| Oral Health Gives People Something To Smile About | https://www.providermagazine.com/Issues/2013/Pages/0413/Oral-Health-Gives-People-Something-To-Smile-About.aspx | Oral Health Gives People Something To Smile About | <div>One need only look around the majority of long term care facilities to see the prevalence of women residents. As women age, by age 85, they outnumber men at least two to one. Aging accounts for the loss of social support—including spouses, partners, friends, and family members—which may result in the need for help with daily care, including oral care. With aging comes a higher risk for oral diseases, regardless of gender. </div>
<h2 class="ms-rteElement-H2">Men, Women Differ In Needs</h2>
<div>Clinicians know that increased medications often mean a decrease in spit or saliva. Most people don’t realize or value the important role that saliva plays in protecting their teeth and mouths. Various chronic diseases, such as arthritis or stroke, can make it more difficult for elders to clean their mouths. These chronic diseases may result in residents needing assistance with their daily oral hygiene care.</div>
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<div>There are subtle differences in oral health between men and women as they age. Men have slightly higher levels of active oral disease, such as cavities (dental caries) and gum (periodontal) disease, when compared with people under the age of 65. However, the amount of dental care men and women receive over a lifetime is about the same. This mirrors the medical fact that in most studies, older women may have better health outcomes than men, even when treatment was the same or less.</div>
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<div>Women as a group, especially older women, make up the majority of adults living in poverty. Older women’s loss of social support combined with poverty may result in their entering long term care with poorer oral health. It is also important to know that most women, whether they have worked outside the home or not, have been called upon to be caregivers at some point in their lives. This role may spill over into how they choose to care for themselves and their oral health. </div>
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<div>Research shows that women are more likely to prefer prescription drugs over invasive treatment, and though the reasons are not clear, it suggests they may be making less stressful, less invasive choices in order to accommodate their daily lives. </div>
<h2 class="ms-rteElement-H2">Providers Should Encourage Daily Care</h2>
<div>There is a definite improvement to be seen in quality of life with a fresh, clean, and pleasant-smelling mouth. Women are more likely to embrace preventive and proactive care than men. This concept can be used to encourage patients or their loved ones to participate in daily care of the mouth. </div>
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<div>The benefits may have to be experienced for a resident to become a believer. And, frankly, it might have been a long time since someone has pointed out the needs and benefits of this often-missed daily ritual. </div>
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<div>Late-life depression is more common in women than in men in long term care facilities. Although this may superficially appear to have little to do with poor oral care, it can be a factor.</div>
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<div>If people do not have the energy or drive, and cannot see the benefits to cleaning their mouths every day, it can be an easy thing to forget to do. As people get older, this lack of daily care can actually increase oral disease even faster than in a younger person. </div>
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<div>Decreased saliva and recession of the gums that leads to more exposed tooth roots are more common in the elderly and can accelerate cavities and periodontal disease. Positive feedback regarding all the benefits of daily oral care is not only helpful, but it also provides encouragement for the woman who may be resistant. </div>
<h2 class="ms-rteElement-H2">Be Mindful Of Meds</h2>
<div>Since women are more likely to have osteoporosis, they may be taking bisphosphonate medications. These medications (such as Fosamax), which are often used to treat osteoporosis, can also increase the risk of causing a non-healing bone lesion to form in the mouth. </div>
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<div>These bone lesions, which are painful, open wounds in the mouth, are more likely to occur if invasive treatment like a tooth extraction is done. </div>
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<div>Dentists always need to know what medications a patient is taking prior to providing any dental treatment to avoid this possibility. </div>
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<div>Likewise, an intravenous form of the bisphosphonate drugs is sometimes used during the treatment for breast cancer and some lymphomas. Therefore, it is very important for women to tell their dentists if they have had treatments for cancer in the past and, if possible, supply the dentists with a list of the medications, even if the treatment occurred years earlier.</div>
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<div>Teeth were designed to last a lifetime, and many more adults are entering their senior years with the expectation of keeping their natural teeth for a lifetime. Older women benefit from good oral health through improved chewing, speaking, swallowing, and smiling, as well as enjoying the social benefits of good oral health. </div>
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<div>Regular dental exams and daily oral care remain vital pieces of a preventive strategy to maintain good health and function whether older women reside at home or in a long term care facility. </div>
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<div><em>Gretchen Gibson, DDS, MPH, is director of Oral Health Quality Group, VA Office of Dentistry and VA Health Care System of the Ozarks, Fayetteville, Ark., and Linda C. Niessen, DMD, MPH, is vice president and chief clinical officer, Dentsply International; and clinical professor, Department of Restorative Dentistry, Texas A&M University, Baylor College of Dentistry, Dallas.</em></div> | Clinicians know that increased medications often mean a decrease in spit or saliva. Most people don’t realize or value the important role that saliva plays in protecting their teeth and mouths. Various chronic diseases, such as arthritis or stroke, can make it more difficult for elders to clean their mouths. These chronic diseases may result in residents needing assistance with their daily oral hygiene care.
| 2013-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/0413/caregiving-thumb.jpg" style="BORDER:0px solid;" /> | Caregiving | Column | 4 |
| Effective Oral Health Care Requires Effective Collaboration | https://www.providermagazine.com/Issues/2013/Pages/0413/Effective-Oral-Health-Care-Requires-Effective-Collaboration.aspx | Effective Oral Health Care Requires Effective Collaboration | <div>Health care experts are increasingly affirming the importance of oral health as an essential component of overall health. The need for quality-based mouth care does not diminish as a person becomes older, chronically ill, or placed within long term care settings. </div>
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<div>Indeed, these individuals experience a disproportionate and debilitating amount of oral disease, which places them at higher medical risk; diminishes their quality of life; and, unless effectively addressed, may add significantly to the cost of care. </div>
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<h2 class="ms-rteElement-H2">Plaque Key Culprit In Oral Health Problems</h2>
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<div>Inadequate daily oral hygiene will lead to a buildup of plaque (biofilms) in the mouth and is primarily responsible for the development of dental cavities, gum disease, and most other oral-related problems. </div>
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<div>Elders, in general, have an increased likelihood of developing oral health problems caused by poor oral hygiene, and older adults living in long term care settings are particularly vulnerable. Many nursing home residents have diminished oral hygiene due to deficits associated with their cognitive status, stroke, arthritis, vision, and other problems. </div>
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<div>In addition, they may have mouth dryness associated with their medications, their diet may be comprised of soft and sticky foods, and their remaining teeth may be poorly aligned, leading to food impaction.</div>
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<div>Unmet dental needs can be quite substantial in long term care residents. For example, in a recent Massachusetts study, nearly 60 percent of nursing home residents had untreated dental cavities, compared with 35 percent of community-dwelling elderly, and 34 percent of these residents had major or urgent needs associated with these cavities. </div>
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<div>Other studies have documented a high level of poor oral health found in nursing home residents:</div>
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<div>■ More than 40 percent had periodontal disease;</div>
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<div>■ Up to three-quarters aged 65 and older had lost some or all teeth;</div>
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<div>■ More than 50 percent of those over age 75 were edentulous (completely toothless); and</div>
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<div>■ Eighty percent of those who had lost all teeth had dentures, but nearly one in five did not use them.</div>
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<div><span><span><img width="309" height="261" src="/Monthly-Issue/2013/PublishingImages/0413/caregiving2_chart.jpg" alt="impact of tooth loss on nutrition" class="ms-rteImage-0 ms-rtePosition-2" style="margin:10px;" /></span></span>The consequences of dental infections from cavities or gum disease can be quite significant. Dental infections may lead to severe pain, as well as systemic health problems such as bacteremia, sinusitis, cellulitis, brain abscess, and/or airway collapse. <br><br></div>
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<div><span></span>Cavities and gum disease are responsible for the loss of natural teeth and can lead to chewing problems, which can impact nutritional health.<br><br></div>
<div><div>Poor nutritional status has been shown to increase the length of hospitalizations, elevate infection rates, and even increase dependence in activities of daily living. </div>
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<h2 class="ms-rteElement-H2">Studies Find Barriers</h2>
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<div>Studies looking at barriers influencing dental care in long term care facilities have identified several key issues that may inhibit satisfactory dental care. Nursing home administrators, unit charge nurses, and dentists have agreed that patient financial constraints, as well as lack of interest by the resident or by the resident’s family, are quite problematic. </div>
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<div>It is interesting to note, however, that administrators and unit charge nurses were generally more likely than dentists to cite unwillingness of dentists to see the resident at the dental office, as well as the nursing home, and nursing staff time constraints as significant barriers. </div>
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<div>On the other hand, dentists were more likely to attribute residents’ oral health problems to the apathy of nursing home administrators and staff, in addition to the lack of suitable portable equipment and inadequate space. </div>
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<div>These findings underscore the need for appropriate dialogue and, ultimately, the need to enhance teamwork between dental care providers and nursing home personnel. In some ways, these differing perceptions are like those of the three blind men trying to describe the elephant: Each may be correct from their individual perspective, but a more accurate picture only emerges when all three views are combined. </div>
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<div>In a white paper entitled, “Improving Dental and Oral Care Services for Nursing Facility Residents,” by the TRECS Institute (www.thetrecsinstitute.org/downloads/DentalCare.pdf), key factors were identified behind the poor response to addressing dental and oral health needs, as follows:</div>
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<div>■ A pervasive lack of knowledge of the importance of dental and oral health care on the part of residents, their families, and the nursing facilities’ staff;</div>
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<div>■ Difficulties faced by some residents in providing self-care due to physical limitations, despite the desire to maintain good oral health and the desire to remain independent;</div>
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<div>■ Providing good daily oral care to residents with dementia and/or behavioral problems can be extremely difficult for staff in spite of good intentions and efforts;</div>
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<div>■ Ageism prejudices are overtly evident among staff, families, and even the residents themselves; and</div>
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<div>■ A lack of or severely limited reimbursement for professional dental services results in significant access problems.</div>
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<div>Oral health is essential for the general health and well-being of nursing home residents. The challenges of meeting their diverse and sometimes complicated dental needs can be imposing, but it is very important to quality of care and quality of life for these individuals. </div>
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<div>The team of multidisciplinary care providers essential to address the constellation of medical, psychosocial, emotional, financial, and spiritual needs of the long term care resident must place greater priority and emphasis on the significant oral health concerns of this population. </div>
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<div><a href="/Monthly-Issue/2013/Pages/0413/It-Takes-A-Village.aspx" target="_blank">Dedicated collaborative efforts</a> between nursing facility professionals and dental practitioners can be very helpful in better meeting the oral health needs of residents in long term care </div>
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<div><em>Douglas Berkey, DMD, MPH, MS, professor, University of Colorado; dental director, InnovAge Greater Colorado PACE; member, National Elder Care Advisory Committee, American Dental Association. Berkey can be reached at <a href="mailto:%20douglas.berkey@ucdenver.edu">douglas.berkey@ucdenver.edu</a> or at (303) 907-5336.</em></div> | Health care experts are increasingly affirming the importance of oral health as an essential component of overall health. The need for quality-based mouth care does not diminish as a person becomes older, chronically ill, or placed within long term care settings. | 2013-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/0413/caregiving3_thumb.jpg" style="BORDER:0px solid;" /> | Caregiving | Column | 4 |
| A Refresher On Social Media Policy | https://www.providermagazine.com/Issues/2013/Pages/0413/A-Refresher-On-Social-Media-Policy.aspx | A Refresher On Social Media Policy | <div>Social media is a vital part of everyone’s lives today on both a professional and a personal level. For human resource professionals, however, there exists some confusion about what constitutes a permissible social media policy or rule and what an employee can safely “post” on a social media website about his or her employer without being subject to discipline and/or termination. </div>
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<div>In fact, the National Labor Relations Board (NLRB) issued its first decision on this topic only last September. Providers should be aware of the latest NLRB developments when crafting their social media rules and/or policies.</div>
<h2 class="ms-rteElement-H2">Costco’s Broad Social Media Policy </h2>
<div>NLRB, in order to determine whether a work rule violates Section 8(a)(1) of the National Labor Relations Act (NLRA) and is thus an unfair labor practice, examines whether the rule tends to chill employees in the exercise of their Section 7 NLRA rights. Section 7 rights include the right to join unions, to bargain collectively, and to “engage in other concerted activities for the purpose of collective bargaining or other mutual aid or protection.” </div>
<h2 class="ms-rteElement-H2">Board Makes First Policy Judgment</h2>
<div>Last September, NLRB, in its first case directly addressing social media policy, held in Costco Wholesale Corp. that an overly broad social media policy promulgated by Costco violated Section 8(a)(1) of the NLRA and ordered Costco to rescind or modify that policy. </div>
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<div>The policy stated that “[e]mployees should be aware that statements posted electronically … that damage the company [Costco], defame any individual, or damage any person’s reputation, or violate the policies outlined in the Costco Employee Agreement, may be subject to discipline, up to and including termination of employment.”</div>
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<div>NLRB found that the “broad parameters” contained in the policy would result in employees refraining from engaging in certain communications (such as those that would be critical of Costco’s treatment of its employees) that are protected under Section 7 of the NLRA. </div>
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<div>NLRB noted that this broad rule did not contain language that would have restricted its application to conduct (malicious, abusive, or unlawful) that an employer can safely prohibit.</div>
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<div>The implication being, of course, that had it contained such restrictive language, the rule might have been found lawful. </div>
<h2 class="ms-rteElement-H2">Firing Employees For Facebook Comments Found Unlawful</h2>
<div>In Hispanics United of Buffalo, Inc., NLRB recently held that the employer violated the NLRA by firing employees for Facebook comments they wrote in response to a co-worker’s criticism of their job performances. </div>
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<div>One worker posted, on her Facebook page, that another employee had complained about her and her co-workers’ performances; she asked other employees to comment about this post on her Facebook page. </div>
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<div>The employer fired both the worker who made the initial post on her page and the four others who then posted comments. It contended that their remarks constituted “bullying and harassment” of a co-worker and violated the employer’s “zero-tolerance” policy of this conduct.</div>
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<div>NLRB held, however, that the employer violated the NLRA by firing the five employees, and it did not find the Facebook comments to be either a form of bullying or harassment.</div>
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<div>In a nutshell, the employees were engaged in concerted activities for the “purpose of mutual aid or protection,” and thus their conduct was protected. NLRB has long held that an employer cannot fire employees for engaging in discussions about job performance.</div>
<h2 class="ms-rteElement-H2">NLRB’s Prior Reports Address Social Media Rules</h2>
<div>Prior to the Costco Wholesale Corp. decision, NLRB’s acting general counsel issued three reports on social media. Some examples contained in the reports are as follows:</div>
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<div> ■ Policy provisions stating that, if an employee posted something about an employer, “you must also be sure that your posts are completely accurate and not misleading,” were found to be unlawful. The terms “completely accurate and not misleading” were found to be overbroad as they could apply to discussions of the employer’s policies and treatment of its employees, which, as long as they are not malicious, are protected activities.</div>
<div> ■ A rule that prohibited “inappropriate postings that may include discriminatory remarks, harassment, and threats of violence or similar inappropriate or unlawful conduct” was found lawful as it prohibited plainly egregious conduct and there was no evidence that the employer had used it to punish employees for exercising their protected rights.</div>
<div> ■ A rule that required employees to maintain the confidentiality of an employer’s trade secrets and confidential information was found lawful because: 1.) employees have no protected right to disclose trade secrets; and 2.) the rule contained sufficient examples of confidential information (for example, information regarding the development of systems, products, and technology) for employees to understand that the rule did not apply to “protected” discussions of working conditions. </div>
<div> ■ Policy provisions stating “[t]hink carefully about ‘friending’ co-workers … on external social media sites” and “report any unusual or inappropriate internal social media activity to the system administrator” were both found unlawful because: 1.) the “friending” provision would discourage communication between co-workers and thus interfere with protected Section 7 rights; and 2.) the reporting provision could be reasonably construed to encourage employees to report to management on the union activities of their co-workers.</div>
<h2 class="ms-rteElement-H2">Drafting Social Media Policies Tricky</h2>
<div>Providers should draft their social media policies so that they do not contain broad prohibitions about workplace concerns that do not thereafter provide examples of activities that an employer may legitimately prohibit. </div>
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<div>Thus, if a provider has a rule such as “do not post comments that damage the company or an individual’s reputation” it should then give examples of conduct specifically prohibited by the rule, such as the disclosure of trade secrets or sexually harassing comments.</div>
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<div>Most importantly, a provider should ensure its policy is carefully reviewed by legal counsel. </div>
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<div><em>Andrew I. Bart is an attorney with Tenzer and Lunin, a New York City law firm. He may be reached at (212) 262-6699 or at <a href="mailto:%20andrewibart@gmail.com">andrewibart@gmail.com</a>.</em></div>
| Social media is a vital part of everyone’s lives today on both a professional and a personal level. For human resource professionals, however, there exists some confusion about what constitutes a permissible social media policy or rule and what an employee can safely “post” on a social media website about his or her employer without being subject to discipline and/or termination. | 2013-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/0413/legal_thumb.jpg" style="BORDER:0px solid;" /> | Legal;Workforce;Management | Legal Advisor | 4 |
| Be Prepared For Higher Acuity In Assisted Living | https://www.providermagazine.com/Issues/2013/Pages/0413/Be-Prepared-For-Higher-Acuity-In-Assisted-Living.aspx | Be Prepared For Higher Acuity In Assisted Living | <div>Assisted living communities are caring for residents with more complex health care needs than just a few years ago and keeping staff realistic about their caregiving capacities, and implementing protocols to manage these higher-care needs can help lower the community’s liability risk and increase their capacity to retain residents, says an expert in nursing and clinical issues. </div>
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<div>Josh Allen, RN, C-AL, chair of the American Assisted Living Nurses Association (AALNA), presented these ideas during a recent webinar, sponsored by the National Center for Assisted Living (NCAL) titled, “Higher Acuity in Assisted Living: Risk or Reward?” </div>
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<div>Allen cited statistics from the 2010 National Survey of Residential Care Facilities. The survey revealed that 50 percent of the nation’s assisted living residents have three or more chronic conditions, and 42 percent of them have Alzheimer’s disease or other forms of dementia. </div>
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<div>In addition, NCAL’s 2012 Performance Measures report found that of the respondents, 94 percent had access to a registered nurse. <br><br></div>
<div>“We know acuity is on the rise. It sounds like a cliché, but many of the residents of assisted living today were in nursing facilities five years ago,” Allen says. “There is more direct caregiving being delivered.”</div>
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<div>To determine if the reward is worth the risk, Allen recommends that staff in an organization evaluate their caregiving capabilities and develop protocols for those residents with more chronic health care conditions.</div>
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<div>“Have you sat down as an organization and really talked about higher acuity?” he says. “Have you talked about who are the residents you are going to care for and what kinds of residents are you going to be able to accommodate?”</div>
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<div>Allen suggested organizations review the top 10 chronic health conditions found in the national survey, evaluating their caregiving capacity by asking the following questions for each condition:</div>
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<div>5. Do we need to partner with a home health agency, physician, or physical or occupational therapist?</div>
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<div>Next, he encouraged communities to get nurses and marketers to work together to overcome any distrust between the departments.</div>
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<div>Often nurses believe marketers oversell staff’s caregiving capabilities, and marketers believe nurses curb their sales efforts. To counteract those perceptions, Allen recommends having sales and nursing staff meet daily to review each resident’s health care conditions—including residents moving in and those at risk of moving out. This daily meeting builds a relationship and trust amongst department members.</div>
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<div>Turning to specific health care conditions, Allen discussed managing residents with Alzheimer’s and other forms of dementia. </div>
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<div>Allen said research has found that the only true indicator of a resident being at risk of eloping is if the resident has actually wandered out of a community before. There are limited methods of determining which residents with Alzheimer’s disease who haven’t walked out of a building will, in fact, walk out of a building. </div>
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<div>Allen suggested all assisted living communities develop an elopement procedure checklist that includes steps for staff to complete when looking for a resident who has eloped. </div>
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<div>“Just like fire evacuation procedures, you want to have the same thing for an elopement, mainly because you panic,” he said. </div>
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<div>“Having that checklist helps focus your person’s energy on doing the steps.” </div> | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Brooklyn Nursing Homes To Sandy: ‘We’ve Come Back’ | https://www.providermagazine.com/Issues/2013/Pages/0413/Brooklyn-Nursing-Homes-To-Sandy-‘We’ve-Come-Back’.aspx | Brooklyn Nursing Homes To Sandy: ‘We’ve Come Back’ | Two Brooklyn nursing homes were preparing to open their doors again, nearly half a year after Superstorm Sandy shuttered them. <br><br>“We went through these hard times, but just like the neighborhood, we’ve come back,” says Michael Schrieber, executive director of the Shoreview Nursing Home and the Sea Crest Health Care Center.<br><br>At Shoreview, in the Brighton Beach neighborhood, staff were a mere fire panel away from opening. Sea Crest, near Coney Island, would likely be ready by April, Schrieber says. <br><br><span><span><img alt="iStock_000004337210XSmall.jpg" src="/Monthly-Issue/2013/PublishingImages/iStock_000004337210XSmall.jpg" class="ms-rtePosition-1" style="margin:5px;" /></span></span>Like many in the long term care profession who suffered under Sandy’s wrath, Schrieber says he’s proud <span></span>that he and his staff were able to survive the challenge and come back. <br><br>“Everyone has been really superb throughout all of this,” he says.<br><br>But—also like many in the profession along the Eastern seaboard—the costs have been appalling. Some 100 residents from Sea Crest and Shoreview have died since the late October storm. <br><br>“It takes such a toll on these individuals who have this pretty standard, quiet life,” Schrieber says. <br><br>“And then this storm comes and they’re seeing things they haven’t seen and they’re in a place they don’t know, and it really upsets that stability.”<br><br>The buildings were gutted, Schrieber says. And the costs are still mounting. <br><br>“It has cost probably—and we’re not done yet because we don’t know what’s coming next, and we have all sorts of legal bills pending—but it probably has cost $10-$12 million,” he says. <br><br>But—adding insult to injury—the homes’ insurance company refused to cover employee costs, Schrieber says. Some 800 employees, including many who have worked at the homes for more than four decades, were laid off, Schrieber says. <br><br>“That, I think, was one of the biggest heartbreaks,” he says.<br>If anything else, though, it also steeled Schrieber and the staff, he says. “Getting that denial letter, that kind of solidified it for us,” he says.<br>“We were going to be able to get back up and running. We took personal loans and whatever we could because we felt an obligation to get back up and running.”<br><br>Schrieber says he’s hopeful that all the laid-off employees will be brought back. <br><br>For now, though, the focus is on getting the doors open. Staff and residents are counting the minutes, Schrieber says. <br><br>“I think, more than anything else, everyone’s excited to get back home,” he says. “We’re getting there.” | | 2013-04-01T04:00:00Z | | | Column | 4 |
| The QIS Expert: Can QIS Help Providers Comply With New QAPI Regs? Part 2 | https://www.providermagazine.com/Issues/2013/Pages/0413/Can-QIS-Help-Providers-Comply-With-New-QAPI-Regs.aspx | The QIS Expert: Can QIS Help Providers Comply With New QAPI Regs? Part 2 | <img src="/archives/archives-2012/PublishingImages/Headshots/AKramer_rollup.jpg" alt="Andy Kramer, MD" class="ms-rtePosition-1" style="margin:5px 15px;" />This is the second column in a series of five addressing how QIS methods can be used in a Quality Assurance and Performance Improvement (QAPI) system by showing the parallels between QIS methods and the five elements of QAPI. <br><br>To better understand the QAPI regulation that will be enacted this year, go to <a href="http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-05.pdf">www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-05.pdf</a>. According to the QAPI at a Glance document, Element 2 of the five elements is Governance and Leadership: “The governing body and/or administration of the nursing home develops and leads a QAPI program that involves leadership working with input from facility staff, as well as from residents and their families and/or representatives.<br><br>“This includes designating one or more persons to be accountable for QAPI [and] developing leadership and facilitywide training on QAPI … They are responsible for establishing policies to sustain the QAPI program despite changes in personnel and turnover.<br><br>“The governing body and executive leadership are also responsible for setting priorities for the QAPI program and … setting expectations around safety, quality, rights, choice, and respect by balancing both a culture of safety and a culture of resident-centered rights and choice.”<br><br>This element stresses how QAPI is about creating a balanced organizational culture that permeates from leadership to every level of staff. This must start with the QAPI program being completely supported by the top leaders in the organization, through both interactions with staff and adequate resource planning. <br><br>Part of this leadership is to ensure that all of the participants in the delivery of services are contributors to the QAPI program.<br><br>This column has previously described guidelines from providers that have successfully used the QIS methods: Select a leader to guide the implementation effort; involve staff at all levels and in all disciplines; and use QIS every day and make it part of a daily routine, as in continuous quality improvement. <br><br>These methods lead to a system that derives much of the Stage 1 information from a wide range of sources involving residents, their families, and staff members.<br><br>There are two reasons that the QIS methods help to establish a system that is sustainable “despite changes in personnel and turnover.” <br><br>First, the QIS methods are embodied in standard procedures for assessment and investigation. A primary objective of QIS is that these processes are used the same way no matter who is conducting them, leading to consistency across staff changes. <br><br>Second, because so many staff members are involved in using the QIS methods rather than one or two individuals, the impact of personnel changes does not have to affect the collective knowledge of the system.<br><br>A fundamental aspect of the QIS methodology is to identify opportunities for improving care in cases of unacceptable levels of performance, up through above-average levels of performance. This can help guide a leader in “setting priorities” for a QAPI program.<br><br>Overall, the balance of resident safety and resident-centered care embodied in QIS methods can assist leadership in setting expectations for performance and improvement, thereby fulfilling this element of QAPI.<br><br><em>Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey (QIS).</em> | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Charting New Waters In Leadership Development | https://www.providermagazine.com/Issues/2013/Pages/0413/Charting-New-Waters-In-Leadership-Development.aspx | Charting New Waters In Leadership Development | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><div>Long term care and post-acute facility residents are individuals whose personalities and feelings must be considered in an effort to keep them safe and happy. </div>
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<div>That is the lesson of culture change, and facilities have embraced it in efforts to ensure quality care and resident satisfaction. Now facilities increasingly have begun to apply this lesson to staff development and motivation with similar results.</div>
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<div>Creative efforts to encourage and inspire staff, recognize and nurture potential leaders, and increase job satisfaction and reduce turnover are more widespread than ever. And facility leaders are pleased with the results. </div>
<h2 class="ms-rteElement-H2">Residents As Educators</h2>
<div>Leaders at Kindred Transitional Care and Rehabilitation of Brighton in Colorado discovered that they had the perfect staff trainer living right under their roof. When they discovered that resident Joan was a former nurse, they asked her if she would be willing to speak at new staff orientation programs, and she agreed. Director of Nursing Amy Szczepanski, RN, says, “We thought she would be a great asset to our program because she understands both the nursing and patient perspectives. We hoped that she could help our staff understand the multiple roles and how their words and actions affect residents personally.”</div>
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<div>Speaking to new staff, Joan shares the overall experience of being a nurse as well as what it is like to be a resident. “We conduct a survey after the orientation, and participants always say that Joan’s words are touching and moving to them. They say it gives them excellent insight and helps them appreciate what their work means to residents,” says </div>
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<div>Jerusha Siegel, facility administrator. Staff have an opportunity to ask questions, and they most commonly ask her what it’s like to make the move from the community to living in a facility.</div>
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<div>The opportunity to meet with staff is as rewarding for Joan as it is for them. As Szczepanski says, “It gives her a sense of purpose, something she can feel good about. She’s helping staff and benefiting other residents, and she enjoys that dual role.” </div>
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<div>Joan says, “For me, it’s an honor. When I speak to staff, I try to convey to them that this job is never going to be easy, but this is a great place to work.” She adds, “I never stopped being a nurse. The residents are very dear to my heart, and I want to help make sure that every one of them gets the care, support, and compassion they deserve.”</div>
<h2 class="ms-rteElement-H2">Residents Want Involvement</h2>
<div>Since Joan got involved in orientation, other residents have asked to participate, too. Siegel says, “It’s great to integrate residents in determining how orientation will go and what new employees will learn.” The facility actually has taken resident involvement to a new level. Siegel says, “We also have residents who lead various activities.” For example, one resident runs a Christian karaoke event.</div>
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<div>“He really loves it, and he is excited and proud to be doing something for his fellow residents. This reminds us that our residents like having independence and a sense of purpose. Having some control over their lives is huge,” says Siegel.</div>
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<div>As Joan observes, “People think you come to a nursing home to die. I don’t think that. You come here because you have needs to be filled. People often don’t realize the positive side of nursing homes.”</div>
<h2 class="ms-rteElement-H2">Personal Connection</h2>
<div>Encouraging new hires to get to know residents is a growing trend at today’s long term care and post-acute facilities. For example, at Exempla Colorado Lutheran Home, site orientation includes time for new caregivers to read the care plans for residents they will be working with on a regular basis.</div>
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<div>“We give them an hour of private time to review care plans and get to know their residents’ needs, preferences, history, and so on. This gets them thinking about how they will approach the residents, care for them, interact with them, and engage them in activities,” says Christie Wimmer-Christie, RN, MS, Exempla’s staff development coordinator. Later during neighborhood orientation and then regularly as they start their job, they have additional opportunities to review these plans. </div>
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<div>Because the plans are written in first person and provide details about each person’s history, communication style, preferred activities, and other information, caregivers can form a real picture of each resident as a person. “The care plans really humanize the residents. People really get wrapped up in the stories.”</div>
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<div>Not only does reading the care plans give caregivers information that they can use as icebreakers and conversation starters when they meet residents, they also give staff a head start on their work.</div>
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<div>“When they come back from reading the care plans during orientation, we have a debriefing time. Everyone has a chance to talk about something positive they found out or something that may present a caregiving challenge. Even before they start their job, they get started on critical thinking and problem solving,” says Wimmer-Christie. This contributes to the new employees’ job satisfaction and enhances their confidence.</div>
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<div>As for the residents, says Wimmer-Christie, “it means the world to them. It makes them feel a little more comfortable with new caregivers.” She adds, “They appreciate that the person has made the effort to get to know them, and this helps them feel a little less apprehensive about change.”<br><br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">Motivating Through Culture Change</h2>
<div>An assessment tool designed to measure and track culture change also can help facilities identify and implement practices that <a href="/Monthly-Issue/2013/Pages/0413/Motivating-Before-Hiring.aspx">motivate staff</a> and encourage teamwork and job satisfaction. The <a href="/Monthly-Issue/2013/Pages/0413/Charting-New-Waters-In-Leadership-Development.aspx?ControlMode=Edit&DisplayMode=Design">Artifacts of Culture Change</a> (www.artifactsofculturechange.org/ACCTool/) includes more than 25 items in six domain areas (care practice, environment, family and community, leadership, workplace, and staffing outcomes and occupancy). Some of these items are very specific to staff growth and development.</div>
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<div>For example, one item involves including frontline staff in care conferences. “I asked CNAs [certified nurse assistants] how they felt about this, and they blew me away,” says author and educator Carmen Bowman, who also is one of the developers of the Artifacts tool. She says, “They told me that they want to learn more about their residents and see the care conferences as a great way to do this. They know their residents behind closed doors, and they yearned to know people more fully and from the viewpoint of other team members.”</div>
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<div>Facility leaders who think that CNAs will balk at taking the time to participate in these conferences will be surprised, says Bowman. “We had talked about doing this at one facility but never formalized it,” she says. “We were having a care conference, and a CNA came rushing in with her lunch. She wanted to give up her lunch hour to attend this conference. It meant that much to her.”</div>
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<div>This story didn’t surprise Bowman, who says, “Research has shown that when CNAs attend care conferences, turnover goes down.”</div>
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<div>The Artifacts tool includes the concept of “guardian angels,” staff members who are matched with residents to be their special friends.</div>
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<div>“Most staff love this idea. One resident was dying in a rural facility, and she ended up passing away in her guardian angel’s arms. Her staff buddy wasn’t on duty at the time, but she wanted to be there for her special friend,” says Bowman. She notes that staff love the opportunity to really impact someone’s life, and being someone’s guardian angel makes them feel more connected and committed.</div>
<h2 class="ms-rteElement-H2">Dress For Success</h2>
<div>One item in the Artifacts tool that some considered somewhat controversial actually may really enhance staff morale, says Bowman. The idea that staff—including caregivers—wear street clothes instead of scrubs or uniforms is designed to encourage a more homelike atmosphere in facilities.</div>
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<div>“Some facilities are hesitant to implement this because it would require caregivers—who usually are on a tight budget—to spend more money on clothing,” Bowman says. </div>
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<div>Susan Black, administrator at Exempla Lutheran Home, admitted that she “got flack,” mostly from nursing staff, when she raised the idea of doing away with uniforms. “I told them that it’s not about what you’re wearing but what kind of relationship you have with residents.” Indeed, clothing cost was a factor, so Black initiated two ideas to ease the financial burden. First, she implemented the idea over six months so that staff could spread out their expenses for new clothing. She also had staff donate clothes and set up racks where staff could “shop” and pick out clothes for free.</div>
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<div>“We still have a dress code, and staff have to dress in a professional manner. They can only wear denim on Fridays. I think they all like it now,” says Black.</div>
<div>Bowman suggests perusing the tool for ideas about ways to motivate and inspire staff. </div>
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<div>“The tool is educational, whether you complete it or not. And because these ideas are positive and designed to empower staff and improve the lives of residents, many are easy to implement and quickly embraced by management and staff alike,” she says.</div>
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<div>Even in a tight job market, it can be difficult to find the right people to fill challenging leadership positions—especially on short notice. </div>
<h2 class="ms-rteElement-H2">Prepping Nurse Leaders For Future Opportunities</h2>
<div>Kindred Healthcare Senior Vice President of Nursing and Clinical Services Barbara Bayliss and her team tired of scrambling to fill director of nursing services (DNS) positions in geographic areas where job opportunities are abundant and turnover is high. So they adapted an administrator training program for nursing staff to hire and mentor promising nurses to fill DNS positions.</div>
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<div>“We seek RNs with some supervisory experience who are interested in investing the time and effort to develop their leadership skills and move up in the organization,” says Bayliss.</div>
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<div>The six-month program involved full-time training, involvement on leadership work teams, and professional nurse supervisor-level pay. Participants learn how to recruit and retain staff, work with and educate nursing staff, implement quality improvement initiatives and achieve quality outcomes, and communicate and interact with residents and family members.</div>
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<div>On successful completion, they are offered a nurse leadership position at a Kindred facility within a 60-minute commute from the training site. “Participants go through an evaluation process every 60 days and have regular phone conversations with leadership to discuss their progress,” says Bayliss. </div>
<h2 class="ms-rteElement-H2">Training Pays Off</h2>
<div>Last year, Kindred had four nurses complete the program, and three of them were promoted within the organization. “Rather than scrambling to fill leadership positions, we had candidates who were trained nurses who know the organization,” says Bayliss.</div>
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<div>The nurse leaders who participated as mentors to the trainees also benefited from the program. “We equipped them with special training on how to be an effective mentor, and they participate with trainees in weekly training activities,” says Bayliss. They used customized training materials that involved eight modules addressing topics such as leadership development, performance improvement, Medicare/Medicaid, medical records and documentation, and clinical systems. The modules help track the program and identify gaps in knowledge and opportunities for learning.</div>
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<div>“Mentors feel privileged to be selected. They enjoy assisting another nurse to move forward,” says Bayliss. However, she discovered early on that it is important to clarify that the “new nurse is not there to take the mentor’s job. There had been some early confusion about that, so some were not readily welcoming. Once they understood how the program worked, they appreciated it and were pleased to be involved.” </div>
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<div>While the mentoring activities add to the DNS’ already busy schedule, having another nurse around also can be a huge benefit. “The trainee takes on various responsibilities such as handling immunizations or managing a unit. This reduces some of the burden and stress for the DNS,” says Bayliss.</div>
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<div>“Sometimes you get a limited amount of applicants for a position, and you have to choose the best of what you get. We realized that if we could develop our own people, we would never have to settle for anything less than the absolute best person for the job,” says Bayliss. “We could be better prepared to fill openings and more proactive in successful hiring.”</div>
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<div>It is useful to identify potential leaders from day one. However, this isn’t always easy, and the best leaders may not stand out right away.</div>
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<div>As David Farrell, one of the authors of <a target="_blank" href="/Monthly-Issue/2013/Pages/0413/Easing-The-Fear-Of-Change.aspx">“The Leadership Challenge in Long Term Care,”</a> says, “It’s not always the most talkative or outgoing people who make the best leaders.” Instead, he says, “In nursing homes, people follow the staff who are the nicest, most competent, and have the best attendance records. It’s the ones others go to for guidance and assistance. Sometimes, it’s the most quiet and humble people who are the best leaders.” </div>
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<div>Farrell suggests that managers always be cognizant of potential leaders among their staff. “You’re looking for a good mind and a good heart. You’re looking for someone with critical thinking and problem-solving skills. You’re looking for someone who is empathetic and can put themselves in others’ shoes and act accordingly,” he says. Farrell suggests identifying these people through rounding, meetings, and team huddles. </div>
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<div>“Watch how they interact with others, how they handle pressures and challenges, how they solve problems, and whether they are willing or eager to take the lead on projects and initiatives,” he says.</div>
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<div><div>When management identifies a potential leader, Farrell suggests having a formal sit-down. “Commend him or her on what you’ve observed and what of their behaviors and actions are especially helpful and positive. Ask them to do more.” He adds, “Give them some additional responsibilities, such as involving them in new staff orientation or presenting inservice programs.”</div></div> | Long term care and post-acute facility residents are individuals whose personalities and feelings must be considered in an effort to keep them safe and happy.
That is the lesson of culture change, and facilities have embraced it in efforts to ensure quality care and resident satisfaction. Now facilities increasingly have begun to apply this lesson to staff development and motivation with similar results. | 2013-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/0413/cs_thumb.jpg" style="BORDER:0px solid;" /> | Management;Workforce | Cover Story | 4 |
| CMS Liberalizes Dining Standards | https://www.providermagazine.com/Issues/2013/Pages/0413/CMS-Liberalizes-Dining-Standards.aspx | CMS Liberalizes Dining Standards | A “regular diet” should be the new standard for nursing facility residents, the Centers for Medicare & Medicaid Services (CMS) said in a recent memo to state survey agency directors. <br><br>Dated March 2, 2013, the memo advises clinicians and prescribers to make “a regular diet become the default, with only a small number of individuals needing restrictions.”<br><br>Following the recommendations of a task force consisting of 12 organizations representing “clinical professionals involved in developing diet orders and providing food service,” CMS noted that research had found “little benefit to many older individuals with chronic conditions from restrictions in dietary sugar and sodium, as well as little benefit from tube feedings, pureed diets, and thickened liquids.”<br><img src="/Monthly-Issue/2013/PublishingImages/0413/News/dining_standards.jpg" class="ms-rtePosition-2" alt="" style="margin:15px;" /><br>Although the new standards are based on the task force recommendations, the agency stopped short of requiring them for all nursing homes. They “do not represent CMS requirements,” and “surveyors should not issue deficiency citations simply because a facility is not following these particular recommended practices,” the memo says. <br><br>Providers that do follow these new standards “may rely on such adherence in response to questions regarding any changes from more restrictive diet protocols previously used,” the memo further says.<br><br>Go to www.cms.gov and search “dining standards” for more information. | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Doc Fix Should Also Fix Therapy Caps For Good, AHCA Says | https://www.providermagazine.com/Issues/2013/Pages/0413/Doc-Fix-Should-Also-Fix-Therapy-Caps-For-Good,-AHCA-Says.aspx | Doc Fix Should Also Fix Therapy Caps For Good, AHCA Says | <img src="/Monthly-Issue/2013/PublishingImages/0413/News/therapy_caps.jpg" class="ms-rtePosition-1 ms-rteImage-1" alt="" style="margin:5px 10px;" />In a letter to the House Ways and Means and Energy and Commerce Committees, the American Health Care Association (AHCA) urged the chairman to include a permanent therapy cap fix in whatever legislative vehicle is created to permanently fix the formula for Medicare physician payments. <br><br>“We appreciate and strongly support your effort to find a permanent fix to the Sustainable Growth Rate” (SGR), which drives the update in physician rates, said the letter from Gov. Mark Parkinson, AHCA’s president and chief executive officer. “The medical directors of the 15,000 skilled nursing centers in the U.S. are doctors, and we appreciate your efforts to ensure that they are reimbursed at reasonable levels.”<br><br>Year after year, the therapy cap fix has been tied to the annual SGR fix. As a result, AHCA said it was concerned that if lawmakers enacted a permanent SGR resolution without doing the same for therapy caps, it would “leave millions of elderly patients without the care they require.”<br><br>Currently, Congress must pass an annual extension of the therapy cap exceptions process, “or face the consequence of residents in our centers not having access to necessary medical treatment,” Parkinson wrote. In the absence of an exceptions process, the cap imposes a limit of $1,900, “which does not come close to adequately covering the cost of needed treatment,” AHCA said.<br><br>The letter further asked lawmakers not to fund the permanent SGR fix with cuts to other providers. | | 2013-04-01T04:00:00Z | | | Column | 4 |
| It’s A Matter Of Taste | https://www.providermagazine.com/Issues/2013/Pages/0413/It’s-A-Matter-Of-Taste.aspx | It’s A Matter Of Taste | <div>A common complaint of most residents of senior living communities is food satisfaction. As an executive director (ED), it is one of the more challenging complaints to resolve.</div>
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<div>There are many times when an ED or chef is sampling the exact same dish about which a resident is complaining and having a completely different experience. For example, a resident might say a dish is lacking in flavor and is difficult to chew, while the ED or chef is finding it flavorful and easy to eat. </div>
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<div>As a result, the food and beverage departments often become demoralized as they find that no matter how hard they try, the level of satisfaction remains an issue. This article hopes to impart a better understanding of the complications related to taste in an aging population, categorize the type of complaints, and offer <br>some cooking suggestions that have brought about increased resident satisfaction.</div>
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<div>Those who oversee the food service in senior living communities will benefit from shifting their orientation and developing an approach that incorporates the common issues of diminishing taste sensations into their daily work.</div>
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<h2 class="ms-rteElement-H2">Taste And Elders</h2>
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<div>When an individual reaches a particular age, the sense of taste deteriorates. Some studies have estimated that a person could lose 20 to 60 percent of their taste buds after the age of 60. </div>
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<div>A younger person’s threshold for tasting salt, sweet, bitter, and sour is much lower than an elder’s. This means that while elders’ senses are able to create a response to the flavor of salt, sweet, bitter, and sour, but their responses are not as strong as the younger person’s. </div>
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<div><span><span><img width="475" height="438" src="/Monthly-Issue/2013/PublishingImages/0413/mgmt_1.jpg" alt="What Impacts Taste" class="ms-rtePosition-1" style="margin:5px 10px;" /></span></span>At the same time, some elders’ main tasting abilities become relatively strong when their other abilities weaken as they age. For example, they may taste pronounced salt because other taste sensations have weakened.</div>
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<div>Taste is impacted by sense of smell, which also declines significantly as one ages. Thirty percent of people between the ages of 70 and 80 have a problem with their sense of smell. Smell that declines with age is called presbyosmia, and it is not preventable. </div>
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<div>The sense of smell, or olfaction, is part of people’s chemical sensing system, along with the sense of taste. Normal smell occurs when odors around in the vicinity, like the fragrance of flowers or the smell of baking bread, stimulate the specialized sensory cells, called olfactory sensory cells. The ability to smell these odors impacts taste.</div>
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<div>Dysgeusia is a distortion of the sense of taste and a common problem among elders. An alteration in taste or smell may be a secondary process in various disease states, or it may be the primary symptom. The distortion in the sense of taste is the only symptom, and diagnosis is usually complicated since the sense of taste is tied together with the individual’s other sensory systems. </div>
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<h2 class="ms-rteElement-H2"><div>Complaints Could Be Flags</div></h2>
<div>It is common for residents to be unaware that their lack of enjoyment of the food may be caused by other factors unrelated to the community’s food service. It is therefore a challenge for the ED and director of food and beverage to discern the true source of the dissatisfaction. </div>
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<div>The first place to look is always the <a target="_blank" href="/Monthly-Issue/2013/Pages/0413/Ensuring-High-Quality-Food.aspx">quality and variety </a>of the food being offered, as well as its preparation. This should be relatively easy for the trained professional. If, on a daily basis, it is determined that the quality and food preparation are very good, then it can be hypothesized that the issue may be with the resident. </div>
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<div>Resident feedback on menu selection is very important, as is offering a variety of dishes and changes to the menu. Boredom with the menu can mimic changes in taste sensations. </div>
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<div>EDs should listen to all food complaints and work with the food and beverage department by keeping track of who is making the complaints and the types of complaints being made. Determine how many people are making the same complaint. A resident who complains on a daily basis that the food is lacking flavor is likely to be suffering from Dysgeusia but does not know it. </div>
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<div>Without a complaint/feedback log it is difficult to distinguish between food preparation errors and an aging palate. </div>
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<h2 class="ms-rteElement-H2">Educate Staff, Residents </h2>
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<div>Residents need to be educated on the things that impact one’s taste buds. Educational programs should be conducted to help create awareness for residents. </div>
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<div>Residents who are chronically dissatisfied with the food should be encouraged to speak with their doctor. Their level of satisfaction may return simply by changing a medication.</div>
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<div>There is little awareness and discussion of Digeusia. Doctors may not be aware of what impacts taste. It is therefore up to the residents and leaders in the field to encourage doctors to learn more.</div>
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<div> <span><span><img src="/Monthly-Issue/2013/PublishingImages/0413/mgmt_2.jpg" alt="Where does responsibility lie?" class="ms-rtePosition-4" style="margin:15px;" /></span></span></div>
<div>The table above highlights the types of complaints received by residents and attempts to categorize them in two groups. The first group reflects possible issues with the food preparation and service. These complaints tend to be more specific and presented by residents who are generally satisfied with the food service. The second group is likely to be related to the resident’s sense of taste. These complaints tend to be more general, making it more difficult to pinpoint a solution. It is time for this type of discussion to become as common in senior living as other health-related topics are common to the older population. </div>
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<div>There is much to learn. These issues spark creativity and a challenge for food and beverage departments. </div>
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<div>Changing the orientation from one of expecting residents to complain to one in which a provider can make a difference may attract more chefs to the industry. </div>
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<div>Click here for some <a target="_blank" href="/Monthly-Issue/2013/Pages/0413/Menu-Development-And-Food-Preparation-Techniques.aspx">palette-pleasing recipes</a>. </div>
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<div><em>Robin Granat, LCSW, CALA, is executive director and Robert Derin is executive chef at Five Star Premier Residences of Teaneck, N.J., part of Five Star Senior Living. The research, opinions, and conclusions in this article do not constitute professional advice or advocacy of particular practices by the community and/or Five Star Senior Living.</em></div>
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Taste is impacted by sense of smell, which also declines significantly as one ages. Thirty percent of people between the ages of 70 and 80 have a problem with their sense of smell. Smell that declines with age is called presbyosmia, and it is not preventable. | 2013-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/0413/mgmt_thumb.jpg" style="BORDER:0px solid;" /> | Management;Quality | Column | 4 |
| Livable Communities For Elders | https://www.providermagazine.com/Issues/2013/Pages/0413/Livable-Communities-For-Elders.aspx | Livable Communities For Elders | <img width="202" height="202" src="/Monthly-Issue/2013/PublishingImages/0413/News/communities.jpg" class="ms-rtePosition-2 ms-rteImage-1" alt="" style="margin:5px 20px;" />The best communities for elderly Americans provide “accessible and affordable housing options; transportation; walkability; safe neighborhoods; emergency preparedness; and support services like health care, retail outlets, and social integration,” according to a new report from the MetLife Mature Market Institute and the Stanford Center on Longevity.<br><br>According to the report, the most critical characteristics of an age-friendly, livable community can be measured using these indicators: <br><br>■ Housing. Accessible/visitable housing that is affordable. Zoning laws that permit flexible housing arrangements such as building assisted living facilities or private homes on relatively small lots.<br><br>■ Safe neighborhoods. Low crime rates and emergency preparedness plans that take the needs of older residents into account. <br><br>■ Transportation. Including mass transit, senior transport programs, walkable neighborhoods (safe for pedestrians), nearby parks and recreation, roads with visible signage, adequate lighting, and adequate vehicle and pedestrian safety at intersections.<br><br>■ Health care. An adequate number of doctors (primary care and specialists), hospitals, and the presence of preventive health care programs. <br><br>■ Supportive services. The presence of home- and community-based caregiving support services and the availability of home health care, meals-on-wheels, and adult day care.<br><br>■ Goods, services, and amenities. Retail outlets within walking distance, restaurants, grocery stores offering healthy foods, and policies supportive of local farmers’ markets.<br><br>■ Social integration. Programs and organizations that promote social activities and intergenerational contact. Places of worship, libraries, museums, colleges, and universities are often underutilized resources.<br><br>“We know people generally prefer to remain where they are as they age, connected to friends and family, and communities lose an economic and social asset when older people leave,” said Sandra Timmermann, EdD, director of the MetLife Mature Market Institute. “With that in mind, we supported the development of these indicators by studying the best existing tools and data. Communities can now make assessments and begin to implement change with readily available public data.”<br><br>According to Amanda Lehning, who collaborated on the report, “Every community is unique. Local governments should think about how to adapt these indicators to best meet the needs of their residents,” she says.<br><br>“Efforts to help older adults age in place can also potentially improve the community as a whole. For example, older adults can make valuable contributions as neighbors, caregivers, and volunteers. They also patronize local businesses and are a factor in tax revenue.”<br>See www.MatureMarket Institute.com. | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Report: Holistic Approach Needed For Dementia Care | https://www.providermagazine.com/Issues/2013/Pages/0413/Report-Holistic-Approach-Needed-For-Dementia-Care.aspx | Report: Holistic Approach Needed For Dementia Care | Experts seeking a holistic approach to health care for people with dementia have published a report that establishes the values, practices, and recommendations for person-centered dementia care.<br><br>“Overall dementia care in this country is impersonal and fragmented,” the authors wrote. “This paper is a call to action to change what is considered the gold standard.”<br><br>The report contains a framework for a holistic health care approach that considers the psychological, social, and spiritual aspects of individuals with dementia. <br><br>The expert group, called Dementia Initiative, came to consensus agreement on the framework and its contents. David Gifford, MD, MPH, senior vice president of quality and regulatory affairs for the American Health Care Association; Lindsay Schwartz, PhD, director of workforce and quality for the National Center for Assisted Living (NCAL); and Jane Clairmont, owner and chief executive officer of English Rose Estates, Edina, Minn., participated in the effort. <br><br>The white paper includes recommendations for the first steps in converting the country’s dementia care systems and practices to person-centered care.<br><br>It calls for the establishment of an advisory group that includes people with dementia. <br><br>This group would be expected to develop a plan for appropriate prescribing guidelines for the use of antipsychotic medications for people who have dementia.<br><br>The Dementia Initiative originally convened to discuss the overuse of antipsychotics for people with dementia. <br><br>“As discussion among the diverse group of dementia care experts got underway in the spring of 2011, it became quickly evident that focusing on one dysfunctional aspect of dementia care—in this case, the overuse of antipsychotics—was not possible without backing up and addressing the root cause of the dysfunction,” the authors wrote. <br><br>“This white paper provides a comprehensive guide to what person-centered care for residents with dementia encompasses and how to deliver that care, utilizing a holistic approach,” said NCAL’s Schwartz. | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Sequester Hits Long Term Care Profession | https://www.providermagazine.com/Issues/2013/Pages/0413/Sequester-Hits-Long-Term-Care-Profession.aspx | Sequester Hits Long Term Care Profession | Long term and post-acute care professionals were girding themselves for massive Medicare cuts after the long-dreaded deadline for sequester came and went. <br><br>President Obama signed the so-called sequester order March 1, and the cuts will take effect beginning in April. Estimates vary on how big a bite the cuts will take—the Congressional Budget Office (CBO) has estimated that Medicare spending will fall by $9.9 billion through fiscal 2013; the White House Office of Management and Budget says that the cuts will equal $11.1 billion over the next 12 months. CBO has estimated that, if the cuts remain on the books for the next decade as scheduled, they’ll slice $123 billion from Medicare spending. <br><img src="/Monthly-Issue/2013/PublishingImages/0413/News/night_capital_thumb.jpg" class="ms-rtePosition-1" alt="" style="margin:20px 15px;" /><br>Debra McCurdy, an analyst with ReedSmith, says that things could be worse: The sequester caps spending cuts to providers by 2 percent; “this 2 percent Medicare cut compares to an almost 8 percent cut to non-exempt defense spending and about a 5 percent reduction in other non-exempt non-defense programs for the remainder of fiscal year 2013,” McCurdy says. <br><br>But those cuts may be the least of it for health care providers, said Rob Schile, a partner with the auditing firm CliftonLarsonAllen. <br><br>“The challenge for health care providers is that sequestration comes on top of other significant reductions taking place in reimbursement as a result of payment reform,” Schile said in a news release. “For these organizations, it isn’t necessarily the 2 percent reduction of sequestration that is so significant, it is the incremental impact of even more cuts on top of it.”<br><br>The cuts were inserted into the 2011 Budget Control Act as a kind of poison pill; congressional Republicans and the White House hoped that negotiators in each party would be able to concentrate on meaningful reforms with the sword of Damocles dangling above their heads. <br><br>As ReedSmith’s McCurdy drily notes, “It did not work out that way.”<br><br>Both parties are now apparently more focused on the public relations of the sequester, as opposed to the public policy of it. Democrats are working hard to portray congressional Republicans as hard-hearted reactionaries; Republicans, for their part, want Americans to see the Democrats as profligate demagogues. <br><br>However Washington moves in the short- and medium-term, experts say that it’s clear the Era of Austerity has begun for providers.<br><br>“In sum,” Schile said, “health care providers are experiencing a monumental shift in revenue cycles. How they meet the challenge of substantial reductions in the midst of a wave of change will determine how well they survive in the new environment.” | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Some States Moving To Innovative AL Survey Models | https://www.providermagazine.com/Issues/2013/Pages/0413/Some-States-Moving-To-Innovative-AL-Survey-Models.aspx | Some States Moving To Innovative AL Survey Models | The national Center for Assisted Living recently released the 2013 edition of “Assisted Living State Regulatory Review,” finding that 18 states made changes to assisted living regulations, statutes, and policies during 2012. <br><img class="ms-rtePosition-1" src="/Monthly-Issue/2013/PublishingImages/0413/News/survey.jpg" alt="" style="margin:0px 10px;" />Nine states—Colorado, Georgia, Michigan, Missouri, New Jersey, New York, Ohio, Oregon, and Washington—made major changes.<br><br>Adding to a growing number of states, Colorado and New Jersey started innovative survey models. Colorado has a one-year licensure term. However, under a new pilot program, Colorado would extend the one-year term if the residence meets specific requirements. <br><br>The community must have been licensed for three years. The residence’s record should not have a citation, an enforcement action, or a pattern of deficiencies and no major deficiencies that affected the life, health, or safety of residents in the three years prior to the survey. <br><br>In late 2012, Michigan’s licensing division for Homes for the Aged (HFA) and Adult Foster Care (AFC) also moved to a new renewal model for onsite inspections. Onsite inspections are required for all licensed facilities every two years for AFC homes and every year for HFA. The licensing division used to give AFC and HFA a few weeks’ notice before conducting the onsite inspection. <br><br>Now the state issues a one-day notice to HFA and AFC’s residences. Inspections consist of interviews and observations with licensees, staff, and residents to determine rule compliance plus resident care quality. Quality of care includes mental and physical health, welfare, and well-being, assessed through key indicators. <br><br>In the Garden State, New Jersey’s Department of Health (DOH) and the Health Care Association of New Jersey Foundation created a program called Advanced Standing, a voluntary program that requires participating assisted living communities to comply with all applicable regulations and submit quality data that meet benchmarks set by a peer review panel. <br><br>In 2012, several states added or changed disclosure and reporting requirements, including California, Florida, Ohio, Oregon, and Washington. In California, the Elder Abuse and Dependent Adult Civil Protection Act established procedures for the reporting, investigation, and prosecution of elder and dependent adult abusers. <br><br>The act requires certain persons, called mandated reporters, to report known or suspected instances of elder or dependent adult abuse. <br><br>If abuse occurs in a long term care facility—including assisted living—the act requires a mandated reporter and authorizes any person who is not a mandated reporter to report the abuse to the local ombudsman or the local law enforcement agency. <br><br>Failure to report physical abuse and financial abuse of an elder or dependent adult under the act is a misdemeanor. <br><br>Florida assisted living communities are now required to notify the state licensing agency within 10 days after the initiation of bankruptcy, foreclosure, or eviction procedures concerning the provider in which the controlling interest is a petitioner or defendant. <br><br>Oregon also required its residential care and assisted living providers to notify the licensing agency of bankruptcy or foreclosure.<br><br>In 2012, states also: <br>■ Changed life safety or physical plant standards (Missouri, North Dakota, Oregon, West Virginia);<br>■ Addressed tuberculosis testing requirements or infection control (Mississippi, Texas); <br>■ Revised or added admission/retention thresholds (Florida, Texas);<br>■ Changed rules relating to medication management (California, New Jersey);<br>■ Changed staffing requirements (Georgia, Ohio);<br>■ Changed resident assessment requirements (Georgia, Oregon); and<br>■ Addressed handling residents’ personal property or funds (Missouri, Oregon). | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Survey Reveals Need For More Preventive Oral Care | https://www.providermagazine.com/Issues/2013/Pages/0413/Survey-Reveals-Need-For-More.aspx | Survey Reveals Need For More Preventive Oral Care | <div>A recent survey of nursing homes in Kansas revealed that one-third
of residents had lost all of their natural teeth, according to the
Kansas Bureau of Oral Health and Oral Health Kansas.</div>
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<div>“When a person loses all of their natural teeth, it affects their
appearance and their ability to eat and speak,” the report said. “An
additional 43.7 percent had lost some, but not all of their teeth. This
is significantly higher than the 17.4 percent of seniors living
independently in the community who have lost all of their natural
teeth.”</div>
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<div>The survey, based on a nationally recognized protocol, included 540
Kansas elders living in 20 nursing homes and consisted of a clinical
oral health screening and a resident questionnaire. <br></div>
<h2 class="ms-rteElement-H2">Key Findings </h2>
<div>■ Residents had significant dental care in the past, but now have
untreated dental disease. More than one-third of nursing facility
residents had untreated dental decay. “The screeners noted a large
amount of past dental work (crowns, bridges, partial dentures) in the
residents’ mouths. This indicates past access and investment in
professional dental care,” the report said. “The presence of current
untreated dental disease suggests that this level of care has not
continued in their current life situation.”<br></div>
<div><br>■ Residents had poor oral hygiene. Daily brushing and flossing
removes the bacteria and plaque that irritates gums and leads to
inflammation (gingivitis) and periodontal disease. Twenty-six percent of
surveyed residents had severe gingival inflammation, meaning that the
gums were swollen, bleeding, and/or painful. Twenty-nine percent had
substantial oral debris on at least two-thirds of their teeth, and 15
percent of the residents had natural teeth that were loose. Taken
together, these indicators suggest that many residents are not removing
the plaque and bacteria from their teeth on a regular basis.</div>
<div><br>■ Residents have limited financial resources for dental care.
Medicare does not cover preventive and restorative professional dental
services or dentures. Kansas Medicaid offers minimal dental benefits for
adults. Sixty-six percent of the residents surveyed were on Kansas
Medicaid. Professional dental care is an out-of-pocket expense for most
seniors, and this is a barrier to care for many on limited incomes.</div>
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<div>Given these findings, the report recommends that residents receive
daily preventive care, improved access to oral care be created via
additional mobile programs in nursing homes, and the sustainability of
the programs be ensured through a reliable payment source. </div>
<div> </div>
<div>“Nursing facilities must monitor residents to ensure they are
receiving adequate daily oral care and to identify oral health needs
that require professional attention,” the report said. “Access to dental
professionals must be physically and financially feasible. All three
components are necessary to see impactful and sustainable improvement in
the oral health of this population.”</div>
<div> </div>
<div><em>Source: “Elder Smiles 2012: A Survey of the Oral Health of
Kansas Seniors Living in Nursing Facilities,” Kansas Bureau of Oral
Health, Kansas Department of Health and Environment, Topeka, Kan. </em></div>
| A recent survey of nursing homes in Kansas revealed that one-third of residents had lost all of their natural teeth, according to the Kansas Bureau of Oral Health and Oral Health Kansas. | 2013-04-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/senior_dental.jpg" style="BORDER:0px solid;" /> | Caregiving | Column | 4 |
| VA Open To Long Term And Post-Acute Care Providers | https://www.providermagazine.com/Issues/2013/Pages/0413/VA-Open-To-Long-Term-And-Post-Acute-Care-Providers.aspx | VA Open To Long Term And Post-Acute Care Providers | The Department of Veterans Affairs (VA) is weighing a rule that would allow non-VA companies to provide long term care and rehabilitation services to stricken vets. <br><br>The rules, which are expected to take effect, could well be an opportunity for providers, experts say. <br><br>“Veterans, who in some cases have had to travel hundreds of miles from their homes to find care in a VA facility, will now be able to play an active role in choosing the best care setting for their needs,” says Jack MacDonald, executive vice president for special projects and chief public affairs officer at Golden Living. “They will be able to receive this care in their communities where their families and support systems are located. It’s also important to note that the rule expands care choices to home health care, palliative care, and non-institutional hospice care—thereby expanding not only the locations in which our veterans may receive care, but expanding the options for choice as well.” <br><br>There are some 23 million Americans who rely on VA for health care, and the costs of VA’s major benefits programs are expected to rise 70 percent, to about $130 billion, by 2022. In fiscal 2007 alone, VA spent more than $4.1 billion on long term care for its patients. VA expected to spend some $108 million on nursing home care in fiscal 2009. <br><br>The proposed rules are the culmination of a lot of work, says Dough Burr of Health Care Navigator, who is also chair of the American Health Care Association Finance Committee. <br><br>“We have been working collaboratively with the VA for many years to get to the point where community nursing homes will now have the regulatory flexibility and reimbursement necessary to deliver high-quality outcome-oriented services to our nation’s veterans,” he says. “This is an example of how government and the private sector can effectively work together for the benefit of people who need post-acute and long term care.” | | 2013-04-01T04:00:00Z | | | Column | 4 |
| Motivating Before Hiring | https://www.providermagazine.com/Issues/2013/Pages/0413/Motivating-Before-Hiring.aspx | Motivating Before Hiring | <br>One way to determine at the outset what you can do to motivate individual staff members and identify potential leaders is to conduct a Predictive Index (PI) assessment prior to hiring. The PI is a scientifically validated assessment that accurately predicts workplace behaviors, tendencies, motivators, and drivers.<br><br>“The PI tells you what makes a person tick and how he or she operates. Based on the information obtained in a PI assessment, I could motivate or demotivate a person in two minutes,” says Nancy Martini, president and chief executive officer of PI Worldwide, a company that works with companies and organizations to conduct and interpret these assessments.<br><br>The PI consists of a self-reported adjective checklist regarding how individuals view themselves and how they think others view them. It takes just five to 10 minutes to complete, and the results provide detailed information about a person’s behavioral drives. By matching a person whose drives are congruous with the job they will be performing, it can enhance retention, job satisfaction, team efficiency, and productivity.<br><br>“One goal of the PI is to determine who the person really is, because this is who managers, colleagues, and residents will have to interact with,” says Martini. This information is valuable, as many people—intentionally or not—hide their real personalities during the interview process. The PI helps managers determine in advance if a potential employee actually will fit in with the team and the facility’s culture and be an appropriate candidate for a leadership position.<br><br>Martini urges facilities that use the assessment to pay attention to the results. “What you don’t want to do is think that you will change someone to make them fit into a job. Instead, you should consider if someone is a fit for the job and how you will leverage his or her talents to get the best from his or her performance,” says Martini.<br><br>Jane Drury, vice president of human resources at Balfour Senior Living in Louisville, Colo., uses the PI as a recruiting tool. “We have each candidate complete a PI, then we match it to the profile of the characteristics required for the position,” she says. “This allows us to understand what motivates people and what their work style is so that we can address their needs when they are hired.” <br><br>Drury and company also use the tool to identify potential leaders and managers. “This not only helps us identify people who might be good leaders, but it also makes it more likely that the people we hire and promote will be more successful in those leadership positions,” she says. | | | | | Column | 4 |