| How AI Can Help Differentiate Between a UTI or Dementia | <p><img src="/Articles/PublishingImages/740%20x%20740/dr_ipad.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Staff, administrators, and medical professionals in senior care communities are acutely aware of the increased frequency of urinary tract infections (UTIs) among older adults and how often they are misdiagnosed as signs of dementia.</p><p>While these two diagnoses are separate, they are inextricably linked based on overlapping symptoms. One of the most significant and obvious overlapping symptoms is a sudden increase in confusion. This often presents as delirium and explains why many jump to a diagnosis of dementia before testing for a UTI. Other overlapping symptoms include increased agitation, withdrawal, and difficulty concentrating. Yet diagnosis can be further challenging because the typical physical symptoms of a UTI, such as a burning sensation during urination, may not be present in older adults.</p><p>Another often overlooked challenge when it comes to proper diagnosis is staff not having enough time with a resident to rule out other health factors. Of course, the faster a UTI is ruled out, the more expedient treatment can be, enabling a resident to resume their regular routine. Conversely, the longer a misdiagnosis lingers, the more detrimental it is for the resident. This includes unnecessary treatments while the underlying infection worsens, longer hospital stays with rising health care costs, and overprescribing antibiotics, along with anxiety.</p><p>A helpful way to help differentiate between a UTI and dementia is to understand that dementia, with few exceptions, is often a progressive condition signified by a gradual decline. However, if staff don’t have the ability to spend enough time with residents, progressive declines are harder to spot.<br></p><h3>The Role of Technology in Supporting Senior Care Administrators</h3><p>The common UTI and dementia misdiagnosis is where innovations in technology, specifically artificial intelligence (AI), help provide insight to augment medical expertise. Technology is now enabling care professionals to spot subtle changes in behavior that may signal a longer-term issue such as a UTI well before a test is necessary.</p><p>Sensors that combine AI and body-heat-sensing technology can understand subtle movements in a room or a hallway without requiring the use of cameras or other devices that compromise privacy. The sensors can help staff recognize an increase in frequency when it comes to a resident’s bathroom habits. This can signal a UTI. Similarly, they can also be alerted to wandering incidents, which can signal cognitive decline.</p><p>The associated data from the sensors provides a benchmark for an individual room. Based on these early indicators, outliers can be more easily detected and often before an infection gets too far along.</p><p>Since the data is anonymized, it can contribute to greater industry learnings. Imagine being able to pool data from a larger population of older adults, or across a national care community. Data analysis based on vast amounts of anonymized behavior data can have many benefits.</p><p>It can lead to more proactive health planning. It can also help administrators plan for future needs of residents as well as their facilities. Also, the data can shape how they recruit and staff communities.</p><p>From a technological point of view, the insights can be used to support the training of data models to analyze actions such as sleep, activities, and social engagement. These additional dimensions of insight provide even more benchmarks across a wider population to better understand the aging process and immediate changes that may need attention.</p><p>Taking this even further, the combination of individual and empirical data to better identify the correlations between symptoms will improve diagnostic accuracy.</p><p>On a more immediate level, this insight can also help close gaps, especially when it comes to noticing subtle changes in residents that often aren’t detected until much later. This insight helps schedulers know where to allocate staff based on the resident needs as opposed to scheduled physical check-ins.<br></p><h3>Weaving Technology into the Senior Care Community</h3><p>For most senior care administrators, this type of benchmark data is critical. Yet many are concerned that the burden of gathering data and analyzing it adds more to their already overextended schedule. The good news is that the emergence of new technologies for senior care and longevity and making serious inroads in addressing these issues. A closer look at The Gerentechnologist’s <a href="https://thegerontechnologist.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Age Tech Market Map</a> provides great insight into the current state of all the emerging technologies being developed specifically to support senior care communities.</p><p><img src="/Articles/PublishingImages/2024/Honghao-Deng.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:115px;height:157px;" />As the population ages, with one in six adults being over the age of 60 by the year 2030, there will be increased challenges for the entire industry. Innovations in technology, especially AI, are making significant strides in helping administrators plan more efficiently and respond more proactively to changes.<br> <br><em>Honghao Deng is a computational designer and entrepreneur, and the CEO and co-founder of <a href="https://www.butlr.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Butlr</a>. In his previous role, he was a researcher at City Science Group, MIT Media Lab. He earned a Master of Design Technology with Distinction at Harvard University.  </em><br></p> | 2024-10-10T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/dr_ipad.jpg" style="BORDER:0px solid;" /> | Technology;Dementia | Staff, administrators, and medical professionals in senior care communities are acutely aware of the increased frequency of UTIs among older adults and how often they are misdiagnosed as signs of dementia. |
| 2024 NCAL Day Offers Inspiration and Diverse Education | <p><img src="/Articles/PublishingImages/740%20x%20740/24NCALDay.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" /></p><div><p><span data-contrast="auto" lang="EN-US"><span data-ccp-parastyle="No Spacing"></span></span><span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"><span data-ccp-parastyle="No Spacing"></span></span></span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">Hundreds of assisted living providers and professionals came together for NCAL Day on Sunday, October 6, making it the biggest NCAL Day since its inception. While AHCA/NCAL was forced to cancel Delivering Solutions 24 late Saturday due to impending Hurricane Milton, Sunday’s programming including NCAL Day was able to go on as planned.    </span></p><p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">Mark Maxfield, an independent owner/operator of several assisted living communities in Idaho and NCAL Board Chair, served as emcee. His welcome remarks included a focus on his passion for delivering high quality care and why his work is personal.</span></p><p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">“I’ve worked in assisted living for more than 23 years. My grandfather, with whom I was very close, needed assisted living care that wasn’t available where he lived,” said Maxfield. “After working as a caregiver and seeing what it takes to really do this work, I knew without a doubt that this was my calling.”</span></p><p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">This year’s event featured two keynote speakers. Licensed health care facility administrator and executive coach Jerald Cosey kicked off the morning with an inspiring session on reigniting purpose. Maja Kazazic, a Bosnian genocide survivor, businesswoman, and motivational speaker, continued to inspire by sharing her amazing story of survival, success, and empathy.</span></p><p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">“NCAL Day continues to get better and better every year, and it is exciting to see the value it delivers for assisted living providers reflected in the growing attendance,” said NCAL executive director LaShuan Bethea. “The work these providers do is one of love and passion. I’m honored to be part of this day where we can help reignite their passion and provide resources to support the tremendous work that happens in assisted living every day.”</span></p><p><span><span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"><span data-ccp-parastyle="No Spacing"><img src="/Articles/PublishingImages/2024/IMG_8965%20NCAL%20Day.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:232px;" /></span></span></span></span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">NCAL Day also included breakout sessions for attendees, all focused on various issues impacting assisted living--from building trust and retaining people to exploring the next steps in the AHCA/NCAL Quality Awards journey. </span></p><p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}">The day wrapped up with a fireside chat that included NCAL director of quality improvement Pam Truscott, NCAL director of policy and regulatory affairs Jill Schewe, immediate past NCAL board chair Gerald Hamilton, and NCAL executive director LaShuan Bethea. They discussed the future of assisted living, with a focus on important quality, regulatory, and impactful strategies to help ensure the profession’s future remains bright.  </span></p></div> | 2024-10-08T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/NCALDay2.jpg" style="BORDER:0px solid;" /> | Assisted Living | Hundreds of assisted living providers and professionals came together for NCAL Day on Sunday, October 6, making it the biggest NCAL Day since its inception. |
| Mandatory Provider Enrollment Off-Cycle Revalidation for ALL SNFs | <p>The Centers for Medicare & Medicaid Services (CMS) recently issued an announcement in the <a href="https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-09-19-mlnc?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-09-19-mlnc%23_Toc177552986#_Toc177552986" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">MLN Connects newsletter</a> that all skilled nursing facility (SNF) providers will receive off-cycle provider enrollment revalidation notices from their Medicare Administrative Contractor (MAC) to collect additional data on ownership, managerial, and related party information not previously required. This information is to be submitted in a new Appendix on the <a href="https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Form CMS-855A</a> (09/24) version.   <br></p><h3>WHAT YOU NEED TO KNOW </h3><ol><li>Be on the lookout for a letter from your MAC from October through December 2024 regarding a mandatory off-cycle revalidation. Approximately one-third of SNFs will receive these notices each month.  </li><li>Providers will have 90 days from the date of the letter to respond and submit the newly required information into the <a href="https://pecos.cms.hhs.gov/pecos/login.do?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://pecos.cms.hhs.gov/pecos/login.do%23headingLv1#headingLv1" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Medicare Provider Enrollment, Chain, and Ownership System (PECOS)</a> system to keep their provider enrollment status active. </li><li>The requested information is quite complex and affects every SNF, regardless of size or ownership characteristics. </li><li>SNF providers no longer report in Sections 5 and 6 of the provider enrollment form, but in a new SNF-specific Appendix. Instructions for the new SNF Appendix are <a href="https://www.cms.gov/files/document/guidance-snf-attachment-855a.pdf?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://www.cms.gov/files/document/guidance-snf-attachment-855a.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">here</a>.  </li><li>In addition to SNF revalidation timeline discussed above, the new <a href="https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Form CMS-855A</a> must be used for all of the following provider enrollment transactions effective October 1, 2024:</li></ol><p>                    a. Initial Enrollment</p><p><span>                    </span>b. Revalidations </p><p><span>                    </span>c. Reactivations </p><p><span>                    </span>d. CHOW </p><p><strong>Note:</strong> If the status of any SNF transaction for a-d above prior to October 1 is “pending” in PECOS as of October 1, the MAC will request the new Appendix be completed by the SNF provider.  </p><h3>WHAT YOU NEED TO DO</h3><ol><li>Review the new <a href="https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Form CMS-855A</a> and the new <a href="https://www.cms.gov/files/document/guidance-snf-attachment-855a.pdf?utm_source=MarketingCloud&utm_medium=email&utm_campaign=Mandatory+Provider+Enrollment+Off-Cycle+Revalidation+for+ALL+SNFs&utm_content=https://www.cms.gov/files/document/guidance-snf-attachment-855a.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">GUIDANCE FOR SNF ATTACHMENT ON FORM CMS-855A</a>. </li><li>CMS and AHCA/NCAL suggest providers seek counsel from an attorney to help interpret the new SNF reporting requirements.  </li><li>Begin compiling the new information that will be required to be reported ASAP. </li><li>Be on the lookout for an upcoming AHCA webinar on this new SNF provider enrollment reporting requirements.   </li></ol><p>Please contact <a href="mailto:dciolek@ahca.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Dan Ciolek</a> or <a href="mailto:mallen@ahca.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Martin Allen</a> at AHCA/NCAL with questions. </p> | 2024-09-24T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER:0px solid;" /> | Medicare | All SNF providers will receive off-cycle provider enrollment revalidation notices from their Medicare Administrative Contractor to collect additional data on ownership, managerial, and related party information not previously required. |
| Balancing Technology and Humanity in Long Term Care | <p><img src="/Articles/PublishingImages/740%20x%20740/telehealth2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The integration of technology into long term care is revolutionizing the way we approach this delicate and crucial stage of life. Being an executive in the senior care space for decades, I've witnessed firsthand the profound impact that technological advancements can have on enhancing the quality of care, communication, and comfort for patients and their families. From innovative medical devices to sophisticated data management systems, technology is not just a tool but a transformative force that is reshaping the landscape of long term care.</p><p>This proactive approach to long term care not only improves patient outcomes but also alleviates the stress and anxiety often experienced by families, knowing that their loved ones are under constant, attentive care. Technology's impact will be significant on the efficiency of care delivery, but also in upholding the dignity and preferences of those at the end of their life, making the journey as peaceful and respectful as possible.</p><h3>Revolutionizing Patient Monitoring and Care Delivery</h3><p>Wearable devices and remote monitoring systems enable the continuous tracking of vital signs such as heart rate, blood pressure, and oxygen levels, providing health care providers with real-time data that can be crucial in detecting early signs of distress or deterioration. This level of constant vigilance allows for timely interventions, which can significantly improve patient outcomes and enhance their quality of life. For instance, a sudden drop in oxygen levels can be immediately addressed with supplemental oxygen or medication adjustments, preventing further complications and ensuring the patient's comfort.</p><p>Telehealth has also emerged as a game-changer in long term care, particularly in reaching patients in remote or underserved areas. Through virtual consultations, patients can access specialized care without needing stressful and often difficult travel. This not only provides them with the best possible medical advice but also ensures that they remain in the comfort of their own homes. Telehealth platforms enable continuous communication between patients, families, and health care teams, keeping everyone aligned and informed about the patient's condition and care plan.</p><h3>Enhancing Pain Management and Comfort</h3><p>Innovations such as smart drug delivery systems, which can administer precise doses of pain medication based on real-time assessments, are transforming traditional approaches to pain relief. These systems can adjust dosages automatically, responding to fluctuations in a patient’s pain levels without the need for constant manual intervention by health care providers. This ensures that patients receive the right amount of medication at the right time, minimizing pain while reducing the risk of overmedication and its associated side effects. </p><p>AI and machine learning algorithms are also being employed to predict and manage pain more effectively. By analyzing data from various sources, AI can identify patterns and anticipate pain episodes before they become severe. This proactive approach allows for preemptive adjustments in pain management strategies, ensuring that patients remain comfortable, and their pain is controlled. Additionally, virtual reality and other immersive technologies are being used to provide patients with non-pharmacological methods of pain relief and relaxation.</p><h3>Personalizing Long term Care through Data and AI</h3><p>The utilization of data analytics and artificial intelligence in long term care is paving the way for highly personalized and effective treatment plans. By harnessing vast amounts of patient data—from medical histories and genetic information to real-time health metrics—AI algorithms can identify unique patterns and trends that inform individualized care strategies. These insights enable health care providers to tailor interventions precisely to the needs and conditions of each patient, ensuring that care is not only more effective but also more respectful of the patient's personal preferences and medical history. For example, predictive analytics can help identify patients who may benefit from early palliative care interventions, thus enhancing their quality of life sooner rather than later.</p><p>AI-driven decision-support tools are also revolutionizing how care plans are developed and adjusted over time. These tools can process complex data sets to generate recommendations for symptom management, medication adjustments, and other critical aspects of care. They provide health care professionals with actionable insights that go beyond traditional clinical guidelines, allowing for more nuanced and responsive care. This level of personalization ensures that long term care is dynamic and adaptable, meeting the evolving needs of patients as their conditions change. Additionally, data-driven approaches can facilitate more meaningful conversations between health care providers, patients, and families about treatment options, ultimately supporting more informed and compassionate decision-making.</p><h3>Ensuring Ethical and Compassionate Care</h3><p>Incorporating technology into long term care necessitates a strong commitment to ethical standards and compassion. While technological advancements offer tremendous benefits, it is crucial to ensure that they are used in ways that uphold the dignity and autonomy of patients. Consent and privacy must be prioritized when collecting and utilizing patient data. Clear, transparent communication about how data will be used and the potential benefits is essential in building trust with patients and their families. Additionally, ethical frameworks must guide the development and implementation of AI and other advanced technologies to prevent biases and ensure equitable care for all patients, regardless of their background or socioeconomic status.<br><span><img src="/Articles/PublishingImages/2023/MelissaPowell.png" class="ms-rtePosition-2" alt="Melissa Powell" style="margin:5px;" /></span></p><p>Compassion must remain at the heart of long term care, even as we embrace technological tools. Technology should enhance, not replace, the human touch that is so vital during this sensitive time. Health care providers must continue to engage with patients and families personally, offering empathy, understanding, and emotional support. Technologies like telehealth can facilitate these connections by enabling more frequent and meaningful interactions. Still, the essence of compassionate care lies in genuine concern and respect for the patient's experiences and wishes. Balancing technological efficiency with ethical considerations and compassionate practices ensures that long term care remains holistic, humane, and centered on the patient's well-being.</p><p>As we continue to navigate this evolving landscape, our ultimate goal must be to provide care that is not only technologically advanced but also profoundly humane.<br></p><p><em>Melissa Powell is </em><em>president and COO of The Allure Group.</em><br></p> | 2024-09-12T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/telehealth2.jpg" style="BORDER:0px solid;" /> | Technology;Management | From innovative medical devices to sophisticated data management systems, technology is not just a tool but a transformative force that is reshaping the landscape of long term care. |
| How NCAL Executive Director LaShuan Bethea Advocates for Residents and Communities | <p>When LaShuan Bethea entered the senior living industry after graduating high school, she had no idea she’d spend the next 25 years in it—let alone that she’d become one of its most important advocates in Washington, D.C., as executive director of the National Center for Assisted Living (NCAL). </p><p>“I never knew that that would be my long-term career option,” she recalled of her first job as an licensed practical nurses at a nursing home. “But I found that as I tried a whole bunch of different types of nursing, I kept coming back to long term care.”<br></p><p>It was the human element of the job that pulled her back over and over again: the opportunity not just to take care of residents, but to spend quality time with them. “I loved engaging with the residents, hearing their story, and getting to know them as individual people and their history,” she said. “There was no other environment where I was able to get that same type of joy. Working with residents and their families, you get this immediate return on the investment that you make in caring for them, because they truly appreciate the work that you do.”<br></p><p>The longer Bethea spent working as a clinician, the more she came to recognize a tension between the realities on the floor and the regulations determining what happens there. However well-intentioned various rules may be, she realized, there was still a gap between the world regulators envisioned and the world as it exists. <br></p><p>“One of the things that became clear to me is there’s this disconnect between the people who write the regulations and what happens when you work in the industry,” she reflected. “I would often find myself saying, ‘There’s no way that a person who worked in our industry could have ever written a rule like this.’ Because they don’t. There’s a disconnect between them and what is happening at the bedside, what’s happening in the day-to-day work that we do.”</p><h3>From the Bedside to the Beltway</h3><p>Instead of navigating around that disconnect, Bethea decided to get to work bridging it. After years working in various nursing home roles—direct care nurse, unit manager, staff development coordinator, assessment coordinator—not to mention earning a JD and an MEd along the way, she started working at Genesis Healthcare in 2007, where she eventually became the operator’s vice president of legislative affairs. The role empowered her to draw upon her time with residents as she worked directly with policymakers, ensuring that the regulations they drafted helped the people they were meant to help. <br></p><p>“It allowed me to take my experience as a nurse and educate the people who make decisions—who make the laws, who make the regulations—about how we do what we do and how the legislation they write impacts us,” she said. “I always saw myself as an educator: I was there to help let them know that we are a resource, we want to collaborate, and we all want the same things—quality care and great outcomes for our residents.”<br></p><p>Having served in a wide range of positions and settings, from the memory care unit to the emergency room, Bethea has seen again and again that there truly is no one-size-fits-all approach to care. No two nursing homes are the same, no two units are the same, and no two care plans are the same, because no two residents are the same. This perspective has long informed her approach to advocacy work on a variety of critical issues, such as the new minimum staffing rule, which she describes as a blanket solution to a complex set of problems that does nothing to address the structural issues causing those problems. In other words, it’s exactly the sort of one-size-fits-all strategy that completely misunderstands how nursing homes work.<br></p><p>“We need a more deliberate approach to how we determine staffing needs, based on the needs of residents in each setting,” she explained. “It’s not the same in every single nursing home, just like it’s not the same in acute care versus post-acute care. A person who comes up with this rule doesn’t recognize that there is a variety of different residents in each of the types of settings that we have.”</p><h3>Being an Effective Voice</h3><p>When Bethea joined NCAL in 2021, her top priority was to hit the road. At Genesis, she advocated for almost 250 facilities in 22 states; now she represented thousands of facilities across every state. To be an effective voice for communities, residents, and employees, she’d have to meet them face-to-face, gaining a deeper understanding of their experiences and needs. <br></p><p>“I wanted to make sure that my voice is reflective of what’s happening in the various settings that I represent,” she recalled. “An assisted living facility in Oregon is very different from one in California, very different from Texas and Maryland. Going into those communities allows me to take that firsthand experience to legislators in D.C., and to make sure they’re aware that you can’t take one piece of legislation and use it to kind of paint that broad brush across the industry.”<br></p><p>Another priority is helping policymakers (and everyone else) understand what assisted living is and how it works. While the industry has received more attention in recent years, Bethea acknowledged that this attention often focuses on negative stories, isolated as they may be. <br></p><p>On one hand, the COVID-19 pandemic helped people understand what distinguishes assisted living from other care settings, such as home health and skilled nursing. On the other hand, common misconceptions remain prevalent—like the notion that assisted living isn’t regulated. The fact that it’s regulated at the state level, Bethea pointed out, is why it’s so misguided for policymakers to approach the sector with a broad brush. “Because it’s different in every state,” she argued, “it’s better to have hands that are closer to what it looks like at that level, rather than make a rule that would apply across all 50 states.”</p><h3>Fostering the Next Generation of Leaders</h3><p>As a leader, Bethea also considers it her responsibility to help cultivate and mentor other leaders. She thinks back to a former mentor at Genesis Healthcare, Marie Quinn, who once gave her some valuable encouragement before an anxiety-inducing presentation to senior executives. <br></p><p>“She said, ‘There’s no one better positioned to present this information than you,’” Bethea recalled. “‘If you go in the room and present as if you are uncomfortable or not confident, then people will receive it that way. But if you go into the room and present this information based on your own experience, the research that you’ve done that you’re confident about, people will walk away from that meeting understanding that you are the person that they need to go to with any questions; that you are the most knowledgeable person on this issue.’” <br></p><p>The pep talk was a game changer. Not only did it inform the presentation she was about to give, it stuck with her throughout every meeting she’s walked into since. “It’s something that I share with other people,” she said. “When I’m doing leadership presentations, I tell them about that experience, because it was so powerful and impactful for me.”</p><h3>‘It Warms Your Heart’</h3><p>Despite the challenges ahead, Bethea is looking forward to the future. She’s especially excited about the potential for new technology, such as wearable health trackers and AI solutions, to transform the assisted living space, making care workers’ lives easier and improving patient outcomes. <br></p><p>“Obviously we need the human touch; it’s a vital part of what we do,” she stressed. “But there are ways that we can complement the staff to be more efficient, and we can do that with AI. I’ve been visiting communities around the country and seeing some of the things that they’re doing, and it’s extremely exciting. We’re just scratching the surface of how technology will help us support our existing workers in our field.”<br></p><p>And, of course, she’s excited to continue doing her favorite part of the job: traveling the country and meeting the people she represents. “When you go into the communities and the nurses and the nurse aides and the other caregivers, like the environmental service and the housekeeping workers—when you see how they engage the residents, it warms your heart,” she concluded. “You can envision your own mom and dad there, enjoying themselves and having the best part of their life being in this community.” <br><br><em>Steve Manning is a freelance writer from New York City.</em></p> | 2024-09-11T04:00:00Z | <img alt="" src="/Issues/2024/Fall/PublishingImages/NCAL.jpg" style="BORDER:0px solid;" /> | Caregiving | Having served in a wide range of positions and settings, from the memory care unit to the emergency room, Bethea has seen again and again that there truly is no one-size-fits-all approach to care. |
| How PharMerica Can Help Facilities Amid New Staffing Mandate Requirements | <p>The Biden Administration’s recently announced minimum staffing rule will require nursing homes to hire an estimated 102,000 nurses and nurse aides, costing approximately $6.5 billion per year. While AHCA/NCAL and other organizations are fighting to prevent the mandate from taking effect, long-term care providers across the country are readying themselves for the additional pressures it will place on their operations.<br></p><p>As a trusted partner to thousands of providers across the country, PharMerica understands that filling prescriptions is just one small part of its role. Its dedicated local account management teams, consultant pharmacists, and nurse consultants provide hands-on support for each client, offering training and resources, conducting monthly medication reviews, participating in QAPI meetings, and integrating themselves into their communities. PharMerica is well prepared to help providers contain costs, enhance efficiencies, and mitigate the negative impacts of new hiring requirements. </p><h3>Streamlining Onboarding and Training</h3><p><img src="/Issues/2024/Fall/PublishingImages/DalePadgett-Pharmerica.jpg" alt="Dale Padgett" class="ms-rtePosition-1" style="margin:5px;" />PharMerica has streamlined its client onboarding process and offers a comprehensive training program. “We not only engage direct stakeholders but also unit-level staff to ensure they understand how to order medications, use the EMR platform, communicate with the pharmacy, refill orders, and manage IVs,” Dale Padgett, senior vice president, client strategy and partnerships, explained. <br></p><p>“We provide essential training,” added Rebecca Wingate, vice president of clinical operations, “especially about pharmacy processes and medication management, policies and procedures, and compliance requirements with regard to anything from high-risk medications to specific disease states like diabetes, CHF, and hypertension.”<br>This training is especially important for facilities dealing with staffing shortages whose clinical infrastructure may be more interim or transitional in nature. PharMerica also enables facilities to address skills gaps among new hires with standard educational offerings that ensure inevitable workforce turnover doesn’t come with negative impacts. </p><h3>Identifying Savings Opportunities to Reduce Operational Costs</h3><p>Meeting new staffing requirements will force facilities to look at other areas to cut costs, and many could save up to 20 percent on pharmacy spend annually. PharMerica’s goal is to explore lower-cost alternatives that maintain equal efficacy, optimize medication usage in terms of dosage and duration, and design specific interventions based on its clients’ referral sources’ prescribing trends.<br></p><p><img src="/Issues/2024/Fall/PublishingImages/Creasy-Pharmerica.jpg" class="ms-rtePosition-2" alt="Stephen Creasy" style="margin:5px;" />PharMerica achieves this goal by developing a personalized approach for each partner facility, recognizing there is no one-size-fits-all approach. “We partner directly with the medical director and the prescribers in the facility, with our consultant pharmacist working hand-in-hand on ordering labs, recommending medication adjustments or gradual dose reductions, and providing education to nursing staff on whatever they may be challenged with,” Wingate said. “Since we’re a guest in that facility, we really try to build that trust and that ongoing collaboration.”<br></p><p>PharMerica develops customized solutions based on a client’s unique circumstances and other relevant factors. “We have a very robust therapeutic interchange program that we administer—where allowed by pharmacy rules and regulations—in which we’re looking for equally efficacious alternatives to higher-cost medications,” Stephen Creasy, senior director, clinical services, explained. “We’re constantly evaluating and looking for new opportunities because we do know how expensive some of these medications are.”<br></p><p>An important part of this approach is identifying and addressing a facility’s unique pain points. In one recent case, a client had a high number of residents using IV medications. “We needed to understand how they train their nurses, and they needed to understand how our nurses help support residents that have IVs,” Padgett recalled. <br></p><p>With 80 percent of nursing homes expected to have to hire more RNs to meet the 24/7 RN requirement, PharMerica’s cost-saving measures can be instrumental in enabling facilities to redirect funds to hiring to comply with the mandate. “By spending less money on medications when there are therapeutic equivalents or other alternatives, they can free up cash flow and regain efficiencies with the nursing staff,” Creasy concluded. “It’s about doing more with less.”</p><h3>An Eagle’s Eye for Compliance Issues</h3><p>In cases where facilities have larger staffing gaps at the nursing or unit levels, PharMerica steps in to help fill them. “We provide a variety of resources to make sure that the facility is able to continue operating compliantly,” said Padgett.<br></p><p><img src="/Issues/2024/Fall/PublishingImages/RebeccaWingate_Pharmerica.jpg" alt="Rebecca Wingate" class="ms-rtePosition-1" style="margin:5px;" />These resources include compliance recommendations, survey preparation and support, and detailed action plans to ensure compliance during transitions and turnover. Then there’s Illuminate, the online educational platform that PharMerica maintains for its partners. “We have webinars where we provide continuing education, clinical resources, quality digests, podcasts, newsletters, bulletins, guides, and comprehensive resources for compliance,” Wingate explained. “We’re very adept at staying ahead of the latest CMS changes and ensuring the success of our customers in regard to compliance changes.” <br></p><p>The regulatory landscape is in constant flux, forcing providers to navigate a complex and ever-changing web of rules and requirements. Last October, for instance, CMS imposed new requirements on the MDS coding of some high-risk medications—and it’s already updating these requirements effective this coming October. “We’re already modifying our reporting that will be available to our client facilities, so they will be able to do that portion of the assessment much quicker,” Creasy said.<br></p><p>By keeping abreast of developments at the state and federal levels, PharMerica helps ease the burden on its partners—an especially valuable level of support as they deal with the additional pressures of the new staffing rule. <br></p> | 2024-09-11T04:00:00Z | <img alt="" src="/Issues/2023/Fall/PublishingImages/Pharmerica.jpg" style="BORDER:0px solid;" /> | Workforce | PharMerica develops customized solutions based on a client’s unique circumstances and other relevant factors. |
| Suicide Risk in Older Men Is a Growing Challenge for LTC Providers | <p><img src="/Articles/PublishingImages/740%20x%20740/sad_senior_man.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />In late 2023, an assisted living facility in southeastern Pennsylvania was shocked by the suicide of an 81-year-old resident. No one had any idea that he was at risk of suicide. No one realized that four men aged 75 and older take their lives in that state every week, and well over 700 men aged 65 and over die by suicide in the United States each month.</p><p>In-house suicide risk among long term care providers is increasing with a steadily growing segment of residents. Men aged 75-85 and older have long had the highest suicide rates of any age group. This tragic distinction will persist and worsen in coming decades as Baby Boomers, a generation characterized by a high incidence of suicide across the lifespan, age out.</p><p>Suicide risk in older men must be acknowledged and aggressively addressed. Little suicide prevention targets the “oldest old” in general and less still focuses on the oldest men. More problematic is a comparable lack of awareness of the problem among those who serve and advocate for older adults. </p><h3>Know the Risk Factors of Suicide</h3><p>Providers must be familiar with the major risk factors for suicide in older men:<br></p><ul><li>Caucasian </li><li>History of suicidal behavior or self-injury</li><li>Physical/psychological harm/sexual assault/domestic conflict</li><li>Social disconnectedness and isolation</li><li>Financial loss/insecurity/exploitation</li><li>History or presence of psychiatric disorders</li><li>Chronic illnesses; disabilities; other impediments to independent living</li><li>Veteran; military service</li></ul><p>Suicidal thoughts may arise after a hospitalization that results in chronic pain, impaired mobility, reduced autonomy, or other conditions limiting self-care. </p><h3>Circumstances Conducive to Suicide Risk</h3><p>Providers must pay attention to conditions that may trigger suicidal thoughts in older men such as:<br></p><ul><li>Loss of spouse or partner</li><li>Depression and anxiety</li><li>Worsening of a long term chronic illness</li><li>Onset of comorbid medical/neurological illness</li><li>Feeling a loss of dignity and control</li><li>Pessimism and seeing life as pointless</li></ul><p>Providers should be alert to suicide risk in new residents. Giving up one’s home, community ties, and residing with a spouse or partner are disruptive and traumatizing experiences. These factors are aggravated when such life transitions occur because of an inability to manage activities of daily living or the death of a caregiver spouse. </p><h3>How Suicide Attempts Happen</h3><p>The prevailing theory of suicide posits two prerequisites to a potentially fatal suicide attempt: (i) an extremely strong desire to die; and (ii) the capability for lethal self-harm. Intent to die arises from a strong belief that one is a burden to others and/or the belief that one does not belong.</p><p>Negative self-perceptions can produce a desire to die. These may lead to a sense of entrapment and defeat. Burdensomeness follows from thinking that one’s death may be more valued than one’s life. A lack of belonging flows from an unmet need for social relationships and a belief that one is not cared for by relatives and friends. Internalization of ageist views may also foment suicidal thinking.</p><p>An ability for lethal self-injury must be present for suicidal desire to become suicidal action and override the instinct for self-preservation. Attempting suicide requires the capability for serious self-harm. This is fostered by an elevated pain tolerance, a diminished aversion to severe injury, and a reduced fear of death.</p><p>Exposure to hurtful, painful, or violent experiences such as self-neglect and self-injury, elder abuse, interpersonal violence, and other types of trauma promote suicide capability. Repeated physical abuse may bring about indifference to living and lower resistance to both thoughts and acts of self-harm.</p><h3>Warning Signs of Suicide</h3><p>Providers must recognize behaviors possibly signaling the presence of suicidality. Examples are statements about being a burden to spouse or family or that they would be better off if he were dead. Other warning signs include:<br></p><ul><li>Feeling useless, purposeless, and hopeless</li><li>Increasing alcohol use or misuse of prescription medications</li><li>Withdrawing from family, friends, or community activities</li><li>Major mood shifts</li><li>Onset of anxiety, agitation, and sleep problems</li></ul><p>Sadly, signs such as these appear all too evident after a suicide. They may be missed in older men who live alone, have minimal social connections, do not engage with caregivers or deliberately hide their feelings. </p><p>Immediate intervention (911) is necessary when imminent danger is indicated by:<br></p><ul><li>Threats of serious self-injury or suicide</li><li>Seeking lethal means such as weapons, medications, toxins</li><li>Voicing an actionable suicide plan giving the when, how, and possibly where </li></ul><h3>Screening for Suicide Risk</h3><p>Screening is a means of detecting thoughts or actions that may signal danger. It generally relies on a structured instrument that distinguishes where a particular individual stands in relation to selected suicide risk factors.</p><p>A suicide risk screener should be brief, easy to use, and have demonstrated validity. An example is the Columbia-Suicide Severity Rating Scale (C-SSRS), which is freely available online and does not require any special training. </p><p>The C-SSRS consists of six questions:<br></p><ol><li>Have you wished you were dead or wished you could go to sleep and not wake up?</li><li>Have you had any thoughts of killing yourself?</li><li>Have you been thinking about how you might do this?</li><li>Have you had these thoughts and had some intention of acting on them?</li><li>Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?</li><li>Have you ever done anything, started to do anything, or prepared to do anything to end your life?</li></ol><p>Suicide risk screening and assessment is not a “one and done” event in older men.</p><h3>Concluding Comments</h3><p><span><em><img src="/Articles/PublishingImages/2024/Tony%20Salvatore.jpg" alt="Tony Salvatore" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" /></em></span>Given the inherently high risk of suicide in older men, providers must accept that it may occur in their facility at some point. They must create a context for suicide prevention by making it a policy and practice. There must be ongoing suicide prevention training for all staff and routine resident suicide risk-screenings. Providers must accept that the emergence of suicidal ideation among residents is a hazard akin to falls and infection and treat it similarly. <br><br><em>Tony Salvatore, MA, is the director of suicide prevention at Montgomery County Emergency Service in Norristown, PA. He has a background in home care and long term care and has published several articles on older adult suicide prevention in those settings. He may be contacted at tsalvatore@mces.org.</em><br></p> | 2024-09-05T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/sad_senior_man.jpg" style="BORDER:0px solid;" /> | Caregiving | Suicide risk in older men must be acknowledged and aggressively addressed. Little suicide prevention targets the “oldest old” in general and less still focuses on the oldest men. |