| How to Structure Your Compliance Program | <p><img src="/Articles/PublishingImages/2025/nurse_paperwork.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Nursing, assisted living, and post-acute facilities have long been an area of scrutiny by the Office on Inspector General (OIG) as they are high-risk areas. It is important that an organization have a formal compliance program as proactive and preventive; a structure to address issues; and as a mitigating factor should compliance violations be identified by regulatory agencies.</p><p>OIG recognizes a common structure for compliance programs centered around seven elements. They are:<br></p><ul><li><strong>Written policies, procedures, and standards of conduct</strong></li></ul><ol><li>How accessible are they to all employees?</li><li>How often are they reviewed?</li><li>What is the process/procedure for review and approval?</li><li>Are they written in understandable language?</li></ol><p>As an example, every policy is subject to review every three years. However, they can be revised at any time. Front-line employees who actually work with the policies should be free and encouraged to make revision recommendations. As policies may impact areas outside of the department owner, an interdisciplinary committee can review them to avoid conflicts and also provide ideas to strengthen them.</p><ul><li><strong>Designated compliance officer and compliance committe</strong>e</li></ul><ol><li>Does the compliance officer report to the CEO directly with independent access to the board?</li><li>The compliance officer should not lead or report to the entity’s legal or financial functions.</li></ol><p>A compliance committee of designated Board members meets on a quarterly basis with a standing agenda. The only member of management present is the compliance officer or its staff so that issues can be presented and openly discussed without management interference or filters.<br></p><ul><li><strong>Effective training for success</strong></li></ul><ol><li>Identify required training by regulatory and accrediting bodies.</li><li>What training is required? What should be conducted for all employees annually?</li><li>How is effectiveness measured?</li></ol><p>Compliance can also develop custom-designed training to address specific reoccurring issues in identified departments. An example is one for Health Insurance Portability and Accountability Act (HIPAA) incidents with identification of their root cause and corrective/preventive actions. The staff usually appreciate the effort and attention shown to help them.<br></p><ul><li><strong>Effective lines of communication</strong></li></ul><ol><li>Have a variety of reporting mechanisms that can be used to report concerns or incidents.</li><li>How are the lines communicated? Are employees aware of them?</li></ol><p>A hotline incident management reporting system can help the compliance officer track, manage, assign, quickly access and review cases and develop metrics of where to place compliance priorities. This should have an anonymous reporting feature and be available to the public for reporting access.<br></p><ul><li><strong>Enforcing standards: consequences and incentives</strong></li></ul><ol><li>They should be publicized and made available.</li><li>Consistently applied and enforced.</li></ol><p>Adherence to compliance standards can be a rated factor in performance evaluations.<br></p><ul><li><strong>Internal auditing and monitoring</strong></li></ul><ol><li>Be proactive and reactive.</li><li>Communications and approach should be working as a business partner with managers for quality and process improvements.</li></ol><p>Compliance should work as a team member with other departments in identifying and monitoring, through audits, opportunities for process improvements that can mitigate risks, make employees’ jobs easier, and increase revenue. One example, in an ambulatory care setting, is improving patient wait times.<br></p><ul><li><strong>Responding to detected offenses and developing corrective action initiatives</strong></li></ul><ol><li>Processes and resources should exist to address them.</li><li>Investigations, corrective actions, and resolutions should be prompt</li></ol><p>Standard timelines should be developed for investigations to be completed. Points-of-contacts in departments should be identified to whom incidents should be sent.</p><p><img src="/Articles/PublishingImages/2025/Robert-Rohr.jpg" alt="Robert Rohr" class="ms-rtePosition-2" style="margin:5px;width:175px;height:175px;" />This model provides a recognized structure for preventing, addressing, and resolving compliance issues in an organization. It is flexible in how organizations choose to develop programs to address them within available resources.</p><p>An annual compliance plan should be developed with the activities and their goals to support each element. An excellent guide for ideas can be found in <em>Measuring Compliance Program Effectiveness: A Resource Guide,</em> HCCA-OIG Compliance Effectiveness Roundtable Meeting: January 17, 2017.<br><br><em>Robert Rohr, J.D., M.A, CHC, SPHR is the director of corporate compliance for Sun Life Health, a federally qualified health center, with 14 locations in southern Arizona. He can be reached at <a href="mailto:robert.rohr@slfhc.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">robert.rohr@slfhc.org.</a></em><br></p> | 2025-01-21T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2025/nurse_paperwork.jpg" style="BORDER:0px solid;" /> | Management;Policy | It is important that an organization have a formal compliance program as proactive and preventive; a structure to address issues; and as a mitigating factor should compliance violations be identified by regulatory agencies. |
| Health Plan Focused Value-Based Care in Nursing Homes | <p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong><br></p><p>Provider Partners is a value-based care (VBC) company singularly focused on nursing homes, assisted living facilities (ALF), and personal-care homes. Provider Partners offers services in three lanes: I-SNP, IE-SNP, and ACO-REACH. From my perspective as the founder of Provider Partners, the VBC model creates a real opportunity to better align the wants and needs of residents, their families, nursing home operators, the health plan, and CMS. That’s a tough combination of constituencies to please at the same time.</p><h3>What Makes VBC Models Work?</h3><p><img src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Models of care that align success metrics with outcomes create powerful incentives to keep individuals well and reduce the need for costly services. A typical inpatient hospitalization costs Provider Partners $8,000 - $15,000. A complex stay, such as with a trach and ventilator, can cost over $100,000.</p><p>VBC models are successful when they identify and deal with issues early. It certainly costs a lot more to provide the staffing and enhanced level of intense services that can identify ailments as they are germinating, yet still minor. We employ a team of nurse practitioners and RN case managers who supplement those services provided by the attending physician, specialists, and nursing facility team. It’s an expensive proposition to hire, train, teach, and monitor the activities of this large group. We don’t bill for their services and their activities do not conflict with those of a primary care physician.</p><p>Trying to monitor every individual to achieve early detection and intervention requires close attention to leading indicators of changes of condition. A tool that is essential to this oversight is one that delivers targeted data analytics, such as Real Time Medical Systems. Obtaining clear concise data in real time is a key early warning signal that helps us reduce admissions and readmissions in skilled nursing facilities.</p><h3>What Does This Accomplish?</h3><p>Frequent hands-on interaction that complements and enhances that of the primary care team provides a dramatically greater opportunity to catch those changes in condition early before they reach critical mass. Our model doesn’t revolve around decisions about whether to approve services—it focuses on making many high intensity services unnecessary by dealing with illness at that earlier stage.</p><p>This approach has been proven by Provider Partners and other VBC entities to improve outcomes and quality of care. Nursing home and ALF residents and their families experience much higher satisfaction for two simple reasons—greater interaction with the clinical team and fewer urgent trips for emergency services. Overall costs are significantly reduced. Not only are direct medical costs reduced but so are the affiliated costs such as transportation expenses. All of this is measurable.</p><h3>What Are Some Challenges? </h3><p>Provider Partners is owned and managed by former owners and operators of nursing home and assisted living facilities. We partner with facilities as a true value-added service. We must communicate and coordinate with the facility operator, primary care physician, administrator, director of nursing, and medical director.  This is our true secret sauce. Building rapport at all levels and really knowing our members is what makes this work. That requires training, reinforcement, and support from the facility and Provider Partners leadership.</p><h3>What About Non-Hospital Services?</h3><p>Trends in nursing home care over the past decade clearly demonstrate a need for non- hospital services that can be provided, when possible, in the facility. Nursing home administrators and directors of nursing covet relationships with behavioral health providers, wound care specialists, and therapy vendors. Those vendors want to attain a certain level of service utilization to make it worth their while to come to a facility. </p><p>One of the challenges to managing a VBC model is attaining a balance between “routine” follow-up visits and reasonable medical necessity criteria. There is a significant degree of excessive “routine” specialty visits for nursing home residents who are quite stable or have disorders that would no longer benefit from ongoing regular follow up. Efforts to address these “affordability” issues create the ongoing need for monitoring and engagement by VBC health plans. This process greatly reduces the frequency of Medicare fraud, waste, and abuse issues.</p><h3>Summary</h3><p>Experienced clinicians working in the value-based care environment are fully committed to creating a high standard of care for our most vulnerable populations. We strongly believe that this model provides the best opportunity to align incentives in order to do right by our members. Provider Partners is dedicated to working with long term care providers to improve quality and allow them to participate in the share of savings that is created.</p><p><img src="/Articles/PublishingImages/740%20x%20740/ScottRifkin.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Learn more at <a href="http://www.partnerwithpphp.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">partnerwithpphp.com</a> or reach us at <a href="mailto:info@pphealthplan.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">info@pphealthplan.com</a>.<br><br><em>Scott Rifkin, MD, is the founder of Provider Partners and has 30 years of long term care experience as a medical director, attending physician, and as an owner of 23 skilled nursing facilities. He has spoken extensively at conferences on the topics of value-based care and regulatory issue reduction. Dr. Rifkin has served on the boards of the Pennsylvania Health Care Association, The Health Facilities Association of Maryland, and Maryland’s LifeSpan. </em><br></p> | 2025-01-16T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER:0px solid;" /> | Caregiving | The VBC model creates a real opportunity to better align the wants and needs of residents, their families, nursing home operators, the health plan, and CMS. |
| Long Term Care 2025 Trends and Outlook | <p><img src="/Articles/PublishingImages/740%20x%20740/nurse_patient.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Long term care services are in greater demand than ever. Given that the oldest Baby Boomers will turn 80 next year, the industry has responded by improving operations, leveraging technology, monitoring legislation, and focusing on wellness. These efforts will show in 2025 as the industry addresses needs, capitalizes on growing trends, and continues to deliver the best care to those in need and their families.</p><p>“Long term care is ever-changing: we continue to innovate, find new approaches to quality care, assess our regulatory environment, and seek ways to improve it,” Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said. “We are a profession that continues to evolve and welcome change. One thing that hasn’t changed—and never will—is our commitment to quality for our residents. By leading with quality, the skilled nursing profession will be poised for success.”</p><p>Porter said assisted living continues to grow steadily, demonstrating its value and satisfaction among seniors. Skilled nursing care continues to be critical to the nation’s health care continuum. He also noted that despite these signs of growth, workforce challenges remain a top challenge, impacting nearly every skilled nursing facility nationwide.<span><img src="/PublishingImages/Headshots/ClifPorter.jpg" alt="Clif Porter" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" /></span></p><p>“We have yet to return to our pre-pandemic workforce levels by a deficit of more than 100,000 workers. This is not about a lack of trying to hire more caregivers: nearly every nursing home in the nation is doing everything possible to fill open positions and recruit more workers,” said Porter. “The reality is that there simply aren’t enough nurses and nurse aides to meet the demand, and we desperately need meaningful workforce solutions to grow our pipeline of qualified caregivers. We remain resolved to offer those solutions on Capitol Hill and to defeat impractical ones, like the federal staffing mandate, which I’m optimistic we can achieve next year.”</p><h3>Growing Needs in Assisted Living</h3><p>A foreseeable challenge facing assisted living will be managing the growing needs of a population that is entering assisted living with more chronic conditions, said LaShuan Bethea, executive director of NCAL.</p><p><img src="/PublishingImages/Headshots/LaShuanBethea_2022.jpg" class="ms-rtePosition-2" alt="LaShuan Bethea" style="margin:5px;width:150px;height:150px;" />“Assisted living communities must adapt to help residents manage these chronic conditions. As seniors age, they increasingly focus on health and wellness to maintain independence. Population health management will be essential in helping seniors stay healthy and enabling providers to offer more personalized and preventative care for seniors requiring assisted living services,” she said.</p><p>Integrating technology, such as wearables, can play an important role in helping providers monitor chronic conditions while helping residents remain independent and minimize the likelihood of health decline, she said.</p><p>Additionally, Bethea said, a critical challenge will be maintaining regulation at the state level.</p><p>“State regulations allow for a more tailored approach that reflects the unique needs of each community,” she said. “Preserving this at the state level will ensure that regulations remain flexible and responsive to the realities of providing care in diverse settings.”</p><h3>Addressing Staffing Shortages </h3><p>Leaders must be prepared to invest in competitive wages to recruit and retain while balancing these demands with inflationary pressures on expenses, according to Brian G. Lawrence, LNHA, CPA, MBA, president and CEO, FellowshipLIFE.</p><p>“We are exploring opportunities to recruit talent from abroad,” he said. “This decision has been assessed through a careful financial lens because of the time it may take for foreign recruitment to take shape. It’s crucial to involve financial experts in human resources and operational planning to ensure the organization can invest in quality staffing.”</p><p>Additionally, leaders cannot rely solely on compensation to retain high-quality employees. </p><p>“Today’s workforce expects an environment with a strong workplace culture that prioritizes their personal and professional development,” Lawrence said. “To retain skilled workers, leaders must be able to articulate the benefits of employment outside of compensation. They must also be willing to build longer onboarding periods, mentorship programs, and more personal skill development opportunities to demonstrate the organization’s investment in each employee.”</p><h3>Mentorships and Apprenticeships Support Staffing</h3><p>More programs involving various nursing homes with mentorship support are planned for 2025, according to James Chang, workforce development manager at New York-based organization, 1199SEIU Training and Employment Funds (TEF), which provides CNA mentorship training through its long term care, community-based organization, and pharmacy division for certified nursing assistants working with CNA apprentices.</p><p>“As a result of the implementation of the projects, the overall post-graduation retention rate of these CNA apprentices with their existing employers has been approximately 90 percent,” Chang said. “The mentorship training teaches the mentors about empathy and compassion, which helps them to build trust with their apprentices. They learn to coach the apprentices on how to practice active/reflective listening skills and learn to respect others in the workplace.”</p><h3>Pay and Benefits a Top Factor for Employees</h3><p>As for employee preferences, the JLL 2024 Employee Perspective on Healthcare Real Estate reports that pay and benefits are the top factors in choosing an employer. However, flexibility, specific roles, and location are important in employee attraction and retention.</p><p>Additionally, generational preferences vary for these workplace factors. Baby boomers prioritize flexibility, with 15 percent ranking it as their top factor, while Gen Z values workplace culture.</p><p>The greatest impact of a facility's location on employee experience is its safety, convenience, and proximity to affordable housing. Employee spaces like break rooms and offices received lower ratings than patient care areas for newness, maintenance, and sound privacy, affecting employee experience. </p><h3>Credentialing Changes</h3><p>Credentials will continue to play an important role in training and hiring. Doug Helman, COO, The Kendal Corporation, foresees a resetting of nursing and caregiver professional credentialing and a continued increase in physician extenders and telemedicine.</p><p>“The health  care workforce shortage has become very real,” he said. “Many health care and medical professionals elected to leave the field or away from direct patient care following the pandemic. While the Baby Boomer demographic is encouraging from a consumer perspective, it has conversely further contributed to the health care workforce shortage. This will translate to resetting credentialing requirements for all licensed health care workers.”According to Helman, “Many state nursing and medical boards will reevaluate their credentialing requirements to address the shortage. This will result in more certified medication aides to support the nursing shortage and more nurse practitioners or physician assistants to support the family medicine and geriatrician shortage.”</p><h3>Wellness as Part of Person-Centered Care</h3><p>Alice Bonner, director of the Moving Forward national coalition, said nursing homes “aren’t just sites of care. They are people’s homes. Residents need to not only direct their care but have a say in the function and communal life of the nursing home,” Bonner said. “Empowering resident councils is vital to ensuring residents have that voice.”</p><p>Erin Caswell, COO, Revel Communities, said her company prioritizes listening to the voices of its independent living residents. Their feedback aligns with 2025 industry trends, highlighting the importance of autonomy and easy access to comprehensive health and wellness services.</p><p>Revel partners with personal trainers, physical and occupational therapists, concierge health care providers, primary care physicians, and mental health specialists to deliver multidimensional care directly to residents in the comfort of their homes and communities. </p><h3>Wellness Accentuated Through Interior Design</h3><p>A facility’s design can lead to healthier living environments, according to Johnny Dagher, director of senior living design, Baker Barrios Architects.</p><p>“Wellness has long been a central focus in the design of senior living facilities,” Dagher said. “Designers and owners have consistently prioritized elements like natural lighting, outdoor spaces, fitness areas, indoor air quality, and accessible design features. While many of these aspects are guided by building codes and shaped by lessons from the pandemic, the current emphasis has shifted toward leveraging wellness as a key selling point.”</p><p>Dagher also anticipates seeing design models that better accommodate individuals who fall between different care levels, such as those transitioning from assisted living to memory care or from independent living to assisted living.</p><p>“There’s a clear need for middle-ground services that offer more support than typical assisted living without requiring memory care,” Dagher said. “Similarly, there will be a demand for options that allow residents more independence while still having access to all the services provided in traditional assisted living.”</p><h3>Technology and AI Help Communities Optimize Efforts </h3><p>Companies are examining the requirements for value-based care models, which may require specific health information technology (HIT) capabilities (e.g., health information exchange) to enhance and improve care delivery by 2030. Technology is a key component for optimizing communities’ efforts to stay ahead.</p><p>However, Gregory L. Alexander, PhD, RN, FAAN, FACMI, FIAHSI, Helen Young CUPHSONAA Professor and Informaticist, Columbia University School of Nursing, said there are significant structural technology disparities among US nursing homes may lead to greater disparities in value-based care, such as poorer patient outcomes and lower quality of care with greater costs. Many of these problems may be exacerbated by a facility's rurality or size, he said.</p><p>“Document-sharing systems for nursing homes are receiving more attention as leaders realize that technology is here to stay and may provide important benefits, like more timely access to critical resident information when a resident’s condition changes,” Alexander said.</p><p>Experts identified AI, robotics, and virtual reality as important emerging capabilities that integrate technological components into care delivery and should provide new opportunities to address the challenges of caring for older adults in new ways. </p><p>“Corporate long term care companies with IT departments may be the first to take advantage of these capabilities because they have the departments and infrastructure to support them,” said Alexander. “There’s much promise in these emerging technologies, but leaders must approach their use cautiously.”</p><p>One example of increased adoption of AI is at Maplewood Senior Living, with communities across the Northeast. Resident-focused innovations include AI-enabled life story platforms that allow residents and families to upload cherished memories, providing easy access to life highlights; wearable, predictive health monitoring systems for early detection of health issues and real-time updates; and machine vision AI safety systems for fall detection and prevention.</p><p>Maplewood also employs operational AI enhancements such as automated financial processing tools and AI-driven planning systems for sustainable and accurate operations and streamlined resident transition platforms to enhance the move-in experience.</p><p>These advancements will continue to provide tangible benefits, offering peace of mind, enhanced safety, and personalized care for residents while reducing burnout and improving job satisfaction among frontline staff, according to Brian Geyser, vice president of enterprise intelligence at Maplewood.</p><p>“Looking to 2025 and the years ahead, AI is positioned to revolutionize how we deliver resident care,” he said. “Our goal is to ensure that innovation enhances—rather than replaces—the personal connections that are the foundation of exceptional senior care.”</p><p>Doug King, vice president emeritus of health care at PMA, said new technology has made it easier for seniors to live independent lives.</p><p>“From the wide adaptation of telehealth to the increasing use of wearables that can track health indicators, monitor for red flags and even alert the proper authorities in the event of a fall or accident,” King said. “In 2025, we will see even broader adoption of these tools and services in the world of senior living. For example, many health care providers are developing digital twins of patient bodies, which can be used to predict and optimize health outcomes through advanced analysis and modeling.”</p><h3>Affordability Still a Challenge</h3><p><img src="/PublishingImages/Headshots/PaulBergeron.jpg" alt="Paul Bergeron" class="ms-rtePosition-2" style="margin:5px;width:150px;height:150px;" />Affordability remains broadly unsolved, though new design trends are emerging, according to Zach Bowyer, executive managing director, Cushman & Wakefield.</p><p>“With middle-income seniors projected to double by 2029, over half of this segment will not have adequate finances to afford conventional senior living and care,” he said. <br></p><p><em>Paul Bergeron is a freelance writer based in Herndon, VA.</em><br></p> | 2025-01-14T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/nurse_patient.jpg" style="BORDER:0px solid;" /> | Caregiving | Long term care services are in greater demand than ever. The industry has responded by improving operations, leveraging technology, monitoring legislation, and focusing on wellness. |
| Polypharmacy Is a Problem in Senior Care | <p><img src="/Articles/PublishingImages/740%20x%20740/medications_4.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Polypharmacy, the concurrent use of multiple medications by a patient, is a growing concern in senior care. As the elderly population continues to grow, so too does the prevalence of chronic conditions that require pharmaceutical intervention. However, while medications can be life-saving, the indiscriminate use of multiple drugs often leads to adverse effects, drug interactions, and diminished quality of life for seniors.</p><p>Addressing polypharmacy is not just a medical issue; it's a critical aspect of providing holistic, patient-centered care that respects the complexities of aging.<br></p><h3>The Complex Challenges of Polypharmacy</h3><p>I've seen firsthand the challenges that polypharmacy presents. The traditional approach to treating multiple conditions often results in a fragmented care model, where specialists focus on individual diseases without fully considering the cumulative impact of their prescriptions. This lack of coordination can lead to seniors taking an overwhelming number of medications, sometimes without a clear understanding of their purpose or potential side effects. The result is a cycle where one drug's side effects are managed by another, compounding the problem rather than addressing the root cause. The complexity of managing multiple medications is already overwhelming for seniors and their caregivers, but this can increase issues with adherence, incorrect dosing, and confusion about the purpose of each drug.</p><p>Polypharmacy also heightens the risk of adverse drug reactions (ADRs), which can be both severe and difficult to diagnose. Seniors are often more vulnerable to side effects due to age-related changes in metabolism and organ function, so the likelihood of experiencing negative interactions between medications rises exponentially with each additional drug. This can lead to a cascade of health problems, including cognitive decline, falls, and hospitalizations, which not only compromise the quality of life for seniors but also place a significant strain on health care resources.<br></p><h3>How Can We Tackle the Issues Presented by Polypharmacy?</h3><p>The solution lies in a multifaceted approach that brings together health care professionals, patients, and caregivers. Addressing the challenges of polypharmacy requires a proactive and collaborative approach that begins with comprehensive medication reviews. These reviews, conducted regularly by health care professionals, involve evaluating all of a patient’s medications to ensure that each one is necessary, effective, and safe. This process optimizes the medication regimen and provides an opportunity to engage in meaningful conversations with patients about their treatment goals and preferences, ensuring that their care aligns with their overall well-being.</p><p>The industry must also promote deprescribing initiatives. Deprescribing involves the intentional and systematic reduction of medications, particularly those that may no longer be beneficial or that carry a higher risk of adverse effects. This is not about withdrawing care but refining it to better meet patient needs, improve their quality of life, and minimize the risks associated with polypharmacy.</p><p>Education and empowerment of both patients and caregivers are also essential. Seniors and their families should be equipped with the knowledge and tools to actively participate in medication management. This includes understanding the purpose and potential side effects of each medication, recognizing signs of adverse drug reactions, and knowing when to seek help. Creating a more transparent and supportive environment within the senior care space, where medication decisions are made collaboratively, empowers seniors to take an active role in their care and have more confidence and autonomy in managing their health.<br></p><h3>The Role of Technology in Managing Polypharmacy</h3><p>Technology plays a transformative role in addressing the complexities of polypharmacy by enhancing the accuracy and efficiency of medication management. Electronic health records (EHRs) are at the forefront of this revolution, offering a centralized platform where all medication data is recorded and updated in real-time. This integration allows health care providers to access comprehensive medication histories, identify potential drug interactions, and avoid duplicative prescriptions. As a result, health care professionals can make more informed decisions, reduce the risk of adverse drug reactions, and streamline the medication review process.</p><p>Medication management apps and digital platforms further support this effort by providing both patients and health care providers with real-time insights into medication regimens. These tools can send reminders for medication adherence, track usage patterns, and provide easy access to information about drug interactions and side effects. Some apps even offer features that allow users to scan their medications and receive immediate feedback on potential issues.</p><p>Additionally, technology helps facilitate better communication and coordination among health care teams. Platforms that enable secure messaging and data sharing among different providers ensure that all members of the care team are aware of each patient’s medication regimen. This is particularly important in managing polypharmacy, as it helps to prevent conflicts between prescriptions from various specialists.</p><p><img src="/Articles/PublishingImages/2023/MelissaPowell.png" class="ms-rtePosition-2" alt="" style="margin:5px;width:129px;height:147px;" />Championing a comprehensive approach to polypharmacy allows us to revolutionize senior care. Embracing these practices not only enhances treatment safety but also reaffirms our commitment to elevating the quality of life for our elderly population, paving the way for a more compassionate and effective health care future.</p><p><em><em>Melissa Powell is </em><em>president and COO of The Allure Group, which manages six eldercare centers in New York City.</em></em><br></p> | 2025-01-07T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/medications_4.jpg" style="BORDER:0px solid;" /> | Clinical | Addressing polypharmacy is not just a medical issue; it's a critical aspect of providing holistic, patient-centered care that respects the complexities of aging. |
| Top 10 Provider Resources of 2024 | <p>A roundup of all the top 2024 resources featured in <em>Provider Magazine</em> and on the website. <img src="/Articles/PublishingImages/740%20x%20740/nurses.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:250px;" /><br></p><p>1.      
<a href="/Articles/Pages/Deficiencies-at-F699-Emerging-Trends-in-the-Enforcement-of-New-Regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Deficiencies at F699: Emerging Trends in the Enforcement of New Regulations</strong></a> (article--2/13/2024)</p><p>One of the major changes in the revised regulations included tags for which many skilled nursing facilities were not adequately prepared to address, specifically F699, which addresses the provision of “trauma-informed care."</p><p>
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<a href="/Video-Resources/Podcasts/Pages/Government-Relations-and-Advocacy-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Government Relations and Advocacy in Long Term Care</strong></a> (podcast--12/19/2024)</p><p>Bassett shares insights on key issues, including the impact of Trump's administration on the long term care industry, staffing mandates, and quality improvement initiatives. </p><p>
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</p><p>3.      
<a href="/Video-Resources/ProviderTV/Pages/A-Playbook-on-Succeeding-in-Long-Term-Care-with-Mark-Parkinson.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>A Playbook on Succeeding in Long Term Care with Mark Parkinson</strong></a> (video--12/19/2024)</p><p>A new book offers long term care professionals a blueprint on how to thrive in every facet of caring for our nation's seniors.</p><p>
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</p><p>4.      
<a href="/Video-Resources/ProviderTV/Pages/Purpose-built-Technology-Supports-Care-Outcomes-with-Viventium.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Purpose-built Technology Supports Care Outcomes with Viventium</strong></a><strong> </strong>(video--12/12/2024)</p><p>Technology should support care providers delivering the highest quality of care, not take up valuable time. Gupta and Glauber from Viventium explain how software purpose-built for long term care can make a big difference. <br></p><p>
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</p><p>5.      
<a href="/Articles/Pages/Delving-into-Data-Steps-to-Make-Sense-of-It-All.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Delving into Data: Steps to Make Sense of It All</strong></a> (article--12/17/2024)</p><p>Data can support decisions about the nursing department by revealing current situations, trends, and predictions, along with potential risks. Data can also offer insight into the cause of an issue.</p><p>
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</p><p>6.      
<a href="/Articles/Pages/4-Tips-to-Improve-Section-GG-Coding-Accuracy.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>4 Tips to Improve Section GG Coding Accuracy</strong></a> (article--1/09/2024)</p><p>The four tips described here will help facility teams develop a process to ensure the accuracy of section GG items.</p><p>
<strong><br></strong></p><p>7.      
<a href="/Issues/2024/Summer/Pages/Top-High-Tech-Trends-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Top High-Tech Trends in Long Term Care</strong></a> (article--6/1/2024)</p><p>New technology in long term care is exciting and promises to deliver many new functionalities as long as the purchase and implementation work for the facility, providers, and residents.</p><p>
<br>
</p><p>8.      
<a href="/Marketplace/Pages/Using-Technology-for-Improved-Outcomes-in-Senior-Living%20Medication-Management.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Using Technology for Improved Outcomes in Senior Living</strong><strong>
</strong><strong>Medication Management</strong></a> (article--11/07/2024)</p><p>Learn how effective medication management technology reduces risks, improves resident outcomes, and prevents staff burnout in senior living communities.</p><p>
<br>
</p><p>9.      
<a href="/Articles/Pages/Why-Directors-of-Nursing-Need-a-Mentor.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Why Directors of Nursing Need a Mentor</strong></a> (article--6/11/2024)</p><p>When a nurse reaches the level of director of nursing (DON), the perspective changes, and sometimes not in the most comfortable of ways. You are being looked at as the person with the answers, but who is there to help you when you have a question? </p><p>
<br>
</p><p>10. 
<a href="/Articles/Pages/Deficiencies-at-F742-Emerging-Trends-in-the-Enforcement-of-New-Regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Deficiencies at F742: Emerging Trends in the Enforcement of New Regulations</strong></a> (article--2/15/2024)</p><p>Vicarious learning is useful when it comes to survey deficiencies—that is, learning about the reasons for deficiencies in other facilities enables us to examine the practices, polices, and procedures in our own facility.<br></p><p></p> | 2024-12-23T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/nurses.jpg" style="BORDER:0px solid;" /> | Management;Survey and Certification | A roundup of all the top 2024 resources featured in Provider Magazine and on the website. |
| Provider Roundup of 2024 Assisted Living Resources | <p>Let's recount the top assisted living resources posted on <em>Provider</em>'s website in 2024. <br></p><p><a href="/Issues/2024/Winter/Pages/Slowing-Progression-Through-Innovative-Dementia-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span></span></a><a href="/Issues/2024/Winter/Pages/Slowing-Progression-Through-Innovative-Dementia-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"><img src="/Issues/2024/Winter/PublishingImages/Win24_AL.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:150px;height:150px;" /></span></a><span class="ms-rteFontSize-4"><a href="/Issues/2024/Winter/Pages/Slowing-Progression-Through-Innovative-Dementia-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Slowing Progression Through Innovative Dementia Care</a></span> (12/4/2024)<br>Kemper House aims to slow the progression of dementia through cutting-edge programs, lifestyle changes, and family support.<br><br><a href="/Articles/Pages/How-to-Keep-Up-with-the-Jones-to-Attract-Residents-.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">How to Keep Up with the Jones to Attract Residents</span></a> (11/05/2024)<br>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.<br><br><a href="/Articles/Pages/2024-NCAL-Day-Sets-Record-Attendance,-Offers-Inspiration-and-Diverse-Education.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">2024 NCAL Day Offers Inspiration and Diverse Education</span></a> (10/08/2024)<br>Hundreds of assisted living providers and professionals came together for NCAL Day on Sunday, October 6, making it the biggest NCAL Day since its inception.<br><br><a href="/Issues/2024/Fall/Pages/Finding-the-Right-Assisted-Living-Community.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"><img src="/Issues/2024/Fall/PublishingImages/Fall24_AL.jpg" alt="assisted living" class="ms-rtePosition-2" style="margin:5px;width:150px;height:150px;" />Finding the Right Assisted Living Community</span></a> (9/11/2024)<br>Providers are committed to meeting the needs of current and future residents, and they are doing this by offering enhanced services, new technologies, and modernized buildings.<br><br><a href="/Video-Resources/Podcasts/Pages/Business-Opportunities-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">Business Opportunities in Long Term Care</span></a> (9/10/2024)<br>Kris Woolley shares key insights into the operations and growth of Avista Senior Living, as well as the challenges and opportunities in the long term care industry.<br><br><a href="/Video-Resources/ProviderTV/Pages/The-Long-Term-Care-Data-Cooperative-with-LaShuan-Bethea.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span><span><span></span></span></span></a><a href="/Articles/Pages/Career-Ladder-Innovations-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"></span></a><a href="/Video-Resources/ProviderTV/Pages/The-Long-Term-Care-Data-Cooperative-with-LaShuan-Bethea.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span></span></a><a href="/Articles/Pages/Career-Ladder-Innovations-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"></span></a><a href="/Video-Resources/ProviderTV/Pages/The-Long-Term-Care-Data-Cooperative-with-LaShuan-Bethea.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span></span></a><a href="/Video-Resources/ProviderTV/Pages/The-Long-Term-Care-Data-Cooperative-with-LaShuan-Bethea.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span></span></a><a href="/Articles/Pages/Career-Ladder-Innovations-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"><img src="/Issues/2024/Fall/PublishingImages/LaShuan-Bethea.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:150px;height:184px;" /></span></a><span class="ms-rteFontSize-4"><a href="/Video-Resources/ProviderTV/Pages/The-Long-Term-Care-Data-Cooperative-with-LaShuan-Bethea.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">The Long Term Care Data Cooperative with LaShuan Bethea</a></span> (7/25/2024)<span><span><a href="/Articles/Pages/Career-Ladder-Innovations-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"></span></a></span></span><br>The long term care industry continues to evolve faster and faster. Providers must collaborate and work together with partners to form a successful team.<span><a href="/Articles/Pages/Career-Ladder-Innovations-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4"></span></a></span><br><br><a href="/Issues/2024/Summer/Pages/The-Intangible-Values-of-Assisted-Living-Love-and-Innovation.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">The Intangible Values of Assisted Living: Love and Innovation</span></a> (6/1/2024)<br>Assisted living caregivers meet and anticipate the needs of residents through love, innovation, and connection.<br><br><a href="/Articles/Pages/Career-Ladder-Innovations-in-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">Career Ladder Innovations in Assisted Living</span></a> (4/18/2024)<br>Career ladders and career paths are not a new concept, but there are new and exciting innovations that come from building your own assisted living career ladder.<br><br><a href="/Issues/2024/Spring/Pages/NCAL-Board-Chair-Mark-Maxfield-Is-Excited-for-the-Future-of-Assisted-Living.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">NCAL Board Chair Mark Maxfield Is Excited for the Future of Assisted Living</span></a> (3/11/2024)<br>Maxfield sees an exciting future for the industry, one where the coming wave of residents can choose from unprecedented options, whether in size, location, care model, or even lifestyle options.<br><br><a href="/Articles/Pages/Assisted-Living-Success-in-2023-and-Looking-Ahead-to-2024.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteFontSize-4">Assisted Living: Success in 2023 and Looking Ahead to 2024</span></a> (1/23/2024)<br>Bethea reviews the accomplishments of 2023 and forecasts what 2024 will hold for the assisted living sector.<br></p> | 2024-12-19T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0620_News2.jpg" style="BORDER:0px solid;" /> | Assisted Living | Let's recount the top assisted living articles posted on the Provider magazine's website in 2024. |
| Delving into Data: Steps to Make Sense of It All | <p><img src="/Articles/PublishingImages/740%20x%20740/nurse_clipboard.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:210px;" />Data, data everywhere, but don’t know what to think? Don’t worry, many directors of nursing services (DNSs) feel this way. Some days all the data can be nerve-wracking, especially when the person collecting it doesn’t know what to do with it. This article will help the DNS develop a process for evaluating the data, determining what information is pertinent, and deciding how to follow up.</p><h3>The Importance of Data</h3><p>Data can support decisions about the nursing department by revealing current situations, trends, and predictions, along with potential risks. Data can also offer insight into the cause of an issue. The bottom line: the DNS can’t perform the job effectively without data. The key is to know what to do with the data once it is available.</p><h3>Triage the Data </h3><p>We tend to associate triage, assessing the urgency of a situation, with a hospital emergency department or a wartime battlefield. But it is also the first step when determining what problem to tackle first. It’s the process of prioritizing information based on its level of importance.</p><p>When a facility has multiple concerns that require investigation, the DNS must triage and review those areas that pose a higher risk first, such as falls with injury or pressure injuries. Then those areas with lower risk or less substantial changes are reviewed. When triaging, each area should fall into one of these categories:<br></p><ul><li>Level 1: Poses an immediate risk to the safety of residents or the facility (e.g., an issue with fire safety or water that is above acceptable temperature range).</li><li>Level 2: Poses a high risk to the safety of residents or the facility (e.g., a high rate of falls with injury or pressure injuries).</li><li>Level 3: Poses a possible risk to the safety of residents or the facility (e.g., a high rate of urinary tract infections).</li><li>Level 4: Poses a low risk to the safety of residents or the facility but needs to be addressed (e.g., late Minimum Data Set assessments).</li></ul><p>When determining what problem areas to address next with corrective action, it is not possible to rectify all areas at once. That would be overwhelming. Select two or three with the highest priority, based on the triage, to work on at one time. After correcting one, proceed to the next one on the list. Consider delegating items that fall into levels 3 or 4. </p><h3>Assess the Data</h3><p>Nurses assess residents to gather data either to determine a nursing diagnosis or to relay that information to facilitate a physician’s diagnosis. Once the nurse identifies a problem, he or she can implement a treatment. This is the same process to use when reviewing an area for improvement. The DNS must assess the system and gather information to conduct a full analysis that can help diagnose the problem. For example, if pressure injuries are an identified problem, the DNS needs to review those residents with pressure injuries and conduct a comprehensive review of their medical records to ensure the following:<br></p><ul><li>Appropriate care is being provided to each resident.</li><li>The standard of care is met.</li><li>Staff are following facility policies and procedures.</li><li>Staff identified changes in the resident’s condition and followed up on them.</li></ul><p>The DNS should then take this assessment a step further with a proactive approach and review those residents at risk of developing a pressure injury. This strategy facilitates identifying and correcting any issues before they impact the residents or facility. Any issues found during the audit should be corrected.</p><p>Next, the group of residents should be analyzed to identify any trends, gaps, or concerns. Are pressure ulcers noted on a particular unit? Does equipment such as mattresses or chair cushions need replacing? Follow up on these to implement sustainable corrections. Conversely, in some areas, staff may be excelling, such as ensuring preventive devices are in place per the care plan. Praise them for these successes.</p><p>The final step of the assessment is to review the correlating policy and procedure, especially important when the policy or procedure is not being followed. If a practice is deficient, such as preventive skin interventions not put into place in a timely manner, review that portion of the policy and procedure first. Then ask these questions:<br></p><ul><li>Is it current with regulatory requirements?</li><li>What portion of the policy and procedure was not followed that led to the issue?</li><li>Why was the policy or procedure not followed? </li></ul><h3>Conduct a Root-Cause Analysis</h3><p>Identifying the cause of the problem is paramount before implementing any intervention. Initiating solutions without knowing the root cause(s) of the problem or underperformance can be likened to washing the car and hoping it will fix the alternator.</p><p>When conducting a root-cause analysis (RCA), ask this question: “What changes can be made that will lead to an improvement?” The proposed changes should directly relate to the root cause. An RCA focuses primarily on inadequate processes or systems rather than on individual performance. It enables the organization to identify improvement strategies and thus decrease the likelihood of recurring incidences.</p><p>Determining the root cause(s) needs to emanate from an objective review of the system or process. The investigator should ask two questions:<br></p><ol><li>Would the event have occurred if this cause had not been present?</li><li>Will the problem reoccur if the cause is corrected or eliminated?</li></ol><p>If the answer to the questions is “no,” the root cause has been identified. If the answer is “yes,” the investigator needs to search further for the contributing factors.</p><h3>Correct the Problem</h3><p>After identifying the root cause of the problem, it is time to create sustainable interventions. They may include a change in equipment or staff education. It is crucial to choose the appropriate intervention or corrective action that tackles the underlying root cause of the problem.</p><p>The <a href="https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/guidanceforrca.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Guidance for Performing RCA with Performance Improvement Projects (PIPs)</a>, from the Centers for Medicare & Medicaid Services, describes three types of corrective actions: strong, intermediate, and weak. Aim for those corrective actions that are strong or intermediate when possible. Stronger actions are those that change the system and don’t allow for recurrence. The DNS must then determine if the correction needs a full-scale performance improvement plan or a simpler corrective action plan.</p><h3>Quality Assurance</h3><p><img src="/Articles/PublishingImages/2024/Denise-Winzeler.jpg" alt="Denise Winzeler" class="ms-rtePosition-2" style="margin:5px;" />After completing the review and implementing correction of the issue, it’s time to ensure those changes stay in place to sustain the improvement. The best way to achieve this goal is through the facility’s QAPI program, a data-driven proactive way to improve quality of life, care, and services in a nursing facility. To succeed, this approach must include surveillance of the interventions implemented to sustain or improve the area. Any issues noted during the surveillance need to be addressed in a timely manner.</p><p>Although following these steps described here doesn’t diminish the amount of data the DNS receives, the ability to triage and prioritize the data will make it much more manageable.<br><br><em>Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT, is curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).<br></em></p><p><em><br></em></p><p><em><img src="/SiteCollectionImages/logos/AAPACN.jpg" alt="" style="margin:5px;width:200px;height:56px;" /><br></em></p> | 2024-12-17T05:00:00Z | <img alt="" height="519" src="/Articles/PublishingImages/740%20x%20740/nurse_clipboard.jpg" width="740" style="BORDER:0px solid;" /> | Management | Data can support decisions about the nursing department by revealing current situations, trends, and predictions, along with potential risks. Data can also offer insight into the cause of an issue. |