| AHCA, NCAL Call on Congress to Include LTC in Infrastructure Package | <p>The American Health Care Association/National Center for Assisted Living is urging Congress to prioritize America’s seniors as it continues to negotiate a bipartisan infrastructure package.</p><p>Lawmakers must allocate support for providers to make capital improvements to nursing homes and assisted living communities across the country to ensure that residents receive the highest quality of care and additional protection against infectious diseases and other emergency events, the association says.</p><p>Too many facilities remain in dire need of upgrades, the group says. Nursing homes would like to evolve and make infrastructure investments, such as improving technology, indoor air quality, and energy backups, but many cannot afford to do so.</p><p>Chronic Medicaid underfunding left the average nursing home barely able to break even—even before the pandemic. Now, the industry is grappling with an economic crisis brought on by the COVID-19 pandemic.</p><p>Only <a href="https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-Only-One-Quarter-Of-Nursing-Homes-Confident-They-Will-Make-It-Through-to-Next-Year.aspx">one-quarter </a>of nursing homes and assisted living communities are confident they will make it through to next year due to the financial strain caused by responding to the crisis, according to a new AHCA/NCAL survey. Facilities are struggling just to make ends meet—they cannot afford to provide much-needed infrastructure improvements without additional help from lawmakers, they report.</p><p>Significant upgrades are needed to ensure long term care residents are protected, connected, and well cared for. Specifically, AHCA/NCAL is advocating that the infrastructure package include funding for long term care to make improvements in:</p><p>• Indoor Air Quality: Upgrading heating, ventilation, and air conditioning systems, as well as humidification and air pressure, helps prevent the spread of airborne infectious diseases and reduces respiratory issues, improving the health and comfort of both residents and staff.</p><p>• Technology: Expanding access to broadband would help rural long term care providers ensure residents stay connected with their loved ones as well as enhance telehealth options.</p><p>• Emergency Preparedness: In the face of escalating, unpredictable weather events and other natural disasters, long term care facilities need back-up energy solutions to maintain day-to-day operations, such as enhanced generator capacity, additional battery power sources, and solar panels.</p><p>• Enhanced Sanitization and Monitoring: Long term care facilities could implement more infection control best practices with UVC lighting and wastewater monitoring to catch and address potential risks more efficiently.</p><p>With the proper government support, nursing homes can invest in their workforce, clinical services, and infrastructure to continue to improve residents’ quality of life. AHCA and LeadingAge’s <a href="https://www.ahcancal.org/Advocacy/Pages/Care-For-Our-Seniors-Act.aspx">Care For Our Seniors Act </a>includes immediate and long-term strategies to address Medicaid underfunding for nursing homes, as well as other reforms that will help boost the workforce, modernize physical structures, and enhance infection control procedures. </p><p>The country must learn from this pandemic and other national emergencies, AHCA/NCAL says. Congress must prioritize seniors in the infrastructure package and help provide critical funding so long term care facilities can provide better care and be better prepared.<br></p> | 2021-07-21T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/senior_man_nurse.jpg" style="BORDER:0px solid;" /> | COVID-19 | Only one-quarter of nursing and assisted living centers are confident they will make it through to next year. |
| Survey Supports Key Role of Attending Physicians in Quality Care | <p>A recent article in JAMDA details a job analysis of attending physicians in long term/post-acute care that documents the unique and specific role they play in this setting.</p><p>“The pandemic highlighted the importance of engaged physicians to care for our residents, provide comfort measures, and prevent avoidable hospitalizations. This analysis bears out the importance of this involvement,” says Laura Morton, MD, CMD, one of the article’s authors. </p><p>The survey of attending physicians addressed a list of tasks, experience, and medical knowledge needed in their role in long term care. These items, developed and refined by a task force of subject matter experts, were written as statements that described distinct, identifiable, and specific practice-related activities. In all the survey consisted of 260 items.</p><p>The results showed that attending physicians supported statements related to ethical and culturally sensitive conduct, including applying principles of shared decision making, to achieve a patient- and resident-centered approach to care.</p><p>They also ranked highly knowledge relating to maintaining good facility coverage. Top medical care delivery statements related to recognizing, assessing, and treating patients and residents in a timely and nondisruptive manner, and ensuring continuous medical coverage. </p><p>Top-rated medical knowledge tasks centered on utilizing individualized information about comorbidities and risk factors to evaluate symptoms, as well as developing and following plans for additional and regular evaluation and re-evaluation. This includes deprescribing medications whenever possible. In support of these tasks, knowledge of differential diagnosis, deprescribing, pain management, multiple morbidity, and the use of decision-making tools were all highly rated.</p><p>“We hope that facility leaders will use this information to start a dialogue with attending physicians,” says Morton. “Talk about how you can work together to ensure the best possible care for residents.” Some physicians are more experienced than others, she notes, but there are numerous training and educational opportunities for all of them. “It is important to give physicians the tools and resources to succeed in this environment,” she says.</p><p>As new attendings come into facilities with little experience in this setting, it is important to ensure they understand the many unique aspects of long term/post-acute care, Morton says. “This requires training and education, and it will be useful to connect them with experienced practitioners who understand the specific regulatory environment, clinical evidence, and best practices for this space.”</p><p>More than ever, she says, “We understand the need for collaboration with all team members. These relationships will help us moving forward and prepare for future outbreaks. Our attendings are a key part of this.”</p><p>The job analysis was conducted for the American Board of Post-Acute and Long-Term Care Medicine. It is available online <a href="https://paltc.org/node/9298">here.</a><br></p> | 2021-07-15T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0120_News4.jpg" style="BORDER:0px solid;" /> | Caregiving | As new attendings come into facilities, it is important to ensure they understand the unique aspects of long term/post-acute care. |
| Access to Remaining Relief Funds Needed to Keep Long Term Care Facilities Afloat | <p>Nursing homes and assisted living communities have received approximately $14 billion of the $178 billion in the Provider Relief Fund (PRF) established by the CARES Act. This funding has been instrumental for long term care facilities struggling to make ends meet during the pandemic, but the remainder of the funds must be released so providers can continue to provide quality care to the nation’s seniors, according to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
</p><p>A recent AHCA/NCAL <a href="https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-Only-One-Quarter-Of-Nursing-Homes-Confident-They-Will-Make-It-Through-to-Next-Year.aspx" target="_blank">survey found</a> that 92 percent of nursing homes and 62 percent of assisted living communities said the PRF has been helpful during the COVID-19 pandemic. The same survey found facilities continue to face significant ongoing economic challenges.<br></p><p>Only one-quarter of long term care providers were confident they will make it through to next year. Without additional government support, facilities may be forced to close. In fact, a recent AHCA/NCAL <a href="https://d3dkdvqff0zqx.cloudfront.net/groups/ahca/attachments/protect%20access%20to%20long%20term%20care_ib.pdf" target="_blank">analysis found </a>that nearly 2,000 nursing homes could shut their doors for good over the course of the pandemic. </p><p>
Increased costs from the pandemic for personal protective equipment (PPE), testing, and additional staffing, among other necessities, have put a strain on providers. Coupled with fewer new residents and patients, as well as longstanding Medicaid underfunding, many facilities are struggling to stay afloat. These facilities are home to millions of frail seniors who cannot afford for them to abruptly shut down and be forced to find new care.
“</p><p>The Provider Relief Fund was a lifesaver for many in long term care last year,” said Mark Parkinson, president and chief executive officer of AHCA/NCAL. “Whether it helped acquire PPE to protect residents and staff from COVID-19 or allowed providers to offer hero pay to workers who went above the call of duty, we are grateful to the federal government for helping us during this historically challenging time.”<br></p><p>While overall the situation has improved, he said, this battle with the virus is not over, and now the sector faces a new battle.<br></p><p>“Our sluggish economic recovery puts thousands of facilities in danger of closing, threatening access to long term care for vulnerable seniors and individuals with disabilities,” he said. “We call on the administration to distribute the remaining aid that was intended for health care providers and help bring stability to our sector, so we can continue serving our residents.”</p><p>
The PRF aid allows for facilities to offset some of the exorbitant costs of care stemming from the pandemic and relieve some of the burden providers face on a daily basis. <br></p><p>The initial funding in 2020 has been the difference between many facilities closing or being able to stay open, Parkinson said, but in 2021, as the pandemic persists and the economic recovery of the industry is slow, more is needed.
</p><p>Members of Congress agree that long term care facilities need more federal aid. A <a href="https://www.ahcancal.org/Reimbursement/Documents/Congressional%20PRF%20Request%20to%20HHS.pdf" target="_blank">letter</a> sent to the U.S. Department of Health and Human Services (HHS) led by Congresswoman Terri Sewell (D-Ala.), co-signed by more than 50 Democrat and Republican members of Congress, requested an additional $10 billion from the PRF to be allocated to long term care facilities.
</p><p>The PRF aid has already made a major impact on facilities across the nation, but the road to recovery does not end here, AHCA/NCAL said. Continued support is needed to win the fight and protect long term care residents and staff. Lawmakers must make long term care a top priority, and that begins with HHS releasing the remainder of the PRF so the nation’s health care heroes can continue serving the nation’s most vulnerable.</p> | 2021-07-13T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/housing.jpg" style="BORDER:0px solid;" /> | Management | Without support, nearly 2,000 nursing homes could shut their doors for good over the course of the pandemic. |
| Senior Housing Industry Continues to Feel Effects of Pandemic | <p>Senior housing occupancy showed no overall change in the second quarter of 2021, maintaining at 78.7 percent, according to new National Investment Center for Seniors Housing & Care (NIC) MAP® data, generated by NIC MAP Vision.</p><p>Although COVID-19 cases in senior living properties continued to drop significantly in the last quarter, overall occupancy has not increased, which NIC attributes to new inventory coming online.</p><p>Despite unchanged occupancy, demand for senior housing improved in the second quarter.</p><p>“Second quarter data confirm anecdotes that occupancy at many properties improved as move-ins accelerated, thanks to limited property-level COVID-19 infections,” said NIC Chief Economist Beth Burnham Mace. “However, inventory grew and outpaced demand, and that’s why we aren’t seeing an occupancy uptick.”</p><p>Both assisted living and independent living properties experienced little change in occupancy, with independent living holding steady at 81.8 percent, and assisted living rising slightly to 75.5 percent.</p><p>San Jose (83.7 percent), Portland, Ore. (83.4 percent), and San Francisco (83.4 percent) had the highest occupancy rates of the 31 metropolitan markets that encompass NIC MAP’s Primary Markets. The markets experiencing the lowest occupancy rates included Houston (73.0 percent), Atlanta (74.8 percent), and Las Vegas (74.9 percent).</p><p>Looking further at the data, occupancy increases are being reported by a growing number of operators. In the second quarter of 2021, without breaking down percentages by care settings, 47 percent of senior housing properties in the NIC MAP Primary Markets reported an increase in occupancy. During the height of the pandemic, only 22.5 percent of properties reported occupancy increases.</p><p>“Some areas of the country are seeing senior housing occupancy improve, but the data show that we haven’t fully turned the corner,” said Chuck Harry, NIC’s chief operating officer. “Senior housing occupancy remaining unchanged suggests that it will likely take more time to see broad, nationwide improvement to the levels prior to the onset of the pandemic.”</p><p>There is a wide gap in performance between markets in NIC MAP’s Primary Markets. In Atlanta and Detroit, 55 percent of properties reported overall occupancy improvement, compared with just 33 percent of properties in Chicago.<br></p> | 2021-07-13T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0320_News4.jpg" style="BORDER:0px solid;" /> | COVID-19;Management | Despite unchanged occupancy, demand for senior housing improved in the second quarter. |
| Sense of Smell Loss Due to COVID May Present Problems for Some People | <p>Early in the pandemic, anosmia—loss of smell—became a common sign of COVID-19 infection. There have been questions about how long this loss of olfactory function lasts. However, a new study published in <em>JAMA Network Open</em> suggests complete recovery is likely at one year, if not sooner.<br></p><p>Over the course of a year, researchers in France followed a cohort of patients who had COVID-related acute loss of smell. At four months, 23 of 51 patients reported full recovery of olfactory function, while 27 reported partial recovery. Only one person still reported total anosmia. At one year, everyone had recovered, although two patients reported that they still had limited olfactory function. <br></p><p>The authors concluded, “Persistent COVID-19-related anosmia has an excellent prognosis with nearly complete recover at one year. As clinicians manage an increasing number of people with post-COVID syndrome, data on long-term outcomes are needed for informed prognostication and counseling.”<br></p><p>This study is promising for COVID survivors in long term care. As Steven Buslovich, MD, CMD, MSHCPM, a New York-based physician and medical director, says, “Weight loss in institutionalized adults is a frailty deficit that contributes to risk for morbidity and decline. It is important to evaluate the etiology of weight loss, nutritional status, adequacy of nutritional support, and one's ability to absorb nutritional intake, recognizing that anosmia may be persistent as part of post-COVID phenomenon.” <br></p><p>Karl Steinberg, MD, CMD, president of AMDA – The Society for Post-Acute and Long-Term Care Medicine, says, “The good news is that even though loss of smell can last a long time, it eventually returns. The bad news is that for some of our residents, it can contribute to a failure-to-thrive clinical picture, since smell is such an important part of the enjoyment of food, appetite, and taste. For some residents—especially those where other factors like isolation due to visiting restrictions have been such a problem—a year may be too long to wait.” <br></p><p>It is important to consider strategies to encourage residents to eat, even when they have anosmia or a diminished sense of smell. Steinberg suggests, “Encouraging people to eat foods with stronger flavors, like spicy food and salty food, and different textures can be a strategy to make food more interesting and appealing for some residents, even though it may go against what we usually recommend.”<br></p><p>At the same time, Buslovich says, “Those who experience anosmia may respond favorably to temperature and texture, as those senses remain preserved.”</p> | 2021-07-08T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/LossOfSmell.jpg" style="BORDER:0px solid;" /> | COVID-19;Clinical | Early in the pandemic, anosmia became a common sign of COVID-19 infection. There have been questions about how long this loss of olfactory function lasts. However, a new study suggests complete recovery is likely at one year, if not sooner. |
| AHCA Expands Board to Add Leaders from Michigan, D.C. | <p>The American Health Care Association (AHCA) has expanded the size of its Board of Governors and elected two new members to at-large positions: Reginald (Reggie) Hartsfield of Michigan and Tina Sandri of Washington, D.C.<br></p><p>Hartsfield is president and owner of Advantage Living Centers, and Sandri is chief executive officer (CEO) of Forest Hills of D.C.<br></p><p><img src="/PublishingImages/Headshots/MarkParkinson.jpg" alt="Mark Parkinson, CEO" class="ms-rtePosition-2" style="margin:5px;width:115px;height:141px;" />“We are fortunate to have Tina and Reggie joining our board. They are both extraordinary leaders in long term care, and their knowledge and passion will be crucial for our sector during this extremely challenging time,” said AHCA President and CEO Mark Parkinson.<br></p><p>“The long term care profession is facing unprecedented challenges on multiple fronts, and it is critical that our board include new voices to help us navigate these difficult times and usher in a stronger, more inclusive future.”<br></p><p>Hartsfield has been in the long term care sector for more than 20 years and is experienced as a licensed nursing home administrator, owner, and operator. His company, Advantage Living Centers, includes 10 skilled nursing facilities and two assisted living communities.<br></p><p>AHCA said Hartsfield is a proponent of high-quality care, enhanced communication, and diverse viewpoints and inclusiveness. Prior to being appointed to the AHCA board, Hartsfield served as board chairman for the Health Care Association of Michigan and on AHCA’s Independent Owner Council and Future Leaders program.<br></p><p>With more than 20 years of operations experience in health care, AHCA said Sandri is committed to improving conditions for frontline caregivers and the public perception of careers in long term care. Sandri has diverse experience, serving as a leader within hospitals, retirement communities, skilled nursing centers, assisted living communities, and hospice care.<br></p><p>Sandri also has extensive experience serving her community in civic, school, and church organizations that focus on developing youth through immersive, hands-on experiential learning and community service.</p> | 2021-07-01T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0420_News1.jpg" width="740" style="BORDER:0px solid;" /> | Management | “We are fortunate to have Tina and Reggie joining our board. They are both extraordinary leaders in long term care, and their knowledge and passion will be crucial for our sector during this extremely challenging time.” |
| Collaborative Effort Best on Pain Management in Nursing Homes | <p>A new report in <em>JAMDA </em>said chronic pain is an enduring issue in nursing homes, but despite its high prevalence, there is no definitive approach to managing this condition in older adults. </p><p>The study suggests that it is important for administrative nursing home leadership, the medical director, and the interdisciplinary team to work together to promote chronic pain management through a multipronged approach, with an emphasis on person-centered care.<br></p><p>In “Chronic Pain Management in Nursing Homes: Navigating the Challenges to Improve Person-Centered Care,” the authors stress that nonpharmacological means are under-used in nursing home settings but are the preferred first step to manage mild pain. </p><p>Nonopioid pharmacological agents should be added as a second step to manage moderate to severe pain. Opioids, commonly prescribed as a first step to manage chronic pain in this care setting, “should be used as a last resort,” according to the report’s authors. </p><p>“We want to emphasize that it is not necessarily inappropriate to prescribe opioids in older adults with chronic pain,” researchers said. Fears and myths about opioids, they added, sometimes have led to an “unnecessarily abrupt cessation of opioid prescriptions for older adults who need them for management of chronic pain.”</p><p>Challenges to the successful implementation of comprehensive chronic pain management at the nursing home may include ambiguous directions on specific therapeutic interventions, insufficient guidance on treatment duration, and limited availability of treatment options, the report said. </p><p>“Clinicians should carefully evaluate the need for continuation of chronic pain medications during their routine visits in nursing homes,” the authors said. </p><p>The facility administrative and clinical leadership, they noted, can promote appropriate opioid prescribing and deprescribing when indicated through an opioid stewardship program. Proper management of expectations of residents and their support systems is essential when such a multifactorial approach toward chronic pain management is taken.</p> | 2021-07-01T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/medications_1.jpg" style="BORDER:0px solid;" /> | Caregiving | Opioids should be used as “a last resort," according to a new report. |