December 2019

Vol. 47 No. 12

December

Cover Story

Assisted Living Brings Meaning to Hospitality

https://www.providermagazine.com/Issues/2019/December/Pages/Assisted-Living-Brings-Meaning-to-Hospitality.aspx

Assisted Living Brings Meaning to Hospitality

<div></div><div> Residents of the Paul Spring Community in Northern Virginia gathered recently to enjoy the day’s lunch prepared by Executive Master Chef Norbert Roesch. Waiters in black bowties and crisp white shirts moved efficiently between the tables, expertly serving a creamy seafood soup, a choice of Cobb, Caesar, or Mediterranean salad, and entrées that included baked salmon, turmeric-spiced cauliflower, and BBQ chicken sandwiches.</div><div> </div><div> <img src="/Issues/2019/December/PublishingImages/bs_paulspring-roesch.jpg" alt="Master Chef Norbert Roesch" class="ms-rtePosition-2" style="margin:5px 15px;" />For dinner, the residents could look forward to a selection of beef tenderloin, shrimp and clam sauté, and seared garlic lamb chops, among other delights. Those who preferred to make their own meals, meanwhile, could join a weekly outing to the nearby Wegmans grocery store, where staff drivers would carry their bags to the waiting club van and then back to the countertops of their trim apartment kitchens. First-rate hospitality? Yes! But gourmet dining and valet shopping excursions are not the only things that distinguish the Paul Spring Community, an independent living, assisted living, and memory care facility in Fairfax County, Va.</div><div></div><div> <br> </div><div></div><div>“What makes us different? It’s not necessarily a dining room, or the food on the table, or the bus that we take residents out on,” says Ray Tate, executive director of the 145-apartment facility that is part of Virginia-based Retirement Unlimited (RUI). Paul Spring is one of 62 other assisted living facilities registered in Fairfax County alone. “It’s us,” he answers. “We, the people, are the ones who make this community different. It has to start with us.”</div><div></div><div> <br> </div><div></div><div>In 2017, RUI renovated Paul Spring with the addition of a memory care wing and enhanced amenities such as a wellness program, concierge services, and an ambassador program to acclimate and introduce residents into the community. Tate emphasizes that all such amenities rest on a strong foundation of personal hospitality, such as courtesy, empathy, attentiveness, and friendliness. </div><div></div><div> <br> </div><div></div><div>“Our values are all centered around providing the best hospitality possible,” he says. “It’s how we treat the residents. It’s how we offer them the service they deserve.” </div><h2 class="ms-rteElement-H2"> Hospitality: Service and Smiles</h2><div>Communities across the country seek to balance the two concepts of hospitality—amenities and personal—as they aim to attract and serve a growing wave of seniors looking for the right facility. The sheer number of people entering the assisted living market in the coming years will require a variety of hospitality offerings to meet the demand, many say.</div><div> <br> </div><div> <img src="/Issues/2019/December/PublishingImages/VanDyk.jpg" alt="Bob Van Dyk" class="ms-rtePosition-1" style="margin:5px 15px;" />It’s clear which variety of hospitality is most important to Robert Van Dyk, president and chief executive officer of Van Dyk Health Care, which operates facilities throughout New Jersey. Gourmet dining, spa-like buildings, and limousine rides to doctors’ visits are elements of hospitality that fall more in the realm of marketing, he contends.</div><div> <br> </div><div>“Hospitality is not ribeye versus chopped meat, or whether you’re using limos or calling Uber. It’s not Egyptian cotton sheets versus plain. I consider all of those marketing,” Van Dyk says. </div><div> <br> </div><div></div><div>“To me hospitality is the people that you employ. It really has more to do with being friendly, generous, and entertaining of residents, visitors, and strangers. The hospitality side is how welcoming do you make people feel? That’s what hospitality is.”</div><div> <br> </div><div>Staff at Van Dyk learn ways to treat and engage visitors, guests, and residents. “It’s always, ‘smile, good morning, how are you?’” Van Dyk notes of one key message imparted. “If someone looks a little lost, it’s, ‘Is there something I can do to help you? Are you looking for someone? Is there anything you need?’ It’s the front desk trying to be aware of where everyone is.” </div><div> <br> </div><div>Van Dyk acknowledges that knowing the whereabouts of 122 residents at any given moment can be a challenge. But the staff have a solution. </div><div> <br> </div><div>All wear earbuds that let the front desk reach out discretely with queries. This is particularly important when a family member comes for a visit: “‘We have Mr. Jones here. Could someone tell me where his mom is right now?’” Van Dyk says of a typical example. “Knowing someone’s name. We’re trying to create a very happy, warm, enjoyable experience in someone’s new home.”</div><h2 class="ms-rteElement-H2">Pledge to Hospitality</h2><div>Others codify their commitment to personal service. At Vetter Senior Living, which operates facilities throughout Nebraska, Kansas, Iowa, Missouri, and Wyoming, all team members must sign the Vetter Way Hospitality Pledge (<a href="/Issues/2019/December/Pages/The-Vetter-Way-Hospitality-Pledge.aspx" target="_blank" title="Hopitality pledge">see sidebar</a>). The pledge includes commitments to empathy, common courtesies, timeliness, eye contact, and always offering a can-do attitude.</div><div> <br> </div><div> <img src="/Issues/2019/December/PublishingImages/ShariOwen.jpg" alt="Shari Owen" class="ms-rtePosition-1" style="margin:5px 15px;" />Shari Owen, talent development coordinator at Vetter, says this pledge is infused throughout the company’s mission, vision, and values. </div><div> <br> </div><div>“We live it every day,” she says. “It’s in our general orientation. Our team members go through a three-day orientation prior to even stepping foot on the floor. We want to make sure the expectations are laid out very clearly. Because we know we retain our talent when expectations are laid out from the get-go. The first presentation they hear is our Vetter Way Pledge.”</div><div> <br> </div><div>Paul Spring’s Tate concurs. When hiring employees and during monthly staff meetings, Tate’s team continually reinforces the community’s core values around hospitality. </div><div> <br> </div><div>“We really do emphasize the need to treat someone the way you want to be treated,” he says of the training. “Sympathy, empathy, it all goes a long way. Our residents plan to age in place, and, therefore, over time they won’t be as strong as they once were. So being able to have that empathy and see them where they are in life is so important.”</div><div> <br> </div><div>Beth Kolnok, a spokesperson for RUI, a Fralin and Waldron family-owned senior living community management company, explains that hospitality traits in an individual can be expanded, but can’t necessarily be taught. Paul Spring looks for employees with the right motivation and right personality, including a willingness to take ownership of the facility. </div><div> <br> </div><div>“When you’re walking down the hallway and see a tissue on the ground, simply pick it up no matter what official title you hold,” Kolnok notes of the attitude that is shared across the team. “Having pride in ownership of your community, that’s what will lead to hospitality. Ensuring the right people are in the right places starts during the recruitment process. We want to make sure they’re the right fit with the right personality from the beginning.”</div><div> <br> </div><h2 class="ms-rteElement-H2">Authentic Culture of Hospitality Starts with Top Management</h2><div>Industry observers agree on the need to ensure that personal hospitality always trumps trendy amenities. </div><div>Having a culture of hospitality is especially important as people become more frail or unsure of their future, which many folks may be approaching in these communities, says Denver Severt, PhD, associate professor in the Rosen College of Hospitality Management at the University of Central Florida (UCF). A culture of hospitality can be discerned by whether one feels welcomed or not, he adds.</div><div> <br> </div><div>“It must start with the top management and trickle down from management to employees to residents,” Severt says. “It must be a culture that is authentic.”</div><div> <br> </div><div>Capturing and marketing that culture will become a competitive advantage as society faces a larger number of people living longer with fewer children to care for them.</div><div> <br> </div><div>“There is a wave of greying that has these communities forecast to grow tremendously across the next few years,” Severt says. <br></div><div> <br> </div><div>“This will require creative options for many to determine what type of care is provided, from home health care to a lifetime care community. The hospitality initiative is closely linked to quality of life and is essentially the right thing to do in any culture.”</div><div> <br> </div><div>But how widespread the culture of hospitality is remains an open question. <br></div><div> <br> </div><div>As former chairman of both the American Health Care Association and the National Center for Assisted Living, Van Dyk recalls how he used to talk about better hospitality training at national meetings. He argued that communities shouldn’t be afraid to spend extra time in helping develop these qualities among employees, especially those who may not have been exposed to the best hospitality. “We weren’t going to see improved care and outcomes if we didn’t invest in our staff,” he would tell his peers. <br></div><div> <br> </div><div>But the response was either, “You’re right Bob, I’m going to go back and work with my team,” or others said there was no way they could invest in that kind of training, he says.</div><h2 class="ms-rteElement-H2">Hospitality Amenities: Sealing the Deal</h2><div>But others contend there is a business case to be made for promoting and touting hospitality, personal or otherwise, especially as the United States faces a rapidly aging population. UCF’s Severt notes that hospitality creates a culture that is more likely to attract people who will later recommend others to come to a facility. </div><div> <img src="/Issues/2019/December/PublishingImages/MelissaMurphy.jpg" alt="Melissa Batchelor-Murphy" class="ms-rtePosition-2" style="margin:5px 10px;" /> <br>This point is echoed by Melissa Batchelor-Murphy, PhD, RN-BC, FNP-BC, FGSA, FAAN, associate professor at The George Washington University (GWU) School of Nursing and director of its Center for Aging, Health, and Humanities. </div><div> <br> </div><div>Facilities should focus first and foremost on providing quality care. But she acknowledges that the latest, snazzy hospitality amenities “tend to be easier to market,” especially to adult children who may feel guilty for not being able to care for an elderly parent. <br></div><div> <br> </div><div>“They do that to make them feel better,” Batchelor-Murphy says of the pitch to amenities. “It’s such an emotional moment that you’re even considering placing your parent in a residence, or that you’re at the point where the care exceeds the demands of what the family can do. These amenities provide comfort to these decisions.”</div><div> <br> </div><div>Recent hospitality trends that Batchelor-Murphy has seen include greater options in dining, such as buffet-style and family-style meals, and the introduction of technology and online programs that allow residents to interact with family members. <br></div><div> <br> </div><div>Once inside, the question looms: Are they happy there? <br></div><div> <br> </div><div>“There’s that balance of wanting to make sure you have an environment that is pleasing and inviting from a marketing point of view,” Van Dyk says. “But you can never, never, never overlook the care you provide, and the care you provide goes right back to the staff.”</div><h2 class="ms-rteElement-H2">Ice Cream Helps Break the Ice</h2><div>Still, no one says that fine amenities are a bad thing. Many traditional hospitality features have intrinsic value that help enrich the lives of residents and families alike. <br></div><div> <br> </div><div>Take Vetter’s soft-serve ice cream station, which has been a signature feature in each community for three decades. The cool treat offered a unique opportunity at one of Vetter’s facilities located near a high school, says Karl Bieber, public relations coordinator for the company.</div><div> <br> </div><div>“Kids were coming in after school to get the free ice cream, and the administrator noticed they were slipping in to get ice cream and leaving,” Bieber recalls. “The administrator told the students, ‘I don’t have a problem with you coming here and visiting. But for you to get the free ice cream, you have to spend a couple of minutes and visit with the residents,’” he says of the interaction.</div><div>The suggestion took off. </div><div> <br> </div><div>“Residents would start to gather near the ice cream area knowing that during the school year they’d probably have a few kids come in for ice cream,” Bieber says. “Even for them to come in and say hello, and tell them how their day was, that makes a difference.”</div><div> <br> </div><div>Ice cream also serves a useful purpose for younger family members. Adult children can tell their little ones that they’re going to have ice cream with grandma. <br></div><div> <br> </div><div>“It’s just a positive association,” Bieber says. “It may sound simple, but it’s hospitality, and it brings a level of comfort to people who come through our doors. It takes their mind off of medical conditions and gives them something to talk about.”</div><div> <br> </div><div>The same concept applies to the new coffee bistros that Vetter is installing in facilities. The coffee bistros are open to the public and have drawn in community members from local junior colleges and elsewhere. “It’s another element of hospitality for the residents who come to live there and anyone who comes through the door,” Bieber says.</div><div> <br> </div><h2 class="ms-rteElement-H2">Back to School: RUI University</h2><div>While many hospitality features, such as ice cream stations and coffee bistros, have been in place for years, others are new to the scene. <br></div><div> <br> </div><div> <img src="/Issues/2019/December/PublishingImages/bs_paulspring-Library.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 15px;" />One is the RUI University at Paul Spring and other RUI facilities in Virginia. The lifelong learning program has operated since 2017 and offers a plethora of courses that are open to both residents and the outside community. Paul Spring has built its own classroom for the courses, and RUI University partners with area colleges, universities, museums, and other institutions to bring in professors who teach the semester-based series of classes. <br></div><div> <br> </div><div>“Our program combines learning and entertainment over several uniquely formatted classes,” says RUI’s Kolnok. “It’s a great opportunity for friends, families, and visitors to not only expand their knowledge on topics of interest but also get a taste of the community and what we have to offer.”</div><div> <br> </div><div>The RUI University 2019 fall semester featured nearly 30 courses, with titles such as Cross-Country Cuisine, Claude Monet: Architect of the Impressionist Movement, the Four Wives of Hemingway, Why Did Pearl Harbor Happen?, Thomas Jefferson’s Monticello, Dressing the Past: Fashion Throughout History, Music and the Brain, and How to Kick the Sugar Habit. </div><div> <br> </div><div>The classes are augmented by field trips to the local Smithsonian museums and other D.C.-area institutions. RUI University complements Paul Spring’s chock-full calendar of other enrichment activities, including live music, poetry readings, nature walks, fruit and cheese socials, karaoke, movie and popcorn nights, and daily devotionals.</div><div> <br> </div><div> <img src="/Issues/2019/December/PublishingImages/DorisSullivan.jpg" alt="Doris-Ellie Sullivan" class="ms-rtePosition-2" style="margin:5px 15px;" />RUI President Doris-Ellie Sullivan notes that RUI’s overall vision aims to provide a lifestyle that the residents have earned and deserve. <br></div><div> <br> </div><div>“From our team greeting you in our staple blue uniform to the fine dining culinary experience to our sophisticated décor with a local flare,” she says. “Providing a memorable experience is of the utmost importance and is a companywide initiative we work to provide each and every day.”</div><h2 class="ms-rteElement-H2">Trying New Things</h2><div>A facility’s hospitality features can ebb and flow. It’s important to be willing to change with the times. Such is the case with a gift shop that Van Dyk installed back in 2001. “I thought that was pretty cool and looked neat,” he recalls of the initial installation. “I had some fun things in there, costume jewelry, toiletries. Over time, fewer and fewer people were using the gift shop. Children were bringing what they needed.” <br></div><div> <br> </div><div>Staying modern, Van Dyk is now working with Amazon to create a personalized online shopping platform where families and residents can purchase things they might use regularly. Families also can post product reviews to help inform fellow residents. And that former gift shop? It’s set to become “Bob’s 24-hour diner,” complete with period 1950s and ‘60s style black-and-white tile floors and vinyl booths. </div><div>Differences by Geography: Always Seek Fun and Enrichment</div><div> <br> </div><div>Capturing a sense of youthful fun is something that runs through Vetter Senior Living facilities. </div><div>The organization’s Springfield, Mo., location features a men’s night out that usually involves a restaurant the men chose, along with entertainment such as playing cards or going to the Eagle’s Club for an event. “It isn’t a big ruckus time,” says Bieber. “But it’s one thing we’ve found that resonates to make it a unique experience for the group of people in that building,” he says.</div><div> <br> </div><div>Similarly, the Vetter facility outside of Omaha, Neb., organizes regular fishing trips. “The residents are more from a rural background, and we’ll take them fishing with a group we have a cooperative agreement with on a large pontoon boat to go fishing for a day,” says. The facility in Alliance, Neb., meanwhile, took some of its residents to the local swimming pool. “They hadn’t been in a pool in decades,” Bieber says. “And they got them in there, some who had been dependent on a wheelchair.”</div><div> <br> </div><div> <img src="/Issues/2019/December/PublishingImages/MelissaMurphy.jpg" alt="Melissa Batchelor-Murphy" class="ms-rtePosition-1" style="margin:5px 15px;" />Geographic differences in hospitality can cause some challenges, says GWU’s Batchelor-Murphy. </div><div> <br> </div><div>Most institutions still don’t cater to the individual, she notes, especially around food. Homey dishes can be very different depending on where you live in the country. “If you grew up in the North and get put in a nursing home in the South, it’s like, ‘why is everything fried here?’”</div><div> <br> </div><div>The differences can be even starker for someone who is particularly old and may have a cognitive impairment. “They’re like, ‘I don’t even know what that food is,’ because it doesn’t look like what they had when they were home,” she says.</div><h2 class="ms-rteElement-H2">Differences by Demographics: Care Should Always Prevail</h2><div>Administrators agree that the level and quality of hospitality amenities will differ, depending on the demographics and affluence of the residents and their families. </div><div> <br> </div><div>But Van Dyk emphasizes there is no reason for there ever to be a difference in true hospitality, which is care, friendliness, and helpfulness. </div><div> <br> </div><div>“There should never be a reason that, well off or not, that hospitality can’t prevail in an organization,” he says as a bottom line. “When we talk about spas and expensive things—all the glitz that attracts people, because someplace doesn’t have it—that doesn’t mean it’s not a great place to be. Just because someone has all of that stuff, doesn’t mean that’s the place you want to be.”</div><div> <br> </div><div> <img src="/Issues/2019/December/PublishingImages/Tate.jpg" alt="Ray Tate" class="ms-rtePosition-1" style="margin:5px 15px;" />Paul Spring’s Tate notes that providing good hospitality centers on listening to the residents and learning what they’ve done and what they like to do. “Regardless of what the demographics are, or regardless of the region you’re in, if you’re not listening to your community, it’s not going to be a happy or successful community.”</div><div> <br> </div><div>Putting this into practice, the staff at Paul Spring gather oral histories of each resident. These are shared with the entire staff, from administrators and life-enrichment staff to housekeepers and maintenance workers. “The entire community is listening to our residents,” Tate says.</div><div> <br> </div><div>RUI’s Kolnok adds, “It’s not about the building, it’s about the people inside the building.”</div><h2 class="ms-rteElement-H2">Hospitality is Not Trendy</h2><div>Bieber of Vetter Senior Living notes that ice cream and coffee bars are features in the facilities. Hospitality, on the other hand, is a culture. “It’s the heart and soul of the building,” he says. </div><div> <br> </div><div>“I have interviewed family members and our residents about why they chose our facility. And a lot of times they talk about touring several facilities, some that are closer to their house, and some buildings were newer,” he says. “But we had engaging employees. And that was what people responded to. They said people actually looked at them and smiled. They thought those were simple things that we make a mandatory part of working for us.”</div><div> <br> </div><div>Tate explains it’s all about providing a home. Some <a href="/Issues/2019/December/Pages/Hospitality-Industry-Eyes-Assisted-Living-Market.aspx" target="_blank">assisted living facilities</a> have tried to recreate a resort or a hotel-style setup. “But you can only stay in a resort for so long,” he says. “You want a home. That’s why I’m so passionate about what we do here. We provide a home.” ■</div><div> </div><div> <em>Neal Learner is a writer and musician living in Alexandria, Va. He can be reached at learnermusic@hotmail.com.</em></div>

Communities across the country seek to balance the two concepts of hospitality—amenities and personal—as they aim to attract and serve a growing wave of seniors looking for the right facility. The sheer number of people entering the assisted living market in the coming years will require a variety of hospitality offerings to meet the demand, many say.

2019-12-01T05:00:00Z

Management;Quality

Planning for Performance Improvement Plans	https://www.providermagazine.com/Issues/2019/December/Pages/Planning-for-Performance-Improvement-Plans.aspx	Planning for Performance Improvement Plans	<div></div><div> The QAPI (Quality Assurance & Performance Improvement) initiative and its associated Performance Improvement Plans (PIPs) may seem daunting, but to a savvy skilled nursing facility (SNF) leader, they represent opportunities. </div><div> </div><div>A PIP is a concentrated effort on a particular problem that involves systematically gathering information to clarify issues or problems and intervene for improvement.</div><div></div><div> <br> </div><div></div><div>PIPs are data-driven efforts, meant to focus on high-risk, high-volume, or problem-prone areas. A team of experts comes together for a limited period of time to identify the root cause of the issue and develop a change in a system or process. The goal of the PIP is to solve a problem using a team approach and trial interventions—testing for improvement, prevention, or elimination of the issue. </div><h2 class="ms-rteElement-H2"> An Opportunity for Improvement<br></h2><div>Fundamentally, the problem-solving approach of a PIP is an opportunity to avoid harm or realize improvements. When the problem is prevented or decreased, residents benefit from an improved quality of life. Moreover, in proposing QAPI, the Centers for Medicare & Medicaid Services’ (CMS’) rationale was that the performance improvement efforts would save time and resources for facilities. While QAPI’s implementation regulations have been delayed, facility leaders have an opportunity to perfect how they select issues for focus in PIPs.</div><div> <br> </div><div>Every facility collects data on topics such as resident outcomes and facility performance. QAPI requirements indicate that organization leaders use a facility assessment to help identify facility-specific issues. </div><div> <br> </div><div>Other possible data sources include facility dashboards, Certification and Survey Provider Enhanced Reports (such as quality measures and survey history), legal/risk reports, employee surveys, resident satisfaction surveys, incident reports, or resident council minutes. </div><h2 class="ms-rteElement-H2">Categorize Data</h2><div>With so much data, it can be difficult to determine which issues require a PIP and which just need a quick fix. To identify opportunities for improvement, start by categorizing data into five areas: quality of care, quality of life, care environment, regulatory requirements, and facility performance. This will help to filter the data and set priorities for action.</div><div>■ Quality of care. Think of quality-of-care areas as those that impact a resident’s health because of something staff do or don’t do that impedes outcomes. Areas that fall under this category include wounds, falls, infections, weight loss, vaccination compliance, and medication errors. When reviewing facility data, look for any area that does or can impact multiple residents. </div><div>■ Quality of life. This area pertains to the physical, mental, and psychosocial needs of residents. Issues such as abuse, neglect, misappropriation of resident property, decline in functional status, incontinence, and restraints fall under this category. If the resident council has raised any related concerns under this area, these deserve particular consideration. Several areas under this category are high-risk, such as abuse and restraint use, and thus may be good options for a PIP.</div><div>■ Care environment. The environment in which residents live is full of possible high-risk, problem-prone areas, such as alarm use, staff retention, employee health, smoking residents, staff competency, laundry, and concerns with the building and grounds. It is easy to overlook the care environment when considering PIPs, but there are several items that have the potential to impact many residents. In some cases, such as smoking and staff competency, these challenges can be high-risk. </div><div>■ Regulatory requirements. Survey deficiencies fall under this category. Consider reviewing the past three years’ worth of survey data to make note of trends, and plan to develop a PIP for areas that consistently show up. </div><div> <br> </div><div>Other regulatory areas to consider are life safety concerns, accreditation requirements, rehospitalizations, and concerns related to the state’s nurse practice act. </div><div>■ Facility performance. Many facility leaders have a dashboard that tracks several performance areas that require monitoring. This can be used to identify possible PIPs. </div><div> <br> </div><div>Other areas that fall under this category include quality measures, staff turnover rates, reimbursement, and census concerns. Another important item that falls under facility performance is near misses. Having a number of near misses that are related could benefit from a PIP in order to prevent high-risk, problem-prone areas from impacting a high volume of residents. </div><h2 class="ms-rteElement-H2">Implementing a PIP</h2><div>Once the data have been reviewed and analyzed, the next step is to prioritize improvement efforts. Nurse leaders should review trends and select high-risk, high-volume, or problem-prone areas, considering the number of residents impacted. Rank the issues in order of severity and risk. When this phase of the process is complete, it is possible a number of PIPs will be needed; if so, keep an inventory list of PIPs. </div><div> <br> </div><div>Once the PIP areas have been identified, gather support and resource approval from the governing body. Maintaining awareness of facility performance and the priorities of executives can help the nurse leader demonstrate strategic alignment of the PIP targets they are recommending. </div><h2 class="ms-rteElement-H2">Form a Cross-Functional Team</h2><div>Following approval, develop the PIP team. Selection should be done based the issue and what expertise is needed to unravel the issue and implement changes. Providing a cross-functional perspective is a key component of an effective PIP team; having the right members equips the team to solve the issue.</div><div> <br> </div><div>For wounds, this might include the wound nurse. If the issue is call-light response time, it might mean having a nurse assistant on the team. Remember: A PIP team role is an opportunity for staff to develop their leadership capabilities and problem-solving skills. </div><div> <br> </div><div>Once team selection is made, a best practice is to develop a PIP charter. Articulate the problem to be solved, background information, goals, how progress will be managed, timetable, responsibilities, resources, and barriers or constraints. By defining the project’s scope at the outset, the nurse leader establishes expectations, clarifies what success looks like, and focuses efforts and resources on facility priorities. </div><h2 class="ms-rteElement-H2">Get to the Root of the Issue</h2><div>Then, the team can come together to conduct a root-cause analysis of the issue. Define processes currently in place, and identify any gaps or opportunities for improvement. Assess where breakdowns occur. Graphical representations, like process maps or flowcharts, can be particularly helpful, as they illustrate breakdowns, unnecessary steps, or workarounds developed. Ensure the PIP team looks at all possible contributing factors before determining a plan of action. </div><h2 class="ms-rteElement-H2">Put Together a Plan</h2><div>Once the root cause or causes have been determined, it is time to put together the plan of action. Using an improvement model such as Plan, Do, Study, Act (PDSA) can bring structure to the inquiry. The next step is to test the plan of action on a small scale before expanding it to the entire facility. This allows the team to collect data from the trial run to determine if the plan should be adopted and expanded as-is, adapted and reapplied, or abandoned and a new plan or intervention put in place. Remember that even a successful pilot does not guarantee success with broader application; the CMS Sustainability Decision Guide can help to determine whether improvements are scalable and can be maintained. </div><div> <br> </div><div>Throughout the PIP process, there are three key questions the team needs to ask: What is it they are trying to accomplish? How will they know when the change is an improvement? What change or changes can they make that will yield the desired results?</div><div> <br> </div><div>Organizing the PIP around these questions positions the team to identify and seize opportunities for improvement. Although the process can be time-consuming, it positions the facility to achieve positive results for its residents, staff, and other stakeholders. </div><div> </div><div> <em> Amy Stewart, MSN, RN, DNS-MT, is vice president of curriculum development for the American Association of Nurse Assessment Coordination. She can be reached at astewart@AAPACN.org.</em></div>	The QAPI initiative and its associated PIPs may seem daunting, but to a savvy SNF leader, they represent opportunities.	2019-12-01T05:00:00Z	<img alt="" src="/Issues/2019/December/PublishingImages/caregiving_t.jpg" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
Using The Six W’s To Assess Approaches For Achieving Functional Goals	https://www.providermagazine.com/Issues/2019/December/Pages/Using-The-Six-W’s-To-Assess-Approaches-For-Achieving-Functional-Goals.aspx	Using The Six W’s To Assess Approaches For Achieving Functional Goals	<div></div> <div>After much anticipation of—and preparation for—the transition of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) from the Resource Utilization Groups, version 4 (RUGs-IV) to the patient-driven payment model (PDPM), providers now have had several weeks’ experience in this new payment world. </div> <br><div>So how is it going? How has your center’s story progressed since Oct. 1? As I think of these questions, I reflect on the Six W’s that students learn in school. According to a Google search, the six words: Who, What, Where, When, Why, and hoW when posed as questions “constitute a formula for getting the complete story on a subject.”</div> <br><div>I pose the following questions to stimulate self-reflection as you assess if you are where you wanted to be under PDPM in assuring that your residents’ functional needs are best met. <br></div> <div><ul><li>Who is the most important person under PDPM? Obviously, it is the patient. However, as your facility has implemented PDPM, how often have your conversations drifted from resident care needs as the primary focus, to discussions about how any PDPM-related changes in procedures impacted your department or you personally? PDPM offers new opportunities for innovative care delivery, but change can create tension that can distract individuals from their main mission. How are you recognizing and addressing that tension to return the focus to addressing the resident’s functional needs and goals?</li></ul></div> <div><ul><li>What are you trying to achieve clinically? Under the RUGs-IV payment model, providers often focused on scheduling a resident’s day so that planned amounts of therapy were delivered to achieve functional goals. Is that the best approach? Have you made any changes to better incorporate the resident’s desired outcomes and personal preferences in their care plan, so the day is scheduled around the resident? </li></ul></div> <div>If so, has this changed your focus on how function-related care is offered? <br></div> <div><ul><li>Where are a resident’s functional needs addressed? If anybody in your center answers this as “in the therapy room,” you are very likely missing a great opportunity to optimize care and make movement a positive experience. No one discipline “owns” a resident’s function, and care approaches to function should address all resident locations within the center as well as the expected residence once the Medicare stay has ended. </li></ul></div> <div>Do you feel you have a “culture of movement” with care plan functional goals integrated seamlessly across all caregivers? Are family members involved? <br></div> <div><br></div> <div>Do residents’ goals include an integrated approach of therapy, flexible restorative nursing programs, and personalized goal-directed activities such as gardening, needlework, games, hikes, and others that are outside of the therapy treatment areas? <br></div> <div><ul><li>When are a resident’s functional goal needs addressed? Again, opportunities to use PDPM flexibilities to offer person-centered care could be lost if staff believe that functional goals are addressed only during therapy treatment sessions. </li></ul></div> Studies show a 24/7 focus on facilitating movement that is meaningful to the patient is the best approach to recover lost function after a health event, or to delay functional loss related to chronic conditions. <br><div>Resident engagement and staff reinforcement of meaningful movement throughout the day is essential. <br></div> <div>Since PDPM has started, have you evaluated whether changes you have made have impacted when and how much time your residents are engaged in movement throughout the day? Have you also seen changes in resident mood, progress toward goals, safety (such as falls and skin integrity) at different times of the day? <br></div> <div><ul><li>Why is this a good time to reassess how PDPM has impacted your center’s care delivery approaches to function? The Centers for Medicare and Medicaid Services has made it clear that the motivation to change from RUGs-IV to PDPM was to encourage providers to refocus care on the patient needs and preferences, rather than on the services themselves.</li></ul></div> <div>Leading up to the PDPM implementation you may have made many changes in clinical and communication processes as well as trained frontline caregivers in anticipation of the new SNF PPS world. Now that you have had some real-world experience, are you comfortable with your progress, or are there process or training shortcomings that may require different strategies before they become entrenched and harder to adjust later? <br></div> <ul><li>And finally, hoW will you assure follow-through with implementing the new ideas you have generated during this reflection of the six W’s of your PDPM approaches to achieve functional goals? </li></ul> <em>Daniel Ciolek is associate vice president, therapy advocacy, for the American Health Care Association.</em><br>	So how is it going? How has your center’s story progressed since Oct. 1?	2019-12-01T05:00:00Z	<img alt="" src="/Issues/2019/December/PublishingImages/PDPM.jpg" style="BORDER:0px solid;" />	Policy	PDPM Update
What is the difference between the new Quality Rating Program and the Quality Measures?	https://www.providermagazine.com/Issues/2019/December/Pages/The-Quality-Forum.aspx	What is the difference between the new Quality Rating Program and the Quality Measures?	<div></div> <div>When the Centers for Medicare & Medicaid Services developed the Quality Measures (QMs) about 20 years ago, the focus was on the resident population that was typical in skilled nursing facilities (SNFs) at the time. These residents were disproportionately receiving long term care, and the QMs reflected the types of quality concerns experienced by long term care residents. </div> <br>With the dramatic growth of the Medicare post-acute care population over the past two decades and the greater acuity of these residents, the QMs no longer reflect the challenges that SNFs were focused on. <br><div>The Quality Reporting Program (QRP) measures apply to Medicare Part A stays only. The eight assessment-based measures use the five-day admission assessment and the discharge assessment, or a matched death in the facility tracking record. Two claims-based QMs are also included in the QRP, as well as a measure of beneficiary cost per stay. <br></div> <div><br></div> <div>Two of the assessment-based measures were implemented in 2016. One of these, Percent of residents experiencing a fall with major injury, was adapted for the short-stay Medicare population from the long-stay QM. This measure is now reported in Nursing Home Compare (national average of 0.9 percent). <br></div> <div><br></div> <div>The other measure, Percent of residents with an admission and discharge functional assessment and a care plan that addresses function, including at least one goal, was adapted from long term acute care hospitals (LTACHs). This measure will be used in all post-acute care (PAC) settings, including SNFs, LTACHs, home health agencies, and rehabilitation facilities. For SNFs, this measure is currently reported in Nursing Home Compare (national average of 97.6 percent).</div> <div><br></div> <div>Four functional outcome measures were implemented in October 2018; these will be particularly relevant as the patient-driven payment model is implemented with different incentives for therapy use. Data collection for these measures is underway, as well as preliminary review of results, so these are not currently reported in Nursing Home Compare.</div> <div><br></div> <div>Two of these are functional change scores for Medicare stays during which residents were receiving rehabilitation. They include: Change in self-care score for medical rehabilitation patients and Change in mobility score for medical rehabilitation patients. The self-care score includes seven self-care items (total scores ranging from 7 to 42), and the mobility score includes 15 mobility items (total scores ranging from 15 to 90). Higher scores on both these scales represent greater independence. </div> <br><div>These two scores will be risk-adjusted based on resident characteristics to yield a facility average change relative to the expected change for stays meeting inclusion criteria. Two similar scores represent observed discharge scores relative to expected discharge scores for these same two indices, that is, the percentage of residents who met or exceeded expected discharge scores. <br></div> <div><br></div> <div>Two other assessment-based measures address different aspects of PAC. Change in skin integrity: pressure ulcer injury is currently reported in Nursing Home Compare with a national average rate of 1.6 percent. The measure Drug regimen review conducted with follow-up for identified issues is still undergoing testing.</div> <div><br></div> <div>The two claims-based quality measures are currently available in Nursing Home Compare. These include risk-adjusted rates of potentially preventable readmissions in 30 days (national average 7.3 percent) and community discharge (national average 49.1 percent).</div> <div><br></div> <div><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.</em><br></div>	With the dramatic growth of the Medicare post-acute care population over the past two decades and the greater acuity of these residents, the QMs no longer reflect the challenges that SNFs were focused on.	2019-12-01T05:00:00Z	<img alt="" src="/Issues/2019/December/PublishingImages/AndyKramer_2015.jpg" style="BORDER:0px solid;" />	Quality	The Quality Forum

AHCA/NCAL Gold Quality Award Achievers Talk Strategy, Sacrifice	https://www.providermagazine.com/Articles/Pages/AHCA-NCAL-Gold-Quality-Award-Achievers-Talk-Strategy-Sacrifice.aspx	AHCA/NCAL Gold Quality Award Achievers Talk Strategy, Sacrifice	<p>A quartet of providers has received the preeminent Gold National Quality Award designation from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) for 2020 and was honored for their achievement during the association’s annual convention, which ran on a virtual basis through the month of October.</p><h2>Starting With Bronze</h2><p><img src="/Issues/2020/December/PublishingImages/Treutlen.jpg" alt="Treutlen Health and Rehabilitation" class="ms-rtePosition-1" style="margin:5px;width:232px;height:303px;" />Jane Martin, RN, director of nursing, Treutlen Health and Rehabilitation, Soperton, Ga., says for her 50-bed facility in rural Georgia, the latest attempt to achieve Gold started five years back when the organization earned Bronze from AHCA/NCAL, then Silver in 2017.<br></p><p>“That is when we decided to go for the Gold,” she says. “We [earned] a site visit last year, and then this year got the Gold award.”<br></p><p>Going for the top honor and going for the Bronze or Silver are worlds apart, Martin notes. “The Gold is so much different, and you really need to dedicate time to it.” This work includes copious writing down to report quality-based outcomes for residents, since getting positive results is what the award process is all about, she says.<br></p><p>“Probably the most difficult things is collecting the data. Everything has a different measurement time frame, so I really rely on LTC Trend Tracker [from AHCA/NCAL], NursingHome Compare… You need to know all of these data today on a regular basis.”<br></p><p>Once all the hard work resulted in the Gold, Martin says sharing the good news, in a COVID-sensitive manner, was a great feeling for staff and residents alike.<br></p><p>“We were in a huge open area when we told them, and it was a lot of yelling through masks,” she says. “It was kind of sad that we could not hug or have family there, but we did our best.”<br></p><p>As for what she would tell fellow providers about the award program, Martin says facilities should do it; even though it is not easy, it is well worth it. “We all learned so much through the process, and there were so many little things along the way, it has changed the way we live and work here.”</p><h2>Driven by Necessity</h2><p><img src="/Issues/2020/December/PublishingImages/Burgess.jpg" alt="Burgess Square Healthcare and Rehab Centre" class="ms-rtePosition-2" style="margin:5px;width:414px;height:308px;" />Kristin Thrun, administrator, Burgess Square Healthcare and Rehab Centre, Westmont, Ill., says her nursing home got into the quality award world because back in 2012 when accountable care organizations and other value-based care entities emerged in her area, it became imperative for her facility to set itself apart.<br></p><p>“The focus became even more pronounced on overall performance outcomes and quality measures, and becoming part of the AHCA/NCAL award process helped us to do this in a systematic way,” she says.<br></p><p>After receiving some local awards for their work with residents, the facility earned Bronze from AHCA/NCAL in 2017 and then eyed going for Gold after that.<br></p><p>“I think the biggest challenge is continuing to push forward in terms of meeting the criteria and putting our programs in place and sustaining them despite the external challenges brought on by things like changes in payment models [Patient-Driven Payment Model] and keeping pace with those,” Thrun says.<br></p><p>An example she gives is the challenge it was to make the systemic change on medication reconciliation when a resident moved from the hospital to the nursing home. <br></p><p>“We worked with the hospital to change the process and reduce errors tied to these transitions of care and created a pharmacy position that just does admission reviews for new patients coming in,” she says.</p><h2>New Skills Help Staff Adapt</h2><p><img src="/Issues/2020/December/PublishingImages/Applewood_cupcakes.jpg" alt="Applewood Center" class="ms-rtePosition-1" style="margin:5px;width:262px;height:383px;" />The third achieving group says its journey to Gold began 18 years ago, according to Gail Cushing, RN, executive director, Applewood Center, Winchester, N.H.<br></p><p>“It has been a long journey for sure, but we continued to forge on throughout the time, but it did not prevent us from getting to where we wanted to go,” she says.<br></p><p>The greatest thing about the Gold process, Cushing says, is that it gave Applewood Center and its staff new skill sets to be able to adapt to new demands. “We can take new problems and adapt very quickly. An example is with COVID-19; I have said handling the pandemic was made more manageable because we went through a dress rehearsal with the Gold awards.”<br></p><p>For her, the award application has taught her and her people to communicate better, get feedback, educate, teach, and fix pitfalls. One example is that during the pandemic, her staff came up with a way to clean their goggles when there was no water source in an area where people were working.<br></p><p>“The whole Gold process is a concept really that provides a facility with new means to achieve success, and the more you practice, the better you become and the more ingrained it all becomes,” Cushing says.</p><h2>Pride for the Gold</h2><p><img src="/Issues/2020/December/PublishingImages/Heritage_EuniTami.jpg" alt="Heritage of Bel-Air" class="ms-rtePosition-2" style="margin:5px;width:351px;height:237px;" />Katie Frederick, administrator, Heritage of Bel-Air, Norfolk, Neb., started out talking about the end game of achieving Gold, which was the joy she, her 160-strong staff, and residents felt at accomplishing so much. Even though the pandemic has made a true celebration difficult, she says the pride all in the community feel about making Gold is real.<br></p><p>For her, making changes to be more efficient and better at evaluating results and outcomes is the lasting impact going through the award process will have.<br></p><p>“Evaluating and learning are what this has all been about. And, really getting better at communicating, listening to each other, and putting ideas into practice. That has all worked for us,” Frederick says. <br></p>	A quartet of providers has received the preeminent Gold National Quality Award designation from AHCA/NCAL for 2020.	2020-12-01T05:00:00Z	<img alt="" src="/Issues/2020/December/PublishingImages/1220_gold.jpg" style="BORDER:0px solid;" />	Quality Awards	Special Feature	Patrick Connole	47	12
COVID-19 Vaccine Promises New Day for America’s Seniors	https://www.providermagazine.com/Articles/Pages/COVID-19-Vaccine-Promises-New-Day-for-America’s-Seniors.aspx	COVID-19 Vaccine Promises New Day for America’s Seniors	<p><strong class="ms-rteForeColor-8">ADVERTORIAL</strong></p><p>America’s seniors are waiting eagerly for positive news on the development of a vaccine for COVID-19 and subsequent information on how they can receive the inoculations, searching for that proverbial light at the end of the tunnel and deliverance from the long and challenging months of coping with a once-in-a-lifetime pandemic. <br></p><p>Standing ready to help deliver this hope to seniors and specifically to those residing in seniors’ housing are national leaders in vaccine delivery and distribution, Walgreens and PharMerica. These two organizations believe firmly that safe and effective vaccines offer the path forward for nursing homes and assisted living communities, and they have a plan in place to get the vaccine to those most in need of it in a rapid and safe manner.<br>Seniors-Directed Efforts<br></p><p>T.J. Griffin, senior vice president of long-term care operations and chief pharmacy officer for PharMerica, is also a member of the Operation Warp Speed program to bring one or more COVID-19 vaccines to market as soon as safely possible. <br></p><p>He says vaccine makers are doing their work with the most vulnerable populations in mind—seniors—and have increasingly included older participants in clinical trials still taking place, which will drive the data “to make us all feel comfortable.”<br></p><p>These data will inform how PharMerica educates its long term care clients on the vaccine, with pharmacists and doctors in the lead on ensuring communities grasp the importance of getting what will amount to safe and effective protection from COVID-19.<br></p><p>“I believe in vaccines, and I believe the way we help our skilled nursing and assisted living partners get back on their feet and make it safe for the public and our frontline staff is through this process,” Griffin says. <br></p><p>“The sector needs it, society needs it, and we need to get back to when folks stop going without health care and rehabilitation and feel safe to send moms and dads to these facilities. This is a real group effort by many, many stakeholders. No one is looking out for their own interests here, this is about saving lives. For us, this is about America, not PharMerica.”</p><h2>Good News </h2><p>And, if recent news on vaccine development is any indication, there is going to be a real push to implement the Walgreens and PharMerica plan to get seniors living in nursing homes and assisted living and related care facilities inoculated at the earliest feasible time.<br></p><p>“On Nov. 9, Pfizer labs announced that their vaccine in Phase 3 trials was producing a 90 percent efficacy rate. While we will need further data, this level of efficacy is on par with our highly effective measles vaccines,” Griffin says. “This gives us hope that we can have a vaccine for our frail elderly and their heroic health care workers who care for them.” <br></p><p>A safe and effective vaccine is a big step to putting the long term and post-acute care sector back on its feet in many ways, starting with the health and wellness of the staff and their residents, he says. </p><h2>Experience in Delivering Vaccines</h2><p>Walgreens is a leader in providing immunizations to protect communities from vaccine-preventable diseases. Now, on the cusp of a breakthrough in the development of a safe and effective vaccine for COVID-19, PharMerica has joined with Walgreens to support and accelerate the administration of a vaccine.<br></p><p>Walgreens is working at the broadest level to support and accelerate the administration of COVID-19 vaccines, once available, collaborating closely with the Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS), and the administration as part of Operation Warp Speed.<br></p><p>The pharmacy provider believes pharmacists can play an important role in helping increase vaccine distribution reach and capacity for an epidemic. <br></p><p>“With our nationwide footprint, trusted community presence, deep history in vaccine administration, and pharmacist expertise, Walgreens pharmacies will be critical to accelerating access to COVID-19 vaccines once they become available," Griffin says.</p><h2>Sharing Duties</h2><p>This expertise in delivering vaccines and ability to collect individualized data are part of the reason PharMerica has such great expectations from its partnering with Walgreens, says Griffin. <br></p><p>This trust in what Walgreens can deliver, combined with PharMerica’s knowledge of the senior housing business, is a combination that is poised to help deliver nursing homes and assisted living communities from the COVID-19 crisis and start the road to recovery.<br></p><p>“I look at their 10 years of experience in stores and delivering clinics and our connection this fall with some 200 flu clinics, and it all comes back to their professionalism. They do a really good job,” he says.<br></p><p>“We have years of experience sending flu vaccines to facilities, but they have not been patient-specific. Because of the speed at which this vaccine [multiple vaccines] is being developed, the vaccinations have to be individually recorded so that any adverse events get reported by the facility. This will all be recorded in the CDC system, and this is where Walgreens’ abilities will come to bear.”</p><h2>Strong Network of Workers</h2><p>Griffin notes that Walgreens has some 20,000 staff around the country delivering vaccinations to the public, and PharMerica has 250 consultant pharmacists to manage the 325,000 patients the company takes care of every day.</p><p>“We could not get it done by ourselves, and the federal government wants a one-stop shop for the administration and reporting of the vaccine and take on the responsibility for the product they have paid for. Remember, there is no cost for the vaccine itself, the government is paying for it,” he says.<br></p><p>In turn, the PharMerica role when the vaccine or vaccines are approved for distribution will be to help schedule clinics, the events in which residents and staff of facilities receive the shots. Likely, there will be one vaccine to start with in 2021, and gradually a second and third added. Griffin thinks the entire long term care sector can be taken care of with the first vaccine, but that will all be determined by operational issues, like if there are enough doses manufactured.<br></p><p>“Walgreens will take the lead most times, and we will schedule directly with the facilities, coordinating consent forms, and organizing the day of clinics and work to supplement their staffing. Consultant pharmacists may be present, depending on the size of the clinic,” Griffin says. <br></p><p>PharMerica is also developing an outreach and education effort as well to inform families, residents, and staff of the safety and efficacy of the vaccine being given and has worked with Walgreens on understanding the unique aspects of long term care, like the fact residents often have to be immunized in their rooms and cannot come to a central location like a dining hall.</p><h2>All Need the Vaccine</h2><p>Griffin says it is important that all residents and staff be vaccinated for the process to work and noted that this includes the entire breadth of residential living in senior housing. An example he gives is that a woman resident in an independent living arrangement may have a husband in a neighboring complex housing people in memory care.<br></p><p>“She will still need to get the vaccine, even though she is not in the assisted living part” of the continuing care retirement community, Griffin says.<br></p><p>Even though there is no word yet on how and when a vaccine will be approved for use, he says the design of the overall program is that there will be three clinical visits to a facility to take care of all the immunization needs.</p><p>“There will be three clinics. So, one today on the day chosen to start, then one 21 days later, and then a third clinic at a later date to capture new admissions, new employees. The federal response will include these three distinct clinics,” he says.</p>	America’s seniors are waiting eagerly for positive news on the development of a vaccine for COVID-19 and subsequent information on how they can receive the inoculations.	2020-12-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/Special-Features/2020/1220_Pharmerica.jpg" width="740" style="BORDER:0px solid;" />	COVID-19;Infection Control	Special Feature		47	12

Senior Vice President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=44	Senior Vice President	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%201220/1220POTM_LeighAtherton.jpg" width="330" style="BORDER:0px solid;" />	Leigh Atherton	Life Care Centers of America
Vice President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=45	Vice President	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%201220/1220POTM_RobPauza.jpg" style="BORDER:0px solid;" />	Rob Pauza	Life Care Centers of America
Vibrant Life Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=46	Vibrant Life Director	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%201220/1220POTM_JulieSmolenski.jpg" style="BORDER:0px solid;" />	Julie Smolenski	WindChime of Marine
Vice President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=47	Vice President	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%201220/1220POTM_CherylSlavinsky.jpg" style="BORDER:0px solid;" />	Cheryl Slavinsky	National Physiatry
Marketing Manager	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=48	Marketing Manager	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%201220/1220POTM_MarthaBader.jpg" style="BORDER:0px solid;" />	Martha Bader	Waltonwood Cary Parkway

AHCA, NCAL Head Parkinson Named a Top Lobbyist for 2020	https://www.providermagazine.com/Articles/Pages/AHCA,-NCAL-Head-Parkinson-Named-a-Top-Lobbyist-for-2020.aspx	AHCA, NCAL Head Parkinson Named a Top Lobbyist for 2020	<p><em>The Hill </em>news outlet this week named American Health Care Association/National Center for Assisted Living (AHCA/NCAL) President and Chief Executive Officer Mark Parkinson one of the nation’s <a href="https://thehill.com/business-a-lobbying/top-lobbyists/529550-the-hills-top-lobbyists-2020">“Top Lobbyists”</a> of 2020.</p><p>According to <em>The Hill,</em> of the more than 10,000 lobbyists in the country, “these are the people who stand out for delivering results […] in the halls of Congress and in the administration.”</p><p>This is the eighth consecutive “Top Lobbyist” award for Parkinson, who was also recognized by <em>Modern Healthcare </em>this year as one of the “Top 100 Most Influential People in Health Care.”</p><p>AHCA/NCAL said 2020 has been the most difficult year in memory for the long term care profession and noted that any lobbying success is on behalf of providers and is an indication of the “immense effort” being undertaken in facilities across the country to combat the COVID-19 pandemic.<br></p>	Any lobbying success is on behalf of providers and toward the “immense effort” being undertaken in facilities to combat COVID-19, group says.	2020-12-11T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/1120MarkParkinson.jpg" style="BORDER:0px solid;" />	Policy
Fogg Assesses State of Pandemic Response for Marquis Facilities	https://www.providermagazine.com/Articles/Pages/Fogg-Assesses-State-of-Pandemic-Response-for-Marquis-Facilities.aspx	Fogg Assesses State of Pandemic Response for Marquis Facilities	<p>Phil Fogg, chief executive officer, Marquis Companies, Milwaukie, Ore., and vice chair of the American Health Care Association (AHCA), offered his take on COVID and the pandemic’s impact on his organization, as well as other insights into the issues affecting long term and post-acute care providers this fall.</p><p>In an interview with <em>Provider</em>, Fogg answered the following questions:</p><p><em>Provider</em>: Where does Marquis stand in the COVID battle? Are you confident in your processes and procedures to help prevent infection to the best ability possible?</p><p>Fogg: I believe that we are all doing better with preventing COVID in our buildings. The POC [point of care] testing solutions will add greatly to our efficacy. Having said that, community infection numbers/rates will remain our biggest risk until there is a vaccine. The virus can spread so quickly asymptomatically, even if you are the most diligent operator and testing routinely. </p><p><em>Provider</em>: How did the recent forest fires in Oregon impact your operations?</p><p>Fogg: The forest fires in Oregon put three of our communities into Level 2 evacuation status. We had not ever had more than one at a time at that status, so it did raise some logistical challenges. However, the team did great, and we were able to avoid full facility evacuations. The smoke and air quality subsequent to the fire containment was just as challenging and required an extra level of grit on top of managing COVID.<br> <br><em>Provider</em>: What have you learned during this pandemic as far as dealing with a crisis?</p><p>Fogg: We have dealt with a lot of crises over the last 31 years. So, dealing with this crisis itself was not too big of a deal. I think it is the duration of the crisis that is unique and requiring us to really focus on how to keep morale up for residents and staff. We have developed a lot of creative ways to do that, and it is helping, and we have had to use more social media, videos, and other nontraditional approaches to accomplish this.<br> <br><em>Provider</em>: Talk about your staff and how they have stepped up during these trying months.</p><p>Fogg: The staff are heroes. They have been there throughout the entire ordeal. They have put themselves at risk while demonstrating courage, grit, compassion, and a positive outlook.<br> <br><em>Provider</em>: What is the status of PPE [personal protective equipment], and have you found new ways to obtain and maintain PPE?</p><p>Fogg: PPE was very challenging in the beginning of the crisis thru May. It has gotten better since then. The biggest challenge has been managing consumption demand with federal/state mandates and/or a facility outbreak. We have also had to develop a new emergency PPE supply system so that we could more effectively deal with the demands/loads if an outbreak occurred.<br> <br><em>Provider</em>: Has technology played a key role in how you adapt to the pandemic and providing care for your residents?</p><p>Fogg: Yes! We immediately deployed a text alert system and linked web pages for our staff and families and used wireless technology to accommodate family communication and telemedicine. And, we also have used Microsoft Workflow to accommodate more efficiency in new processes around PPE and testing.<br></p>	Association vice chair says community infection numbers and rates will remain his company’s biggest risk until there is a vaccine.	2020-10-26T04:00:00Z	<img alt="" src="/Articles/PublishingImages/headshots/PhilFogg.jpg" style="BORDER:0px solid;" />	COVID-19
Legislation Seeks to Protect LTC Residents from COVID via Housing Design	https://www.providermagazine.com/Articles/Pages/Legislation-Seeks-to-Protect-LTC-Residents-from-COVID-via-Housing-Design.aspx	Legislation Seeks to Protect LTC Residents from COVID via Housing Design	<p>The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) offered its support of HR 8540, the Keeping Seniors Safe from COVID-19 Through Home Design Act, introduced by Rep. John Katko (R-N.Y.).</p><p>Co-sponsored by Reps. Antonio Delgado (D-N.Y.), Max Rose (D-N.Y.), and Ann Kuster (D-N.H.), the legislation would commission a study by the Departments of Health and Human Services, Housing and Urban Development, and Agriculture to develop best practices in senior housing design to mitigate the spread of COVID-19 and other contagious diseases.</p><p>“We applaud Rep. Katko for introducing this bipartisan measure that will help protect long term care residents,” said Mark Parkinson, president and chief executive officer of AHCA/NCAL.</p><p>“Since the start of the pandemic, long term care providers have done everything in their power to protect residents and staff, but the highly contagious nature of COVID-19 in congregate settings like long term care facilities has contributed to the disproportionate impact the virus has had on our nation’s seniors.”</p><p>He added that examining ways providers can improve the design of long term care housing is a positive first step in preventing the spread of communicable diseases and keeping the nation’s most vulnerable citizens safe.<br></p><p>“As we look to the future, we must take the lessons we’ve learned from the COVID-19 pandemic to adopt meaningful reforms that will ensure long term care providers are equipped to handle future public health crises. We look forward to working with members of Congress on long term solutions that will help strengthen the high-quality care we provide," Parkinson said.</p>	Finding ways providers can improve long term care housing design is a positive first step in preventing communicable disease spread, says AHCA/NCAL head Mark Parkinson.	2020-11-05T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/capitol_nighttime.jpg" style="BORDER:0px solid;" />	COVID-19
NCAL Focus Remains on Saving Lives as Pandemic Continues to Test Communities	https://www.providermagazine.com/Articles/Pages/NCAL-Focus-Remains-on-Saving-Lives-as-Pandemic-Continues-to-Test-Communities.aspx	NCAL Focus Remains on Saving Lives as Pandemic Continues to Test Communities	<p>Scott Tittle, executive director, National Center for Assisted Living (NCAL), spoke to Provider recently about the ongoing pandemic and its impact on life inside assisted living communities among residents and staff, as well as the ongoing effort to get more federal assistance to stem what is now another rising tide of COVID-19 cases across the nation.</p><p>After a successful October for NCAL in which the association held its annual NCAL Day during the American Health Care Association/NCAL convention, Tittle said the focus there showed how the coronavirus remains the top priority in assisted living.</p><p>Tittle noted that the 14th annual NCAL Day featured sessions, done on a virtual basis, to help providers effectively manage and prepare for COVID and to make, as he says, “life as normal as possible” for residents and their families.</p><p>“As states open up, there will be visitation even in colder temperatures. And, I think this makes it even more important to address topics that were addressed at the convention, which included how to improve communications and customer service during COVID with families and other caregivers,” Tittle says.</p><p>NCAL also offered education sessions on affordable assisted living, which remains a critical concern across the country for providers searching for ways to meet the requirements of operating a community but also in a way that is economically viable for residents.</p><p>As for the COVID battle, he says assisted living operators are learning to adjust as “best as they can and in ways they did not anticipate.” Tittle says there are of course differences between what constitutes a skilled nursing facility and an assisted living community, but that has not mattered to the coronavirus.</p><p>“Assisted living, like skilled nursing, has really been fighting since day one like everyone else,” he says. “Resident classifications are similar to those in skilled nursing, with ages and acuity a little lower, but our residents do have health care needs, of course.”</p><p>Despite having the same needs to fight the virus, Tittle says, “Quite honestly, assisted living has largely been left out of the discussion at the national level for support and funding.” The federal government did allocate some funds in September, and in doing so acknowledged the intense work being done in assisted living buildings to recalibrate living arrangements to battle against infections, but more is required.</p><p>“Providers have taken the needed steps like moving to noncommunal dining, implementing visitor restrictions, and addressing all sorts of things like how residents enter and leave buildings and other retrofits to ensure the safety for all, including staff,” he says.</p><p>The added cost of having to use voluminous amounts of personal protective equipment has also been a strain on the resources and bottom line. In addition, Tittle says the workforce challenges, like those in nursing homes, is acute given the stress and strain of maintaining daily operations while battling to keep infections out of buildings.</p><p>“This has been a long road for assisted living, and I think operators have been resilient and creative in finding new ways to resolve problems for residents,” he says.</p><p>In looking ahead, Tittle says NCAL will continue to advocate for more funding for assisted living when it comes to the dollars made available for health care providers and the pandemic. Even though states regulate assisted living, the work to get federal funding for operators to protect residents and staff does not conflict with the NCAL mission to maintain state control of the industry.</p><p>“I have heard some questions like that recently, and really it is all about our national board early on making a determination that the most important priority was to ensure operators had what they needed to save lives,” he says.</p><p>“We have been advocating for federal stimulus as a result. As for regulation, we believe states are the best incubators for needed regulation. This virus does not discriminate between people and how they are regulated. So, we separate the two matters and continue to believe a one-size-fits-all regulation at the federal level is not good for residents or operators of assisted living.”</p>	NCAL executive director discusses the ongoing pandemic and its impact on life inside assisted living communities among residents and staff.	2020-11-17T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0320_News4.jpg" style="BORDER:0px solid;" />	COVID-19
Providers Urge Congress to Extend Relief From Medicare Sequester Cuts Into 2021	https://www.providermagazine.com/Articles/Pages/Providers-Urge-Congress-to-Extend-Relief-From-Medicare-Sequester-Cuts-Into-2021.aspx	Providers Urge Congress to Extend Relief From Medicare Sequester Cuts Into 2021	<p>The American Health Care Association, American Hospital Association, American Medical Association, and National Association for Homecare and Hospice wrote congressional leaders urging them to extend the congressionally enacted moratorium on the application of the Medicare sequester cuts into 2021 and through the duration of the public health emergency (PHE) caused by the COVID-19 pandemic.<br></p><p>In total, these organizations provide health care to more than 62 million Medicare patients, and the persistently high COVID-19 rates across the country are stressing the health care system, they said.<br></p><p>The letter to House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.) urges extension of the relief from the 2 percent sequester cut enacted in the CARES Act that afforded critical relief during the pandemic to all providers who participate in the Medicare program through the end of 2020.<br></p><p>“Physicians, nurses, hospitals, health systems, long term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and hospices have been hit hard by the pandemic, incurring significant expenses to treat the sick, but experiencing historic financial losses due to the decrease in inpatient and outpatient services,” the letter said.<br></p><p>Relief from the 2 percent sequester cut by way of the CARES Act afforded critical relief during the PHE to all providers who participate in the Medicare program through the end of 2020, it continued.<br></p><p>“Clearly Congress recognized the importance of this relief for the duration of the PHE. Given that the PHE is certain to continue into 2021, it is a safe assumption that America’s health care providers will continue to face the overwhelming financial challenges and pressures associated with higher overhead costs due to personal protective equipment and other safeguards, lost revenue due to delayed elective procedures and/or forgone routine visits, and hazard pay to staff.”<br></p><p>The organizations said they are grateful that Congress has provided a much-needed reprieve from the Medicare sequestration since May. Without future sequestration relief, however, America’s health care safety net could be at risk of collapse, they said.</p>	The letter to House Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell urges extension of the relief from the 2 percent sequester cut enacted in the CARES Act.	2020-12-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/1220_news2.jpg" style="BORDER:0px solid;" />	Capitol Hill;Congress

December 2019

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