></ul><p>Outdoor Activities:<br></p><ul><li>Organize outdoor outings, picnics, and nature walks for residents who are physically able to participate.</li><li>Spending time in nature and fresh air can be uplifting and provide a change of scenery.</li></ul><p>Technology Access:<br></p><ul><li>Provide access to computers, tablets, and video conferencing platforms to help residents stay connected with family and friends who may not be able to visit in person.</li><li>Staff can assist residents in using these devices.</li></ul><p>Pet Therapy:<br></p><ul><li>Arrange for pet therapy sessions where trained animals visit the facility.</li><li>Interactions with animals can bring comfort and companionship to residents.</li></ul><p>Cultural and Spiritual Activities:<br></p><ul><li>Offer religious or spiritual services and cultural events that align with residents' beliefs and interests.</li><li>These activities can foster a sense of community and belonging.</li></ul><p>Support Groups:<br></p><ul><li>Organize support groups for residents who share common experiences or conditions, such as those dealing with chronic illnesses or grief.</li><li>Support groups provide a safe space for sharing and emotional support.</li></ul><p>Person-Centered Care:<br></p><ul><li>Tailor care plans to the individual needs and preferences of each resident.</li><li>Consider their interests, hobbies, and social histories when planning activities and interactions.</li></ul><p>Staff Training:<br></p><ul><li>Train nursing home staff in recognizing signs of social isolation and addressing residents' emotional needs.</li><li>Empower staff to engage in meaningful conversations and companionship with residents.</li></ul><p>Assessment and Screening:<br></p><ul><li>Routinely assess residents for signs of social isolation and loneliness as part of their care plans.</li><li>Use validated tools to identify those at risk and develop targeted interventions.</li></ul><p>Environment and Design:<br></p><ul><li>Create common spaces within the facility that are conducive to social interaction, such as comfortable lounges and communal dining areas.</li><li>Decorate spaces with familiar and comforting elements.</li></ul><p>Family Support and Education:<br></p><ul><li>Offer support and education to families on how to best support their loved ones in the nursing facility.</li><li>Provide guidance on effective communication and engagement strategies.</li></ul><p><img src="/Articles/PublishingImages/2023/VeronicaBirch.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" />Addressing social isolation in nursing home residents requires a holistic and person-centered approach that considers each resident's unique needs and preferences. By implementing these strategies, facilities can create a more supportive and socially connected environment, ultimately improving the overall well-being of their residents.<br><br><em>Veronica Birch is the principal consultant for Gem Healthcare Consulting LLC. She has been a nurse for more than 20 years in the long-term care industry, and is board certified in geriatrics, case management, as well as a board-certified nurse executive, and a licensed nursing home administrator. </em><br></p>
<img alt="" src="/Articles/PublishingImages/740%20x%20740/lonely-senior.jpg" style="BORDER:0px solid;" />
Addressing social isolation among nursing home residents is particularly important as they are often at a higher risk of experiencing loneliness and isolation due to factors such as physical limitations, health conditions, and the institutional setting.