January 2020

Vol. 47 No. 1

January

Cover Story

https://www.providermagazine.com/Issues/2020/January/Pages/Managing-Medications-in-a-New-Age.aspx

Managing Medications in a New Age

<div><br></div> <div> </div> <div>Providing care in skilled nursing facilities (SNFs) and assisted living and memory care communities includes any number of <a href="/Issues/2020/January/Pages/What-a-Pharmacy-Prioritizes-in-Managing-Medications.aspx" target="_blank">priority issues,</a> with the role of medication management ranking at or near the top of the list, long term and post-acute care (LT/PAC) professionals say. </div> <div><br></div> <div> </div> <div>Making sure residents receive necessary prescriptions on time for pain and underlying conditions, while maintaining a vigilant stance on the use of psychotropics (which includes antipsychotics) and opioids is part of a complex effort that plays a vital role in any facility’s bid to maintain and improve quality while striving for clinical excellence, these experts stress.</div> <div> </div> <div><br></div> <div> As the LT/PAC profession nears the end of a decade-long push that has seen the use of antipsychotics tumble dramatically, issues like coordinating care and employing patient-centered care models have also become significant drivers in how medication management helps shape the way in which providers and residents view quality of life in a facility.</div> <h2 class="ms-rteElement-H2">Making Sure to Get it Right</h2> <div><img src="/Issues/2020/January/PublishingImages/FioraPetillo.png" alt="Fiora Petillo" class="ms-rtePosition-2" style="margin:15px 10px;" /></div> <div><br></div> <div>Flora Petillo, senior vice president of strategic initiatives and clinical practice at Genesis HealthCare, spearheads her organization’s care coordination efforts for both short- and long-stay residents, working collaboratively with physician colleagues. </div> <div><br></div> <div>She says unlike most LT/PAC providers, Genesis is a member of an accountable care organization (ACO), with many residents’ care tied to the program that is now in its fourth year.</div> <div><br></div> <div>A colleague, Molly Langford, senior director of clinical practice at Genesis, is also focused on improving patient care based on delivering evidence-based solutions to clinical teams. For her, medication management is all about providing the right medication to the right patient at the right time. <br></div> <div><br></div> <div>“You start by having the right medication for the diagnosis of each patient,” she says. “Then you explore how well that patient can tolerate the medication and really try to make sure you are using it in a way where the benefits outweigh the risks. In geriatric care it is all about the ‘start low, go slow’ mantra that is focused on first using the lowest dose necessary to help treat the underlying illness.”</div> <h2 class="ms-rteElement-H2">Two Types of ‘Stays’ </h2> <div>Petillo notes that in the LT/PAC setting Genesis is really serving two patient populations. One is the short-stay cohort, grouped together by the fact that these residents are expected to return home. They also often arrive at the SNF from an acute-care hospital. </div> <div><br></div> <div>She says on admission these patients have their medications scrutinized and possibly trimmed to reduce unnecessary doses or even entire medications. “The hospital tends to be more adventurous with meds for this population,” Petillo says. <br></div> <div><br></div> <div>When these short-stay residents are discharged back to the community, there are questions not only about what medications to maintain at home but also questions about the affordability of prescription drugs. “The latest and greatest meds may not be continued,” she says. “We really work hard also to connect the patient to a primary care provider and communicate with them to let them know they are leaving that facility.”</div> <h2 class="ms-rteElement-H2">Medications Tailored to Resident</h2> <div>The second patient population is long-stay residents. The same philosophy holds for them, which is to make sure the medications are proper and in the right dosage. The difference, however, is that as these residents remain in the facility, their various chronic conditions may force changes in management of their drugs.</div> <div><br></div> <div>“We ask ourselves if the medication is still benefitting them or have we moved into a more palliative approach to care, like say for the later stages of dementia,” Petillo says. “There may be an opportunity to go off some medications that are not as effective in the later stages. You really have to monitor the patient trajectory when you do care.”</div> <div><br></div> <div>It is critical to be honest with the resident and take the time to have conversations with them and their families on matching the medication management cycle to their own goal of what is most important to them as individuals, she says.</div> <div><br></div> <div>“We want to match the care we are giving to the patient and not be doing things just because you can, but instead identify the patient’s own health and vision,” Petillo says.</div> <div><br></div> <div><img src="/Issues/2020/January/PublishingImages/MollyLangford.png" alt="Molly Langford" class="ms-rtePosition-1" style="margin:5px 15px;" />An example, Langford says, is diabetes management. Clinicians follow evidence-based care in this area, which involves a keen focus on numbers, like glucose levels. But for some patients with multiple chronic diseases and a limited life expectancy, the numbers are not paramount.</div> <div><br></div> <div>“This is where the goal for the patient may be more about quality of life and them enjoying certain foods. The medications in this case would be more about the quality of life than about the strict adherence to a medication that may become a burden,” she says.</div> <h2 class="ms-rteElement-H2">A Mission to Reduce Medications</h2> <div>When it comes to medication management, the buzz remains about implementing programs and processes to cut down on the use of antipsychotics, which are part of the larger family of drugs classified as psychotropics.</div> <div><br></div> <div>For Dinaz Bengali, director of nursing for Bartley Healthcare in Jackson, N.J., the changes in how antipsychotics are distributed has been dramatic in recent years. “Basically, we have worked on reducing antipsychotic medications. In the past we as a profession would always start the patient on meds, but now we look at this before we start them off and then review their use on a monthly basis if we keep them on,” she says.</div> <div><br></div> <div>When a nurse or related staff member sees disruptive behaviors, they are documented, but antipsychotics are only given when absolutely necessary. Beyond even the clinical issues of having someone on antipsychotics, there are practical safety concerns, too, as Bengali notes that residents on this class of drugs experience more falls, for instance, than those who are not.</div> <div><br></div> <h2 class="ms-rteElement-H2">Once a Cop, Always a Cop</h2> <div>Lauren Kessler, administrator at Bartley who works closely with Bengali, says there is also plenty of communication with the resident and their loved ones about family history, for example, and the individual’s life story, which can help facility staff figure out what may be causing behaviors or how to help remedy problems without turning to medications.</div> <div><br></div> <div>Bengali points to an example of one resident who would have awful issues with going to sleep at night. The old way of medication management would have been to dose the person to help them sleep, but the new way, the person-centered care way, involved asking questions about why the insomnia was so pronounced in this one individual.</div> <div><br></div> <div>“What we found was that this person used to be police officer and for years worked the night shift,” Bengali says. “In response to this news, we adjusted our environment and found a way to change his sleeping hours to reflect his past life.”</div> <div><br></div> <div>Other nonpharmacological methods that Bartley has found useful for its dementia residents is distraction, or ambulation. “Distraction is a big thing, such as giving a resident a task like folding towels. Ambulation, or walking them around, helps and so does food; giving a snack when they are upset can be a great way to work around behaviors, as can music.”</div> <h2 class="ms-rteElement-H2">Results Are Positive</h2> <div>Kessler says the efforts to steer away from antipsychotics has reaped positive rewards. Since December 2018, Bartley has seen a 50 percent reduction in the use of such medications. The numbers fluctuate, and actually leveled at some point due to Bartley taking in some 22 new residents from a facility that had shut down. The fresh residents were receiving antipsychotics at a higher rate, but that use has gone down now that they have a new home.</div> <div><br></div> <div>Other numbers show short-term residents at Bartley with a 0 percent use of antipsychotics, compared with the state of New Jersey average of 1.5 percent and national average of 1.9 percent. <br></div> <div><br></div> <div>Long-term Bartley residents who are on antipsychotics had a rate of 4.1 usage percentage versus the state average of 9.5 percent and national average of 14.3 percent, Kessler says, citing statistics from the Centers for Medicare & Medicaid Services. <br></div> <div><br></div> <div>Bengali says the positive results are part and parcel of all new residents with a dementia diagnosis receiving a thorough psychiatric review, with the goal to reduce or eliminate medications that were possibly prescribed in the hospital setting.</div> <h2 class="ms-rteElement-H2">Depression a Major Factor</h2> <div><img src="/Issues/2020/January/PublishingImages/MelissaGreen.png" alt="Melissa Green" class="ms-rtePosition-1" style="margin:15px 10px;" /><br>For Melissa Green, chief clinical officer, Trio Healthcare, the effort to turn residents away from antipsychotics as part of a medication management program has to consider all forms of mental health issues related to both dementia and non-dementia scenarios. </div> <div><br></div> <div>Trio, which owns, operates, and manages 23 facilities (18 SNFs and five assisted living communities) in Ohio and Virginia, prides itself on nonpharmacological intervention, Green says. As part of the evaluation and monitoring of a resident’s health and well-being, Trio care teams have learned to recognize signs of depression. <br></div> <div><br></div> <div>“This is really under-evaluated in the elderly,” Green says. But it should not be, and it should not be unexpected considering the life-altering change of moving from home or a long term living arrangement to a SNF or assisted living community, she says. <br></div> <div><br></div> <div>“A lot of our residents come to us as their health is deteriorating, and then they have of course lost their home, and for a lot of them their properties have been sold and family members may be lost,” she says. “They move into a facility and no longer have all of that. I mean, that would depress me as well, which we don’t like to think about.”</div> <div><br></div> <div>So, to see where a new resident is at in this regard, an evaluation takes place that includes a depression screen. “Most come from the hospital where—face it—hospitals have free range to throw medications at people with dementia who may act up. They are discharged to us, and we have to figure out how to get rid of their use,” Green says.</div> <h2 class="ms-rteElement-H2">Participation Figures in the Mix</h2> <div>Once a new resident is in the facility, part of the assessment keys on socialization, which helps to weigh medication use and possible alternatives. </div> <div><br></div> <div>“Are they coming to the dining room or coffee chats or what not,” she says. “If they are isolated, we look into psychosocial history. Some folks we get are not verbal, and maybe they don’t communicate or have dementia, it can be really hard to diagnose or assess them.”</div> <div><br></div> <div>Green says even when a resident displays disruptive behaviors or acts out, the care teams convene with the goal of avoiding medications if at all possible.</div> <div><br></div> <div>“And, if we have someone who is, say, on antidepressants, we are constantly evaluating and looking at gradual dose reductions to see how they react. And, sometimes they even come to us on medications and they have no diagnosis,” she says.</div> <div><br></div> <div>Some of the methods to ease residents without deploying medications include activities or use of a quiet room, featuring sound therapy, such as hearing waterfalls and soothing lights. “When we see someone escalating, we can try these interventions,” she says. <br></div> <div><br></div> <div>The same holds true for those residents who may experience pain to the point they have been put on <a href="/Issues/2020/January/Pages/Opioids-in-the-Care-Setting.aspx" target="_blank">opioids.</a></div> <div><br></div> <div>“A lot of people come here and have been taking opioids for a long time,” Green says. In cases where opioids are the choice prescribed by a doctor, it usually comes in the form of fentanyl patches for cancer patients, for example, but the process is done on a tiered basis with attempts starting at less potent drugs all the way up to the strongest option if necessary.</div> <div><br></div> <div>“When someone is terminal, we don’t want to see them in pain, especially if there is no chance for them,” she says.</div> <div><br></div> <h2 class="ms-rteElement-H2">Searching for Alternatives</h2> <div>When it comes to medications and how to utilize them, and when to do so, Corie Sass, social services coordinator, Vetter Health Services, Elkhorn, Neb., says there are a lot of hands-on skill sets for nursing staff to deploy before that may even be necessary.</div> <div><br></div> <div>A lot of research and programming in the past five years has pinpointed ways to understand dementia and how better to communicate with residents. <br></div> <div><br></div> <div>“When you see a resident being combative and yelling out and challenging, this is typically treated with antipsychotics, but we are teaching our teams to interpret what the resident is trying to communicate first,” Sass says.</div> <div><br></div> <div>She points out that much of what a nurse does is highly personal, as in helping to bathe a resident or take the person to the bathroom, so much care needs to take place to ease into these situations, especially if the resident with dementia is displaying disruptive behaviors on a routine basis.</div> <div><br></div> <div> “When you think about, like when you are undressing a resident, they may not understand what is happening, and this can provoke a response. We are telling our people, here are some ways to approach this so, for example, you don’t get kicked,” Sass says.</div> <h2 class="ms-rteElement-H2">Eye Level Important</h2> <div>One of the most important things to do for a nursing staff member is to get down or below eye level of residents, Sass says. When the resident is sitting in a wheelchair, for example, it is key for the caregiver to lower herself, as towering over someone can be very threatening.</div> <div><br></div> <div>“There is also 7 and 7. This means to make all of your sentences to a resident seven words or less and give them seven seconds to respond,” she says. Simple and direct communication, done at eye level or below and with a happy and sparkling manner, is the way to go.</div> <div><br></div> <div>Does it work? Yes, she says. With the national averages of antipsychotic use near 15 to 20 percent over the years, Vetter has seen the new methods of communication help take their levels down to 6 to 8 percent.</div> <div><br></div> <div>“When you look at them trying to communicate, they may be cold, hungry, or need to use the bathroom, or be in pain as well. When they are uncomfortable it comes out in different ways,” Sass says. <br></div> <div><br></div> <div>One example is of a woman resident who would wander from room to room, disturbing other residents and care teams. The resident was locked into a pattern, it seemed, but it turns out she was simply trying to get to a bathroom. <br></div> <div><br></div> <div>“With dementia patients you cannot be task-focused, which is hard for staff to do, since it is counterintuitive to what nurses do as part of their normal routines, which is working off lists of tasks to be achieved on a daily basis,” Sass says.</div> <h2 class="ms-rteElement-H2">Finding the Transformation</h2> <div>Other advice is to not send too many staffers to complete a task, since this can be overwhelming for a patient with dementia. </div> <div><br></div> <div>“If you take two team members, one team member goes in with the eye level communications, and the other team member takes a back seat by not standing there and talking at the same time,” she says. “One team member should be the driver and say to the resident, ‘I have a helper’ so as not to make it fearful for them. It gives the resident a sense of peace and comfort.”</div> <div><br></div> <div>In the end, these approaches take time, but oftentimes result in extraordinary moments.</div> <div><br></div> <div>“It can be unbelievable. The nursing profession is a rushed profession, but over time you just have to see it work once and see the resident’s reaction, see them smile and give a hug or a kiss, and it is transformative,” Sass says.</div> <div><br></div> <div>“It gives you purpose. You took someone who was drugged up to help make them a functioning person. It makes all the difference; it is just treating them like people.”<br></div>

Providing care in SNFs and assisted living and memory care communities includes any number of priority issues, with the role of medication management ranking at or near the top of the list, LT/PAC professionals say.

2020-01-01T05:00:00Z

Management;Caregiving;Clinical

Following the Meds	https://www.providermagazine.com/Issues/2020/January/Pages/Following-the-Meds.aspx	Following the Meds	<p>Today’s world of medication management includes not only making sure all residents are taking the correct dosage of the correct drug throughout an episode of care, but keeping a vigilant stance on the misuse of antipsychotics and opioids throughout any skilled nursing, memory care, or assisted living community, says cover story author Senior Writer and Editor Patrick Connole. One movement he found to be widespread was provider efforts to ease residents in distress without deploying medications. One method entails asking family members questions about what the person’s life and habits were before the onset of dementia for clues into current behavior.<br></p><p>A good night’s sleep has long been recognized as important to health, but research has now shown that a lack of adequate sleep can lead to or worsen such conditions as dementia, diabetes, and cardiovascular disease. In Focus on Caregiving, Cathy Haines Ciolek says that nightly noises in the facility are the chief culprits of causing residents to sleep poorly and offers ideas for how to alleviate them.<br></p><p>A special interview this month is with Christy Hinkle, social services director for Hillcrest Health and Rehabilitation in Corbin, Ky. Managing Editor Amy Mendoza reports on Hinkle’s growth in the job, her challenges and her successes. When residents don’t want to be in the facility but have no place else to go, Hinkle focuses on helping them understand their current needs and the positives of having help available to them. Then she says to the resident, “Let’s get the best out of life. Let’s figure out how to make it pleasant and memorable for you.” And then she helps them find ways to do so.<br></p><p>With the rise in acuity among patients comes a higher risk of spreading infection. In this month’s Management column, Daniel Gravatt makes the case for a switch from “housekeeping” to environmental services, a type of cleaning keyed to infection elimination. <br></p>	Today’s world of medication management includes not only making sure all residents are taking the correct dosage of the correct drug, but keeping a vigilant stance on the misuse of antipsychotics and opioids.	2020-01-01T05:00:00Z	<img alt="" src="/SiteCollectionImages/Joanne-Erickson.jpg" style="BORDER:0px solid;" />		Editor's Desk
Sleep: A Key Factor for Well-Being	https://www.providermagazine.com/Issues/2020/January/Pages/Sleep-A-Key-Factor-for-Well-Being.aspx	Sleep: A Key Factor for Well-Being	<div></div> <div> <img src="/Issues/2020/January/PublishingImages/CathyHainesCiolek.png" alt="Cathy Haines Ciolek" class="ms-rtePosition-1" style="margin:5px 15px;" />Staff practices that interrupt resident sleep often fall into the category of, “We’ve always done it this way,” or misinterpreted as being required in the regulations. Sleep disruption is known to interfere with residents’ physical, emotional, and mental well-being, yet the practices are so ingrained in the system that staff do not think twice about why they do so.</div> <h2 class="ms-rteElement-H2">A Key Ingredient to Health</h2> <div>The need for sleep has long been recognized as important to health, but recent research has linked a lack of adequate sleep to the development and worsening of dementia, diabetes, and cardiovascular disease. Similarly, fragmented or inadequate sleep is associated with depression, anxiety, agitation, and aggression.</div> <div><br></div> <div>For the population in skilled nursing care and assisted living, these physical and cognitive conditions resulting from sleep disruption may lead to medication use and risks associated with the medications themselves and polypharmacy. <br></div> <div><br></div> <div>Many sedative hypnotic medications that aid in sleep have side effects that have placed them on the AGS Beers Criteria to be used with caution in older adults. Similarly, psychotropic medication to address behavioral concerns that may in fact be related to sleep inadequacy and not psychosis places older residents at higher risk for falls and mortality.</div> <div><br></div> <div>Some changes in sleep can occur with normal aging. Others are associated with neurologic conditions like Parkinson’s disease and various forms of dementia that can impact sleep through disordered breathing, restless leg syndrome, and REM (rapid eye movement) sleep behavior disorders. Effective sleep cycles can be disrupted by these internal issues, so minimizing external disruptions is even more essential.</div> <h2 class="ms-rteElement-H2">The Noise Factor </h2> <div>For well over a decade, studies of hospitals and skilled nursing centers have demonstrated that noise and staff practices impact sleep quality and quantity for patients and residents. Each of these are distinct from a traditional home environment due to the nature of multiple people living near each other and having caregivers working near them. </div> <div><br></div> <div>Noise is a key factor in sleep disruption. While the physical design of many nursing centers with tile floors, central nursing stations, and shared rooms increases the risk of excessive noise levels, one of the key factors in increased noise levels is staff conversations. Particularly during the prime sleeping hours, staff need to be conscious that their work area is where people are sleeping, and conversations need to be kept to a minimum and occur away from sleeping areas.</div> <div><br></div> <div>Other residents who may be experiencing altered sleep/wake cycles, and who are up most of the night, should be provided engagement activities in an area where their noise is least likely to disrupt other residents.</div> <div><br></div> <div>Other factors that can add to the noise pollution include squeaky carts (linen, medication, housekeeping) and alarms, as well as televisions and music that can permeate from lounges and resident rooms. The World Health Organization recommends that sound levels in hospitals (and by extension nursing centers) should not exceed 30 to 40 decibels at night, yet most findings exceed this both at baseline and with spikes throughout the night.</div> <div><br></div> <div>This is easily measured with low to no cost “smart” phone apps. Have staff take turns sitting in various areas of the facility with decibel-measuring devices at various times of the day to get a good understanding of just how noisy the workplace, and the residents’ home, really is.</div> <h2 class="ms-rteElement-H2">Staff Practices </h2> <div>Beyond the noise of conversations, many staff practices are known to interfere with resident sleep. Witness the resident who is awakened for a sleep medication! But most staff practices were implemented for improved care: repositioning residents every two hours, waking people to go check for incontinence, “body” checks for people who may be at risk of elopement.</div> <div><br></div> <div>Many of these were created decades ago when equipment and products were not as advanced as they are today. For example, no one wants residents with incontinence to be exposed to wet surfaces and irritation. Products today are significantly better than existed 30 years ago when the practice of checking every two hours originated. </div> <div><br></div> <div>Consider working with the product vendor for their help to individually assess residents’ needs, particularly those with the most challenging problems. Developing teams of staff to assess how fluids are distributed across the day, what is a resident’s typical voiding pattern, and then trying to gradually increase time between awakening to be sure skin integrity is sustained, can lead to less forced awakenings each night.</div> <div><br></div> <div>Other ideas that can be implemented include reviewing all medications delivered between certain hours (an example may be 10:00 p.m. and 7:00 a.m.). Does it truly have to be administered during that time period? Involve the physician and pharmacy and discuss this medication schedule with the family in relation to the value of sleep. Any medication during the nighttime hours should be reviewed and only used as a last resort, with the recognition of the negative impact it could have on sleep. </div> <div><br></div> <div>Support the certified nurse assistant staff to be flexible in their morning assignments, encouraging residents to sleep until a natural awakening. Meet with outside vendors such as lab technicians to schedule blood work for a morning time that will not wake the resident (and potentially any roommates), at least on any kind of routine basis. Review the care tasks assigned to the overnight shift for relevance and interruption. For example, take a critical eye to common practices of refilling linens and ice water during the night. </div> <h2 class="ms-rteElement-H2">Person-Centered Care</h2> <div>Assessing each individual’s unique needs is the standard set by the Centers for Medicare & Medicaid Services as part of the Requirements of Participation. One method of identifying sleep efficacy is the use of Actigraphy, a wearable bracelet that records sleep/wake patterns over 24 hours.</div> <div><br></div> <div>As technology improves, this becomes an even more cost-effective way to see if changes in facility noise levels and staff practices have improved resident sleep. Other subjective methods can include measuring daytime sleepiness/wakefulness, changes in day/nighttime sleep patterns, and behavioral expressions of anxiety and agitation. <br></div> <div><br></div> <div>Changing practices that have been ingrained for years is difficult but not impossible. Focusing change efforts on a single unit and specific residents may be a key to getting staff to re-evaluate their practices.</div> <div><br></div> <div>Find the staff members who are resident advocates, who other staff look to for advice and guidance, and ask them to help lead the effort. Celebrate small changes to help focus on success. Most of all, help the residents to experience a higher level of well-being with better sleep practices. </div> <div><h4 class="ms-rteElement-H4B">Free Noise Level Apps Available for Download</h4> <div>■ NIOSH Sound Level Meter: <a href="https://apps.apple.com/us/app/niosh-slm/id1096545820" target="_blank">https://apps.apple.com/us/app/niosh-slm/id1096545820</a></div> <div>■ Decibel X: dB, dBA Noise Meter: <a href="https://apps.apple.com/us/app/decibel-x-db-dba-noise-meter/id448155923" target="_blank">https://apps.apple.com/us/app/decibel-x-db-dba-noise-meter/id448155923</a></div> <div>■ Sound Meter: <a href="https://play.google.com/store/apps/details?id=com.gamebasic.decibel&hl=en_US" target="_blank">https://play.google.com/store/apps/details?id=com.gamebasic.decibel&hl=en_US</a></div></div> <div> </div> <div><em>Cathy Haines Ciolek, PT, DPT, FAPTA, is president of Living Well With Dementia®, providing education and consulting to improve well-being and create positive expectations for aging adults. She can be reached at <a href="mailto:cciolek@livingwellwithdementiallc.com" target="_blank">cciolek@livingwellwithdementiallc.com</a> or 302-753-9725.</em></div> <div> </div>	The need for sleep has long been recognized as important to health, but recent research has linked a lack of adequate sleep to the development and worsening of dementia, diabetes, and cardiovascular disease.	2020-01-01T05:00:00Z	<img alt="" src="/Issues/2020/January/PublishingImages/caregiving_t.png" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
Making the Leap to EVS-Level Cleaning Protocols	https://www.providermagazine.com/Issues/2020/January/Pages/Making-the-Leap-to-EVS-Level-Cleaning-Protocols.aspx	Making the Leap to EVS-Level Cleaning Protocols	<div></div> <div> <img src="/Issues/2020/January/PublishingImages/DanielGravatt.png" alt="Daniel Gravatt" class="ms-rtePosition-1" style="margin:5px 15px;" />Cleanliness is a high priority in skilled nursing facilities (SNFs) for many reasons. Foremost is to protect the health of residents and create a pleasant living environment. Other considerations include image and reputation. Residents and their families often base their opinion of a SNF on its cleanliness. If they see dirt, grime, or clutter, or if they smell odors, they may look elsewhere for care.</div> <h2 class="ms-rteElement-H2">Infection Prevention New Focus</h2> <div>Proper cleaning and disinfection in the SNF environment have recently become even more important. New Centers for Medicare & Medicaid Services (CMS) reimbursement rates are now based on five case-mix-adjusted components. <br></div> <div><br></div> <div>Two components, nursing and non-therapy ancillary needs, are included to account for increasing acuity of SNF patients. This may lead SNFs to enhance their levels of care and infection prevention to accommodate these patients, according to CMS.</div> <div><br></div> <div>The new reimbursement guidelines will lead some SNFs to offer care and services for patients who formerly would have been treated in acute-care facilities. With an increasing number of vulnerable patients will come a greater emphasis on housekeeping, specifically infection control.</div> <div><br></div> <div>“The value proposition at skilled nursing facilities may change as CMS reimbursement rules change,” says Ben Madrid, region director, ServiceMaster Clean Albuquerque, whose clients include four SNFs and three hospitals. “You may see more market awareness of infection control, and the financial environment will have something to do with that.”</div> <h2 class="ms-rteElement-H2">What's the Difference?</h2> <div>At many SNFs, the term “housekeeping” includes tasks such as floor and surface cleaning, trash removal, and laundry services. These duties are performed by in-house staff, are outsourced to janitorial companies, or some combination of the two. Now, with an increasing need to eliminate infection and airborne irritants, facility managers may consider transitioning to an “environmental services” cleaning model.</div> <div><br></div> <div>Environmental services (EVS) differs from housekeeping in one significant way: EVS focuses on the science and procedures necessary to eliminate pathogens. EVS technicians are taught cleaning techniques that not only remove dirt, dust, and grime, they also kill viruses, bacteria, and fungi—the microorganisms that can threaten the health of residents and staff.</div> <div><br></div> <div>Hospitals and other acute care facilities have been focused on infection elimination for years; many SNFs have lagged behind.</div> <div><br></div> <div>“Skilled nursing facility managers understand the difference between housekeeping and environmental services, but most of them don’t have the staff or technical training to implement an EVS approach,” says Madrid. “For that reason, some SNF clients have outsourced housekeeping to companies with EVS capabilities, to help elevate their level of housekeeping and reduce infection risk.”</div> <div><br></div> <div>EVS training is very specific regarding the tools and techniques of infection elimination. Technicians use only Environmental Protection Agency-registered health care-grade disinfectants, and they understand appropriate dwell times. They wear approved PPE (personal protective equipment), which for EVS technicians would include hand protection (chemical-resistant gloves), approved eye protection, and in some cases respiratory and hearing protection. They also practice proper hand hygiene; they use lint-free cleaning cloths and have HEPA (high-efficiency particulate air) filtered vacuum cleaners. By U.S. Department of Energy standards, HEPA filters must remove 99.97 percent of the particulate matter of three micrometers or larger. </div> <div><br></div> <div>The technicians also are thoroughly trained to know why they clean as well as how to clean. It’s all about patient care and healing. EVS professionals consider themselves the first line of defense against infection.</div> <h2 class="ms-rteElement-H2">What's the Benefit?<br></h2> <div>The investment in infection control can pay dividends beyond those that are evident at first glance. For instance, the opportunity to attract residents who previously would require acute facility care creates a larger potential pool of residents. As a result, facilities will have more patients with acute illnesses who require elevated infection prevention services than in years past.</div> <div><br></div> <div>EVS-level cleaning lowers infection risk for all residents and staff. Common problems like Clostridium difficile outbreaks will be significantly reduced. Management will also appreciate lower expenses related to infectious outbreaks, like hospitalizations and staff absenteeism due to illness. Higher satisfaction scores from residents and their families are another plus, and that’s great for the facility’s reputation.</div> <div><br></div> <div>One other noteworthy benefit is better staff morale. Clinical staff can focus more on patients, management has fewer of the worries that are typically associated with infections, and the image of the EVS staff is elevated. Everyone is happier.</div> <h2 class="ms-rteElement-H2">Where to Start?<br></h2> <div>Transitioning to an EVS cleaning model is not like flipping a switch. There must be commitment from management, a period of technical training, and a transition from a housekeeping mindset to a “culture of clean,” as EVS professionals like to describe it.</div> <div><br></div> <div> </div> <div>Every department, every function at the facility must be focused on infection control. Communication and accountability are vital as processes and procedures to keep the SNF infection-free are implemented. Some basic foundational steps include:</div> <ul><li>An emphasis on hand hygiene for everyone in the facility;</li> <li>Identification of high-touch zones for daily, or more often, cleaning;</li> <li>A thorough knowledge of EPA-registered health care-grade disinfectants, dwell times, and cleaning techniques;</li> <li>Elimination of airborne irritants like dust and mold spores;</li> <li>Identification and isolation of residents who are contagious; and</li> <li>Linen management—preventing infection spread through linens and clothing.</li></ul> <div> Taking these steps is a good start, but infection-control training and proper staffing are necessary to achieve real control of infectious agents. If unsure how to achieve EVS-level cleaning, contact a company with environmental control experience. Also check out the Association for the Health Care Environment at www.ahe.org for more information. </div> <div> </div> <div><em>Daniel Gravatt, LNHA, T-CSCT, is business operations manager for ServiceMaster Clean, which has more than 900 franchised and licensed locations around the world. He is a licensed nursing home administrator and a trainer of the Certified Surgical Cleaning Technician program. He can be reached at dgravatt@smclean.com. </em></div>	Residents and their families often base their opinion of a SNF on its cleanliness. If they see dirt, grime, or clutter, or if they smell odors, they may look elsewhere for care.	2020-01-01T05:00:00Z	<img alt="" src="/Issues/2020/January/PublishingImages/mgmt_t.png" style="BORDER:0px solid;" />	Management;Infection Control	Management

Interview: Kimberly Stevens, RN	https://www.providermagazine.com/Articles/Pages/Interview-Kimberly-Stevens-RN.aspx	Interview: Kimberly Stevens, RN	<div></div> Sometimes people branch out in their careers to venture into new territory. Other times, it’s to test the waters. Kimberly Stevens, an award-winning registered nurse (RN) at Greenwood Nursing and Rehabilitation Center in Bowling Green, Ky., shares her career path and why she decided to stay in her licensed practical nurse (LPN) role for so many years. <br><div><em><br></em></div> <div><em><strong>Provider:</strong></em> Tell us about your role. </div> <span class="ms-rteForeColor-1">Stevens:</span> I’ve been a charge nurse for several years as an LPN and RN. I just got my RN about a year and a half ago. In this facility, I’ve been here for two years as a charge nurse.<br><br><div>I’ve done upper management positions, but I like being in my patients’ faces. I’m a people person, and I just like to be there. I tried the assistant director of nursing as an LPN under an RN and didn’t like that as much.</div> <div><em><br></em></div> <div><em><strong>Provider:</strong></em> How did you get your start in skilled nursing care? </div> <span class="ms-rteForeColor-1">Stevens:</span> I was in Danville, Pa., where I was born and raised. Went to nursing school there as an LPN. I started at a hospital on a half pediatric unit. It was an overflow for a pediatric unit, and for patients with diabetes and kidney issues. The reason I went to long term care is because the first person I had to get ready for the morgue was a 10-year-old boy. And I knew from that point on. To this day I could still hear the mother scream when she lost her son. So I thought, I’ve got to go to the other end of the spectrum, and I’ve been doing this ever since. <br><div><em><br></em></div> <div><em><strong>Provider:</strong></em><strong> </strong>Tell us about your career path.</div> <span class="ms-rteForeColor-1">Stevens:</span> When you work in the center that I worked in, you realize there’s a lot of things that RNs can do that I can’t do. And I had to go to an RN and ask them to do it for me. And it was frustrating to me because even though I had been an LPN for so long, I knew how to do the things that they could do, I just needed a license for it. So that’s why I went back to nursing school. I want to be able to flush a pick line and not have to bother another nurse to do that for me. It’s just one of those things.<br><br><div>I also [thought I] wanted to be a director of nursing at my own facility one day. But then I saw that they are not with the patients nearly as much. </div> <br><div>I’m 52, I don’t see myself down the road ever retiring, I seriously don’t see it. I think I’d go crazy. I just like being out and being with people and taking care of them. I want them to not just physically get better, but spiritually and in their own souls. I realized you’ve got to make them laugh. They are in a sick environment, so you’ve got to make them laugh to feel better. </div> <div><em><br></em></div> <div><em><strong>Provider:</strong></em> What have been the biggest lessons for you? </div> <span class="ms-rteForeColor-1">Stevens:</span> Listen to your CNAs [certified nurse assistants]. It’s very important because they are your eyes and your ears on the floor. You need to hear them and listen to what they have to say. And it may not be that big of importance, but a few days later it could be huge. So look into it right there and then.<br><br><div>Another lesson is that health care has changed since 30 years ago. Patients are coming out of the hospitals a lot sicker into long term care. So you need to be on top of things. You need to know what you’re doing. You need to really listen to CNAs. Because they pick up on things you may not pick up on because they are in the rooms more than you are. </div> <div><em><br></em></div> <div><em><strong>Provider:</strong></em> What have been some of the biggest challenges you’ve noticed?</div> <span class="ms-rteForeColor-1">Stevens:</span> Nowadays I know that LPNs don’t get into hospitals as a career path. And hospitals now are hiring all RNs. I know a lot of hospitals now are going for nurses with a bachelor of science degree in nursing, not just associate nurses, and I think that’s one of the biggest challenges. <br><br><div>And what I’ve noticed over the years is that just because you have an RN, it doesn’t mean that the LPN under you doesn’t know what they’re doing. I’ve been a LPN for 30 years, and I ran circles around most RNs because I was a task nurse, and I learned so much because I wanted to do things. I wanted to learn. </div> <br><div>So I think as an RN, there is a ladder, of course, with education but we’re all team players. We’ve got to work cohesively no matter what the title is. Even our director of nursing, she works beside us. When someone calls in, and she’s on call, she’s right there beside us. She does whatever needs to be done. She works as a CNA, she works as a med-tech. She does whatever needs to get done.</div> <div><em><br></em></div> <div><em><strong>Provider:</strong></em><strong> </strong>Everyone knows that staffing is a challenge these days. What are your thoughts on that?</div> <span class="ms-rteForeColor-1">Stevens:</span> In long term care facilities, it’s a different beast than that of a hospital. A whole different beast. The last company I worked with, I worked there for 24 years. The grass is not greener on the other side. You go and be the best nurse that you can be for that patient. Because you’re not there for the management, you’re not there for the staff, you’re there for the patient. And you have to keep that focus. <br><br><div>Also, take care of yourself. That’s the very first thing you have to do is take care of yourself. People in this industry, they work so much overtime they burn themselves out. And they don’t want to do it anymore. <br></div> <div>When I was a younger nurse, I worked a lot of overtime. I also had a family. As an older nurse, I don’t work as much overtime. Could I use a little extra money? Probably so. But at the end of the day, I know I have to be the best nurse that I can be. Or the best mother. Or the best wife. </div> <div><br></div> <div>This is a very tough industry. Nursing is tough. You give out so much throughout your day. I work a 12-hour shift. At the end of my day when I go home, I just need some time to regroup before I can give my family anything. So I go take a bubble bath, and I come back out and I’m refreshed.</div> <div><em><br></em></div> <div><em><strong>Provider:</strong></em><strong> </strong>Yes, burnout is an issue.</div> <span class="ms-rteForeColor-1">Stevens:</span> People jump around in a lot of places. And everywhere you go, there’s going to be issues. And not only in nursing, but in other jobs, too. But you’re there to take care of the patient. And if you stay patient goal-oriented, then I think you’ll stay right where you are, and you’ll do what you know how to do, and you’ll be the best that you know how to be. That’s the way I look at it. I don’t go running around looking for other jobs.<br><div><em><br></em></div> <div><em><strong>Provider:</strong></em> What would you say to your younger self?</div> <span class="ms-rteForeColor-1">Stevens:</span> Go back to nursing school quicker. When I met my husband 25 years ago, I was going to nursing school. And I met him, I knew him for three months, I sold everything I had and moved to Mexico City, Mexico. I got married, and then after four years we had our son. We had our daughter three years after that, and then, raising a family became more important at that time. When they got to be teenagers, I had this inkling that I wanted to go back [to school]. And my husband and I talked about it. My feeling about it got stronger and stronger. <br><br><div>When we stepped out of the boat in 2008, his company went under, and it was on me. I was working, so I did online nursing [classes] because I had to keep working full time. I got my RN. I didn’t go to the classroom. I actually had a blow-up doll as a patient. I took an oil bottle and put a hecklock in there and made my own pickline. You should have seen it, it was awesome. I would say go back to school earlier. </div> <br><em>Stevens was given the Professional Achievement Award for Nursing Care during the Kentucky Health Care Association and Kentucky Center for Assisted Living Quality Awards Banquet Nov. 21, 2019. Stay tuned to future issues for more interviews with individuals from all walks of care. </em><br><span style="display:inline-block;"></span>	Kimberly Stevens, an award-winning registered nurse at Greenwood Nursing and Rehabilitation Center in Bowling Green, Ky., shares her career path and why she decided to stay in her licensed practical nurse role for so many years.	2020-04-01T04:00:00Z	<img alt="" src="/Issues/2020/April/PublishingImages/Stevens_t.jpg" style="BORDER:0px solid;" />	Management;Caregiving	Special Feature	Amy Mendoza	47	1
Interview: Christy Hinkle	https://www.providermagazine.com/Articles/Pages/interview-Christy-Hinkle.aspx	Interview: Christy Hinkle	<div></div> <div> </div> <div><img src="/Issues/2020/January/PublishingImages/ChristyHinkle.png" class="ms-rtePosition-1" alt="Christy Hinkle" style="margin:5px 10px;" />True sunshine. Those are just two words used to describe Christy Hinkle, a long-time social services director who is known at Hillcrest Health and Rehabilitation in Corbin, Ky., for brightening the day of everyone she comes in contact with. Other words like compassionate, understanding, and loving are spoken.</div> <div><br></div> <div> </div> <div>While she previously worked helping youngsters in the federal Head Start program, her transition to working with elders was a natural one. “I was raised by my grandparents, so I always wanted to work with the elderly,” Hinkle says. “When I saw the position in the paper, I just applied. I really enjoy it.”</div> <h2 class="ms-rteElement-H2">Her Biggest Challenge</h2> <div>That was back in 2011. Hinkle felt an immediate connection. But in the early days, she encountered one of her biggest challenges. “I would get really close to a resident, and then they would pass away,” she says. “I was nine years at my other job, and we dealt with the beginning of life. So, when I transitioned to long term care, the end of life was the hardest thing I dealt with.”</div> <div><br></div> <div>Since beginning at Hillcrest, Hinkle has faced her greatest challenge not only professionally but personally. About three years into her role, she lost her husband. “She was dealing with her own grief as well as that of her two young children,” says Gail Gibbs, administrator at Hillcrest. Gibbs points out that Hinkle’s role and faith helped her.</div> <div><br></div> <div>“She said that being here around the residents helped her get through each day,” she says. “She knew that our residents counted on her to be there to comfort them and keep them smiling, so she had to do the same in order to help them.” <br></div> <div><br></div> <div>Prior to working at Hillcrest, Hinkle lost her sister to cancer. “When I came to work here, I had not really dealt with her death,” Hinkle says. “Through dealing with the death of a resident, I was able to finally step back.”</div> <div><br></div> <div>By being there with a resident during the death process and then with the family as they were dealing with his death, Hinkle learned to cope. “This allowed me to see it differently and finally learn to cope with her death,” she says.</div> <div><br></div> <div>“Christy never falters with her smiles, positive outlook, and dedication to her residents and their families, while caring for and adapting in her personal family dynamics,” says Gibbs.</div> <h2 class="ms-rteElement-H2">A Changing Role</h2> <div>Since her early days eight years ago, Hinkle has watched her role evolve. When she first started as social services director, she was also doing admissions. “The main thing was keeping my beds filled at all times,” she says. “This was hard to do plus doing the social work part of it because there are two different avenues there.” Since then, an admissions coordinator has been added so that Hinkle can strictly focus her time on the social service needs of her residents.</div> <h2 class="ms-rteElement-H2">Broader Changes </h2> <div>Other guideline changes came from the state. “We went from utilizing bed and chair alarms for fall interventions, to no longer using them,” Hinkle says. “They were no longer recommended, and were considered to cause a more distracting environment. So we found other interventions for people that have a fall risk such as various calming methods, redirection techniques, visual cueing, etc. The guidelines have changed, so the interventions have changed.” </div> <div><br></div> <div>Hinkle notes that the company has upped its quality improvement efforts. For example, “Now when we have a behavior issue, we put in an intervention like a therapy dog,” says Hinkle. “Or some residents have the electronic companion pets as companions. Or we pair them up with someone with similar likes such as playing cards or watching movies like they do. <br></div> <div><br></div> <div>“I think it’s great. More activities mean more people are happy with their lives. Residents are making friends and being more active, and they are learning to cope with things, and that’s what they need to do.”</div> <h2 class="ms-rteElement-H2">All Types of Accomplishments</h2> <div>When asked about Hinkle’s accomplishments, Gibbs points to a number, and they all have to do with improving the lives of the residents. “Her ability to give to others and reach out in times of need is unmatched,” says Gibbs. Hinkle has done everything from pulling together furniture and setting up new residents’ apartments to filling up trucks with donated items for outgoing residents returning to the community. </div> <div><br></div> <div>Hinkle uses the gift of her singing voice to entertain residents or brighten a special holiday dinner. She’s often at the piano playing and singing with a resident at her side. “There are no words to describe looking into the eyes of a resident who is struggling with memory deficits and seeing them shine with joy as they sing songs from a time that is so clear to them,” says Gibbs. </div> <div><br></div> <div>Hinkle also organizes fun events for staff and helps her co-workers by finding resources when the need arises. In her work she touches the lives of employees, their children, grandchildren, or even their own elderly parents.</div> <h2 class="ms-rteElement-H2">A Leading Role</h2> <div>At the heart of Hinkle’s role are discharges and counseling. When individuals come to Hillcrest for short-term therapy and go home, Hinkle works to make sure they will be successful when they do. “It’s about that person living at home independently with the most support that we can possibly provide for them with different agencies across the county,” she says. “So that’s a big assignment.”</div> <div><br></div> <div>The biggest part of her job, she says, is counseling. “There’s behavior issues in nursing homes that most people don’t realize,” she says. So Hinkle and her staff act accordingly. Sometimes there are couple assessments to be done to determine if residents are alert and oriented to make the decision to have an intimate relationship, or sex education, for example.</div> <div><br></div> <div>And then there are individuals who don’t want to be in a facility, but have nowhere else to go. In this case, she helps them learn to cope with what they feel is losing their independence. She focuses on helping residents understand their current needs and the positives of having help available to them. <br></div> <div><br></div> <div>“I talk to them just like how I’m talking to you, or anybody else,” Hinkle says. “I give them the same advice I give my children. Or my sister or my brother. I try to help them cope with the hand they’ve been dealt, and then make the best of it.” When asked how, she says she focuses on one thing—”getting the best out of life.”</div> <h2 class="ms-rteElement-H2">Getting the Best Out of Life</h2> <div>“When they finally realize that this is where they’re going to be for the rest of their life or for a certain amount of time, then I say, ‘Let’s find something that’s going to make your life better while you’re here,’” she says. “’Let’s get the best out of life. Now that we know that this is where you’re gonna be, let’s figure out how to make it pleasant and memorable for you.’”</div> <div><br></div> <div>The best out of life is something different for everyone. But Bingo reigns as the favorite activity at Hillcrest. “Everyone likes something different, but the big thing is Bingo,” says Hinkle. “If you can get them started with Bingo or a church service or connecting and meeting new friends, that’s great.” <br></div> <div><br></div> <div>Sometimes the best out of life is another person. Hinkle tells a story of two patients with dementia. “One feels lost all the time, and one wants to hug everybody,” she says. “So I go up to them and say, ‘Hey there’s your long lost friend, she’s right there,’ They don’t remember. I reintroduce them every day, and then the one is no longer lost and the other one has purpose.” The two residents hang out with each other all day until it’s time for bed. And this seems to help them, she says. <br></div> <div><br></div> <div>Another resident wants simply to be heard. “He comes to my office and sits for hours on end just talking,” she says. “I’ll go on and be doing my charting or whatever I need to be doing, and he’ll be talking, and I’ll be listening to him. You’ve got to treat them as a person. They’re still human. Even if they have dementia or even if they have schizophrenia, they’re still human.”</div> <h2 class="ms-rteElement-H2">Simple Words</h2> <div>The advice Hinkle has for others in the unique role of social work in long term and post-acute care is simple. “Always treat people the way you want to be treated,” she says. “Always see them as a person and not just a resident or client. You treat them as you would want your parent to be treated if they were in a facility.”</div> <div><br></div> <div>It’s not easy, she admits. “You’re not going to get rich off being a social worker. But if you really care about people and want to see life better for them, then social work is the way to go because you’re in their lives all the time.” <br></div> <div><br></div> <div>Hinkle was given the Professional Achievement Award for Supportive Care during the Kentucky Health Care Association and Kentucky Center for Assisted Living Quality Awards Banquet Nov. 21. Stay tuned to future issues for more interviews with individuals from all walks of care. </div> <div> </div>	“Christy never falters with her smiles, positive outlook, and dedication to her residents and their families, while caring for and adapting in her personal family dynamics.”	2020-01-01T05:00:00Z	<img alt="" src="/Issues/2020/January/PublishingImages/interview_t.png" style="BORDER:0px solid;" />	Quality	Special Feature	Amy Mendoza	47	1

AHCA, NCAL Sign Letter Backing Legislation on Medical Expense Deduction	https://www.providermagazine.com/Articles/Pages/AHCA,-NCAL-Sign-Letter-Backing-Legislation-on-Medical-Expense-Deduction.aspx	AHCA, NCAL Sign Letter Backing Legislation on Medical Expense Deduction	<p>Efforts to have Congress make permanent the 7.5 percent threshold for the medical expense deduction accelerated this week as a letter from the Medical Expense Coalition was sent to lawmakers. The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), along with 48 other organizations, are signed onto the effort, which is led by AARP.<br></p><p>In the letter, these groups request that lawmakers become co-sponsors of the Medical Expense Savings Act (S 110/HR 2017), a bipartisan bill that would make permanent the 7.5 percent threshold for the medical expense deduction. <br></p><p>“We also ask you to support an extension of the 7.5 percent threshold in an end-of-year legislative package,” the letter said. “Without action, 4.4 million Americans with high medical costs will face an unexpected tax increase when they file their returns in the coming months.”<br></p><p>Of note, the coalition said that for more than 75 years, Americans with high health care costs have been able to deduct medical expenses from their taxes. And, for the millions of Americans who annually take this deduction, it provides important tax relief that helps offset the costs of acute and chronic medical conditions.<br></p><p>“This includes costs associated with long term care, assisted living, and nursing homes. These families are often struggling with high deductible co-pays and out-of-pocket expenses related to prevention, diagnosis, treatment, equipment, qualified long term care service costs, and long term care insurance premiums,” the letter said. <br>Some 70 percent of the taxpayers who claim this deduction have incomes between $23,100 and $113,000 per year, and the immediate tax increase they face will make their health care less affordable.<br></p><p>“Even for those people who are covered by Medicare, beneficiaries spend a large portion of their income on out-of-pocket expenses. The average Medicare beneficiary spends about $5,680 out of pocket on medical care,” the letter said. <br></p><p>In addition, older Americans often face high costs for long term services and supports, which are generally not covered by Medicare, as well as hospitalizations and prescription drugs. <br></p><p>“Tax relief in this area can provide needed resources, especially important to middle-income individuals with high medical costs,” the letter said.<br></p><p>AHCA/NCAL and the others also urged the legislation’s inclusion in any end-of-year legislative package.<br></p>	In the letter, these groups request that lawmakers become co-sponsors of the Medical Expense Savings Act (S 110/HR 2017), a bipartisan bill that would make permanent the 7.5 percent threshold for the medical expense deduction.	2020-01-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/notes_2.jpg" style="BORDER:0px solid;" />	Caregiving;Management
AHCA Says Proposed Arbitration Not Good for Providers, Patients	https://www.providermagazine.com/Articles/Pages/AHCA-Says-Proposed-Arbitration-Legislation-Not-Good-for-Providers-or-Patients.aspx	AHCA Says Proposed Arbitration Not Good for Providers, Patients	<p>Legislation introduced in the U.S. House of Representatives that would prohibit long term care facilities from requiring or soliciting residents to enter into pre-dispute, mandatory, binding arbitration agreements would not be positive for patients or providers, according to a statement by the American Health Care Association (AHCA) in opposition to the proposal.<br></p><p><img src="/Articles/PublishingImages/headshots/ClifPorter.jpg" alt="Clifton Porter, II" class="ms-rtePosition-1" style="margin:5px;" />Clifton Porter II, AHCA senior vice president, government relations, said the Fairness in Nursing Home Arbitration Act subtracts a vital option for stakeholders.<br></p><p>“AHCA does not support any bill that aims to ban the use of pre-dispute arbitration agreements. Banning arbitration agreements would eliminate a fair and efficient legal remedy that provides benefits to patients and providers,” he said. <br></p><p>Skilled nursing facilities, Porter added, are just one of many health care providers that use pre-dispute arbitration. “Residents with legitimate claims are awarded reasonable damages, oftentimes equal to the amount that would be awarded under litigation. We strongly oppose efforts to ban this long-used, effective procedure for residents and families to pursue legal recourse.”<br></p><p>The legislation’s authors, Reps. Linda Sánchez (D-Calif.) and Jan Schakowsky (D-Ill.), said they introduced the bill “to protect the legal rights of elderly Americans.”<br></p>	Clifton Porter II, AHCA senior vice president, government relations, said the Fairness in Nursing Home Arbitration Act subtracts a vital option for stakeholders.	2020-01-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/capitol_full.jpg" style="BORDER:0px solid;" />	Policy
Seniors Not Prone to Switching Medicare Advantage Plans	https://www.providermagazine.com/Articles/Pages/Seniors-Not-Prone-to-Switching-Medicare-Advantage-Plans.aspx	Seniors Not Prone to Switching Medicare Advantage Plans	<p class="ms-rteElement-P"><span>At a time more long term and post-acute care providers are either exploring or actually starting their own Medicare Advantage (MA) plans, new research shows that seniors are not likely to switch from one MA plan to another when given the opportunity every open enrollment period.</span></p> <p class="ms-rteElement-P"> <span>In a new report by the Kaiser Family Foundation (KFF), “No Itch to Switch: Few Medicare Beneficiaries Switch Plans During the Open Enrollment Period,” researchers said even though MA plans vary greatly from one another and change from year to year in their benefit offerings and structure, the fact is not many beneficiaries change their selection. This also holds true for beneficiaries and stand-alone Part D prescription drugs plans (PDPs), the report said.</span></p> <p class="ms-rteElement-P"> <span>The non-movement by consumers also is happening as the Centers for Medicaid & Medicare Services (CMS) encourages beneficiaries to shop around for new plans to potentially save money on prescriptions or get new benefits.</span></p> <p class="ms-rteElement-P"> <span>“Overall, a small share of MA-PD [MA-Part D] and PDP enrollees without low-income subsidies (8 percent and 10 percent, respectively) voluntarily switched to another plan during the 2016 annual open enrollment period for the 2017 plan year,” KFF said.</span></p> <p class="ms-rteElement-P"> <span>Among 9.4 million MA-PD enrollees without low-income subsidies, 7.6 percent (710,000 beneficiaries) voluntarily switched to another MA-PD during the 2016 open enrollment period for 2017, and another 0.9 percent (90,000 beneficiaries) switched from an MA-PD to traditional Medicare (with a PDP). </span></p> <p class="ms-rteElement-P"> <span>And, the report said of the 11.7 million PDP enrollees without low-income subsidies, 8.3 percent (980,000 beneficiaries) changed to another PDP and another 1.7 percent (200,000 beneficiaries) switched to an MA-PD during the 2016 open enrollment period for 2017. </span></p> <p class="ms-rteElement-P"> <span>Researchers noted that only a small slice of Part D enrollees switch to MA-only plans or traditional Medicare without Part D coverage; they are excluded from this analysis.</span></p> <p class="ms-rteElement-P"> <span>“A substantial majority of Medicare private plan enrollees have not voluntarily switched plans in any given year over the time period of this analysis,” the report said. During the open enrollment periods between 2007 and 2016, the share of enrollees without low-income subsidies switching plans on their own for the coming year ranged between 6 and 11 percent for people in MA drug plans, and between 10 and 13 percent among those in stand-alone PDPs.</span></p> <p class="ms-rteElement-P"> <span>Of the individuals who did not switch in any given year are Medicare beneficiaries who were enrolled in plans that left the market and were “crosswalked” (that is, automatically enrolled) by their plan sponsor into a new plan the following year. </span></p> <p class="ms-rteElement-P"> <span>“This means their plan is different from the previous year, but they did not voluntarily choose a new plan,” report authors said.</span></p> <p class="ms-rteElement-P"> <span>For the 2017 plan year (corresponding to the 2016 open enrollment period), this comprised roughly 8 percent of MA-PD enrollees and 3 percent of PDP enrollees. Another small share of enrollees involuntarily switched MA-PDs (3 percent) or PDPs (less than 1 percent) because their plan exited the market for 2017 and they were not automatically crosswalked into a new plan.</span></p> <p class="ms-rteElement-P"> <span>In discussing what all of this means, the report said it is important to note that there are indeed a lot of options for most Medicare beneficiaries to weigh with an average of 28 MA plans and the same number of 28 stand-alone Part D plans available to beneficiaries in 2020.</span></p> <p class="ms-rteElement-P"> <span>“Relatively low rates of plan switching during the open enrollment period could indicate that beneficiaries are generally satisfied with their current plan and therefore have little motivation to compare and switch plans, or they may be actively choosing to remain in their plan after comparing other available options,” the report said.</span></p> <p class="ms-rteElement-P"> <span>Conversely, authors said low switching rates could also mean that many beneficiaries find the shopping around for a new plan process too daunting, are possibly not aware of the open enrollment season, or have limited confidence in their ability to choose a better plan.</span></p> <p class="ms-rteElement-P"> <span>Find the report at </span><a href="https://tinyurl.com/qlcz6r8"><span>https://tinyurl.com/qlcz6r8</span></a><span>.</span></p>	New research shows that seniors are not likely to switch from one MA plan to another when given the opportunity during open enrollment periods.	2019-12-11T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News2.jpg" style="BORDER:0px solid;" />	Caregiving;Medicare Advantage
Studies Show Major Issues with Medicare Coverage and Affordability	https://www.providermagazine.com/Articles/Pages/Studies-Show-Major-Issues-with-Medicare-Coverage-and-Affordability.aspx	Studies Show Major Issues with Medicare Coverage and Affordability	<p>A pair of studies discovered that Medicare beneficiaries with a serious illness are finding it difficult to afford their medical bills even as they receive support from the government-funded program. <br></p><p>The reports said the trend is mainly a result of skyrocketing out-of-pocket medical costs and the fact some care is not covered by Medicare.<br></p><p>First, a survey in Health Affairs said slightly more than half of Medicare beneficiaries with a chronic illness have experienced financial hardship when seeking care, with the most pressing concern being their ability to pay for prescription drugs and hospital bills.<br></p><p>“Financial Hardships of Medicare Beneficiaries with Serious Illness” said overall beneficiary satisfaction with Medicare is high, but that comes with a caveat that many respondents to the survey have supplemental insurance to fill in the gaps of traditional Medicare coverage. <br></p><p>A second study published by the Kaiser Family Foundation examined Medicare beneficiaries’ out-of-pocket spending. The average for this area was $5,460 per year in 2016, which included premiums. Leading the way on expenses was long term care (LTC), with beneficiaries with diseases most likely to result in LTC, like Alzheimer’s or other types of dementia, recording the highest spending.<br></p><p>For the Kaiser study, the medical and LTC services in their analysis included dental services, inpatient hospital services, LTC facility services, skilled nursing care, medical providers and supplies, outpatient hospital services, and prescription drugs.<br></p><p>In looking closer at the numbers, Kaiser said, “not surprisingly” beneficiaries living in LTC facilities (5 percent of traditional Medicare beneficiaries overall) spent significantly more on LTC services than the average beneficiary in traditional Medicare in 2016 ($19,632 versus $1,014). <br></p><p>“Out-of-pocket spending was much higher among LTC facility residents who did not have Medicaid ($41,782), which is the primary source of public support for long term care,” the report said. <br></p><p>Out-of-pocket spending on LTC facility services was also higher among beneficiaries with certain chronic conditions. Specifically, the data show those with Alzheimer’s disease or other types of dementia had a $9,565 expense per year on average, with that number at $27,308 among LTC residents only.<br></p><p>For Parkinson’s disease, the average was $4,120, but $28,165 among LTC residents only.<br></p><p>“In 2016, traditional Medicare beneficiaries with five or more chronic conditions spent $1,065 on prescription drugs, on average, compared with $416 among those with one or two chronic conditions,” the report said. <br></p><p>Those beneficiaries in poor self-reported health spent $1,018 on prescription drugs, compared with $410 for those categorized as in excellent self-reported health. <br></p><p>On the question of which beneficiaries are impacted the most by high out-of-pocket expenses, Kaiser said its analysis shows that half of all beneficiaries in traditional Medicare spent at least 12 percent of their income on out-of-pocket health care costs in 2016. <br></p><p>“The financial burden of health care as a share of income falls disproportionately on lower-income Medicare beneficiaries,” the report said. “Half of traditional Medicare beneficiaries with incomes below $10,000 spent at least 18 percent of their total per capita income on health care costs in 2016, compared with 7 percent for those with incomes of $40,000 or more.”<br></p>	A pair of studies discovered that Medicare beneficiaries with a serious illness are finding it difficult to afford their medical bills even as they receive support from the government-funded program.	2020-01-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER:0px solid;" />	Policy
Warner, Scott Introduce bill on Background Checks for SNFs	https://www.providermagazine.com/Articles/Pages/Warner,-Scott-Introduce-bill-on-Background-Checks-for-SNFs.aspx	Warner, Scott Introduce bill on Background Checks for SNFs	<p>Bipartisan legislation introduced by Sens. Mark Warner (D-Va.) and Tim Scott (R-S.C.) aims to make it easier for senior living facilities to screen potential workers by providing operators with access to the National Practitioner Data Bank (NPDB).<br></p><p>The bill, titled the Ensuring Seniors Access to Quality Care Act, would let nursing centers tap into the NPDB, an existing national criminal background check system, giving employers a heightened ability to screen and vet potential employees to ensure that caregivers do not have a history of behavior that could endanger the seniors under their care.<br></p><p>Currently, senior living facilities are not authorized to use the NPDB and instead must use state-level criminal background checks that often omit key details about an employee’s background. <br></p><p>Another section of the bill would amend “overly restrictive regulations” that bar certain senior living facilities from conducting training programs for in-house certified nurse assistants (CNAs) for a two-year period after a care facility is found to have deficiencies, such as poor conditions or patient safety violations. <br></p><p>Under existing regulations by the Centers for Medicare & Medicaid Services (CMS), senior living facilities that receive a civil monetary penalty (CMP) over $10,000 are automatically prohibited from conducting CNA staff training programs for a period of two years. <br></p><p>Specifically, the legislation would permit senior living facilities to reinstate their CNA training program if the facility has corrected the deficiency for which the CMP was assessed, the deficiency for which the CMP was assessed did not result in an immediate risk to patient safety and is not the result of patient harm resulting from abuse or neglect, and the facility has not received a repeat deficiency related to direct patient harm in the preceding two-year period.<br></p><p>In response to the legislation, Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living, said the proposed legislation tackles two important areas.<br></p><p>“First, it will help ensure that long term care providers have the ability to provide training programs for CNAs. Just as important, it will allow skilled nursing facilities access to the National Practitioner Data Bank, providing a better way to conduct background checks on potential employees,” he said.<br></p><p>Parkinson added that “we applaud Sen. Warner and Sen. Scott for taking this important step to address the worker recruitment and retention challenges facing providers.”<br></p><p>He also stressed that CNAs are essential to the quality care provided in long term care facilities. “In addition, the jobs provided by nursing homes and assisted living communities are important to many communities, especially rural areas, where they are often a major employer,” he said.<br></p><p>In releasing the legislation, Warner said anyone with a loved one in a senior living facility should have the peace of mind of knowing that they are receiving care from compassionate, dependable, and well-qualified staff as they live out their golden years. “This bipartisan legislation will help provide these facilities with the tools they need to hire experienced staff and to continue to meet the demands of high-quality care without losing staffing levels,” he said.<br></p><p>Scott said senior citizens and their families know how important it is to have well-qualified, compassionate, and trustworthy caregivers in senior living facilities. “The Ensuring Seniors Access to Quality Care Act will help these facilities more efficiently hire the best candidates and, in turn, provide better care for seniors everywhere,” he said.</p>	The bill, titled the Ensuring Seniors Access to Quality Care Act, would let nursing centers tap into the NPDB, an existing national criminal background check system, giving employers a heightened ability to screen and vet potential employees.	2020-01-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News3.jpg" style="BORDER:0px solid;" />	Workforce;Management

Executive Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=9	Executive Director	<img alt="" src="/PublishingImages/People%20on%20the%20Move/HaileyWetherbee.jpg" style="BORDER:0px solid;" />	Hailey Wetherbee	Summercrest
Executive Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=10	Executive Director	<img alt="" src="/PublishingImages/People%20on%20the%20Move/DenaMackey.jpg" style="BORDER:0px solid;" />	Dena Mackey	Jackson Creek Senior Living
Regional Director for Operations, St. Louis region	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=11	Regional Director for Operations, St. Louis region	<img alt="" src="/PublishingImages/People%20on%20the%20Move/TracyCecil.jpg" style="BORDER:0px solid;" />	Tracy Cecil	Arrow Senior Living Management

January 2020

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