| Sneak Peek of Long Term Care Success | <p><img src="/Issues/2024/Winter/PublishingImages/LTC-Book-cover.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:264px;" />Mark Parkinson, the former president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), along with Dr. David Gifford, AHCA's chief medical officer, and Rae Anne Davis, AHCA's chief strategic officer and senior vice president for administration, have authored a unique new book on how long term care (LTC) providers can achieve success both clinically and financially, even during the most challenging of times. <br></p><p>Full of in-depth interviews, descriptions of bold strategic initiatives, and deep-dive analysis, the book offers long term care professionals a playbook on how to thrive in every facet of caring for our nation's seniors. Learn from some of the sector's most successful companies, no matter your organization's size or business structure.  <br>Following is a brief excerpt from <em>Long Term Care Success: How Senior Care Communities Thrive Clinically and Financially.</em></p><h3>Ensign’s Rise Revolutionizes the LTC Business Model </h3><p>Roy Christensen was a remarkable businessman with a kind heart.<br></p><p>Everything he touched turned to gold. He was an even better human being. For those of you who are Good to Great disciples, you know he lived the life of a humble, sacrificing servant leader, long before Jim Collins had ever written about Level 5 leadership. If you are a fan of Leadership and Self-Deception, you know he was treating people as people before the existence of the Arbinger Institute. Roy was born in 1933 and could have done anything. Fortunately, he chose a life in long term care.<br></p><p>He saw our aging population as a business opportunity. Roy’s kind heart led him to a service that would improve people’s lives. He used that pairing of talent and heart to develop and grow some of the greatest companies in the long term care space. He became a true titan in the industry. He was an original founder of Beverly Enterprises, which grew into the largest long term care company in history, and he had a hand in forming other major operators.<br></p><p>Sadly, those companies all have one thing in common. They all failed. The companies had great highs. Roy and others who created them became financially successful. And for a time, the companies succeeded. But over time, all went out of business.<br></p><p>Roy, and others, had thought that size was an advantage. The more buildings, the better. After all, a large company could offer resources to buildings that smaller operators did not have. They could do all the back-office administrative work, create standardized policies and procedures, and spread best practices across its platforms. In addition, a large company has economies of scale that create efficiencies. They have better deals with vendor partners because they can buy everything in bulk. There are real advantages to size. As a result, these companies grew and grew. At its peak, Beverly had over 1,100 buildings.<br></p><p>But size proved to have one major disadvantage. There were no owners working in and running the Beverly buildings. The owners were shareholders or C-suite executives, far removed from the local setting of the facilities. That matters. Long term care is more than a real estate investment. Those weren’t just 1,100 buildings in Beverly; they were buildings filled with people who needed attention and care.<br></p><p>Taking care of nursing home residents is hard. Really hard. It takes passionate people who are intensely dedicated to the residents and staff. It takes someone losing sleep because they are worried about the success of the building and the health of the residents. To meet all these challenges, having an owner or someone who acts like an owner in the buildings is critical to success.<br></p><p>There are multiple reasons for this. When a shift must be filled, a resident needs special attention, or if there is an emergency, having an owner or someone who acts like an owner in the building matters. Consider the example of an open shift. If a shift is open, an owner’s immediate thought is to fill it themselves or fill it with someone who does not create overtime.<br></p><p>Stacy and I worked every weekend for 10 years. This wasn’t because we were so committed. It was because we couldn’t figure out weekend staffing, and we weren’t going to use an agency. An employee who doesn’t think like an owner will be tempted to fill open shifts with agency workers or fill it by creating overtime. Those decisions are bad for care and bad for the bottom line.<br></p><p>It is also difficult for a non-owner to have the passion of an owner. It’s not impossible. It does happen. There are phenomenal administrators in buildings across the country who prove that every day. But it’s not universal. A big company can have the best processes possible, but if leadership in the buildings doesn’t care passionately about the staff, residents, and success of the enterprise, then it will not matter.<br></p><p>Roy learned this the hard way. While his companies had well-trained administrators, it was different from having owners. These companies usually paid the administrators modest salaries, and some viewed them as commodities. Decision-making took place at the home office. Administrators were in the buildings to implement corporate policies, not to innovate and lead.<br></p><p>The larger the companies became, the more this disadvantage of size became apparent. There are multiple companies with 40 to 50 buildings that have succeeded in creating a model where their administrators may not own the business, but act like they do. There are even companies in the 200-building range, like the Good Samaritan Society, Saber, and LifeCare that have succeeded in developing passionate building leaders and providing great care. Many of their administrators share the same mission and passion as their ownership. But, as organizations become larger, it becomes harder to sustain that commitment.<br></p><p>On top of that, the large companies made a fatal business decision. They took on too much debt. This is a mistake that operators of any size can make, but large companies have added pressure to make this error. Often, shareholders will require that providers extract every last cent out of their real estate and then some, so that they can experience a one-time capital gain. Very few companies have avoided the temptation to do so. These transactions can mean hundreds of millions of immediate dollars to the shareholders of the companies that lever-up. But these transactions then leave the operator with mounds of debt that make it difficult to succeed. Virtually all the companies that have succumbed to this temptation have failed. Beverly was no exception, and its debt was part of its demise.<br></p><p>But Roy Christensen was not going to give up. He wanted to take the lessons of these failures and start a new type of nursing home company. At the age of 66, he decided to begin again, this time with his son Christopher. In one of his last speeches Roy explained the reason he formed Ensign:<br></p><p>“Ensign was conceived to redefine long term health care. To lead in its evolution of delivery from where it was to where it should be. The very name ‘Ensign’ means the standard the world should follow. It was a bold pretense to begin a new company. Ensign was an attempt to improve on all the mistakes I made at Beverly, all the things I had done wrong in terms of growth, and the whole cultural concept of Ensign was a complete paradigm shift.”<br></p><p>Roy and Christopher made promises to each other as they constructed the Ensign model, a set of unbreakable commitments to sustain the company. To develop the promises, they reviewed everything that Roy had done, and other big companies had done, that had not worked. They spent time, before ever earning a dime, deciding why they were going to exist and what core values they would hold themselves accountable for. Two of these promises proved to be critical to the success of Ensign. Those were:<br></p><ul><li>That they would distribute ownership liberally. Each of them started with 50 percent ownership, but the plan was to give most of that away at every level of the operation to team members who proved worthy. The strategy was to create true owners in every building and at every level of the company.</li><li>To be frugal and avoid leverage. They committed to avoid the mistake that so many companies had made in taking too much money out of the enterprise and leaving the operations with massive debt or lease payments.</li></ul><p>The unbreakable promises became the foundation of remarkable business decisions that, in part, explain how Ensign has become what it is today.<br></p><p>The year was 1999. That turned out to be a notable time to start a new company. In 1998, the Medicare payment model changed, and it wreaked havoc on the nursing home sector. A full 20 percent of the sector went bankrupt, and investors fled the space. But Roy and Christopher were determined. Out of the ashes of a series of failed companies, and a failing sector, Ensign was born. <br></p> | 2024-12-04T05:00:00Z | <img alt="" src="/Issues/2024/Winter/PublishingImages/Book-cover.jpg" style="BORDER:0px solid;" /> | Caregiving;Management | A Unique Book Published by AHCA/NCAL |
| Celebrating the Center for Long-Term Quality & Innovation’s 10th Anniversary | <p><img src="/Issues/2024/Winter/PublishingImages/Win24_SF-LTC.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />With the new year comes an important milestone for the membership of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the broader provider community: in 2025, the Center for Long-Term Quality & Innovation, a research center within Brown University School of Public Health, will see its 10th anniversary. The center—or Q&I, as researchers call it—has proven itself vital, with a growing portfolio of projects, educational initiatives, and resources that represent the cutting edge of interventional research. <br></p><p>Established in 2015 with $1 million in seed funding from AHCA/NCAL, Q&I has a simple goal: to improve care for older adults, focusing in particular on those living with dementia and those receiving post-acute and long term care. “Older adults are a chronically ill and vulnerable population of people often excluded from trials,” explained Rosa Baier, MPH, the center’s director. “We’re interested in how we develop effective partnerships and implement changes that are practical and feasible in real-world conditions.”<br></p><p>Baier, who earned her master of public health from Brown, describes herself as an “improvement scientist” deeply concerned with pragmatic research—the development and implementation, in close collaboration with health care providers, of interventions that are designed to be “useful and used” in the real world. She runs the center with input from an advisory council of leaders within both the academic and provider communities, including several former AHCA/NCAL board chairs. <br></p><p>“We were moving along before Rosa joined as our executive director, but, once she joined, it really took off,” recalled advisor Mary Ousley, chief strategy officer at PruittHealth and a former AHCA board chair. “That's when we started getting the large funding grants to do the level of research and investigation that we had all hoped for.”<br></p><p><img src="/Issues/2024/Winter/PublishingImages/Rosa-Baier2.jpg" alt="Rosa Baier" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Key to the center’s approach is its unique position at the crossroads of academia and the health care industry, which allows it to investigate and respond to real-world conditions as they emerge. “Part of what's distinct about Q&I and how we operate is that we're really trying to use methods to engage our provider partners as active collaborators,” Baier explained. “We try to learn about the realities and needs on the front line in a way that helps to surface research questions from the bottom up, rather than helicoptering in with ideas and trying to recruit research participants.<br></p><p>“Our ability to be nimble and responsive, which is aided by our ongoing collaboration with AHCA, has enabled us to really learn about the environment, the research priorities, and then incorporate that into what we do,” she added.</p><h3>Real-World Research, Real-Time Results</h3><p>Look no further than the center’s work during the early days of the COVID-19 pandemic for an illustration of this pragmatic approach. Leveraging their relationship with AHCA/NCAL, Baier and her team conducted a survey of a large audience of providers within the first three months of the pandemic. Another month later, it published early findings about the conditions faced by frontline workers,<sup>1</sup> and then a peer-reviewed paper less than six months after that. <br></p><p>“We were the first to describe the frontline experiences of staff working in nursing homes during the pandemic,” Baier recalled. “Not only did we disseminate information quickly, but those findings reflected experiences in the earliest days of the pandemic and laid out issues that are still being explored by research across the country.”<br>During that same period, the center worked closely with PruittHealth to study the potential benefits of air purifiers<sup>2</sup> on COVID-19 outcomes. Ousley said, “[PruittHealth was] among the very first in those first few weeks to put air purifiers in our centers, long before we were getting any financial support. It showed that it decreased the incidence of individuals in our centers, both residents and staff, who got COVID. And we still have air purifiers in our centers.”<br></p><p>Ousley also spoke fondly of Q&I’s Music and Memory<sup>3</sup> study, a five-year trial finding that personalized playlists may have psychological benefits for residents with dementia. “In our organization, we had a very enthusiastic young staff person that spearheaded this for us,” she said. “He would call and talk to me and say, ‘You just can't believe what happened today. Mrs. Smith is agitated, and she fights when we try to give her a bath or provide care for her. If we turn the music on and enjoy the music with her, that agitation goes away.’”<br></p><p>This study is yet another illustration of the center’s pragmatic approach to research, in which interventions are delivered by caregivers instead of researchers, offering insight into the effects on patients and workers alike. </p><h3>A ‘Successful Partnership’</h3><p>Looking back over the last 10 years, AHCA/NCAL Chief Medical Officer Dr. David Gifford reflected on the “successful partnership” between AHCA/NCAL and Q&I, which has served as a funded partner for multiple projects. (Member organizations have served as funded partners for even more.) <br></p><p>“[This arrangement] doesn’t just work with Brown faculty,” Gifford pointed out. “It reaches out to people outside of Brown to form research partnerships. It opens up the door, because one of the challenges in doing this type of research is having good, accurate data, which is often costly, timely, and a burden to our members.”<br></p><p><img src="/Issues/2024/Winter/PublishingImages/Mary-Ousley.jpg" alt="Mary Ousley" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Reducing those barriers to conducting quality research is one of the center’s top priorities. To that end, it provides training and infrastructure grants, research funding, and resources like the Long-Term Care Data Cooperative, a massive initiative assembling electronic medical record (EMR) data from nursing homes around the country in near-real time, enabling research, public health surveillance, and population health analytics. (Learn more at <a href="http://www.ltcdatacooperative.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">LTCdatacooperative.org</a>.)<br></p><p>This project originated in an early-pandemic effort to gather EMR data from nursing homes and examine how COVID-19 presents in residents. “It started with one corporation, then grew to 12 corporations, and that became the foundation for the Long-Term Care Data Cooperative, which is now available to researchers across the country to conduct effectiveness research,” Baier said. <br></p><p>Another important initiative is the Learning Health Systems Rehabilitation Research Network (LeaRRN),<sup>4</sup> which partners researchers with health systems to advance research designed to improve quality of care. Three LeaRRN Learning Health Systems Scholars have worked or are working with AHCA-affiliated organizations on their research, which will yield important benefits for both patients and systems. <br></p><p>“Each scholar is paired with an academic mentor and a health system mentor,” explained Linda Resnik, LeaRRN’s director and a professor of Health Services, Policy and Practice at Brown. “This work is exciting because it is guided by the questions and needs of the health system. Thus, the knowledge produced is likely to produce actionable insights and improvements in care.”</p><h3>It Takes a Village</h3><p>As she celebrates the center’s 10th anniversary, Baier credits her team’s partnerships within Brown and the broader provider community for helping to realize the vision with which she set out a decade ago.<br></p><p>“It takes a long time to develop those relationships, so I feel like 10 years have passed quickly,” she reflected. “We now have momentum that we’ll carry forward for the next 10 years as we continue to surface research priorities from the communities we’re partnering with, and work together to elevate quality of care for older adults.”</p><p><span class="ms-rteStyle-Normal">References<br>1.    https://pmc.ncbi.nlm.nih.gov/articles/PMC7685055/<br>2.    https://pmc.ncbi.nlm.nih.gov/articles/PMC10247880/<br>3.    https://www.brown.edu/news/2017-05-10/music<br>4.    https://sites.brown.edu/learrn/</span></p> | 2024-12-04T05:00:00Z | <img alt="" src="/Issues/2024/Winter/PublishingImages/Win24_SF-LTC.jpg" style="BORDER:0px solid;" /> | Caregiving | In 2025, the Center for Long-Term Quality & Innovation, a research center within Brown University School of Public Health, will see its 10th anniversary. |
| Clif Porter Takes the Reins as AHCA NCAL’s New President and CEO | <p><img src="/Issues/2024/Winter/PublishingImages/CPorter_740_web.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />As Clifton J. Porter, II, officially assumed the role of president and CEO of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) in October 2024, one of the strengths he brought was his experience in the long term care industry. Porter knows what it’s like to work in direct care and shares a passion for giving residents the best care possible.<br></p><p>Formerly AHCA/NCAL’s senior vice president of government relations, Porter has spent his career advocating for caregivers and the elderly: during the COVID-19 pandemic, he helped secure billions in resources for the long term care sector, and he was named one of The Hill’s Top Lobbyists 2023. As he prepares to face the challenges ahead, he’s more than ready to meet them head-on.</p><h3>The Importance of Genuine Human Contact</h3><p>Porter’s 35-year career began when he was a teenager volunteering at nursing homes through a church outreach program. In college, he decided to pursue a degree in health care management with a focus in long term care, and he began working as an administrator soon after graduating. He credits his former boss Liz Kail, the administrator of a facility in Lynchburg, Virginia, with giving him his first job in 1989. <br></p><p>“I got in my car, drove from Richmond, and asked her if I could be her administrator in training, and she gave me the chance,” he recalled. “She was my very first mentor.”<br></p><p>Looking back to those early years, Porter said that a number of lessons stuck with him throughout his career. One of the most important is that there’s no substitute for what he calls genuine human contact. <br></p><p>“One thing that stuck with me is the fact that the residents so enjoyed seeing us,” he said. “You got to know them. They got to know you. They looked forward to seeing you. You got big smiles. It’s just important to take the time to engage with them, and doing that makes a big difference. I still carry that with me today.”</p><h3>From Administrator to Lobbyist</h3><p>Porter made the leap from operations to policy, as he described it, “quite by accident.” In the early 1990s, he was managing a group of facilities in the Atlantic region when Maryland began planning to transition its Medicaid program to managed care. <br></p><p>“Based on our portfolio, it would have eviscerated the business,” he recalled. “We had to do something about it.”<br>There was just one small problem: Maryland’s legislative session lasts only 90 days. This meant that Porter and the operators he was working with had a very brief window to develop an alternative proposal and convince lawmakers to support it—which is exactly what they did. “It was quite the amateur hour,” Porter said. “But we consulted with some people, got to work, figured out a solution, and we won.”<br></p><p>This caught the attention of the chief operating officer of ManorCare at the time, Keith Weikel, who offered Porter an opportunity to build up the operator’s government affairs department. “I said, ‘I’m not a lobbyist. I don’t know what I’m doing,’” Porter recalled. <br></p><p>Weikel disagreed, telling Porter that what mattered were his skills as an administrator. “He said, ‘You can learn the ins and outs of lobbying,’” Porter explained. “‘I can’t teach a lobbyist our business.’” <br></p><p>Porter took the job, moved to Toledo, Ohio, with his family, and spent the next decade building ManorCare’s lobbying arm. “It was learning by doing,” he recalled, though he had a little help from his friends at other organizations. Perhaps the most important among them was Larry Lane, then the head of government affairs at Genesis Healthcare, who advised him on how to structure ManorCare’s approach. He also shared a bit of wisdom that Porter never forgot: “He said, ‘In operations, we’re competitors, but in government affairs, there are no competitors. We’re all on the same team.’”<br></p><p>There’s one other team that’s supported Porter throughout his career: his family. “I’ve got a wife of 35 years and three kids that are now grown,” he said. “From snowstorms and natural disasters, to not having enough staff, to having to move to Toledo, to all the things that have been my career, they’ve been super supportive. I wouldn’t be able to have the success that I have without them.”</p><h3>Meeting the Demands of the Future</h3><p>A few months into his new role, Porter’s top priority is staying committed to AHCA/NCAL’s mission. “Providing solutions to problems is core to our mission, and at the end of the day, we have to be laser-focused on that,” he said. <br></p><p>That means not only listening to the organization’s membership in a broad sense, but also spending ample time in facilities themselves. “I spent the first 16 years of my career in buildings, so I think it’s important for all of us—particularly the leadership team—to make sure that we’re spending time in facilities and understand what the issues are.”<br></p><p>Naturally, he’s also deeply concerned with the unfolding caregiver crisis. Solving it will require close collaboration with lawmakers, as well as leaders in other health care sectors who are facing the same problems and will benefit from common solutions. <br></p><p>“If we’re going to be able to meet the demands of the future—and they are significant—none of it matters if we don’t have the workers to take care of this burgeoning demand,” Porter warned. “And right now, America really does not have a plan to provide the supply of workers that are needed. It doesn’t exist.”<br></p><p>To that end, he’s hopeful about the two pieces of legislation AHCA/NCAL has been working on with Congress. One would create an apprenticeship-like program for nursing assistants; the other would augment facilities’ own nursing assistant training programs. <br></p><p>“I think it’s going to be an incremental battle,” he said of the workforce shortage. “It’s our goal to continue to offer solutions and at least incrementally move the bar.”<br></p><p>Another focus area will be the development of what he called a more “rationalized” regulatory system: in short, one that leads to quality improvement and facilitates a positive, rather than punitive, relationship between regulators and operators. “We need to have a regulatory system that keeps providers that shouldn’t be in the business out of it, and that supports providers that are doing a good job or intend to do a good job,” he said.<br></p><p>At the same time, Porter takes solace in the belief that policymakers have finally come to recognize the industry as a central service, one that will become increasingly important as the population of people ages 85 and older grows. “I’m excited to see how the government works with us in the future to meet that demand,” he said. “It gives us a great opportunity to get additional support to do all the things we want to do.”</p><h3>Rising Up, Learning, and Overcoming</h3><p>While there may be challenges ahead, Porter believes the long term care industry has proven itself more than able to navigate crises great and small—and he’s excited to work closely with AHCA/NCAL’s members to solve the problems facing them. <br></p><p>“It’s the resilience of our members that excites me,” he said. “Every time we face a challenge, I always say to myself, ‘They’re underestimating our people once again. We know how to rise up, learn, and overcome. It’s just the nature of who we are.’” <br><br><em>Steve Manning is a freelance writer from New York City.</em></p> | 2024-12-04T05:00:00Z | <img alt="" src="/Issues/2024/Winter/PublishingImages/CPorter_740_web.jpg" style="BORDER:0px solid;" /> | Management | Clifton J. Porter, II, officially assumed the role of president and CEO of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) in October 2024, one of the strengths he brought was his experience in the long term care industry. |
| Get Vaccinated | <p><img src="/Issues/2024/Winter/PublishingImages/vax.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />With winter ushering in a surge of respiratory illnesses, nursing homes and assisted living communities nationwide are working to shield residents from influenza (flu), COVID-19, and respiratory syncytial virus (RSV). Vaccination programs continue to be a cornerstone of these efforts, reinforcing the importance of staying ahead of the evolving challenges that respiratory viruses present.</p><h3>Who Needs Vaccines the Most?</h3><p>In nursing homes and assisted living communities, residents are particularly vulnerable to severe outcomes <br>from these viruses. <br></p><p>Flu and COVID-19 pose risks for:<br></p><ul><li>People ages 65 years and older.</li><li>Those with certain medical conditions.</li><li>Individuals with weakened immune systems.</li></ul><p>RSV also presents serious risks to older adults, especially:<br></p><ul><li>People ages 75 years and older.</li><li>Adults 60 years and older in long term care settings.</li><li>Those with chronic health issues.</li></ul><div><h3>Sustaining Vaccination Efforts Throughout the Season</h3>Although the season is well underway, it’s not too late to get vaccinated. Long term care providers play a crucial role in maintaining vaccination efforts through the winter to help safeguard the health of residents and staff.<br></div><div><br></div><div>Providers can use resources from AHCA/NCAL and the U.S. Department of Health and Human Services to promote vaccinations, address hesitancy, and make immunization as accessible as possible. Encouraging residents to stay up-to-date on their vaccines helps minimize the severity of infections and reduces hospitalizations.<br><h3>GetVaccinated.Us</h3>Long term care providers are already doing extraordinary work to protect their residents. By continuing to promote flu, COVID-19, and RSV vaccinations, they can further enhance these efforts.<br></div><div><br></div><div>For the latest resources and tools to support vaccination efforts, visit <a href="https://www.ahcancal.org/Quality/Pages/GetVaccinated.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">GetVaccinated.us</a>. <br><h3>Risk Less. Do More.</h3>Be sure to check out the U.S. Department of Health and Human Services’ Risk Less. Do More. campaign, which also has resources to help providers discuss vaccines with staff and residents. Find resources at <a href="http://www.hhs.gov/risk-less-do-more" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.hhs.gov/risk-less-do-more</a>. <br><h3>Conversations That Build Trust</h3>Building trust through meaningful conversations is essential to combatting vaccine reluctance. Providers can draw on insights from the AHCA/NCAL Building Trust in LTC Course, which offers practical strategies such as motivational interviewing and empathetic communication to address concerns and instill confidence in vaccines. <a href="https://www.ahcancal.org/education/Pages/Building-Trust.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.ahcancal.org/education/Pages/Building-Trust.aspx</a><br></div> | 2024-12-03T05:00:00Z | <img alt="" src="/Issues/2024/Winter/PublishingImages/vax.jpg" style="BORDER:0px solid;" /> | Clinical;Infection Control | With winter ushering in a surge of respiratory illnesses, nursing homes and assisted living communities nationwide are working to shield residents from flu, COVID-19, and RSV. |
| Don’t Underestimate the Importance and Complexities of Senior Nutrition | <p><img src="/Articles/PublishingImages/740%20x%20740/food.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Everyone, no matter your age or who you are, needs to have a balanced diet along with exercise to maintain a good and healthy lifestyle. As we get older, the body changes and many different food requirements are added and/or changed through the years depending upon a person’s health criteria. These include areas such as sugar and glucose levels, blood pressure, cholesterol, other cardiac issues, or perhaps it’s about cancer prevention. These are taken into account for seniors and others who are living long-term or short-term at skilled nursing facilities (SNF), as well as assisted living housing. </p><h3>The Importance of Dietary</h3><p>At a typical SNF, the dietary department is the second largest department after nursing. What goes into having a robust and successful dietary and nutrition department is more complex than meets the eye. Kitchen preparation for three meals a day at a SNF that can host either 60 or 560 residents, no matter the amount, the kitchen staff needs to meet all of their food needs. There’s so much more.</p><p>This department oversees everything food-based, from production to calories and fluid intake. It’s a highly complex system, and its importance cannot be taken for granted. The head of dietary oversees it all, they need to be on top of the kitchen staff at all times, making sure the residents have their food, that it’s healthy, on time, and the taste makes them happy. So much is happening behind the scenes when it comes to food that the average person doesn’t realize, and it’s always changing. Staying on top of it is the challenge but a system where dietary listens to what the residents want and need is a successful program.</p><h3>Residents’ Wide Range of Dietary Intake and Needs</h3><p>At SNFs, one of the biggest areas that dietitians look at are carbohydrates in the diet, especially for people with diabetes and cardiac issues. Additionally, salt content, portion control, monitoring calorie count and fluid amount in the diet are areas that are followed within the daily recommended allowances.</p><p>If a resident requires more food, the dietary staff adheres to that after reviewing with clinical staff. If there are residents who require more calories or they just want more food, the facility does provide double portions and even healthy conscious snacks, some fortified foods like super puddings, super mashed potatoes, or super cereals for extra calories. If they need a supplement or something with more protein, dietary provides that as well.</p><p>From a dietitian’s point-of-view, these areas are considered requirements, but happiness may not be 100 percent fulfilled because taste is also a big factor. Taste leads to happiness and one of the biggest areas in feedback from families comes from food complaints. According to management at SNFs, complaints can be easily handled through communication and open dialog between the families, their loved ones, and the facility. Drawing the balance between healthiness and taste may be the million-dollar question because of it being highly individualized and subjective, but easily tackled through family and resident council meetings. </p><h3>Food Prep and Menus</h3><p>Whether a SNF is a stand-alone or part of a large network, a massive amount of food is prepared and served each day three times a day. The trick is to have an organized food service director who plans and leads the kitchen staff professionally, as well as gets to know the residents over time. This director is key to a successful dietary program. Residents are given menus, many times a regular menu and an alternative food menu, but some residents may want something that’s not on the menu.</p><p>At a large network of multiple SNFs, the corporate dietary department also includes regional directors and the facility’s dietitian. On a monthly basis in a food committee meeting, they gather to talk about changes, additions, and edits to the menu while also taking into account requests. The food menu will also be brought up at resident council meetings so anytime a food service director wants to change or improve something that’s on the menu, the clinical staff will be aware and informed.</p><p>Sometimes the residents will have a home recipe that they request. Dietary can add it into production, but they need to make sure that the calories and the overall nutrition pieces work out. SNFs are always trying to balance the types of foods because often the long-term residents prefer comfort food and short-term folks choose wraps, salads, and food they can pick at. It’s a constant push-and-pull with menu items. The provider wants the food to be the best it can be and gives the residents that choice, keeping in mind that the food needs to be highly nutritional and palatable. </p><h3>Regular Meals vs Alternative Means</h3><p>From time to time, families may bring food for their loved ones when they visit. They do this from the goodness of their heart as an alternative to the resident’s everyday meals. The dietary department suggests that whatever is brought in should have a nutritional value.</p><p>Additionally, dietary receives questions regarding food supplements. The facility’s dietary department know that these supplements may have value, but they should not take the place of food and regular meals. The bottom line is that residents need vitamins and minerals from all of the food groups in order sustain strength, health, and longevity, especially for those of advanced age and who are fighting diseases.</p><p>There are residents who cannot feed themselves so placing a straw into a supplement is much easier, but the residents may need more to meet their nutritional needs. Regular food can be better absorbed in the body; it’s better for their muscle mass and bone structure. The dietary staff may recommend more fortified, enhanced foods.</p><h3>Room for Improvement and the Need for Change</h3><p>Dietary personnel at SNFs are always looking to improve their food in terms of spicing it up, so many health institutions investigate outside food vendors exploring new tastes for their residents. In many markets throughout the country, vendors invite SNFs in for taste tests so the facility can get a new flavor perspective on many new items they can offer, such as soups, cooked vegetables, and different types of desserts. These taste tests are attended by the SNF’s nutritionists, dietitians, purchasing managers, and members of leadership.</p><p>Like restaurants, the kitchen at SNFs needs to be aware of food items that are not ordered or are even complained about. When this occurs, the dietary staff will meet with the kitchen staff and try to figure out how to improve the item or remove it. The dietitian will also speak to their vendor about ways to improve that item.</p><h3>Feedback, Social Media, and the Future</h3><p>In today’s world of social media, the field of nutrition and dietary in post-acute care are not immune from feedback over social media. Families who are on social media have discussions about the food where their loved one lives. Dietary leaders need to take that seriously and look at these discussions as an education about how to change or improve.</p><p><span><span><img src="/Articles/PublishingImages/2024/TonjaWerkman.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:155px;height:190px;" /></span></span>Looking into the future, dietary and nutrition leaders would like to see better options for the residents who need to have mechanically altered diets—food that is pureed and blended—geared towards to those who have ongoing, advanced age illnesses. These menu options need to be more visually and tastefully appealing and present on the menu. Simultaneously, foods need to have that overall “home” appeal where the residents can connect with the food better, mirroring foods that they would have in their home. Nursing home and assisted living residents are someone’s family so offering them healthy food with a balanced diet 365 days a year is the overall goal. <br><br><span></span><em>Tonja Werkman is a registered dietitian nutritionist and corporate director of food and nutrition at <a href="https://centershealthcare.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">Centers Health Care</a>. Werkman oversees the heads of dietary and food services in all of Centers Health Care’s 45 skilled nursing facilities throughout the Northeast, making sure the residents’ food intake is healthy and plentiful so they can maintain a strong and healthy life. She has been a leader in the dietary field for over 25 years.</em></p> | 2024-12-03T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/food.jpg" style="BORDER:0px solid;" /> | Caregiving;Diet | As we get older, the body changes and many different food requirements are added and/or changed through the years depending upon a person’s health criteria. |
| Help Is Here for the OSHA Respiratory Protection Standard | <p><img src="/Articles/PublishingImages/740%20x%20740/mask.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Efforts to keep residents, staff, and others safe were heightened during the pandemic, and respiratory protection was a top priority. The Occupational Safety and Health Administration (OSHA) is increasing the focus on its Respiratory Protection Standard (29 CFR 1910.134) to make sure these efforts continue. As facilities are wrestling with regulatory changes, staffing shortages, and other challenges, this may seem like one more concern to deal with; but there is help and guidance to enable everyone to breathe easier. </p><h3>Stringent Standards: What Do They Mean?</h3><p>The OSHA Respiratory Protection Standard requires nursing facilities, assisted living communities, and ID/DD centers, among other health care organizations, to establish and maintain a respiratory protection program when respirators are required to protect against airborne hazards, including infectious agents such as COVID-19.</p><p>This mandate includes performing medical evaluations, conducting fit testing, providing appropriate respirators, and ensuring proper training for all at-risk employees. Failure to comply can result in substantial fines, penalties, increased liability, and severe health risks to employees.</p><p>OSHA identifies several required elements for a respiratory protection program within its standard. These include:<br></p><ul><li>Identification/assignment of a “suitably trained” program administrator to oversee the program. This could be an infection preventionist or nurse, for example.</li><li>A written respiratory protection program (RPP) with details of specific procedures and elements for required respirator use and other information. </li><li>A risk assessment to identify workers who are at risk of exposure to airborne hazards. These individuals could include clinical or nonclinical staff who come in close contact with residents who have confirmed or suspected COVID-19 or other airborne illnesses during services such as bathing, dressing, toileting, and direct care.</li><li>Procedures to select appropriate types of respirators based on the facility’s hazards and other workplace factors.</li><li>Assurance that any worker using a tight-fitting respirator is fit tested before initial use. This ensures that the size, make, and model provides a proper facial seal to protect the wearer.</li><li>Procedures for conducting medical evaluations of workers who are required to use respirators to assess their ability to wear a respirator safely before they need one.</li><li>Procedures/schedules for respiratory maintenance and storage.</li><li>Training for workers who are required to wear respirators. These should be customized for the education level of each person and ensure that they understand all instructions.</li></ul><p>A facility’s respiratory protection plan applies to all employees who are required to wear a respirator and those that voluntarily wear one. Each employee must be medically cleared to wear a respirator, and a health care professional must review a medical questionnaire form that may include information such as limitations or conditions of use. </p><p>A fit test is needed to determine that the respirator a person will use on the job fits their facial features and maintains a tight seal. Every person must be re-fit tested annually, as well as if the facility changes respirator models or a person experiences a change in facial structure (such as weight loss or gain). Workers should never use a different model of respirator other than the one they are fit tested to use; and they should notify their supervisor if their respirator no longer fits for some reason or the respirator they are fit tested on isn’t available. </p><p>The written plan can be flexible, enabling facilities to respond to possible changing guidance during an emergency, shortages in supplies, reallocation of personnel, and other circumstances that may cause certain aspects of the plan to be impossible to follow or require additional precautions.</p><h3>New Focus for Old Standards</h3><p>As penalties for noncompliance with these standards can be significant, facilities are feeling pressure to get processes in place. However, Michael Arther, owner of MCA Consulting, LLC , noted that this actually isn’t a new standard. What’s new is the focus on nursing homes and assisted living facilities. The baseline is: Have you done a hazard assessment? If you identify a hazard, an airborne hazard in this case, it requires you to implement protections that meet the OSHA standard.</p><p><img src="/Articles/PublishingImages/2024/MichaelArther.jpg" alt="Michael Arther" class="ms-rtePosition-1" style="margin:5px;width:130px;height:161px;" />In long term care facilities, said Arther, the closest thing to an identifiable hazard pre-COVID was tuberculosis (TB); and the standard only applied if a facility housed “known active” TB patients. They would need a method of transferring those individuals out to a secondary provider, such as a hospital, with respiratory protection efforts such as negative pressure environments.</p><p>When COVID hit, the need for more formal respiratory protection processes became clear. This contributed to <a href="https://www.osha.gov/sites/default/files/respiratory-protection-covid19-long-term-care.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">OSHA’s expansion of their standards to encompass long term care.</a> The agency noted, “Long term care facilities are different than other health care settings because they assist residents and clients with tasks of daily living in addition to providing skilled nursing care.” The agency further observed, “While this guidance focuses on protecting workers from occupational exposure to SARS-CoV-2 (the virus that causes COVID-19 disease) by the use of respirators, primary reliance on engineering and administrative controls for controlling exposure is consistent with good industrial hygiene practice and with OSHA’s traditional adherence to a ‘hierarchy of controls.’ Under this hierarchy, engineering and administrative controls are preferred to personal protective equipment (PPE). Therefore, employers should always reassess their engineering controls (e.g., ventilation) and administrative controls (e.g., hand hygiene, physical distancing, cleaning/disinfection of surfaces) to identify any changes they can make to avoid over-reliance on respirators and other PPE.” </p><p>It is worth noting that addressing respiratory protection in long term care has been a focus for the U.S. Department of Labor for several years. In 2021, the agency announced a <a href="https://www.federalregister.gov/documents/2021/11/05/2021-23643/covid-19-vaccination-and-testing-emergency-temporary-standard" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">new emergency temporary standard to protect more than 84 million workers from the spread of the coronavirus</a> on the job. Under this standard, covered employers were required to “develop, implement, and enforce a mandatory COVID-19 vaccination policy, unless they adopt a policy requiring employees to choose to either be vaccinated or undergo regular COVID-19 testing and wear a face covering at work,” according to a press release from the agency at the time. “The federal government was really pushing for an infectious disease standard that would cover all potential exposures for all employers, but primarily health care providers,” said Arther. </p><h3>Respirator Review</h3><p>Arther stressed, “The primary purpose of a respirator is to protect your health from airborne hazards, which come in multiple forms.” These include solid particles like dust, droplets like mists, or even gases. Respirators are a type of PPE used to protect workers against breathing these airborne hazards. They are often used in conjunction with other types of PPE such as gloves, goggles, and procedure gowns. Practitioners and direct care staff are obvious candidates for the use of respirators and other PPE and a clear target of training for the OSHA standard. However, Arther observed that respiratory protection may be needed for other workers as well. For instance, maintenance staff may be exposed to airborne hazards when they are performing tasks such as replacing filters or making repairs in high-risk areas.</p><p>When a respirator is required to protect against COVID-19, employees should use a National Institute for Occupational Safety and Health (NIOSH)-approved filtering face piece respirator rated at N95 or greater. The respiratory protection program administrator should coordinate with infection preventionist and/or other team leaders regarding respirator selection, supplies, and usage. This individual also will monitor the inventory and availability of respirators. Of course, there may be instances where respirator supply is limited; when this happens, alternate precautions may be employed based on guidance such as emergency use authorization. </p><h3>Help Is Here</h3><p>“Preparation for compliance with the standard starts with the training and education piece,” said Arther. This is especially key in a world where turnover is high, and training can fall through the cracks for new employees. Everyone needs to know what the potential exposures are and the correct application of PPE. They need to know that if masks and other devices are used properly, they are protected. Arther, who frequently conducts training on respiratory protection, said that there is a sigh of relief among people once they understand the basics and the value of a respiratory protection plan. They realize that if there is another pandemic or other respiratory emergency, they will be able tobest protect their residents, colleagues, family, friends, and themselves. <br><span><a href="https://educate.ahcancal.org/products/osha-respiratory-protection-plan-training-and-compliance-resources#tab-product_tab_overview" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/Articles/PublishingImages/2024/24%20RPP%20300x250.png" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:167px;" /></a></span></p><p>There are many tools and materials for providers to help them start this journey and stay on track. Among the resources is a comprehensive <a href="https://educate.ahcancal.org/products/osha-respiratory-protection-plan-training-and-compliance-resources#tab-product_tab_overview" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Respiratory Protection Plan</a> from AHCA/NCAL, in collaboration with MCA Consulting. This training program and tool kit provides everything needed to comply with the new OSHA standard, including a customizable template plan, essential forms, training videos, and detailed reference guides. </p><p>Resources include:<br></p><ul><li>Access to OSHA-compliant forms for program documentation.</li><li>Step-by-step fit testing instructions to ensure proper respirator use.</li><li>Customizable templates tailored to your facility's specific needs.</li><li>Practical guides and tools for straightforward implementation.</li><li>Video training for managerial staff and program administrators on respiratory protection requirements.</li><li>Video training for employees, meeting all annual OSHA training requirements.</li></ul><p>“This is beyond a template or a course. We built a system with all the tools providers need,” said Arther. “They don’t need to be experts on respiratory protection. We know what OSHA requires and what they will be looking for and enable them to have OSHA-compliant policies and procedures. This system is customizable for each organization.” </p><h3>Looking on the Bright Side</h3><p>While a more comprehensive awareness of this standard may require facilities to implement some new programs and policies, they will also reap benefits. “It’s important for staff to know that you have a respiratory protection program and that you are going to supply them with everything they need to protect themselves,” said Leslie Eber, MD, CMD, a Colorado-based multi-facility medical director.</p><p>The OSHA standard, she suggested, “codifies for facilities the steps they need to take to have an appropriate respiratory protection program.” She added, “This helps ensure you don’t get caught off guard with the next respiratory emergency.” As a result, everyone in a facility or community—from the business offices to the kitchen and housekeeping staff—will have the knowledge and confidence to protect residents, themselves, and others from airborne illnesses and other infections. They will know what it feels like when an N95 mask fits correctly.</p><p>Once this gets on everyone’s radar and facilities get a process in place, they can ensure yearly testing and keep their plans moving forward. Arther added, “It's going to reduce airborne infection and make it possible for facilities to take in more residents.”</p><p>He stressed, “This isn’t about keeping people in respirators day in and day out. You want to maintain it for the purpose of being able to react and respond quickly and agilely. This will keep you ahead of things, which is important for reacting to surges in respiratory virus activity in your community.”</p><p><img src="/Articles/PublishingImages/headshots/JoanneKaldy.jpg" alt="Joanne Kaldy" class="ms-rtePosition-2" style="margin:5px;width:145px;height:183px;" />Instead of panicking, facility leaders should take stock about what processes and policies they already have in place so they don’t try to reinvent the wheel. “Providers likely have most of the pieces, but the AHCA/NCAL resource gives them the checklists to identify any gaps or missing pieces and address them promptly and effectively,” said Arther. He added that having an effective respiratory protection program sends a positive message to current and prospective staff. It tells them, he suggested, that the facility prioritizes staff safety and will work to protect them from illness and infections. </p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em><br></p> | 2024-11-19T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/mask.jpg" style="BORDER:0px solid;" /> | Caregiving;COVID-19 | As facilities are wrestling with regulatory changes, staffing shortages, and other challenges, this may seem like one more concern to deal with; but there is help and guidance to enable everyone to breathe easier. |
| How to Keep Up with the Jones to Attract Residents | <p>Are you a Baby Boomer or Gen Xer who feels like you don’t quite fit in your generation? It could be because you’re really Generation Jones, a member of that group of people born between about 1954 and 1965. </p><p><img src="/Articles/PublishingImages/2024/Jonathan-Pontell.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:185px;height:171px;" />According to Jonathan Pontell, who coined the term ‘Generation Jones,’ research has shown that these individuals have personalities, attitudes, and values that distinguish them from Boomers and Xers. “I think Gen Jones plays a particularly pivotal role. It’s arguably the most important demographic for people in this industry to learn about,” said Pontell. After all, he observed, while they may be a bit young for assisted living or even senior communities, there “is going to be a huge wave of these people headed your way;” and the time to start preparing is now. </p><h3>Who Are The Jonesers?</h3><p>Generation Jones takes its name from a common, almost anonymous name from the ‘50s and ‘60s, as well as the terms “jonesin,’” meaning craving, and “keep up with the Jones,” two concepts that were popular among kids growing up in the 1970s. </p><p>Most Generation Jonesers, unlike Boomers, didn’t have fathers who were World War II veterans, and they didn’t have to deal with a military draft. They grew up with television, and many haven’t lived in a world without a TV. Jonesers were young adults in the go-go ‘80s, but high mortgage rates made it nearly impossible for most to buy a house on a single income. Their music was disco, punk, and new wave; and the concept of free love waned as the AIDS epidemic made headlines. </p><p>Gen Jones “has a distinctive personality that is quite different than Boomers and Xers,” said Pontell. If anything, he added, “We are closer to Xers.” One important thing to understand about Gen Jones is that “as children, we were given huge expectations during arguably the height of post-World War II American confidence and affluence.”</p><p>Financially, Jonesers assumed they would do at least as well as their parents financially. “We turned our eyes to future with sort of a new, improved American dream,” Pontell said, that wasn’t just about money and financial security. “Our dream was more reflected in the zeitgeist of self-fulfillment and self-realization,” he explained. </p><p>While Jonesers grew up with huge expectations, they were confronted with a dramatically different reality as they came of age in the ‘70s and ‘80s with a souring economy and accompanying disillusionment. Pontell said, “We entered the workforce at a difficult time with some of the worst employment options since the Great Depression.” In order to survive, many Jonesers put their dreams on hold and “went first for the cash.”  Young Jonesers dreamt of writing the great American novel, traveling the world, or doing great humanitarian things, but they put these things off and hoped to revisit them some day.</p><h3>Gen Jones and Long Term Care</h3><p>While Gen Jonesers may not be looking at assisted living for themselves, many of them are decision makers for their parents. As a result, providers need to appeal to these individuals in their marketing and amenities. “Providers need to be effective at selling Gen Jones children on why their parents should choose their facilities,” Pontell said. They will want communities that offer both quality of life and security. For instance, many will want to know what will happen to their loved one if they are no longer able to afford monthly fees. Jonesers will be counting on technology to keep in touch with their loved ones in assisted living or other setting, so they will be looking for a robust digital presence. As they value authenticity, they will be viewing websites critically. Instead of stock photos, said Pontell, consider using images of actual residents and staff.</p><p>For themselves, Gen Jones is likely to be attracted to communities that are more like a college campus, a place of growth and learning where they can explore things they’ve always wanted to. Pontell suggested that they are going to want to more amenities than are typically offered and won’t be satisfied with the same old same old. </p><p>“Our generation is going to be challenging for people in this industry because of how fiercely independent we are,” said Pontell. This stems from the fact that this was the first generation of latch-key kids and many were children of divorce. “This is fundamentally different than previous generations, including Boomers,” he said. As a result, they will be “less than enthusiastic” about going into an assisted living community or similar setting. To attract these individuals, it will be important to emphasize how they will be able to maintain their independence and what technology and other supports will enable this. </p><p>At the same time, said Pontell, “The nature of Gen Jones is such that it that it's going to be much more effective with them to create a more cooperative business model where the residents help determine what's going on, where you ask them what they want, and then you create more of a horizontal than a linear style analogous to the ‘it takes a village’ model.” It is important for providers to embrace this concept, he noted, as Jonesers are going to demand customization and personalization. The one-size-fits-all approach “is just not going to work with Gen Jones.”<br></p><h3>Words Matter</h3><p>Marketing/promotional words and phrases that were particularly effective with older generations won’t work with Jonesers, Pontell said. For instance, “You earned it” is a phrase that has been used effectively with the generations that grew up during the Depression and World War II. Gen Jones, on the other hand, “has a sense of entitlement,” so “you deserve this” is more likely to resonate with them. He explained, “We feel that we deserve things, and this messaging appeals to us.”</p><p><img src="/Articles/PublishingImages/headshots/JoanneKaldy.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:131px;height:165px;" />Generation Jones is more reachable, more persuadable today than they were 15 years ago, said Pontell, and there is a lot of data to support this. “They are changing brands and open to trying new things, so it’s a good opportunity for people who are trying to sell them things,” he suggested. However, he stressed that Jonesers are much more skeptical than Boomers so it will be important to win their trust. This means, for instance, not just telling them that the food is good but inviting them in for a meal. Instead of telling or even showing them how good the amenities are, invite them to spend the day or a night and experience things firsthand. “It will be really important to communicate with them in transparent and authentic ways.”</p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em><br></p> | 2024-11-05T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/boomers.jpg" style="BORDER:0px solid;" /> | Caregiving;Assisted Living | Are you a Baby Boomer or Gen Xer who feels like you don’t quite fit in your generation? It could be because you’re really Generation Jones, a member of that group of people born between about 1954 and 1965. |