| The Complexities of Assisted Living Fire Evacuation Planning | <p style="text-align:center;"><img src="/Articles/PublishingImages/2025/189661849_fire.png" class="ms-rtePosition-3" alt="" style="margin:5px;width:400px;height:233px;" /></p><p>The popularity of assisted living communities continues to grow as aging individuals look to simplify their lives while receiving limited support and maintaining much of their independence. Residents in assisted living communities can benefit from custodial or personal care services including prepared meals, transportation, and basic medical assistance while shedding the challenges associated with managing their own home and property as they transition toward needing additional care.</p><p>The tragic fatal fire that occurred on July 13, 2025, at the Gabriel House assisted living community in Fall River, Mass., has reignited a critical and complex conversation around assisted living fire evacuation planning—specifically, how well communities understand their unique fire protection features, evolving resident capabilities, staffing availability, and ongoing training and drills. </p><h3>Fire Protection Challenges</h3><p>One of the primary challenges stems from overlapping regulatory frameworks. Fire and life safety requirements are governed by individual state building codes (often based upon the International Building Code), the Life Safety Code (NFPA 101), and various state-specific licensure rules. Each of these codes and regulations approach assisted living occupancies differently, affecting criteria for construction, egress, fire protection systems, and even staffing. Communities are often caught between conflicting or inconsistent standards, especially when states adopt different versions or impose unique amendments.</p><p>This risk may also be impacted by building design features. Some communities incorporate smoke barrier wall assemblies that allow for horizontal evacuation, moving residents to a protected area on the same floor without leaving the building. While others rely on full evacuation to the exterior every time a fire alarm activates. This distinction affects evacuation planning and may create challenges, especially during nighttime hours or in inclement weather.</p><p>Another critical variable is the sprinkler system. Communities equipped with systems fully compliant with NFPA 13 provide comprehensive sprinkler coverage, whereas those meeting NFPA 13R, a residential standard, may omit sprinklers in certain areas, including attics, concealed combustible spaces, exterior overhangs, small closets, and bathrooms. </p><h3>Resident Capabilities and Staffing Availability</h3><p>Adding to this complexity is the assisted living model itself. It’s common for residents who are mobile and capable of self-preservation upon move in to later experience a gradual decline in mobility and/or cognition. Yet, the community’s original design and classification may not change to reflect these evolving realities, leading to a growing gap between code assumptions and actual risk.</p><p>Staffing levels also vary from one assisted living community to another, particularly overnight, when fewer staff members are available to initiate a community’s fire response procedures and provide direction and assistance to residents. Support and guidance are particularly important for residents who may have mobility or cognitive impairment. </p><h3>Evacuation Response Plan</h3><p>All of these factors play a role in determining a community’s fire and evacuation response plan, and specifically its ability to defend in-place, relocate within the building (progressive evacuation), or execute a complete building evacuation. Codes and regulations aside, the following factors must be addressed to consider options other than full building evacuation.<br></p><ul><li><strong>Building Compartmentation with Smoke Barriers: </strong>Similar to a health care facility, smoke barrier walls must be in place to divide each floor into two or more compartments. Smoke barrier walls are designed to be continuous from floor to floor and outside wall to outside wall with any penetrations sealed to limit the passage of smoke. Smoke barrier walls minimize the ability for smoke to travel to adjacent portions of the building, allowing for the horizontal relocation of occupants to unaffected portions of the same floor. </li><li><strong>Comprehensive Sprinkler Coverage:</strong> A sprinkler system designed and in compliance with NFPA 13 will provide complete and comprehensive sprinkler protection throughout the building. Buildings with NFPA 13R systems are permitted to omit sprinklers in attic spaces. This can allow a fire to spread through the attic, requiring full evacuation of the building without delay. </li><li><strong>Early Fire Detection:</strong> Smoke detectors installed throughout building common areas can provide early notification to building staff, residents, and the local fire department to enable quicker execution of a building fire response plan.</li><li><strong>Staffing:</strong> If residents are directed to remain in the building, whether in their apartments or another interior location, trained staff must be available at all times to respond to the fire/alarm area and provide direction to residents. If there are times when staff are not on-site and available for that role, the expectation is that residents will evacuate the building under their own power, remaining at an assembly location until otherwise directed by fire department personnel. </li></ul><h3>Staff and Resident Training </h3><p>The success of any fire safety program, regardless of the type of evacuation, relies on an effective staff training and testing program. Periodic staff training on the community fire response plan, including specific roles and responsibilities, is critical. While training can be presented through various mechanisms, in-person training that includes building familiarization, an overview of evacuation routes, familiarization with the fire alarm system, and highlighting the location of smoke barrier walls is a comprehensive training program. In-person training also allows for real-time questions and answers.</p><p>In similar fashion, residents should receive training upon admission and then at predetermined frequencies thereafter that clarifies their role and appropriate response during a fire or upon hearing the fire alarm. This includes instruction on whether they should remain in place while waiting for further direction or if they should automatically commence evacuation upon activation of the fire alarm system.</p><p>Education on the functionality of the fire alarm system is particularly important for assisted living residents. Apartment smoke detectors may only sound locally upon activation, therefore requiring the building-wide fire alarm to be activated manually. The systems in place and resulting response may be very different from what residents were familiar with in their previous residential settings.</p><p>Training is specifically identified as a lesson learned in the Gabriel House Fire After Action Report, prepared by the Fall River Fire Department and released on October 21, 2025. The report states that, “staff and residents must be trained in shelter-in-place and compartmentalization strategies, including maintaining closed doors and using designated refuge areas, while also recognizing when conditions require prompt evacuation to triage or transport points. While shelter-in-place was not feasible at Gabriel House, it should be strongly considered whenever appropriate.”</p><p>Fire drills are an excellent way to both test and educate. Fire drills test staff and resident knowledge, validate the effectiveness of procedures, verify resident evacuation capability, and provide an opportunity to learn through actions. An effective fire drill program will incorporate all aspects of the community fire procedure, including activation of the alarm, containment of the fire and smoke, implementation of the appropriate evacuation strategy, communications, and accountability. Fire drills are best conducted on different days and at different times. Most states have detailed requirements related to fire drills.</p><p>Coordination and collaboration with the local fire department is essential to ensure positive fire outcomes. It is critical that fire department personnel are familiar with the building, the fire safety plan, and resident capabilities. These factors will affect their pre-planning efforts and help establish proper expectations when they respond to the community, minimizing surprises.</p><p><span><em><img src="/Articles/PublishingImages/2025/DaveHood.jpg" alt="Dave Hood" class="ms-rtePosition-1" style="margin:5px;" /></em></span>Ultimately, assisted living communities require a customized fire safety and evacuation planning approach that complies with applicable codes. Additionally, an assessment of the building design, staffing patterns, and fire protection features should be coupled with an ongoing risk assessment that considers the changing capabilities and needs of the residents. While the analysis required to properly develop emergency procedures can be complicated, the product should be a clear and concise set of fire and evacuation procedures tailored to the building and its occupants. By ensuring proper procedures are in place, assisted living communities can better protect both their residents and staff, ensuring safety remains at the heart of care. <br><br><em>David Hood is a technical fellow at Jensen Hughes and a past Chairman of the National Fire Protection Association (NFPA) Health Care Section Executive Board. He currently serves as the Chair of the Health Care Section Education Committee. Hood also has fire service experience at the Company Officer level in Prince George’s County, MD, and Monroe County, NY, and previously served as the Fire Chief in Honeoye Falls, NY.</em></p> | 2025-12-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/fire_evac.jpg" style="BORDER:0px solid;" /> | Emergency Preparedness | An assessment of the building design, staffing patterns, and fire protection features should be coupled with an ongoing risk assessment that considers the changing capabilities and needs of the residents. |
| AHCA/NCAL Staff Visit Providers Across the Country | <p>In 2025, AHCA President and CEO Clif Porter challenged staff to visit member facilities to learn more and connect with staff and residents as a way to inspire and guide the association's work.</p><p><br></p><table cellspacing="0" width="100%" class="ms-rteTable-2"></table><table style="background-color:lightblue;text-align:left;"><tbody><tr class="ms-rteTableEvenRow-2"><td class="ms-rteTableEvenCol-2" colspan="3" style="width:100%;padding:20px;">
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<br>"Seeing firsthand the amazing work of our provider members and their teams across the country is inspiring and is an important reminder of why we do what we do at AHCA/NCAL." <br>
<div style="text-align:center;">-Dana Ritchie, Associate Vice President of Workforce and Constituency Services, AHCA/NCAL<span class="ms-rteForeColor-8"></span></div></span></span></td></tr></tbody></table><p>
</p><table cellspacing="0" width="100%" class="ms-rteTable-default"><tbody><tr style="text-align:center;"><td class="ms-rteTable-default" style="width:50%;"><span><img src="/Issues/2025/Winter/PublishingImages/bs_Akena%20and%20Yazmyn_lancashire.jpg" alt="" style="margin:5px;width:400px;height:533px;" /></span></td><td class="ms-rteTable-default" style="width:50%;text-align:center;"><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_kiran%20and%20team_pruitt%20brookhaven_2.jpg" alt="" style="margin:5px;width:400px;height:533px;" /></span></span></td></tr><tr><td class="ms-rteTable-default" style="text-align:center;">Lancashire Nursing & Rehabilitation, Kilmarnock, Va.</td><td class="ms-rteTable-default" style="text-align:center;">PruittHealth Brookhaven, Brookhaven, Ga.</td></tr></tbody></table><table cellspacing="0" width="100%" class="ms-rteTable-default" style="text-align:center;"><tbody><tr><td class="ms-rteTable-default" style="width:50%;"><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_Dana%20and%20team_CESLC_2.jpeg.jpg" alt="" style="margin:5px;width:400px;height:300px;" /></span></span></td><td class="ms-rteTable-default" style="width:50%;"><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_Clif%20-%20Oregon.jpg" alt="" style="margin:5px;width:400px;height:300px;" /></span></span></td></tr><tr><td class="ms-rteTable-default">Charles E. Smith Life Communities, North Bethesda, Md.</td><td class="ms-rteTable-default">West Hills Health & Rehabilitation, Portland, Ore.</td></tr></tbody></table><p>  </p><table cellspacing="0" width="100%" class="ms-rteTable-default"></table><table style="background-color:lightblue;"><tbody><tr><td class="ms-rteTable-default" style="width:100%;padding:20px;"><div>
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<img src="/Issues/2025/Winter/PublishingImages/bs_heritage.jpg" class="ms-rteImage-0 ms-rtePosition-2" alt="Claire Krawsczyn" style="margin:5px;width:400px;height:262px;" />
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<br></span></span></span>"Visiting Heritagespring of West Chester was a great reminder of how many committed people show up every day to make a care center run smoothly."</div><div style="text-align:center;">-Claire Krawsczyn, Senior Director of Media Relations, AHCA/NCAL</div>
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</td></tr></tbody></table><p> </p><table cellspacing="0" width="100%" class="ms-rteTable-default"><tbody><tr><td class="ms-rteTable-default" style="width:50%;"><span><img src="/Issues/2025/Winter/PublishingImages/bs_IT%20team_unique%20rehab_1.jpg" alt="" style="margin:5px;width:400px;height:300px;" /></span></td><td class="ms-rteTable-default" style="width:50%;"><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_PA%20Facility%20Visit%206-10-25.jpg" alt="" style="margin:5px;width:400px;height:254px;" /></span></span></td></tr><tr><td class="ms-rteTable-default" style="text-align:center;">Unique Rehabilitation & Health Center, Washington, D.C.</td><td class="ms-rteTable-default" style="text-align:center;">Ingleside at Rock Creek, Washington, D.C.</td></tr><tr><td class="ms-rteTable-default"><span><img src="/Issues/2025/Winter/PublishingImages/bs_lisa%20erica%20mindy_hebrew%20home_1.jpg" alt="" style="margin:5px;width:400px;height:533px;" /></span></td><td class="ms-rteTable-default"><span><img src="/Issues/2025/Winter/PublishingImages/bs_Nikki_Shelby%20Oaks%20Post%20Acute.jpg" alt="" style="margin:5px;width:400px;height:533px;" /></span></td></tr><tr style="text-align:center;"><td class="ms-rteTable-default">Charles E. Smith Life Communities, North Bethesda, Md.</td><td class="ms-rteTable-default">Shelby Oaks Post Acute, Memphis, Tenn.</td></tr></tbody></table><p>      </p><table cellspacing="0" width="100%" class="ms-rteTable-default;"><tbody><tr></tr></tbody></table><table style="background-color:lightblue;width:823px;height:334px;"><tbody><tr><td class="ms-rteTable-default" style="width:100%;text-align:left;padding:20px;"><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_jen%20humphrey_springs%20at%20stony%20brook_2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:400px;height:300px;" /><br><br>The residents aren't just people; they become family in the facility." <br><div style="text-align:center;">-Jen Humphrey, Senior Manager, Vendor Relation, AHCA/NCAL</div></span></span></td></tr></tbody></table><p></p><table cellspacing="0" width="100%" class="ms-rteTable-default"><tbody><tr><td class="ms-rteTable-default" style="width:50%;"><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_silver.jpg" alt="" style="margin:5px;width:400px;height:300px;" /></span></span></td><td class="ms-rteTable-default" style="width:50%;"><span><span><span><img src="/Issues/2025/Winter/PublishingImages/bs_julie%20ryan_caretel%20inns.jpg" alt="" style="margin:5px;width:400px;height:179px;" /></span></span></span></td></tr><tr><td class="ms-rteTable-default" style="text-align:center;">Silver Birch of Mishawaka, Mishawaka, Ind.</td><td class="ms-rteTable-default" style="text-align:center;">Caretel Inns Brighton, Brighton, Mich.</td></tr></tbody></table><span> </span> | 2025-12-01T05:00:00Z | <img alt="" src="/Issues/2025/Winter/PublishingImages/facility.jpg" style="BORDER:0px solid;" /> | Caregiving;Quality | In 2025, AHCA President and CEO Clif Porter challenged staff to visit member facilities to learn more and connect with staff and residents as a way to inspire and guide the association's work. |
| How Technology Is Reshaping Senior Living | <p><img src="/Issues/2025/Winter/PublishingImages/Tsumani4.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />The coming silver tsunami will bring not just a wave of new customers to the senior living profession, but also a seismic shift in expectations. Unlike previous generations of customers, baby boomers are digitally fluent: technology is already woven into the fabric of their lives, and they’ll expect this to remain the case as they age into senior living facilities.<br></p><p>For providers, that means technology is no longer an optional amenity. Rather, it’s a strategic imperative. Providers must embrace recent technological advances to meet the demands of their new market, ease the burden on a strained workforce, and deliver a higher quality of care.</p><h3>The New Resident Mandate</h3><p>The technophobic senior is a thing of the past. The boomer generation has spent the last several decades getting used to rapid technological advancement, incorporating new devices and paradigms into their daily routines. </p><p>According to a 2022 survey by Pew Research, 61 percent of adults ages 65 and over are smartphone owners, while 75 percent of the same group are Internet users. They use technology for recreation, as well as for communication, according to a 2021 AARP survey, which found that 79 percent of adults in their sixties and 70 percent of adults in their seventies rely on technology to keep in touch with friends and family.<br></p><p>Naturally, they share this tech-forward mindset with their adult children. “Technology is fundamentally reshaping the expectations of residents and their families in post-acute care,” observed Tim Smokoff, general manager at MatrixCare. “Today, they expect more transparency; real-time, secure communication; and greater engagement in care decisions. Families want to be informed and involved, and residents want their preferences and needs reflected in every aspect of their experience.”</p><p>In other words, residents and their families want the best of the best—not as a replacement for the human element, but as a supplement to it. Residents expect tech-savvy facilities that provide a high quality of care, perhaps even addressing needs they don’t yet know they have. Families, meanwhile, want peace of mind, reassurance that providers have eyes and ears on their loved ones twenty-four hours a day, seven days a week. </p><h3>New Care Paradigms</h3><p>According to Smokoff, the most significant recent advances in health care technology have been in the “convergence of technology, data, and care delivery.” New interoperability and data-exchange solutions, for example, allow providers to “share data seamlessly and bidirectionally across care settings,” he explained, offering a more holistic, real-time view of the patient. Then there are advances in AI and analytics, which have allowed providers to shift resources from reactive to proactive care. <br></p><p>“We’ve moved beyond simply collecting data to actually using it to guide decision-making,” Smokoff said. “Now it’s helping providers anticipate risk, personalize care, and improve outcomes in a way that wasn’t possible even a few years ago.”</p><p>At TapestryHealth, cofounder Mordy Eisenberg works at the forefront of proactive care. Using AI and machine learning technology, his platform helps providers distill massive amounts of data and identify where they should be dedicating their resources. <br></p><p>“What we’re using it for is to really connect the dots and say, ‘OK, one plus one is ten,’” he said. “‘This person is your highest-risk patient in the building, because this occurred two days ago, this occurred yesterday, and this occurred just now.’ When you put those three together, that’s really, really impactful.”</p><p>As he stressed, the technology doesn’t replace human caregivers. Instead, it helps connect dots for employees who might not otherwise be aware of events that occurred in previous shifts.</p><p>These AI tools are supplemented by advanced monitoring technology, such as wall-mounted radar devices that detect subtle changes in a patient’s heart rate or breathing. Crucially, these devices can be calibrated to different baselines—for instance, for residents on beta blockers, who have resting heart rates that are lower than average. Eisenberg also offered the example of a patient with congestive heart failure who has a subtle increase in respiratory rate while sleeping.</p><p>“If there hasn’t been any assessment because the resident hasn’t been complaining of any shortness of breath, but our radar picked up that their respiratory rate has increased a few points above their baseline over the last two or three nights, that information comes into the data center,” he said. “And now the alert could say, ‘Hey, this person is high priority,’ and we can escalate that to the staff and say, ‘Hey, you need to look at this patient.’”</p><p>The benefits cannot be understated. TapestryHealth recently conducted a retrospective study of its devices, finding that they detected changes between four and five days before hospitalizations. This gives providers a vital window to intervene in place, preventing risky transfers that may lead to adverse consequences. <br></p><p>“Once they are transferred to the hospital, it’s just a cascade of bad things,” Eisenberg said. “When you can tell a family member that you can use these technology tools to make their loved ones safer, that somebody’s got eyes on them at all times, that they’ll be able to mitigate problems before they become bigger issues, that really resonates.”</p><h3>Innovating Through the Workforce Crisis</h3><p>The silver tsunami is arriving at a time when there is a growing caregiver shortage. While new technologies cannot replace human caregivers, they can help address workforce issues by giving human caregivers powerful tools to make their jobs easier. <br></p><p>“All of the numbers say we’re going to be hard-pressed to have enough staff to care for all these people,” said Christian Mason, CEO of Senior Housing Managers. “What do you do? Find ways to work smarter and not harder, and hopefully ways that will reduce the negative impact and burnout on staff.”</p><p>At Senior Housing Managers, Mason has found incredible value in one particular tool that doubles as a means of addressing social isolation among residents: AI companions for memory care patients. Developed with CloudMind Software, the companions appear as avatars on iPads using one-directional microphones tuned to the resident’s voice. They use machine learning technology to sift through the resident’s life story, giving them someone to talk to when they’re lonely, depressed, angry, or otherwise in need. The technology also uses sentiment analysis to alert providers to changes in the resident’s condition.<br></p><p>“We have residents who will talk to their avatars for hours on end,” said Mason, “which is fascinating, because we have residents who have significant cognitive loss on the one hand, and at the same time, they’re dealing with everything else that’s going on.”</p><p>He described one resident, a former schoolteacher and church choir leader who has Alzheimer’s. Before a pilot of the AI companion tool, she was frequently combative with other residents and used her call light thirty to thirty-five times per day. During the pilot, that figure went down to one or two times per day. <br></p><p>“She began singing again and was singing hymns every morning with her avatar,” Mason said. “She was very different. It showed that companions can really make a difference. Now, is it going to replace staff? No, but it will certainly provide staff with some time that we’re giving back to them so that they can be focused on all the residents and deliver even better care.” </p><h3>Navigating the Challenges </h3><p>As Smokoff acknowledged, providers may be hesitant to make significant investments in new technologies—and reasonably so. In addition to the obvious expenses, adopting new tech can disrupt workflows in facilities that are already well established. To make matters even more complicated, new systems pose interoperability challenges with existing ones, not to mention compliance concerns.<br></p><p>To help mitigate these concerns, providers might look to solutions that use the approach Smokoff and his team implement at MatrixCare. “We prioritize building solutions that are intuitive and make daily processes and workflows easier, not more complicated,” he said. “Additionally, hands-on training and support, as well as self-guided, flexible options make adoption easier and less stressful for staff.”<br></p><p>At the same time, Smokoff focuses on tools that function across a variety of systems and use open standards, with integration support provided up front. As for regulatory concerns, he stresses the need for tools to be designed with privacy and regulatory requirements in mind. “Vendors should provide clear guidance on how they support compliance and reduce administrative burden,” he said.</p><p>While some may feel a cultural resistance to change, perhaps out of habit or skepticism or both, the future is coming, whether we like it or not. And, as Smokoff put it, new technology can ultimately make that future brighter and better for providers and patients alike. <br></p><p>“These advancements are reshaping how providers deliver care,” he concluded, “helping the industry evolve toward a more connected and patient-centered ecosystem.” </p> | 2025-12-01T05:00:00Z | <img alt="" src="/Issues/2025/Winter/PublishingImages/Tsumani4.jpg" style="BORDER:0px solid;" /> | Caregiving | The last in a four-part article series about the challenges and opportunities the silver tsunami will bring to long term care in the United States. |
| How Aging Infrastructure Threatens Senior Care Emergency Plans | <p><img src="/Articles/PublishingImages/740%20x%20740/emergency-plan.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:300px;" />Emergency preparedness in senior care facilities often focuses on what’s inside the walls: evacuation procedures, emergency food and water, medical protocols, staff readiness, and more. However, there’s a critical vulnerability that often goes overlooked—the local infrastructure these plans depend on.</p><p>Local infrastructure risks may include aging water systems, deteriorating roads, crumbling bridges, and outdated drainage networks, which could undermine even the most carefully developed emergency plans. When the water stops flowing or the evacuation route becomes impassable, your facility may find itself isolated and unsupported.</p><p>Recent hurricanes, fires, and floods have shown something important: even a well run facility can be disrupted by problems far outside their control.<br></p><h3>The Infrastructure Problem: A National Weakness</h3><p>The American Society of Civil Engineers (ASCE) recently gave U.S. infrastructure a C- grade on its national report card. Among the most concerning findings:<br></p><ul><li>43% of U.S. public roadways are in poor or mediocre condition.</li><li>Over 46,000 bridges are considered structurally deficient.</li><li>The average U.S. drinking water treatment plant is 50 years old—many are operating beyond their intended lifespan.</li><li>The U.S. currently has a $125 billion shortfall in stormwater infrastructure upgrades.</li></ul><p>These breakdowns have immediate consequences during disasters. Flooded roads delay emergency responders. “Do not drink” alerts leave facilities without safe water. Sewer backups can cause costly property damage and increase the risk of illness.</p><h3>Threat #1: Water System Failures</h3><p>Water is often the most overlooked necessity—until it’s unavailable. Cities like Jackson, Mississippi, and Houston, Texas, have issued boil advisories, experienced water pressure loss, or even had complete shutoffs during major storms and infrastructure failures.</p><p>For senior care facilities, this means every aspect of care, such as hydration, hygiene, food prep and medication, may be impacted. </p><h3>Best practices:</h3><ul><li>Store at least three days of potable water on-site—1 gallon per person, per day (residents and staff).</li><li>Keep documentation of how much water is stored and the expiration dates to meet compliance requirements.</li><li>Understand shelf life: bottled water typically lasts 12–18 months; canned water lasts up to 10 years; large tank storage should be treated and cycled every 6 months.</li><li>Reevaluate your water needs annually, especially if census or staffing levels change.</li></ul><h3>Threat #2: Impassable Evacuation Routes</h3><p>During Hurricane Ian in 2022, dozens of Florida senior care communities experienced evacuation delays—not due to internal disorganization, but because of washed-out roads and closed bridges.</p><p>If your evacuation plan relies on a single bridge, low-lying roadway, or local highway, that route could become a choke point during a major weather event.</p><h3>Best practices:</h3><ul><li>Contact local emergency managers to map alternate evacuation routes.</li><li>Conduct mock evacuations using multiple evacuation routes.</li><li>Prepare to shelter-in-place (enough food, water, medical, and power continuity) in case an evacuation is impossible.</li><li>Use real-time traffic apps to verify road conditions during severe weather events.</li></ul><h3>Threat #3: Overloaded Drainage and Flooding</h3><p>It doesn’t take a hurricane to flood a facility. Drainage systems that were built decades ago are often under-equipped for today’s rainfall levels and urban density. Routine storms can now overwhelm sewers and storm drains, causing significant damage to senior care communities.</p><p>Flooded basements, elevator shafts, and electrical rooms can create life-threatening hazards—and result in lengthy closures.</p><h3>Best practices:</h3><ul><li>Know your facility’s proximity to flood-prone areas or outdated storm drains.</li><li>Elevate critical systems off the floor (generators, electrical panels, supply storage).</li><li>Use waterproof containers for essential emergency gear.</li><li>Have absorbent barriers or sandbags ready in known leak-prone areas.</li></ul><h3>Focus on What You Can Control</h3><p>Senior care operators can’t fix bridges or modernize sewer systems, but they can strengthen internal resilience. Facilities that build self-sufficiency—especially for 72+ hours—are better equipped to maintain care continuity when outside systems fail.</p><h3>Key investments include:</h3><ul><li>Evacuation kits stocked with essentials: water, masks, name tags, hygiene items.</li><li>Backup lighting, flashlights, battery-powered medical devices, and mobile charging banks.</li><li>Shelf-stable food bars or MREs that don’t require water, heat, or preparation.</li><li>Portable hygiene supplies: wet wipes, sanitizers, disposable bed pads, etc.</li></ul><p>These strategies protect resident health and dignity, support compliance with CMS and state emergency preparedness requirements, and reduce the stress on frontline staff during emergencies.</p><h3>External Infrastructure Audits</h3><p>Emergency preparedness should extend beyond your property line. Adding an external infrastructure audit to your facility’s planning cycle can help to expose hidden vulnerabilities.</p><p>Consider: <br></p><ul><li>Are the roads in and out of the facility in good condition year-round?</li><li>Has the city updated its flood zone or stormwater maps?</li><li>How frequent are boil water advisories in your area?</li><li>If power, water, or access failed, how long could you sustain operations?</li><li>How many alternative evacuation routes do you have if the main route is not passable? </li></ul><h3>Emergency Planning Doesn’t Stop at the Property Line</h3><p><img src="/Articles/PublishingImages/2025/Byron-Walker.jpg" alt="Byron Walker" class="ms-rtePosition-1" style="margin:5px;" />Infrastructure failure can have a meaningful impact on senior care facilities. These failures can escalate quickly, especially for vulnerable residents with mobility or medical needs.</p><p>By planning beyond your walls and by preparing for infrastructure failures, operators can better protect residents, reduce operational risk, and build a reputation for true emergency readiness.<br><br><em>Byron Walker is the founder and CEO of Peak 10 Emergency, a Colorado-based company specializing in emergency preparedness solutions tailored to the senior care industry. He can be reached at <a href="mailto: byron.walker@peak10emergency.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">byron.walker@peak10emergency.com</a>.</em></p><p><em><br></em></p><p><span class="ms-rteFontSize-1"><em>Provider</em> magazine includes information from a variety of sources, such as contributing experts. The views expressed by external contributors do not necessarily reflect the views of <em>Provider</em> magazine and AHCA/NCAL. </span><a href="/About/Pages/Submit-Article.aspx" title="https://www.providermagazine.com/About/Pages/Submit-Article.aspx" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" target="_blank"><span class="ms-rteFontSize-1">Learn how to submit an article.</span></a><br></p> | 2025-11-18T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/emergency-plan.jpg" style="BORDER:0px solid;" /> | Architecture;Emergency Preparedness | Local infrastructure risks may include aging water systems, deteriorating roads, crumbling bridges, and outdated drainage networks, which could undermine even the most carefully developed emergency plans. |
| Increasing Accessibility for Residents with Low Vision | <p style="text-align:center;"><img src="/Articles/PublishingImages/2025/iStock-1077244500.jpg" alt="" style="margin:5px;width:500px;height:334px;" /></p><p>Across the world, the population is aging rapidly, and with age comes a greater risk of certain health conditions; among these, vision loss is one of the most significant.</p><p>According to the Royal National Institute of Blind People (RNIB), more than half of residents in assisted living or care homes are blind or have low vision. Long term care facilities cannot afford to treat vision loss as a marginal issue.</p><p>Yet, many care facilities can have challenges in offering an accessible experience. Menus, schedules, signage, and paperwork are designed primarily in print formats, leaving residents dependent on staff for even the smallest of tasks. This in turn can lead to other significant issues that impact both residents and care staff alike, including reduced resident independence, increased staff strain, unhappy and disconnected family members, and potentially reduced profits.</p><h3>The Cost of Inaccessible Care Environments</h3><p>When accessibility for blind and low-vision residents is overlooked by a care provider, they face many avoidable challenges. Reading a meal plan, finding a room, or completing paperwork are daily tasks that many residents are very capable of doing. But for others, that independence can be lost as they would require staff interpretation and support even for simple tasks such as these.</p><p>Many care providers often don’t see an issue here, as they are still helping the individual and providing support. However, the problem has implications.</p><p>For residents who are blind or have low vision, they can very quickly feel a loss of independence, frustration, and in some cases, it can even affect their mental well-being.</p><p>For care facilities, spending a minute or two assisting a resident with reading a menu, for example, might not seem like a lot, but dozens of requests a day soon add up and can take away from critical care giving. By providing accessible solutions, this time can also be saved.</p><p>When you consider that 96 percent of assisted living facilities and 99 percent of nursing homes in the United States are experiencing staffing shortages, according to The American Health Care Association, every minute of staff time saved is hugely beneficial.</p><h3>The Benefits of Improving Accessibility </h3><p>Accessibility should never be a box-ticking exercise. It goes far beyond compliance and legislation. When care organizations embed accessibility into the core of their operations, they can benefit from;</p><h4>1.    Reduced strain on staff members.</h4><p>With staffing shortages, hiring a new nurse or caregiver can be challenging and existing staff members often have a full plate. When care is accessible for blind and low-vision individuals, however, what would otherwise be frequent micro interventions (reading menus, accessing schedules, and help with choosing clothes to wear) can now be done independently by the resident.</p><p>This reduces strain on staff by freeing up time and gives them additional capacity to do medication rounds, for example. Reduced strain on staff helps mitigate the costs of labor shortages.</p><h4>2.    Boost in resident satisfaction.</h4><p>When blind and low-vision residents are able to carry out daily tasks with independence, they enjoy a greater quality of life, feel less isolated, and in general are likely to feel happier and more satisfied with the long term care facility they are living in.</p><p>This increase in resident satisfaction can reduce turnover and potentially bring in additional business through word of mouth.</p><h4>3.    Improved family confidence.</h4><p>Putting a loved one in care is an emotional journey for families. Oftentimes, several family members are involved in the process, and the well-being of their loved one is the top priority. When a resident is unhappy, this extends to their family, who, over time, can lose trust and confidence in a facility. On the flip side, when a resident feels confident, independent, and empowered, their family typically feels the same.</p><p>Accessible care means happy residents and a family that has confidence in the facility they have put their trust in. As with the boost in resident satisfaction, this can also help reduce resident turnover and bring in new business.</p><h3>How Technology Can Improve Accessibility</h3><p>When businesses think about accessibility, one of the first things that comes to mind is cost. While implementing accessibility solutions will come with a cost, the long-term benefits outweigh this many times over.</p><p>The truth is, providing accessible care doesn’t need to cost hundreds of thousands or take years to update buildings, thanks to the latest advancements in technology. While there are many physical adjustments to facilities that can also be made to improve accessibility, one of the biggest advancements is AI.</p><p>For blind and low-vision people, AI has been particularly useful. Specific AI software can, for example, interpret menus and activity timetables from a photo and read these aloud to a resident. With forms and paperwork, a blind resident can take a photo, upload it to an AI platform, and get an almost instant, detailed description of what it is.</p><p>AI, when implemented correctly within a care facility, truly enables greater independence for the blind and low-vision community. Care providers who recognize this now will benefit for many years to come, along with their staff and residents.</p><h3>Where to Start?</h3><p>As a care provider wanting to improve accessibility, the first place to start is by conducting a resident and family satisfaction survey. This not only highlights where frustrations currently exist but also signals to families that their voices matter.</p><p>From there, care home managers should take the time to speak directly with blind and low-vision residents in one-on-one conversations. No checklist or policy can replace the insights gained from lived experience, and residents will often suggest simple, inexpensive improvements that make a meaningful difference in their day-to-day lives.</p><p><span><img src="/Articles/PublishingImages/2025/andy%20bailey.png" alt="Andy Bailey" class="ms-rtePosition-2" style="margin:5px;" /></span>With this feedback in hand, the next step is to carry out a thorough accessibility audit. This includes evaluating menus, signage, activity boards, paperwork, and the technology currently in use, alongside the physical environment.</p><p>Finally, facilities should prioritize any quick wins identified from the surveys and audit. This might be something as simple as offering large-print or braille menus or having a strategy for implementing technology solutions.<br><br><em>Andy Bailey is chief marketing officer at Be My Eyes, an accessibility management platform for people who are blind or have low vision. </em></p><p><em><br></em></p><p><span class="ms-rteFontSize-1"><em>Provider</em> magazine includes
information from a variety of sources, such as contributing experts.
The views expressed by external contributors do not necessarily reflect
the views of <em>Provider</em> magazine and AHCA/NCAL. </span><a href="/About/Pages/Submit-Article.aspx" title="https://www.providermagazine.com/About/Pages/Submit-Article.aspx" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" target="_blank"><span class="ms-rteFontSize-1">Learn how to submit an article.</span></a><br></p> | 2025-11-04T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/AAseniorwoman_ipad.jpg" style="BORDER:0px solid;" /> | Management | According to the Royal National Institute of Blind People, more than half of residents in assisted living or care homes are blind or have low vision. Long term care facilities cannot afford to treat vision loss as a marginal issue. |
| Using Psychological Safety to Build a QAPI Culture | <p><img src="/Articles/PublishingImages/740%20x%20740/healthcare-staff.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:350px;height:350px;" />Quality assurance and performance improvement (QAPI) has the potential for meaningful change as long as it is not reduced to a compliance exercise—documents filed away, minutes recorded, and action items noted. </p><p>The facilities that thrive are those that treat QAPI as a culture, not a checklist. And at the heart of that culture is psychological safety—the belief that every staff member, from the CNA to the administrator, can speak up, share ideas, and challenge processes without fear of punishment.</p><h3>Defining Psychological Safety in QAPI</h3><p>Psychological safety, a concept rooted in organizational behavior research, describes the sense of confidence that one’s voice will be heard and valued. In health care, where hierarchies are deeply ingrained, psychological safety is essential.</p><p>For QAPI teams, psychological safety transforms meetings from routine compliance updates into vibrant problem-solving sessions. It ensures that concerns are raised before they become citations, and that creative solutions are not stifled by fear of reprisal.</p><h3>The Four Dimensions of Psychological Safety</h3><p>To intentionally build psychological safety in QAPI culture, leaders must focus on four dimensions.<br>1. Learner Safety<br>“It’s safe to discover, ask questions, make mistakes, and learn.”<br></p><ul><li>Normalize curiosity by celebrating questions rather than dismissing them.</li><li>Protect new learners with coaching and just-in-time education.</li><li>Reframe mistakes as learning opportunities for system improvement.</li></ul><p>2. Inclusion Safety<br>“It’s safe to belong, regardless of role, title, or background.”<br></p><ul><li>Audit who is at the QAPI table—are CNAs, dietary staff, and housekeeping included?</li><li>Use inclusive language and invite contributions from all disciplines.</li><li>Honor diverse perspectives, recognizing that every role contributes to resident outcomes.</li></ul><p>3. Collaborator Safety<br>“It’s safe to share openly and interact without fear of rejection.”<br></p><ul><li>Facilitate shared decision-making, ensuring no single voice dominates.</li><li>Rotate roles in QAPI meetings to empower frontline staff.</li><li>Encourage peer-to-peer communication and model active listening.</li></ul><p>4. Challenger Safety<br>“It’s safe to speak up, challenge norms, and offer bold ideas.”<br></p><ul><li>Praise constructive pushback and reward curiosity.</li><li>Separate reporting from punishment—focus on transparency over blame.</li><li>Use real-time root cause analysis (RCA) to uncover issues, not to assign fault.</li></ul><p>When all four quadrants are present, staff can move from passive compliance to active engagement in improvement.</p><h3>Practical Strategies to Build Psychological Safety into QAPI</h3><p>Changing culture requires deliberate action. Facilities can begin by implementing these strategies.</p><ul><li>Embed QAPI into Daily Operations</li></ul><p>Culture is built in moments, not meetings. Make QAPI language part of shift huddles, care plan reviews, and daily problem-solving.<br></p><ul><li>Recognizing Contributions Publicly</li></ul><p>Acknowledge staff input during rounds, newsletters, or team huddles. Recognition reinforces the value of participation.<br></p><ul><li>Establish a “QAPI Champion” Role</li></ul><p>Designating staff as champions ensures quality improvement is carried between formal meetings and daily routines.<br></p><ul><li>Train Leaders to Coach, Not Correct</li></ul><p>Leadership tone makes or breaks psychological safety. Coaching builds confidence; criticism silences voices.<br></p><ul><li>Create a QAPI Rhythm Calendar</li></ul><p>Consistent, predictable cycles of data review and performance improvement build trust and engagement.<br></p><ul><li>Incorporate QAPI Into Orientation and Onboarding</li></ul><p>New staff must see QAPI not as leadership’s project, but as the facility’s way of operating.</p><h3>Why Psychological Safety Is the Foundation of Sustainable QAPI</h3><p>QAPI is only as strong as the culture that sustains it. A compliance-driven approach produces binders of data but little change. A culture-driven approach, fueled by psychological safety, produces staff who bring forward problems, propose solutions, and feel ownership in the quality journey.</p><p>The difference is visible:<br></p><ul><li>Staff engagement improves.</li><li>Residents receive more consistent, person-centered care.</li><li>Facilities move from reacting to citations to proactively solving problems.</li><li>Performance improvement plans (PIPs) become living projects rather than paper exercises.</li></ul><p>Ultimately, psychological safety transforms QAPI from a task into a tool of transformation.</p><h3>Final Reflection for Leaders</h3><p><span><span><em><img src="/Articles/PublishingImages/2025/Veronica-Ceasar.jpg" alt="Veronica Ceaser" class="ms-rtePosition-2" style="margin:5px;" /></em></span></span>As you reflect on your facility, ask yourself:<br></p><ul><li>Which quadrant of psychological safety: learner, inclusion, collaborator, challenger is weakest?</li><li>What is one actionable step you can take this month to strengthen it?</li></ul><p>The answers to those questions will determine whether QAPI in your facility remains a compliance exercise or becomes the cultural engine that drives lasting quality improvement.<br><br><em>Veronica Ceaser is a long term care consultant and the founder of GEM Healthcare Consulting. With a background spanning bedside nursing to executive leadership, she specializes in MDS training, quality improvement, and regulatory readiness for skilled nursing teams across the U.S.</em></p><p><span><span class="ms-rteFontSize-1"><em>Provider</em> magazine includes
information from a variety of sources, such as contributing experts.
The views expressed by external contributors do not necessarily reflect
the views of <em>Provider</em> magazine and AHCA/NCAL. </span><a href="/About/Pages/Submit-Article.aspx" title="https://www.providermagazine.com/About/Pages/Submit-Article.aspx" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" target="_blank"><span class="ms-rteFontSize-1">Learn how to submit an article.</span></a></span><br></p> | 2025-10-30T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/healthcare-staff.jpg" style="BORDER:0px solid;" /> | Quality Assurance and Performance Improvement;Quality | QAPI has the potential for meaningful change as long as it is not reduced to a compliance exercise—documents filed away, minutes recorded, and action items noted. |
| Improving Section GG Accuracy Through QAPI | <p><img src="/Articles/PublishingImages/2025/iStock-464806966.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:250px;height:249px;" />Accurate data collection and reporting are more important than ever in skilled nursing facilities. Among the challenges is coding section GG of the Minimum Data Set (MDS) that captures usual performance in self-care and mobility tasks. This data also drives care planning, quality reporting, Medicare reimbursement, and, in some states, Medicaid reimbursement, so it has a widespread impact. Thus, addressing and resolving the root cause of any inaccuracies and inconsistencies in a timely way must be a top priority.</p><p>Common issues are incomplete or missing observations, inconsistent input across disciplines, or the lack of an interdisciplinary effort to determine usual performance. The quality assurance and performance improvement (QAPI) process is an effective method for facility teams to identify and address the root causes of these issues.</p><p>QAPI is designed to be a proactive, data-driven framework that goes beyond compliance to focus on measurable and sustainable improvements. This article shows how to include section GG in the QAPI process. It will help ensure improved accuracy of documentation and coding and also establish a lasting system of accountability and collaboration.</p><h3>The Role of Section GG in QAPI</h3><p>Section GG lends itself well to QAPI monitoring because it provides clear, measurable indicators of compliance. Facilities can begin by routinely auditing a sample of assessments each quarter, at least 5 percent of all completed MDS submissions. During these reviews, staff can examine whether each self-care and mobility item was observed, whether the entire 3-day observation window was covered, and whether the input from nurse aides, therapists, nurses, residents, or families was incorporated. The audit should also confirm that discrepancies between disciplines were addressed and resolved before the assessment was finalized.</p><p>The approach just described allows the facility to assign a percentage of compliance for each item, creating a set of key performance indicators (KPIs) to track over time. For example, instead of relying on anecdotal impressions (e.g., “our nurses’ aides aren’t documenting enough”), the facility can use concrete numbers that reveal whether compliance is trending up or down.</p><h3>Understanding the Source of the Issue</h3><p>Once data is collected, the QAPI committee must ask why errors or inconsistencies are occurring. In some cases, the root of the problem may be related to the process. Staff may not complete all episode documentation on each specific self-care or mobility task or they may not recognize that documentation is required throughout the 3-day window. In other situations, the issue relates to training. Staff may not understand the difference between specific tasks or the performance levels used for section GG. Sometimes the problem is inherent in the systems. For example, electronic health records (EHRs) may not provide sufficient prompts or fields for capturing required information, leaving staff to remember the details on their own. Finally, the culture of the facility may be a factor. Completing documentation and focusing on accuracy may be viewed as a siloed MDS issue, rather than a responsibility of the entire collaborative interdisciplinary team.</p><p>Root cause analysis (RCA) should be used to identify the primary cause of the issues identified. Whether through the Five Whys method or a fishbone diagram, facilities can begin to uncover the deeper reasons behind persistent noncompliance. Without identifying the root cause, any efforts to improve section GG documentation risk addressing symptoms rather than causes.</p><p>By applying RCA consistently, facilities can move beyond quick fixes and create sustainable improvements. For example, if training gaps are identified as the primary cause, the focus should be on the process or system used for training to ensure staff clearly understand performance levels and documentation expectations. If workflow barriers or EHR limitations are uncovered, processes can be redesigned or system prompts added to guide staff during the observation window. When the root cause is cultural, believing that section GG is solely the responsibility of the nurse assessment coordinators (NACs), leadership can emphasize the shared accountability of the interdisciplinary team, reinforcing that precise documentation reflects the resident’s true abilities. In each case, addressing the root cause leads to more accurate coding, stronger compliance, and ultimately better resident outcomes.</p><h3>Moving into Action</h3><p>When section GG issues are isolated or minor, the QAPI team may be able to address them through targeted feedback, training, or process adjustment. But if problems are systemic or persistent, it may require a formal Performance Improvement Project (PIP). A PIP provides structure, scope, and accountability, ensuring that the facility moves beyond merely identifying issues to actively solving them.</p><p>For example, if a facility discovers that dashes are used too frequently in GG0130 or GG0170 items, the QAPI team might charter a PIP with the goal of reducing dash use to less than 2 percent of MDS assessments within six months. The project might involve staff training on appropriate coding, daily check-ins during the 3-day assessment window to ensure observations are documented, and routine interdisciplinary reviews before MDS coding. Each step would be monitored through continued audits, with progress shared at QAPI meetings.</p><p>To be effective, the PIP must include measurable goals and a clear plan for monitoring progress. Assigning responsibility is also essential. The NAC, therapy staff, nurse aides, and charge nurses all may have distinct roles to play in the plan that the project should make clear.</p><h3>Sustaining Long Term Improvement</h3><p>Section GG documentation and coding issues are not a one-time effort. Without reinforcement, even well-executed improvement plans can lose momentum. To ensure long-term success, facilities need to include these practices in their daily routines. It could start with staff orientations, to create a positive culture and clear expectations for the importance of section GG documentation. Ongoing monitoring and education should be scheduled and not just hastily organized when problems arise.</p><p>Recognition is another powerful tool to improve a culture focused on accuracy for section GG. When staff meet or exceed compliance goals, celebrating those achievements helps reinforce positive behaviors and encourages a sense of ownership.</p><p>Most importantly, QAPI meetings should continue to review section GG compliance until results are consistently strong. Even then, it is wise to revisit section GG periodically to confirm that gains are maintained and to identify new opportunities for refinement. Facilities should also be prepared to adjust their benchmarks upward over time, fostering a culture of continuous improvement.<br></p><h3>Conclusion</h3><p><img src="/Articles/PublishingImages/740%20x%20740/JessieMcGill.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:175px;height:175px;" />Section GG documentation and coding are foundational to quality care and accurate reporting in nursing facilities. Yet they are also areas where many facilities stumble, whether through incomplete observations, missing documentation, or lack of interdisciplinary collaboration. By integrating section GG into the QAPI framework, facilities will gain tools to measure performance, identify root causes, implement targeted interventions, and sustain long-term improvement.<br><br><em>Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, is senior curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).</em></p><p><em><br></em></p><p style="text-align:center;"><em><span></span></em></p><h4 style="text-align:left;"><em><span><em><img src="/SiteCollectionImages/logos/AAPACN.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:56px;" /></em></span>The American Association of Post-Acute Care Nursing
(AAPACN) represents more than 17,000 long-term and post-acute nurses
and professionals working in more than 5,750 facilities through its
subsidiary associations, the American Association of Nurse Assessment
Coordination (AANAC) and the American Association of Directors of
Nursing Services (AADNS). Learn more at <a href="https://www.aapacn.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteThemeForeColor-2-0">AAPACN.org</span></a>.</em></h4><p><span><span class="ms-rteFontSize-1"><em>Provider</em> magazine includes
information from a variety of sources, such as contributing experts.
The views expressed by external contributors do not necessarily reflect
the views of <em>Provider</em> magazine and AHCA/NCAL. </span><a href="/About/Pages/Submit-Article.aspx" title="https://www.providermagazine.com/About/Pages/Submit-Article.aspx" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" target="_blank"><span class="ms-rteFontSize-1">Learn how to submit an article.</span></a></span><br></p><p></p> | 2025-10-21T04:00:00Z | <img alt="" height="739" src="/Articles/PublishingImages/2025/iStock-464806966.jpg" width="740" style="BORDER:0px solid;" /> | Quality Assurance and Performance Improvement;Quality | Common issues are incomplete or missing observations, inconsistent input across disciplines, or the lack of an interdisciplinary effort to determine usual performance. The QAPI process is an effective method for facility teams to identify and address the root causes of these issues. |