| Why the Right Hot Water System Matters in Senior Care | <p><img src="/Articles/PublishingImages/740%20x%20740/water.jpg" alt="hot water" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />Access to hot water is essential. We depend on it for comfort and for cleanliness, whether it’s for showers or for washing the evening’s dishes.</p><p>Senior living communities are no exception. In fact, access to reliably hot water may be especially important for these facilities, where it’s a major aspect of daily care routines.</p><p>From resident showers and laundry services to kitchen operations and infection control, access to hot water promotes a positive resident experience and allows caregivers to complete their work efficiently. To ensure that kind of access, it’s important to have the right equipment, including a water heating system that’s correctly sized to match the facility’s needs.</p><h3>When the Water Heater Is the Wrong Size</h3><p>When senior living communities have inadequate water heating systems, it can cause a number of unwanted complications.<br></p><ul><li>Inconsistent water temperatures can disrupt the daily routines of residents—leading to dissatisfaction and even hygiene concerns.</li><li>Similarly, there may be complaints from employees, whose ability to fulfill their daily caregiving functions can be compromised by inconsistent water temperatures.</li><li>Trying to serve the entire community with undersized or inefficient equipment can put a strain on the entire plumbing apparatus, contributing to expensive repair needs and premature equipment failure.</li><li>Outdated or poorly sized equipment may also elevate utility bills, meaning it can be an ongoing budgetary concern for the entire facility.</li></ul><p>For these reasons, it’s crucial for the management and facilities teams of any senior living community to verify that their water hearing system is appropriately sized to meet everyday needs.</p><h3>Key Considerations for Water Heater Selection</h3><p>When it comes to choosing the right water setup, there’s no one-size-fits-all solution. Different senior living communities will have different needs, and it’s important to work with a trusted installer who can provide some guidance.</p><p>One factor that will always prove determinative is demand. Water heater sizing depends on the number of rooms and appliances within the community, but also peak demand times—for example, if there are certain blocks of the day when most residents bathe or shower, it’s important to have a water heating system that can accommodate.</p><p>Setpoint delivery is a common concern when selecting a water heating system, and in most commercial contexts, a setpoint temperature of 140 degrees is recommended. Because senior living communities need water hot enough for sanitization purposes, a setpoint temperature of 180 degrees may be required.</p><p>Still another major concern is the footprint of the mechanical room itself. Simply put, it’s important to choose water heaters that can get the job done while still fitting in the allocated space—leaving some room for maintenance and servicing. Take into account piping, venting clearance and more, remembering that the spatial limitations of the mechanical room may dictate the number and size of tanks used (or in some cases, dictate the need for tankless heaters).</p><h3>Optimizing Hot Water Delivery in a Senior Living Community</h3><p>There are a number of things facilities managers can do to optimize the performance of their water heating system, both during the initial system setup and over the long haul.</p><p>First things first: For any kind of residential facility, water heater redundancy is highly recommended. Sharing the load between multiple units not only ensures greater consistency for residents, but it also means that if one unit malfunctions, there can still be at least some measure of hot water availability for the broader facility.</p><p>A particular concern in senior living communities is resident safety; scalding may be a real concern, but there are ways to minimize danger. Installing mixing valves can regulate water temperature before it reaches the tap, a critical way of averting potential accidents among the most vulnerable residents.</p><p>When investing in new water heating equipment, it’s always important to ask about maintenance—not just the required maintenance (necessary to keep the warranty valid) but also suggested maintenance, which can extend the unit’s longevity. Visual assessment and anode rod inspections are critical for keeping water heaters in good working order.</p><p>For larger facilities, integration with a building management system is another important way to remain vigilant about preventing significant issues—potentially addressing them before they become serious, and before they disrupt daily operations.</p><h3>The Right Hot Water System Is Key</h3><p>Having a dependable hot water source is necessary for any residential space—and it may be particularly important in senior living centers, where safety and sanitation concerns loom large. Facility managers have plenty of options to consider, including different fuel types, tank sizes and tankless options—and making the right choice for the facility can yield many long-term benefits.<br><br><em>Keith Kuliga is the mechanical sales support – commercial products for <a href="https://www.bradfordwhite.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Bradford White Water Heaters,</a> an American manufacturer and five-time ENERGY STAR</em><sup><em>®</em></sup><em> Partner of the Year.</em><br></p> | 2025-07-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/water.jpg" style="BORDER:0px solid;" /> | Caregiving | From resident showers and laundry services to kitchen operations and infection control, access to hot water promotes a positive resident experience and allows caregivers to complete their work efficiently. |
| Why Orientation and Ongoing Training Matter for Reducing Turnover | <p><img src="/Articles/PublishingImages/2025/staff2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:300px;" />The long term care industry is no stranger to high turnover rates. In fact, according to the 2023 AHCA/NCAL survey, the average turnover rate for nursing staff in skilled nursing facilities hovers around 53 percent, with some facilities facing even higher rates. Yet behind every statistic is a resident waiting for consistent, compassionate care—and a team struggling to keep up.</p><p>Too often, we point fingers at wages or staffing ratios when part of the cause of turnover lies in how we onboard, support, and develop our teams. If we don’t give new hires the tools, mentorship, and ongoing training they need to succeed, they won’t stay. And when they leave, our residents and remaining staff pay the price.</p><p>It’s time to rethink our approach. Orientation and ongoing training aren’t optional extras; they are essential investments in quality care, staff engagement, and retention.</p><h3>Why Orientation Matters More Than Ever</h3><p>Onboarding isn’t just a checklist of HR paperwork and a quick tour of the building. It’s the first impression new employees get of the organization’s culture, and it can set the tone for whether they stay or leave. <a href="https://www.glassdoor.com/blog/hidden-costs-employee-onboarding-reduce/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteForeColor-2">Research indicates that 69 percent of employees</span></a> are more likely to remain with a company for at least three years if they experience a positive onboarding process.</p><p>Best practices for an effective orientation include:<br></p><ul><li>Customized role-specific training. Ensure that RNs, LPNs, CNAs, and ancillary staff each receive targeted content relevant to their scope of practice.</li><li>Peer mentorship. Pair new hires with experienced staff mentors who can provide hands-on support during the first 30-90 days.</li><li>Mission-driven integration. Introduce the facility’s values, resident population, and team expectations—not just policies and procedures.</li></ul><h3>Ongoing Training: The Secret to Retention</h3><p>Orientation is just the beginning. Ongoing training—both clinical and interpersonal—keeps staff engaged, competent, and connected. Facilities that invest in regular skill development, leadership pathways, and cross-training report lower turnover and higher staff satisfaction.</p><p>Strategies include:<br></p><ul><li>Quarterly in-services tied to real challenges, like dementia care techniques, infection prevention updates, and PDPM documentation skills.</li><li>Leadership development programs for CNAs and nurses interested in career growth.</li><li>Hands-on coaching. Administrators and DONs who round daily, offering real-time feedback and support, help staff feel seen and valued.</li></ul><p>For example, a 120-bed SNF in Texas saw a 22 percent reduction in CNA turnover after implementing a structured CNA career ladder program that included quarterly training sessions and mentorship opportunities. Another facility in Ohio embedded a “Culture of Learning” model, offering monthly education tailored to their quality priorities, and reported improved staff engagement scores and a 15 percent drop in overall turnover.<br></p><h3>The Cost of Inaction</h3><p>When facilities neglect orientation and training, they pay for it—literally. The estimated cost of replacing a single CNA is over $5,000, not to mention the impact on resident care and survey readiness. Multiply that across multiple roles, and the financial and human costs become staggering.</p><p><img src="/Articles/PublishingImages/2025/Veronica-Ceasar.jpg" alt="Veronica Ceaser" class="ms-rtePosition-2" style="margin:5px;" />If we want to create nursing homes where staff thrive—and residents receive the quality care they deserve—we must start by rebuilding our orientation and training processes. It’s not enough to hire people; we must invest in them.</p><p>Turnover is a symptom. Training is part of the cure.<br><br><em>Veronica Ceaser, MBA, MSN, LNHA, RN, GERO-BC, QCP, RAC-CT, is a long term care consultant and the founder of GEM Healthcare Consulting. With a background spanning bedside nursing to executive leadership, Ceaser specializes in MDS training, quality improvement, and regulatory readiness for skilled nursing teams across the U.S.</em><br></p> | 2025-06-17T04:00:00Z | <img alt="" height="740" src="/Articles/PublishingImages/2025/staff2.jpg" width="740" style="BORDER:0px solid;" /> | Turnover | If we want to create nursing homes where staff thrive—and residents receive the quality care they deserve—we must start by rebuilding our orientation and training processes. It’s not enough to hire people; we must invest in them. |
| Long Term Care Voices in Research: What We Are Doing and Why | <p><img src="/SiteCollectionImages/logos/ahcancal_740.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />AHCA/NCAL helps shape and execute federally-funded research across the country that will deliver solutions to our members. We are action-oriented—we want to find out what works to achieve better outcomes in post-acute and long term care (LTC). Our involvement spans different levels of effort, and includes advising, recruiting research participants, and implementing new strategies to evaluate. We and our research partners, who are often universities, are funded by the National Institutes of Health (NIH), National Institute on Aging (NIA), the Patient-Centered Outcomes Research Institute (PCORI), and others. </p><h3>Why do we prioritize research on effectiveness?</h3><p><strong>1.    Most studies on the effectiveness of treatments do not include older adults.<sup>1</sup></strong>  Most clinical trials enroll a younger population. The under-representation of older, medically-complex adults in clinical trials has real-world effects. For example, the use of semaglutide (e.g., Ozempic) is on the rise, and not just among younger patients. Yet, we don’t fully know the effects on an older population. Additionally, individuals receiving care in long term care settings—particularly people living with dementia—are frequently excluded from clinical trials. Building the capacity to help test treatments in older adults with a wider range of conditions will yield better information to improve care delivered in long term settings. That is one of the reasons AHCA established the <a href="/Issues/2024/Winter/Pages/Celebrating-the-Center-for-Long-Term-Quality-%26-Innovation’s-10th-Anniversary.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Center for Long-Term Care Quality & Innovation</a> at the Brown University School of Public Health 10 years ago.<br><strong>2.    We want to deliver solutions.</strong> The bulk of published literature about the LTC setting focuses on analysis of trends in outcomes over time or for specific populations. These types of studies are just the first step. We often already know where the opportunities for improvement are, so we want to encourage more attention on evaluating what strategies and interventions can achieve different—and better—resident outcomes. <br><strong>3.    We want to increase learning and development opportunities for professionals working in LTC settings. </strong>Research that yields information on what works for improving outcomes for older adults, and how new clinical practices and treatments can be implemented in nursing homes and assisted living communities, will generate an evidence base that LTC setting professionals can use. This evidence base is just one piece of what is needed to create a learning health system<sup>2</sup> within LTC settings. A learning health system creates development and career opportunities for professionals, attracts and retains leadership and staff who are committed to continuous improvement, and identifies additional topics for future research.<br></p><h3>How is AHCA/NCAL supporting effectiveness research in LTC? Some examples:</h3><ul><li><strong><a href="https://www.ltcdatacooperative.org/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">LTC Data Cooperative.</a> </strong>The LTC Data Cooperative is a provider-led initiative that is funded by NIA and involves a partnership with Brown. It assembles electronic health record (EHR) data from the major LTC EHR vendors on behalf of provider organizations that choose to participate. This resource is developed with minimal burden to providers. The Research Review Committee, with a majority of providers as members, reviews proposals from researchers to use these data for two approved uses: observational, comparative effectiveness research or clinical trials. Data may be linked with Medicare and Medicaid claims for research purposes.</li><li>Led by Brown, the University of Pittsburgh, and Boston University with funding by NIH, <a href="https://sites.brown.edu/learrn/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Learning Health Systems Research Rehabilitation Network (LeaRRN)</a><strong> </strong>funded two types of projects: 12-month partnerships between rehabilitation researchers and health systems to research topics of interest to the health system, and pilot grants to research priority topics to test and improve rehabilitation science in LTC settings.</li><li><strong><a href="https://sites.duke.edu/prism/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Prevention of Injury in Skilled Nursing Facilities through Medication Optimization (PRISM).</a></strong> Funded by PCORI, this trial compares three evidence-based approaches to determine which is better at reducing falls with injury after a fracture, and which has fewest adverse side effects and other symptoms. A fracture nurse consultant identifies eligible patients at participating skilled nursing facilities and works with them (or their representatives) remotely to recommend potential ways to either (1) reduce medications that increase risk of falls, (2) increase osteoporosis medications, or (3) both. The study will compare the outcomes of people who received each of these approaches.</li><li><strong><a href="https://www.cdc.gov/project-firstline/programs/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Project Firstline and Building Trust Leadership Academy.</a></strong> Funded by the Centers for Disease Control and Prevention (CDC), AHCA has developed a library of infection prevention and control resources housed at the <a href="https://www.ahcancal.org/Quality/Pages/NIPF.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">National Infection Prevention Forum (NIPF)</a>. The NIPF invites Infection Preventionists in LTC to share questions and answers with each other in an online format. Similarly, AHCA has developed and evaluated the Building Trust Leadership Academy, which brings together LTC leaders in live online sessions to follow evidence-based practices in assessing and improving levels of trust within buildings.</li></ul><h3>Why is federal funding for research important to nursing home and assisted living owners and operators? </h3><ul><li>Increasing the evidence for what works to improve outcomes—whether it’s care practices, staff education, or treatments—can help guide policy, regulations, and operations, which could yield benefits both clinically and financially.</li><li>For example, we learned during the COVID-19 pandemic that getting faster, more accurate understanding of outcomes from real-world data like the EHR data in the LTC Data Cooperative can guide action and policy to save lives in LTC.</li><li>Federal funding for research helps to attract new scientists to study important questions that are relevant to our sector—and get answers to the challenges we will face as the older population expands and the demand for post-acute and LTC increases. </li></ul><div><h3>Key points:</h3><ul><li>Older, medically complex adults are frequently excluded from clinical trials, even if they will be frequent end-users of the treatments being tested.</li><li>AHCA/NCAL supports projects in LTC settings like the LTC Data Cooperative, LeaRRN, PRISM, and others that investigate the effectiveness of care and treatments for older adults – and create actionable findings for our members.</li><li>Protecting federal research funding conducted in the long term care sector is imperative to improve outcomes for the expanding older population.</li></ul><br></div><div><br></div><ol><li><span class="ms-rteStyle-Normal">Schwartz, JB. Current status of inclusion of older groups in evaluations of new medications: Gaps and implementation needs to fill them. J Am Geriatr Soc. 2024;72:2894–2902. DOI: 10.1111/jgs.18912.</span></li><li><span class="ms-rteStyle-Normal">Agency for Healthcare Research and Quality, Rockville, MD. About Learning Health Systems. Accessed at: </span><a href="https://www.ahrq.gov/learning-health-systems/about.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteStyle-Normal">https://www.ahrq.gov/learning-health-systems/about.html. </span></a></li></ol><div>Rev: 6.17.25</div> | 2025-06-10T04:00:00Z | <img alt="" src="/SiteCollectionImages/logos/ahcancal_740.jpg" style="BORDER:0px solid;" /> | Policy;Caregiving | AHCA/NCAL helps shape and execute federally-funded research across the country that will deliver solutions to our members. |
| What You Can Do to Prepare for a Data Incident | <p><img src="/Articles/PublishingImages/740%20x%20740/dr_computer.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />While long term care and senior living organizations may not be able to prevent a data incident, there are many steps an organization can take to prepare.<br></p><h3>Know Your Data</h3><p>The first step in preparing for a data incident is to understand the landscape, including the applicable regulatory schemes, your organization’s contractual and other commitments, and the individually identifiable data it maintains and transmits.</p><p>A threshold question is whether HIPAA and its breach notification requirements will apply. HIPAA applies to health care providers billing federal or commercial payors or engaging in other “standard transactions” using prescribed forms, including electronic coordination of benefits or enrollment activities, which will include most skilled nursing facilities, home health agencies, hospices, and certain assisted living facilities. Vendors supporting long term care organizations will be regulated by HIPAA if their services involve using or disclosing protected health information.</p><p>Organizations falling outside of HIPAA that provide electronic health care offerings, including websites and apps that track fitness, sleep, and diet, as well as vendors that provide services to such organizations, may be subject to the breach notification requirements of the FTC’s Health Breach Notification Rule.</p><p>In addition, each state has a data breach notification law. While similar, the varying state provisions defining the types of data deemed to be personal information and the types of events that trigger a breach can pose challenges for organizations serving individuals across multiple states. For example, certain states consider health information to be personal information while others focus on Social Security numbers, driver’s license numbers, and financial account information.</p><p>In addition to understanding applicable laws and regulations, long term care and senior housing entities should understand their organization’s contractual commitments, as well as its policies and any public-facing commitments. For example, vendors in the long term care space should understand data incident reporting requirements of any HIPAA business associate agreements that they have executed, and an organization with a website privacy policy or a HIPAA Notice of Privacy Practices should take into account any commitments made in those documents regarding incident or breach notification.</p><p>Finally, in order to prepare for a data incident, a long term care or senior housing organization should understand what individually identifiable data it holds, where that data is maintained, and, to the extent applicable, where and how that data is transmitted. This will include resident and patient data as well as other types of sensitive data, including employee/board member/volunteer/vendor personal information, financial information on individuals or entities, and any data held by sponsors of self-insured health and welfare plans on plan beneficiaries. Your organization should understand on which servers or other locations it stores which data; which apps, systems, or other methods are used to transmit data; and the persons or entities who receive individually identifiable data from your organization.<br></p><h3>Analyze Risks and Make a Plan</h3><p>Your organization should take what you learned about your data, applicable laws and regulations, and relevant commitments and apply those elements to risk analysis and management and incident preparation. One of the best ways to prepare for a data incident is to conduct a comprehensive and enterprise-wide security risk analysis. This is a requirement for entities regulated under HIPAA and other cybersecurity compliance structures, such as an International Standards Organization (ISO) certification, and it is a vital best practice for every organization. </p><p>A risk analysis can be conducted internally by information security and compliance personnel or externally by a vendor to analyze risks and vulnerabilities to confidential data across the organization. This analysis should be conducted at least annually and should be a living document, updated to reflect any new service lines, processes, or technology.</p><p>Long term care and senior housing organizations should take the results of a security risk analysis and create a risk management plan, focusing on eliminating or mitigating areas of high risk and progressing down to areas of lower importance. This process can be structured in a manner that is manageable for the organization and that allows different individuals to tackle issues simultaneously under a centralized plan. <br></p><h3>Training Staff and Vendors</h3><p>As organizations look to address identified risks, it is important to ensure that their data security program addresses risks related to two common “weakest links”—personnel and vendors. HIPAA, certain state laws, and other certification requirements mandate that organizations implement data security training. While this can be accomplished with a template online module, providing personnel with focused, role-based data security training may result in greater security awareness. Entities also should provide training updates, reminders, and tailored responses to identified threats or actual incidents.</p><p>Vendor diligence and security controls also are critical to preventing data incidents, and vendor contracts can be used as a vehicle to require the vendor to maintain certain security standards to protect confidential data, to specify incident reporting requirements, and to require indemnification for data incident-related liability. <br></p><h3>Formulate an Incident Response Plan</h3><p>Another key component to preparing for a data incident is an organization’s incident response plan. Similar to a security risk analysis, the incident response plan must be a living document that is updated to account for personnel changes within the organization, new vendors, identified risks, and other organizational changes. It should outline your incident response team, including internal personnel and external vendors, as well as the responsibility allocated to team members. The plan should be structured in a way that describes how the organization will respond to specific types of incidents and the risks identified by your organization.</p><p>The incident response plan also should include template documents to facilitate a rapid response at the time of an incident. For example, your organization can prepare template data breach notifications for regulators, individuals, consumer reporting agencies, and the media. The plan also can include communication templates for internal and external stakeholder notifications.</p><p>The final implementation step is to ensure that your incident response team, as well as all of your organization’s personnel, understand the protocols in place for an incident or potential incident. The incident response team should conduct periodic tabletop exercises to simulate an incident and practice the organization’s response. Lessons learned and gaps identified should be addressed in an update to the incident response plan.</p><p><img src="/Articles/PublishingImages/2025/ValerieBreslingMontague.jpg" alt="Valerie Breslin Montague" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />While your organization may not be able to thwart a data incident, resources invested into planning for one may result in greater security for confidential data, faster identification of a potential issue, and more efficient data event response.<br><br><em>Valerie Breslin Montague is partner at Nixon Peabody LLP and a Certified Information Privacy Professional/United States (CIPP/US), the preeminent credential in the field of privacy.</em><br></p> | 2025-06-03T04:00:00Z | <img alt="© <a href='https://www.123rf.com/profile_rawpixel'>rawpixel</a>, <a href='https://www.123rf.com/free-images/'>123RF Free Images<" src="/Articles/PublishingImages/740%20x%20740/dr_computer.jpg" style="BORDER:0px solid;" /> | Caregiving | Your organization should take what you learned about your data, applicable laws and regulations, and relevant commitments and apply those elements to risk analysis and management and incident preparation. |
| AHCA's Better Way to Support an Aging America | <p>Our country has a growing elderly population. More people than ever will need long term care. It is critical that our nation’s leaders prioritize, support, and invest in America’s seniors and their caregivers.</p><p>Keep in mind that the oldest baby boomers turn 80 in 2025, and there are more than four million people turning 80 in the next five years. America will have 18.8 million people over the age of 80 in 2030. </p><h3>Obstacles to Progress</h3><p>Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage: workforce shortages, threats to reimbursement, and a broken oversight system.</p><h3>How We All Win</h3><p>At the American Health Care Association (AHCA), we believe there is A Better Way forward, and we stand ready to offer bold solutions that benefit all stakeholders. <br></p><p><img src="/Issues/2024/Winter/PublishingImages/CPorter_740_web.jpg" alt="Clif Porter" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />“There is a better way forward where we not only sustain the high-quality care that our nation's seniors deserve, but grow and transform it to meet the evolving demands of an aging population," said Clif Porter, president and CEO of AHCA. “Our 2025 policy priorities are proactive solutions that put residents and their caregivers first—without unnecessary bureaucratic hurdles that stifle progress and risk limiting access to care. These policies ensure residents are the center of all policy discussions, and quality is at the core of every solution. We stand ready to work with policymakers to protect access to care and continue delivering for America's aging population."<br></p><p>Seniors and their families need quality, choice, access, and clear information. Caregivers deserve jobs that grow with them, competitive pay and benefits, and opportunities to develop skills and careers. Providers are looking for sustainability and growth, support for improvements to modernize, and an environment to foster innovation. Policymakers must create efficiencies, ensure accountability and transparency, and provide a better return on investment. </p><h3>AHCA 2025 Policy Agenda</h3><p>Our work will remain centered on finding efficient and effective solutions that support the continued delivery of high-quality care to our nation’s seniors and individuals with disabilities.</p><p>To achieve those goals, we will prioritize the following:<br></p><ul><li>Strengthening the long term care workforce.</li><li>Protecting Medicaid.</li><li>Reaffirming the promise of Medicare Advantage.</li><li>Rationalizing the regulatory environment.</li></ul><h3>Strengthening the Long Term Care Workforce</h3><p>Nursing homes have been slowly recovering from historic workforce losses during the COVID-19 pandemic. Despite unprecedented efforts to recruit and retain workers, including the highest wage rate increases across health care, nursing homes struggle to compete for workers. While every other health care sector has rebounded, nursing homes still need more than 47,000 workers to return to our pre-pandemic workforce levels.<br></p><p>As the population ages, the demand for long term care is increasing, but younger population is not keeping pace, leading to a growing caregiver shortage. Meanwhile, retirements and COVID-19 are accelerating the shortage as many caregivers have left or are leaving the profession entirely. Across health care, approximately 100,000 registered nurses (RNs) left the workforce, and another 600,000 RNs intend to leave the health care profession by 2027. <br></p><p>It is estimated that by 2028, there will be a nationwide shortage of 100,000 health care workers. The biggest projected deficit is among nursing assistants, the backbone of the long term care workforce.<br></p><p>The shortage of caregivers is creating a challenge in access to care. Workforce shortages in long term care have forced many nursing homes and assisted living communities to limit or deny new admissions, downsize their facilities, or close altogether. Since 2020, 774 nursing homes have closed, displacing 28,000 residents. The overall decline in the number of nursing homes accelerated by nearly four times compared to pre-pandemic rates.</p><h4>A Better Way</h4><p>Our solutions for the workforce shortage are multipronged. They include building a stronger pipeline by addressing faculty shortages at nursing schools and streamlining legal pathways for international caregivers to work in the United States. To boost recruitment and retention, we support student loan forgiveness tax credits, affordable housing, and childcare incentives, along with subsidies and grants to schools whose graduates work in long term care.<br></p><p>Grants and scholarships should be available for ongoing training and career ladder programs should be expanded. We also need to expand the ability of nursing homes to offer in-house training programs to develop nurse aides. We will push Congress to help us permanently ban unrealistic staffing mandates and advance these more meaningful workforce solutions. </p><h3>Protecting Medicaid</h3><p>Medicaid is the lifeblood of long term care. Nearly two-thirds of nursing home residents rely on Medicaid to cover their care. In many states, Medicaid fails to cover the actual cost of nursing home care (on average, 82 cents on the <br>dollar), leaving providers with a significant financial shortfall. Chronic underfunding makes it difficult to invest in <br>the nursing home workforce, care services, and modernization. For some providers, it means closing their doors altogether.</p><h4>A Better Way</h4><p>We must protect and defend Medicaid from cuts. Federal policymakers should require that Medicaid rates be brought up to equal the cost of care and regularly updated to keep pace with increasing operational costs. </p><h3>Reaffirming the Promise of Medicare Advantage</h3><p>Medicare Advantage (MA) plans have seen tremendous growth, as more seniors are attracted to their many perks (out-of-pocket limits, vision, dental, hearing, and other supplemental benefits). More than half (54 percent) of eligible Medicare beneficiaries are enrolled in Medicare Advantage.<br></p><p>Yet, we’re hearing many concerns about MA plans, especially when it comes to access. As patients get sicker, MA plans are too often denying or delaying seniors’ access to necessary post-acute care, including in skilled nursing facilities. From 2019 to 2022, the top three MA insurers denied prior authorization requests for post-acute care at higher rates than for other types of care. As a result, the rate of seniors in the final year of their lives leaving MA plans for traditional Medicare doubled from 2016 to 2022, leaving taxpayers with the bill.</p><h4>A Better Way</h4><p>Seniors have earned the right to make choices and changes, and have timely access to medically necessary care. We must put the power to determine the course of care in the hands of medical professionals and patients, rather than in artificial intelligence or insurers. MA transparency and the rating system should be enhanced, so seniors can make informed decisions. <br></p><p>Market competition should be fostered, so seniors have options to select the best plan. And we need to make sure patients, policymakers, and taxpayers are getting the best deal by encouraging insurers to work with providers <br>to improve outcomes and reduce costs through shared savings programs. </p><h3>Rationalizing the Regulatory Environment</h3><p>We all want safe and high-quality nursing homes. But for decades, America has struggled with a broken oversight system that has failed to produce real change. Federal regulators pile on regulations, guidance, and penalties, while administering enforcement disproportionately. <br></p><p>The current system is inconsistent and ineffective. It does not drive quality improvement among nursing homes or enhance quality of life for residents. Stakeholders across long term care are unsatisfied with the results, and policymakers aren’t getting a return on their investment. </p><h4>A Better Way</h4><p>We must create more effective and balanced oversight that prioritizes quality care while maintaining safety, accountability, and transparency. We can do that by rationalizing the regulatory environment through a variety of areas, including: <br></p><ul><li>Updating the Five-Star Quality Rating System to provide more complete and useful information to consumers. </li><li>Expanding risk-based surveys nationwide to reduce survey backlog, recognize higher-quality facilities, and incentivize more facilities to qualify.</li><li>Improving access to the Civil Monetary Penalty Reinvestment Program to increase use of funds on quality-improvement initiatives and allow them to be used for workforce programs and technology investments to enhance care. </li><li>Strengthening the Special Focus Facility Program to help poorly performing facilities get better and out of the program. </li></ul><h3>Quality at the Core</h3><p>AHCA is dedicated to our mission of improving lives by delivering solutions for quality care. By showing policymakers A Better Way to prioritize, support, and invest in long term care, we can deliver for our residents and patients as well as those who care for them. <br></p> | 2025-06-01T04:00:00Z | <img alt="" src="/Issues/2025/Summer/PublishingImages/Better-Way.jpg" style="BORDER:0px solid;" /> | Caregiving | Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage. |
| Matching the Mindset of Active, Independent Baby Boomers | <p><img src="/Issues/2025/Summer/PublishingImages/SilverTsunami.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />With the so-called silver tsunami of aging baby boomers well on its way, long term care operators have no choice but to adapt to this new generation of customers—if they haven’t already. <br></p><p>One of the most important paradigm shifts is in the mindset of the new consumer base. Unlike previous generations, baby boomers don’t plan to slow down as they retire; they plan to continue living active, independent lives. <br></p><p>“They have a growth mindset and are looking for engagement and independence,” explained Rita Mabli, president and CEO at United Hebrew of New Rochelle. “They want to maintain their lifestyle, not give it up. They value living with purpose, lifelong learning, and staying connected to their communities through giving back and maintaining creative pursuits.”<br></p><p><span><img src="/Issues/2025/Summer/PublishingImages/Rita-Mabli.jpg" alt="Rita Mabli" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span>This means operators have to change their mindset, as well, down to the very words they’ve used for decades. As Moti Gamburd, CEO of CARE Homecare, pointed out, many boomers are “allergic to terms like ‘elderly’ or ‘retirement care.’” From their perspective, they’re not retiring but entering a transitional period. <br></p><p>“Many of our clients are still running businesses, going to music festivals, or raising grandchildren,” Gamburd explained. “The senior care format—like communal meals at set times, home activities, and transportation system—can feel infantilizing. If you don’t acknowledge that in your services and your messaging, you lose them.”<br></p><p>A 2023 American Seniors Housing Association (ASHA) report illustrated the growing aversion to that conventional format. Almost 100 percent of respondents indicated a desire to remain independent and self-sufficient, according to Senior Housing News, with roughly a third reporting that they don’t want or need help with activities of daily living. As Trilogy Health Services administrator Anthony Wilson wrote for the National Investment Center for Seniors Housing & Care (NIC) last year, the days of the one-size-fits-all approach to senior living are behind us. <br></p><p>“Instead, senior living operators need to embrace a more personalized approach, offering a variety of housing options ranging from independent living apartments to assisted living suites and memory care units,” Wilson wrote. “This allows residents to choose the level of support and assistance that best suits their individual needs, empowering them to maintain their independence while receiving the care they require.”<br></p><p>At the same time, more than 50 percent of respondents in the ASHA report said they’d prefer to receive care where they already are. This is the other side of the trend toward individualization. <br></p><p>“Many baby boomers are quietly, and increasingly, exploring in-home care options that give them the same benefits without giving up their home, their routines, or their independence,” explained home care entrepreneur and consultant Aaron Marcum. To win those older adults over, operators need to radically redefine their product. <br></p><p>“Baby boomers want autonomy, flexibility, and a lifestyle that aligns with who they are today, not a version of aging that feels institutional or outdated,” Marcum added. “Senior living communities that offer vibrant, resort-style amenities are going to be the winners in the future.”<br></p><p>“Resort-style” aptly describes Choreograph Gainesville, a new active living offering from Discovery Senior Living, which conducted extensive research into the boomer demographic as it developed the community. <br></p><p>“We know they seek to live independently for longer periods, so attracting them to senior living earlier could be challenging,” said Diana Ferrante Thies, Discovery’s executive vice president of brand management and corporate communications. “They’ve spent the last chapter of their life putting others’ purpose first—children, career, aging parents. Now they have the opportunity to shed responsibilities, to experiment, innovate…a sense of freedom to discover new things and invest in themselves.”</p><h3>Focusing on Lifestyle over Care</h3><p>Operators nationwide have already risen to the challenges posed by the aging population, increasing their emphasis on independent living options and other services tailored to active lifestyles. A recent report in The Daily Record, which covers business, legal, and legislative news in Maryland, offered a glimpse of the amenities available in communities across the Eastern Seaboard: arts centers, fitness centers with classes and personal training, pickleball courts, walking paths, libraries, and lecture series. A 2023 report in Multi-Housing News, meanwhile, described communities with on-site movie theaters, sports facilities, community gardens, bars, and salons. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Diana-Ferrante-Thies.jpg" class="ms-rtePosition-1" alt="Diana Ferrante Thies" style="margin:5px;width:150px;height:184px;" />The unifying thread isn’t necessarily luxury; it’s community in the sense boomers are most accustomed to—what Mabli, of United Hebrew of New Rochelle, describes as a marriage of “engagement and independence” that allows residents to lead their own lives while still feeling connected to others. “They want the freedom to age in place with the added benefit of access to health care services, social connections, and opportunities to stay active and engaged,” she said. “They’re looking for places that are modern and flexible—places that allow them to live fully among friends, not just safe and securely.”<br></p><p>No detail is too small. When New Jersey-based operator FellowshipLIFE set out to renovate the cultural arts center at its Applewood Village community, its leaders noticed something a little off about the auditorium space. <br></p><p>“When we looked at the room, everything looked great except for the fact that the flooring was wall-to-wall floral pattern, kind of ballroom-looking,” said Liz Fandel, FellowshipLIFE’s chief marketing and innovation officer. “It felt like an older hotel space. So we're going to put an engineered hardwood surface in and have areas around the perimeter with softer carpeting tiles.” Her comments reflect the broader shift away from traditional, stodgy notions of senior living toward more of a lifestyle product. <br></p><p>“For those considering senior living communities, the demand is for more than just a place to stay,” said Nicole Brackett, director of quality and care delivery at Homewatch CareGivers. “Boomers want customized care, fitness options, strong social connections, and access to high-quality health care partnerships.”<br></p><p>One other amenity they want: good food. “When it comes to dining, baby boomers expect a culinary experience, not just a meal,” wrote Jaime Pacheco, general manager at The Cardinal at North Hills, in McKnights last year. “From tableside service to farm-to-table ingredients to tasting menus with wine pairings, food has become cultural capital within communities, providing residents with a sense of belonging through food and social connection.”<br>Fandel phrased it a little more simply: “Who says that eating well has to be unenjoyable?”</p><h3>How to Market to Baby Boomers</h3><p>Of course, operators can’t adjust their models and expect the flood of baby boomers to immediately come calling. To meet the challenges—and reap the opportunities—of the aging population, they also have to rethink their marketing and branding strategies. <br></p><p>The change in messaging follows naturally from the change in mindset. To meet boomers where they are, marketers need to let go of the old ways of thinking about their product.<br></p><p>“Senior living providers need to shift from a care-first narrative to a wellness-and-lifestyle-driven model,” argued Mabli. “To resonate with boomers, marketing and messaging must reflect vitality and purpose, not just care. Operators who embrace innovation, cultivate community, and make clear what sets them apart will be best positioned to meet the expectations of this powerful generation.”<br></p><p>At United Hebrew, she explained, that means framing the campus as “a model of integrative senior living—one that is inclusive, future-focused, and empowering at every stage of aging.” In addition to modernizing its messaging, the operator has invested in community partnerships and technology while focusing on branding that showcases its inclusive, empowering environment. A video on its website prominently features residents engaged in activities such as painting, cooking, and attending a concert. <br></p><p>Digital marketing is key, especially for a generation that rarely owns a landline anymore. “Full digital-marketing channels, social media platforms, using influencers, and developing group forums online need to be an essential part of any marketing program,” said Discovery’s Ferrante Thies. “Connecting with them directly, knowing their likes and dislikes by developing much more edgy and creative advertising campaigns than ever before for seniors—focused on social lifestyles and choices and personalized programs that are true differentiators for your communities—will be attractive to them.”<br></p><p>Ron R. Browning, CEO of digital-marketing agency Intellibright who’s worked with senior living professionals, remarked, “Operators need to think like consumer brands. Start with a strong digital foundation: your website should be mobile-optimized, fast, and lead-generating. Offer virtual tours, transparent pricing, and tools to schedule visits without a phone call.”<br></p><p><img src="/Issues/2025/Summer/PublishingImages/Liz-Fandel.jpg" alt="Liz Fandel" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Fandel, at FellowshipLIFE, stressed the need to steer clear of branding that positions the operator as a care provider. Too many senior living community websites are adorned with photos of residents being supported by caregivers, she argued; too few highlight the active lifestyles residents continue to lead. One of FellowshipLIFE’s current direct mail campaigns features a woman with short, blonde hair wearing orange sunglasses and a leather jacket. “Who says getting older is boring?” the mailing asks. “Join us to learn what life is really like at Fellowship Village.”<br></p><p>At CARE Homecare, Gamburd’s team takes an approach that senior living communities may benefit from, as well—what he describes as serving residents’ lifestyle, not their age. “We made lighter terms that are easier to absorb, from how we describe our services to how we train our care managers,” he said. “We removed care plans and discussed their routines. To sandwich our approach, we asked about travel plans before medical history. <br></p><p>“We had a client in his late seventies who insisted we help him maintain his weekend motorcycle rides,” he added, “so a caregiver rides with him in a separate car in case anything happens.”<br></p><p>His comments echo Fandel’s descriptions of FellowshipLIFE’s prospective residents, who often aren’t even focused on a community’s care offerings. “They’re 100 percent focused on independent living; even when they tour assisted living or skilled nursing, they don’t want to look at it,” she said. “They’re like, ‘Yeah, but I want to see the apartments.’” <br></p><p>Crucially, that’s not to suggest operators should sideline the care aspect entirely. Rather, the idea is to engage with the potential resident’s plan to continue living life as they’ve lived it while giving them security in the knowledge that options from a trusted provider will be there later. <br></p><p>“It’s independent living; you truly are living independently,” said Fandel, “and if there's a need for a higher level of care later in your life, it will be here.” <br><br><em>Steve Manning is a journalist based in New York City.</em></p> | 2025-06-01T04:00:00Z | <img alt="" src="/Issues/2025/Summer/PublishingImages/Sum25_Tsunami.jpg" style="BORDER:0px solid;" /> | Caregiving | The second in an article series about the challenges and opportunities the silver tsunami will bring to long term care in the United States.
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| The Power of Partnership with PharMerica | <p>Running a senior living community is a tremendous responsibility that’s becoming more challenging as residents’ medical needs increase and regulations rapidly change. Providers must not only hold themselves to the highest standards in quality care, but they must also find partners who adhere to the same principles. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Alexis-Martini-pharmerica.jpg" alt="Alexis Martini" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Two years ago, Ciel Senior Living, which has 14 communities in nine states, tapped PharMerica as its preferred provider of pharmacy services. PharMerica’s knowledge of nationwide industry trends and best practices, as well as its understanding of the intricacies of Ciel’s markets, helped cement the relationship. The two companies’ patient-centric approach to care is an essential element in the partnership.<br></p><p>“When you’re looking for a strategic partner, their vision and values need to align with yours,” said Alexis Martini, president and chief operating officer at Ciel. “We have an incredible amount of trust in our PharMerica partner.”<br></p><p>PharMerica’s passion for exceptional, personalized service and high standards for trust and lasting relationships made it easy for Ciel to choose PharMerica as a preferred pharmacy partner. </p><h3>Staying Current on Changes</h3><p>PharMerica’s dedication to helping Ciel provide the best care manifests itself in multiple ways. The company keeps Ciel’s staff updated on laws and regulations affecting its various locations, trains staff, provides time-saving technology, and quickly addresses problems. <br></p><p><span><img src="/Issues/2025/Summer/PublishingImages/Ashley-Guido-pharmerica.jpg" alt="Ashley Guido" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span>Martini said that whenever mishaps occur, PharMerica staff will jump on the phone or respond in person to correct the situation and determine how to prevent it from happening again. “That’s going above and beyond, and that’s a uniqueness that you don’t really find in this space,” Martini explained.  <br></p><p>Another hallmark of PharMerica’s service is constant and clear communication with clients. Part of the messaging centers on the changing regulatory environment. <br></p><p>“The states do vary in their requirements for medication administration—not just the requirements for the training personnel, but processes,” said Ashley Guido, Ciel’s chief clinical officer. “There are a lot of nuances that PharMerica helps us navigate in terms of regulatory compliance.”</p><h3>Innovative Education and Initiatives</h3><p>Lisa McClure, PharMerica’s senior vice president, senior living general manager, said staying abreast of the changing health care landscape is not only part of the company’s educational responsibility, but also essential to its role as a thought leader in the industry. Also critical is providing information that is easy to understand, or as she puts it, delivering “snackable educational pieces” to support informed decision-making. McClure added, “We believe that knowledge is power, and PharMerica is a trusted resource that providers can easily tap into.”<br></p><p>Education comes in various forms, such as webinars, round-table discussions, live meetings, and written guides. It encompasses a broad spectrum of topics, including reducing medication errors, opioid use, antipsychotic reduction, and antibiotic stewardship. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Lisa-McClure-pharmerica.jpg" alt="Lisa McClure" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Guido heralded PharMerica’s Polypharmacy Initiative as especially useful and innovative. In this program, PharMerica’s pharmacists review residents’ medications to potentially reduce the number of prescriptions, prevent duplicative therapies, and reduce the risk of falls and adverse drug events. This contributes to resident safety and well-being and can help reduce out-of-pocket expenses. It can make dispensing medicines more efficient, allowing nurses to spend more quality time with residents. <br></p><p>McClure said that PharMerica prides itself on ensuring the highest standards of service and trust, with medication delivery that is correct and on time. Reconciling medications can consume precious time, but working with PharMerica can reduce the time needed for that task. “Reducing the time for medication reconciliation allows the nurses to focus on what’s important, and that’s patient-centered care,” said McClure.</p><h3>Picking a Preferred Provider</h3><p>Even though residents have the freedom to choose their pharmacy services provider, PharMerica works closely with Ciel Senior Living to increase resident adoption, as that increases safety as opposed to using a local retail pharmacy. Selecting PharMerica enhances safety, medication accuracy, and efficiency in prescription drug plans and billing. Providers also note increased operational efficiency and staff satisfaction.</p><h3>Reducing Staff Turnover</h3><p>A significant part of providing excellent care is satisfied, engaged staff. Turnover in the health care industry has been a challenge, though Martini said that Ciel’s partnership with PharMerica has led to greater staff retention. That’s because PharMerica’s educational platform helps support learning, training, and teaching at Ciel’s locations.</p><p>“We’re giving our staff opportunities to train, to grow,” said Martini. “That’s allowed us to reduce our turnover and keep people engaged in a career track that makes sense for them.”<br></p><p>PharMerica is a vital part of the local Ciel medication-management team, offering a local, dedicated team of account managers, billing specialists, nurses, and pharmacists who provide a wide range of valuable services to the community. They live and work near each facility, making them an integral part of the fabric of the Ciel community.</p><h3>A Bright Future</h3><p>Martini expects the partnership with PharMerica to continue flourishing. <br></p><p>“I see our partnership evolving through deeper integration and innovation, particularly in technology-driven solutions, enhancing clinical education with our teams, continuing to access real-time data, which PharMerica is tremendous in providing us with,” said Martini. “The data informs us to make smarter decisions.”<br></p><h3>About PharMerica Senior Living</h3><p>PharMerica Senior Living provides personalized pharmacy care through empowered local teams, serving communities nationwide. Combining the personal touch of a neighborhood pharmacy with the resources of a national network, PharMerica offers comprehensive clinical support to enhance resident safety, improve health and well-being, ease care team burdens, and foster thriving communities where seniors enjoy optimal quality of life. Its unwavering commitment to quality ensures the highest standards of service and trust. <br>Discover more at <a href="http://www.pharmerica.com/senior-living" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">pharmerica.com/senior-living</a>. <br></p><p style="text-align:center;"><a href="http://www.pharmerica.com/senior-living" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/Issues/2025/Summer/PublishingImages/PMC_SeniorLiving.png" alt="" style="margin:5px;width:200px;height:66px;" /></a><br></p> | 2025-06-01T04:00:00Z | <img alt="" height="244" src="/Issues/2025/Summer/PublishingImages/PMC_SeniorLiving.png" width="740" style="BORDER:0px solid;" /> | Management | PharMerica’s passion for exceptional, personalized service and high standards for trust and lasting relationships made it easy for Ciel to choose PharMerica as a preferred pharmacy partner. |