July 2020

Vol. 47 No. 7

July

Cover Story

Providers Plug In: Telehealth Catches On

https://www.providermagazine.com/Issues/2020/July/Pages/Providers-Plug-In-Telehealth-Catches-On.aspx

Providers Plug In: Telehealth Catches On

Prior to COVID-19, long term and post-acute care providers interviewed for this article were at different stages of adopting telehealth technology—while some had only discussed the possibility, others had selected a vendor partner and were close to implementing strategies. All credit the federal government’s relaxing of telehealth regulatory restrictions via pandemic-related <a href="/Issues/2020/July/Pages/Telehealth-Waivers-Impact-Assisted-Living,-Skilled-Nursing.aspx" target="_blank" title="Telehealth Waivers Impact Assisted Living, Skilled Nursing">waivers</a> as the catalyst to act now on telehealth versus down the road. <h2>Putting A Plan Into Action</h2>The staff at Burgess Square Healthcare and Rehab Centre, which provides post-acute nursing and rehabilitation care services in Westmont, Ill., was in the process of implementing new telehealth technology when the COVID pandemic forced the center to go into lockdown. Located just outside of Chicago, one of the largest COVID hotspots in the country, staff acted quickly to set up a separate COVID unit, and most of the residents there have recovered. Today, the center is taking new admissions and has <a href="/Issues/2020/July/Pages/Technology-grows-amid-pandemic.aspx" target="_blank" title="Technology grows amid pandemic">implemented a software platform</a> to keep residents, staff, and physicians connected. <img src="/Issues/2020/July/PublishingImages/KristinThrun.jpg" alt="Kristin Thrun" class="ms-rtePosition-1" style="margin:5px;" />“We had done the setup and had purchased the supplies, and we were starting to do the training with our managers, and then COVID hit,” says Kristin Thrun, Burgess administrator. “At that point we basically accelerated the implementation and made it available.” Investments were made not only into the software but into iPads and Bluetooth-enabled devices such as stethoscopes. iPads are used to conduct telehealth visits, and Bluetooth devices are used to record information during patient assessments and integrate that information on the software platform. “We did buy dedicated equipment for the isolation unit so that was easy to rectify,” says Thrun.<h2>Challenges Make an Appearance</h2>Challenges arose. Physicians reported that it was difficult to hear patients and vice versa, and the role of a dedicated nurse to conduct telehealth visits became even more important. “The physicians do rely on the staff in the facility to do the assessment,” says Thrun. “So, it really has to be a nurse who is with a patient because they will ask them to give a report on how their lungs sound, for example, or ask them to check for edema.” Once Burgess’ physicians and specialist partners were set up and got the hang of it, things got easier, but it’s still a learning experience, says Thrun. In the future, she’d like to get equipment that has better audio capabilities, she says. While the time is not right to make more investments, Thrun and her staff are dealing with their audio issues as best they can. This often means a nurse is repeating information, which extends the session. On average, visits take about 30 minutes per patient. The visits have become a fundamental part of operations, says Thrun. Being in an urban location, doctors would often visit patients at the center, but the COVID pandemic changed that, and now the center averages 30 telehealth visits per week. Another challenge has been figuring out the billing and at least recovering some of the costs associated with the telehealth program, says Thrun. “When we first started this, we were not able as a facility to recoup any of our costs even though we dedicated a lot of resources to it,” she says. “Now with the waivers that the government put in place for telehealth, we can bill an origination fee under Part B even if they are a Medicare A stay.” <h2>Jumping Right In</h2>How telehealth services were regulated by the Centers for Medicare & Medicaid Services put the brakes on telehealth adoption for American Medical Facilities Management (AMFM), a provider operating 18 skilled nursing and rehabilitation centers in West Virginia. But that all changed. Vickie Powell, an AMFM nurse practitioner who oversees other nurse practitioners in the facilities, has been coordinating telehealth implementation since March. “We have 18 centers, and each one of them now has telehealth capabilities, with seven centers using it routinely,” says Powell. “We’ve had over a thousand calls since the middle of March.” <img src="/Issues/2020/July/PublishingImages/VickiePowell.jpg" alt="Vickie Powell" class="ms-rtePosition-1" style="margin:5px;" />Prior to COVID, Powell and her staff explored telehealth options but couldn’t figure out how it would work at AMFM’s centers based on the regulations of the time. Once regulations relaxed, Powell and her staff jumped in, a move they are happy they made. “We have a lot of partners that would not only come into our facility, but they would go back and forth to the hospital, and we realized this may be a source of transmission,” says Powell. To implement online visits instead, Powell and company invested in iPads for the nursing staff. Noting that audiovisual quality of a patient’s health information could make or break a telehealth visit, they also invested in a digital stethoscope for each building. Bluetooth wireless technology helps exchange data between the stethoscope and the iPad. Powell led education for staff on using the new technology, including how-to guides.“We can do auscultation of lung sounds, heart sounds, abdominal sounds, etc.,” says Powell. “And that has been very helpful for us to have a full assessment going on.” In a facility, a nurse would carry an iPad and the digital stethoscope to the meeting with the patient and proceed to dial into the online conference room via Zoom or FaceTime. The provider outside the facility would participate via iPad and converse with the patient with added ability to hear the input from the stethoscope. Powell says staff are able to auscultate patients’ lungs, determine their status, and keep them in house while treating them. “One of our doctors was telling me he was able to pick up that a patient had a heart arrhythmia,” says Powell. “He was able to treat it successfully in-house and not have to send the patient to the hospital where he would be exposed to not only COVID-19 but all other infections out there.”<h2>Features Matter</h2>Picking up on a patient’s changed or new symptoms sooner rather than later has helped tremendously, says Powell. “We have avoided unnecessary hospital readmissions and have kept transmission of the COVID virus down,” she says. “We were able to treat patients sooner rather than later, and the other aspect of this is not only for our attending physicians using this technology to make their regular rounds and see patients who are acute, but specialists as well.” Orthopedic specialists, cardiologists, pulmonologists, and others have made follow-up visit calls with patients. “We’ve been able to avoid the hardship of transporting these frail patients to the hospital,” says Powell. Follow-up visit capability also attracted Burgess staff to the new technology platform. Specifically, it was the emphasis on its development of customer service modules and extensions into the community, says Thrun. “We have a program here with nurse practitioners; they typically track the patients who go back home with follow-up visits. This is especially for helping high-risk residents who are at risk for readmission to keep them safe at home and give them access to the care they need. Our technology partner is working toward doing telehealth at home, so that was another factor that we really liked about them.” One of the other benefits of the new software is that it integrates with Burgess’ electronic medical record platform, PointClickCare. “We like the fact that our physicians can use it,” says Thrun. “We have a lot of doctors who take their own calls, so they can use it even at night if they want to.”<h2>On the Same Page</h2>Getting physicians and other partners to speak together on a new technology platform was one of the benefits that appealed to Coleen Kohaut, an independent owner of three facilities—The Villa Rehab Center, a skilled nursing facility, The Holiday House, a residential care community, and Franklin County Rehab Center, a skilled nursing facility, all located in St. Albans City, Vt. Kohaut is also administrator at Franklin. “If we are dealing with someone who is sick, we can get an infectious disease provider and a vascular provider on the same call together, along with my clinicians and clinical team and our therapy team,” says Kohaut. “This opens things up for a more comprehensive clinical evaluation, with the providers working together on a more cohesive plan.” Kohaut recalls a patient on a short-term rehab wing who entered the facility with a vascular podiatry wound. “We were able to connect with the specialist on the call and had a very good result,” she says. “The plan of treatment has really been effective, and that patient has gone home and is doing very well.”<h2>How it Works</h2>Kohaut says her facilities have had their mobile X-ray company on a call with an orthopedic surgeon, the facility’s attending physician, and the entire clinical team so they can all have a conversation about a patient. <img src="/Issues/2020/July/PublishingImages/ColeenCondonKohaut.jpg" alt="Coleen Kohaut" class="ms-rtePosition-1" style="margin:5px;" />“It’s been great,” says Kohaut. “It’s obviously very efficient time-frame wise, and I think we have better communication with everyone talking together and on the same page. It’s so much better than having to transport someone who is somewhat fragile and having them be in a vehicle for over an hour.” Kohaut purchased iPads and an account with Zoom, a cloud platform for video and audio conferencing, collaboration, chat, and webinars across mobile devices, desktops, and phones. Partners of Kohaut’s centers also have Zoom accounts, allowing them to coordinate meetings, calls, and information via Zoom’s shared screen feature. When it comes to risks, Kohaut said that security was on top of her mind. But after some research, she discovered that Zoom provides a standard security technology for establishing an encrypted link between a server and a client, also known as a Secure Sockets Layer. While Kohaut’s centers have stable coverage from internet providers, she points out that Vermont still has areas that are in need of stronger internet coverage, especially in rural areas. <h2>The Assisted Living Story</h2>While Kohaut has implemented telehealth technology at The Holiday House and is seeing good outcomes, running a residential care home during the COVID-19 pandemic is financially no easy task, she says. She points out that a very large share of her budget has been spent on personal protective equipment. “Both of my skilled nursing facilities have been a part of the CARES Act and [Department of Health and Human Services] funding, but unfortunately the federal money at this point has not assisted my residential care home,” she says. The Holiday House accepts Medicaid patients and is licensed as an enhanced residential care provider and participates in the Medicaid waiver program, so the impact has been fairly negative financially, says Kohaut. All three of Kohaut’s centers were approved for the Paycheck Protection Program, a loan of the Small Business Administration designed to help small businesses keep their workforce employed during the COVID-19 crisis, and this has helped, she says. The state of Vermont has also helped with a Medicaid retainer fund, and the Holiday House has been receiving small payments, but challenges still remain. “Like a lot of the industry, we have not been taking admissions, so we have seen a drop in census,” says Kohaut. “We have really seen a decrease of our occupancy at both the SNFs and the residential care home.” “It would certainly be wonderful if there was some relief for residential care and assisted living federally,” she says. “I know the states are trying to do what they can.” <h2>Lessons Learned </h2>Thrun says that overall, implementing new technology was a user-friendly process, thanks to the ease of the technology and the partnership with the vendor. Also, the investment in equipment was reasonable. “You don’t have to spend a fortune on things like special equipment,” she says. “You can do it cost-effectively if you need to do so. I think that’s a real benefit for facilities that may not have a lot of resources.” However, she says, be prepared to invest dedicated staff. “You have to have one nurse educator to do telehealth visits, otherwise you will run into problems and get backed up,” says Thrun. “It’s just like if you go visit your doctor and have to wait 15 minutes. It can be time consuming, and your staff can get frustrated.” A floor nurse could conduct the visit if it is about a quick change in condition, says Thrun. But if it is a planned visit, it’s best to have a dedicated nurse. Powell stresses that telehealth is not about taking away face-to-face visits, which are important, but telehealth technology is still a valuable tool. “We can pull it out when we have situations such as this,” she says. “It may be we have a flu epidemic going on, or maybe we have an immunocompromised patient and this works better for them than a face-to-face visit.” When implementing telehealth technology, Powell encourages providers to consider all that nurses are dealing with during COVID-19, and that staff trying something new will take some time. However, the investment is worth it, she says. “I would say be open to it,” says Powell. “I think it’s not going to go away when COVID goes down, it’s here to stay and will grow as a valuable tool.”

Prior to COVID-19, long term and post-acute care were at different stages of adopting telehealth technology—while some had only discussed the possibility, others had selected a vendor partner and were close to implementing strategies.

2020-07-01T04:00:00Z

COVID-19;Health Information Technology

Telehealth at the Forefront	https://www.providermagazine.com/Issues/2020/July/Pages/Editors_Desk_July_2020.aspx	Telehealth at the Forefront	<p>Many providers had contemplated adopting telehealth technology when the coronavirus hit, but once it did, they accelerated their plans, says Managing Editor Amy Mendoza in this issue’s cover story. When providers started exploring the telehealth option, they worried about how they were going to pay for it. Fortunately, once the government started putting waivers in place to make health care more accessible, they began to ease the pressure, providers say. Mendoza reports on how the coronavirus has been a game-changer when it comes to telehealth. <br></p><p>Pandemic-necessitated bans on friends and families are clearly intended to protect staff and residents. But as a result, staff may be experiencing moral distress, an emotional state in which a person understands what is morally right but is prevented from doing so, says Amy Stewart, RN, in Human Resources. For example, a nurse caring for a resident who died without family near may feel distress. Stewart offers ways leaders can support staff and help build their resilience. <br></p><p>Karl Steinberg, MD, CMD, says ideally the skilled nursing facility’s medical director should be a vital member of the center’s infection protection and control program. If the medical director is lacking these skills, an excellent and free online infection preventionist course is available from the Centers for Disease Control and Prevention.<br></p><p>In a special feature, AHCA’s Lisa Hohenemser reports on this year’s National Skilled Nursing Care Center Week, which was planned to begin on Mother’s Day. Despite the challenges of these uncertain times, the event went forward as scheduled. Following the theme, Sharing Our Wisdom, centers around the country found creative ways to honor their residents and staff. Opportunities for connection in spite of social distancing included drive-by caravans, live outdoor concerts, hallway games, and a balloon launch.<br><br></p>	Mendoza reports on how the coronavirus has been a game-changer when it comes to telehealth. Stewart offers ways leaders can support staff and help build their resilience.	2020-07-01T04:00:00Z	<img alt="" src="/SiteCollectionImages/Joanne-Erickson.jpg" style="BORDER:0px solid;" />		Editor's Desk
Assisting Staff Through Adversity	https://www.providermagazine.com/Issues/2020/July/Pages/Assisting-Staff-Through-Adversity.aspx	Assisting Staff Through Adversity	<p>Decisions made during the pandemic could have a lasting impact on nursing staff. Many arrive to work and find a sign on the entrance of the nursing facility stating that, for the protection of staff and residents, visitors are prohibited due to COVID-19.<br></p><p>Rationally, it is easy to explain that these restrictions, and other similar decisions, are intended to protect staff and residents. But it also puts staff in new situations, ones that can challenge their values, ethics, and morals. <br></p><p>As a result, staff may be experiencing moral distress: an emotional state that occurs when a person knows the morally right thing to do but is prevented from doing so by some constraining factor.<br></p><h2>Uncommon Circumstances</h2><p>While moral distress isn’t a new phenomenon, it may have gone unnoticed and occurred less frequently before the pandemic. In contrast, during COVID-19, staff may find themselves prevented from “doing the right thing” because of limitations placed on health care providers. <br></p><p>For example, a nurse caring for a terminally ill resident who died without family due to visitation restrictions may be emotionally affected, particularly if, due to staffing constraints, the nurse was unable to sit at the bedside to be with the resident. Low or unsafe staffing levels intensify high levels of moral distress as nurses struggle to provide appropriate care.<br></p><p>Unfortunately, the pandemic makes these circumstances all too common. These situations go against nurses’ core values and are likely to have a negative emotional impact on them, especially when there are several instances of this type of challenge. As the pandemic unfolds, and there are more situations in which circumstances beyond their control render nurses unable to do what they know is right, more will experience moral distress. <br></p><p>While immersed in the crisis, moral distress might not be obvious—even to the staff themselves; they are too busy dealing with what is in front of them. As it continues, how can facility leaders support staff? And, for both the pandemic and other crisis situations, how can one mitigate the impact of moral distress? <br></p><h2>Consequences and Strategies </h2><p>Moral distress leads to decreased quality of life and burnout. Staff struggling with moral distress can present with both physical and psychological symptoms. They may be anxious, depressed, exhausted, discouraged, and feeling a sense of helplessness. Others report feeling regret, remorse, and guilt.<br></p><p>Physical symptoms include insomnia, headaches, or gastrointestinal issues. Staff may call off from work, or, when they are at work, they may appear disconnected. If left unaddressed, high levels of moral distress lead to staff turnover. Some staff may not only leave an organization, but the profession as well.<br></p><p>Facility leaders should begin to build a plan to address moral distress to help build resiliency. To aid in coping, consider implementing: <br></p><ul><li>Quick debriefings following stressful events. When an event occurs that is out of the normal, take a pause to acknowledge what happened and why it feels bad. For example, the sudden death of a fellow staff member may shake colleagues. Remember to give all staff that were impacted by the event an opportunity to confer. Talking about a situation immediately lessens moral distress.<br></li><li>Regular team meetings to discuss difficult emotions. Staff who have suffered from moral distress indicate that having a peer with whom to examine their emotions and to discuss how they felt helped them cope. This forum allows staff to share how they feel about crisis care delivery and how it differs from conventional care.<br></li><li>Promoting gratitude. Start each shift with all staff sharing one to three things they are thankful for. Expressing gratitude has been linked to positive physical and psychological health and lower levels of aggression. Expressing gratitude helps start the shift on a positive note and brings optimism into the workplace.<br></li><li>Checking on new nurses. The degree of moral distress experienced by nurses may vary depending on age and experience. For newer nurses, the decisions made during a crisis may have a greater impact. These individuals may require daily check-ins and greater information on why certain crisis decisions are necessary. <br></li><li>Special check-ins with nurse assistants. Nurse assistants are often affected by moral distress in a slightly different manner, which may include feeling powerless. They are responsible for carrying out functions that nurses or management staff have asked of them. As such, nurse assistants are often excluded from decision making. During a crisis, it is imperative to include them in discussions and share why care practices have changed or will change. <br></li></ul><ul><li>Starting a wellness campaign. It can seem impossible to begin anything new with so many competing priorities. However, a wellness campaign today may mitigate staff turnover tomorrow. The campaign can start small, such as encouraging all employees to take breaks. Encourage self-care, such as getting enough sleep, eating healthy, and exercising. Or, as a thank you, provide staff with access to a meditation app on their phone that they can use to relax after a stressful day. <br></li></ul><ul><li>Referrals to an employee assistance program (EAP). Staff may be severely impacted by recent events and need to talk with a professional. Remind staff that the EAP is there to assist them confidentially. <br></li></ul><ul><li>Post-crisis management education. Education related to ethics or ethical decision making can help staff process their experiences and put them in context. Providing ethical education correlates positively with a reduction of moral distress. This is especially needed for nurse assistants who may not otherwise receive ethics education. <br></li></ul><h2>Support Critical</h2><p>Situations that arise during the pandemic are bound to impact staff. Already difficult care decisions are made more difficult due to constraints related to COVID-19. Nursing staff are especially susceptible to moral distress. Not only are they on the frontline of the response, but the impossible choices that the constraints they are experiencing impose undermine the core values of a caring profession.<br></p><p>Moral distress has serious implications for frontline staff and threatens the nursing workforce if not addressed. Caregivers cannot care for others if they don’t take care of themselves. The more that leaders can assist in building moral resiliency, the more they can help improve staff emotional well-being and quality of life. <br><br><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 <a href="mailto:astewart@AAPACN.org" target="_blank" title="Email Amy">astewart@AAPACN.org</a>.</em></p>	Decisions made during the pandemic could have a lasting impact on nursing staff.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/0720_HR.jpg" style="BORDER:0px solid;" />	Workforce;COVID-19	Human Resources
COVID-19 Infection Prevention and the Medical Director	https://www.providermagazine.com/Issues/2020/July/Pages/COVID-19-Infection-Prevention-and-the-Medical-Director.aspx	COVID-19 Infection Prevention and the Medical Director	<p></p>The COVID-19 pandemic has been a nightmare for everyone associated with nursing facilities, with the most severe devastation landing on their residents. Outbreaks have wiped out a large swath of these precious, vulnerable elders, and this virus is even more cruel in that most of them have not been able to have loved ones at their side on their deathbed.<br><div><br></div><div>It is estimated that over 40 percent of the COVID deaths in the United States have occurred in the long term care setting, which constitutes only about 0.6 percent of the U.S. population. In other words, a nursing center resident is about 70 times more likely to die of the coronavirus than a person who lives in the community at large. Unavailability of personal protective equipment (PPE) and testing have been problematic.</div><h1>Effects on Staff</h1>The pandemic has also been extremely difficult for the nursing center workforce. These frontline heroes are placing themselves, and potentially their families, in harm’s way because they care about the people who reside in nursing centers, and they are doing it with grace and compassion. Some of them have died. Some staff work in multiple facilities, increasing the risk of transmission, and there is no simple solution to this problem. Staffing shortages can also occur when there are outbreaks, which can compound the difficulties nursing centers are facing.<br><div><br></div><div>COVID-19 has been an insidious, diabolical foe—the asymptomatic transmission, the unreliability of testing, the unknowns about immunity after infection, and the severe respiratory manifestations requiring prolonged mechanical ventilation are just a few of the factors that make it very different from, say, influenza A.</div><div><br></div><div>Numerous online resources are available on COVID from organizations like the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare & Medicaid Services. Amid the plethora of helpful sites, AMDA – The Society for Post-Acute and Long-Term Care Medicine has excellent clinical and nonclinical COVID information, suitable for all professionals working in skilled nursing centers, but perhaps best shared with medical directors and other attending practitioners (https://paltc.org/COVID-19).</div><h2>How the Pandemic is Playing Out</h2>Clinicians have learned much since the early days of the pandemic, and they continue to learn rapidly and improve their processes accordingly. Medical information is coming out on a daily basis, and there is a reasonable hope that an effective vaccine may be available within a year.<br><div><br></div><div>At the same time, there has been a wide variability in how the federal government and the various states and county health departments have provided guidance to nursing centers, creating mixed messages and often—unfortunately—bringing a continued punitive and critical attitude toward their efforts to prevent COVID cases and to use best practices in using PPE, cohorting, quarantining, and treating outbreaks.</div><div><br></div><div>Some states, seemingly in the interest of ensuring hospitals did not become overburdened, created mandates for nursing centers—even those with no known or suspected COVID cases—to accept COVID-positive patients from hospitals, with predictably unfortunate results. AMDA and AHCA released a joint statement on March 29 opposing such policies forcing COVID patients into nursing centers, which almost certainly saved lives as some states and counties walked back or never initiated similar mandates.</div><div><br></div><div>The public sentiment and media coverage often vilify nursing centers, dredging up years-old, resolved infection control deficiencies (for example, one nurse assistant failed to wash her hands after checking a resident’s vital signs three years ago during survey) to somehow suggest that this is why a COVID outbreak has now occurred in 2020 in this facility.</div><div><br></div><div>Media posts and broadcasts similarly tend to emphasize perceived failings in nursing centers’ efforts and not the conscientious, diligent, and demanding endeavors to provide safe and appropriate care to its residents under the most extreme circumstances.</div><h2>The Washington Case</h2>The nursing center in Washington that really appeared to have been ambushed by the first severe nursing center COVID outbreak in mid-February (weeks before COVID had even been deemed a pandemic) received over $600,000 in civil monetary penalties for perceived deficiencies, mostly related to infection control (the deficiencies and fines are being contested).<br><div><br></div><div>Among the deficiencies were an alleged failure to timely notify the public health department of a respiratory outbreak and an alleged failure to have a backup practitioner available if the attending physician or medical director were not available.</div><div><br></div><div>Even though this nursing center had the medical director or a nurse practitioner available by telephone, the statement of deficiencies suggests that another provider should have been available to make an in-person visit—although that does not appear to be an explicit requirement in the federal or state regulations. </div><div>There will no doubt be many more state agency and federal deficiencies written in nursing centers, and some may be deserved, but it is clear that most nursing centers are doing the very best they can under extremely difficult circumstances.</div><br><div><br></div><div>The COVID lawsuits have already begun and may represent a new boutique industry for plaintiff attorneys, although in some 20 states there have been executive orders granting immunity to nursing centers (except in cases of willful misconduct, gross negligence, or other extreme situations), acknowledging that the standard of care during a disaster is different from the usual standard. </div><div><br></div><div>Infection prevention and control programs (IPCP) were already a mandate before this pandemic began, and the importance of the nursing center’s infection preventionist (IP) has never been clearer. Local health departments can be a source of additional information, but probably the best resource for most centers is their medical director.</div><h2>Leadership During the Crisis</h2>Nursing center medical directors and other staff interested in infection prevention can access an excellent (and free) online IP certificate course via CDC at <a href="http://www.train.org/cdctrain/training_plan/3814" target="_blank">www.train.org/cdctrain/training_plan/3814</a>. It is hoped that during this pandemic, medical directors and IPs should step up their surveillance and ensure employees and essential visitors are doing consistent, appropriate hand hygiene and utilizing PPE, including donning and doffing, correctly. <br><div><br></div><div>The medical director should be a vital member of every center’s infection prevention and control program, and should be a leader in quality assurance/performance improvement (QAPI) in addition to merely attending the center’s mandatory Quality Assessment & Assurance committee meetings.</div><div><br></div><div>Nursing centers that do not have engaged medical directors are encouraged to support their medical director by recommending or requiring education through AMDA and its state affiliates, certification as a Certified Medical Director through the American Board of Post-Acute and Long-Term Care Medicine, and considering time spent on education in infection prevention and medical direction as hours toward medical direction for the center.</div><br>Alternatively, if a medical director is not supporting the center during this pandemic, it may be time to consider a new medical director or obtaining additional medical support and guidance from physicians who do have the requisite knowledge of clinical issues, geriatrics, bioethics, telemedicine, and the unique and arcane regulatory framework nursing centers work under.<br><div><br></div><div>Nursing center leaders, including an engaged, knowledgeable medical director, can be a godsend, as many of Provider’s readers already know. Nursing centers, and the people who live and work there, will face a difficult road ahead, even looking at things most optimistically. More precious residents and staff will be lost.</div><div><br></div><div>But centers will get through it. A unified, supportive, compassionate, and collective attitude will carry them beyond this catastrophe together, and may they pray that some good things actually come along with all of the tragedy. </div><br><em>Karl Steinberg, MD, CMD, HMDC, is president-elect of AMDA – The Society for Post-Acute and Long-Term Care Medicine, vice president of National POLST, chief medical officer for Mariner Health Care, and a long-time skilled nursing center and hospice medical director and attending physician from Oceanside, Calif. He is also a certified health care ethics consultant and takes his dogs to work on most days.</em><br>	The COVID-19 pandemic has been a nightmare for everyone associated with nursing facilities, with the most severe devastation landing on their residents.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/MedDirect0720.jpg" style="BORDER:0px solid;" />	COVID-19;Infection Control	Medical Director Focus

A Smarter Health Benefit Option	https://www.providermagazine.com/Articles/Pages/A-Smarter-Health-Benefit-Option.aspx	A Smarter Health Benefit Option	<h4><span class="ms-rteForeColor-2">ADVERTORIAL</span><br></h4><p>The predicament is twofold. Long term and post-acute care (LT/PAC) providers need to attract and retain quality staff while offering competitive wages at a time of tight margins, occupancy challenges, and uncertain reimbursement from state and federal sources.<br></p><p>At the same time, potential employees and active frontline workers across the country require health insurance benefits that do not have crippling deductibles, which can rapidly siphon off hard-earned wages or curtail access to health care because of economic concerns.<br></p><p>Enter American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Insurance Solutions and its broker partner, Compass Total Benefit Solutions.<br></p><h2>Plan Designed for LT/PAC</h2><p>The pairing now offers a variety of employee health insurance programs designed for the LT/PAC profession, including a new minimum essential coverage plan (MEC) for only $161 per month that provides the most commonly utilized health benefits employees want, with copays they can afford, and also meets the Affordable Care Act (ACA) individual mandate. <br></p><p>Nick Cianci, president of Compass Total Benefit Solutions, says AHCA/NCAL Insurance Solutions feature not only health insurance options, but group and voluntary benefit packages, an aggressive Stop-Loss insurance program, the aforementioned MEC plans, as well as cloud-based Human Resource platforms that will help AHCA/NCAL members achieve savings and greater efficiencies on employee health benefits.<br></p><p>On the MEC product—the Compass Plan—Cianci says from an employer perspective, the health insurance package gives employers another option to use as a recruiting and retention tool that costs the owner/operator exactly $1 an hour for a typical full-time employee on top of whatever wages are being offered.<br>“As an employer, you can subsidize this from 0 percent to 100 percent if you want to make it so that you can recruit off the offering,” Cianci says. “And, it can be for part-time or full-time workers.”<br></p><p>Cianci says the MEC plan was specifically designed with long term care staff members in mind. “It was developed to help long term care employees who cannot afford traditional ACA-compliant plan premiums, or the high deductibles associated with many ACA plans. Even though traditional ACA-compliant plans are classified as ‘affordable,’ they are not an option that many long term care employees can afford,” he says. </p><h2>A Recruitment Tool </h2><p>Cianci notes that the Compass Plan, which features two tiered options to choose from, originated a few years back as a solution for a LT/PAC provider in need of a recruitment tool.<br></p><p>“An AHCA/NCAL member came to me and said he had been putting ads in newspapers offering to pay a little higher than everyone else, but he still could not get people to apply. He asked, what can we do, and I said, ‘Well, what are you paying, $12.50 an hour? What’s minimum wage, $12? Okay, so you’re paying a little more than minimum wage, and just beating McDonald’s.’”<br></p><p>Instead of upping the wage range 50 cents or so to top a fast food company’s wages, Cianci suggested instead that the provider keep his salary around $12 an hour but add <br>a free health care plan that would add around $1 to total compensation. From this idea came a lot of work to come up with the Compass Plan, which adheres to the ACA, <br>keeps employers happy with its low costs, and satisfies employees.<br></p><p>Cianci explains that the traditional ACA-compliant plan is a major medical plan with an affordable premium, but one that includes a not-so-easy-to-afford high deductible. For an employer, putting the Compass Plan as an option to the major medical plan makes sense.<br></p><p>“A provider can make it a third option. You don’t displace your current options because your employees like those as some of them are going to need them. So, what you do is you layer this right in, and it becomes another option for employees who don’t need the more expensive coverage,” he says.</p><h2>What Is the Plan?</h2><p>The MEC plan is run by a third-party administrator, the entity that processes claims and distributes health insurance cards to members who choose this option. The plan includes a national network of 960,000 providers, and also includes the Teladoc Health telemedicine benefit that is free and unlimited 24/7, 365 days a year for anyone on the plan.<br></p><div class="ms-rteElement-BlockQuoteRight">“You can get as many consults as you want with Teladoc, which is important because some of these rural areas that LT/PAC providers are in makes this a very helpful benefit,” Cianci says.<br></div><p>Copays for regular doctor visits are $20 and for specialists the copay is $50 per use for up to three times a year, per person. Three Urgent Care visits per year, per person on the plan are also billed at a $50 copay, he says.<br></p><p>Annual physicals and mammogram visits are 100 percent covered in the plan as well.<br></p><p>“This plan is not designed for the very sick person, but for someone who has minimal needs as they go and who cannot afford the $6,000 deductible,” Cianci says. There are, he adds, provisions for X-rays, blood work, and full coverage for COVID-19 testing.<br></p><p>Prescription drugs are also included in the plan, with a six-tier offering, including select generic pricing at $1 per script. <br></p><p>“For major medical needs, the standard plan would say if you’re admitted to the hospital it’s a $1,000 indemnity benefit automatically, and it’s $200 per day for up to a 10-day stay. There also might be an anesthesia benefit, or a surgery benefit based on the state involved, but we designed Plan 2 to cover roughly 70 percent of the traditional labor and delivery,” he says.<br></p><h3 style="text-align:center;">Snapshot of Other Benefit Details</h3><p>Below are some quick answers to other likely questions about the Compass Plan. <br><strong>Q: </strong>Can employees enroll directly into this plan?<br><strong>Cianci:</strong> This is a group health insurance benefit so it must be offered by an employer for the employee to enroll. There must be a minimum of 10 employees on the plan as well.<br><strong>Q:</strong> Can Compass help with the enrollment process?<br><strong>Cianci:</strong> Absolutely. We have teams across the country that help enroll employees. We utilize communication tools like ringless voicemails, text messages, and online scheduling to educate and enroll employees in all the benefits that we offer through the Insurance Solutions Program.<br><strong>Q: </strong>How have benefits changed during the COVID-19 crisis?<br><strong>Cianci:</strong> The biggest thing that members need to know is that communication is key. Your employees need to be supported now more than ever. We currently aren’t doing face-to-face enrollments at any facilities. We utilize a virtual call center with a recorded line to educate and take elections for all benefits. We also now include COVID-19 testing in the plan.<br></p><p>To explore the Compass Plan, go to the Member Benefits section of the AHCA portal at <a href="http://www.ahcabenefits.org/" target="_blank">www.AHCABenefits.org</a>. Members can also call Cianci at 202-898-2841 or email <a href="mailto:Nick@compasstbs.com" target="_blank" title="Email Nick!">Nick@compasstbs.com</a>. <br></p>	Nick Cianci, president of Compass Total Benefit Solutions, says AHCA/NCAL Insurance Solutions feature health insurance options, group and voluntary benefit packages, and much more.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/Compass_advert.jpg" style="BORDER:0px solid;" />	Caregiving;Management	Special Feature		47	7
Annual Celebration Takes on Deeper Meaning	https://www.providermagazine.com/Articles/Pages/Annual-Celebration-Takes-on-Deeper-Meaning.aspx	Annual Celebration Takes on Deeper Meaning	<p><img src="/Issues/2020/July/PublishingImages/HilaryMasthson.jpg" alt="Hilary Masthson, Nazareth Home Clifton" class="ms-rtePosition-1" style="margin:10px;width:215px;height:287px;" />Held annually since 1967 and kicking off on Mother’s Day, National Skilled Nursing Care Center Week (NSNCW) was celebrated during the week of May 10-16 this year. The observance is sponsored by the American Health Care Association (AHCA) and recognizes the role of skilled nursing centers in caring for America’s seniors and individuals with disabilities.<br></p><h2>Not Conceding to Crisis</h2><p>Many plans and activities were in place well before the first news of the COVID-19 crisis. Because nursing centers were among the first and hardest hit by the pandemic, there was thought of canceling or postponing NSNCW. <br></p><p>However, along with the devastating news and growing crises in many nursing centers, there were also stories about the life-saving efforts of frontline staff and their dedication to protecting the residents in their care. <span><img src="/Issues/2020/July/PublishingImages/Mary_resident.jpg" alt="resident" class="ms-rtePosition-2" style="margin:5px;width:238px;height:316px;" /></span></p><p>Recognizing the amazing work of certified nurse assistants, nurses, food service workers, and other nursing center staff members is at the root of NSNCW, and for this reason, despite the challenges of these uncertain times, the event went forward as scheduled.<br></p><h2>Sharing Their Wisdom</h2><p>Each year there is a special theme for NSNCW with activities and events that build on it. In February, AHCA announced that this year’s theme, Sharing Our Wisdom, would focus on the collective wisdom that residents can offer and share. Centers were encouraged to showcase the insight and wisdom of seniors, those living with dementia, and people with developmental and intellectual disabilities.<br></p><p><img src="/Issues/2020/July/PublishingImages/WisdomTree.jpg" alt="Wisdom Tree" class="ms-rtePosition-1" style="margin:0px;width:253px;height:189px;" />While not all centers were able to celebrate the week, others pivoted, adapted, and got quite creative. Despite social distancing rules and the inability of friends and family to enter the buildings, nursing centers across the country developed wonderful ways to honor their staff and residents during NSNCW.<br></p><p>Photos and stories, shared via Twitter and Facebook, depict activities and events ranging from fun and uplifting, like ice cream deliveries, line dancing, costume parties, contests, and raffles, to opportunities for connection, such as drive-by caravans, live outdoor concerts, hallway games, and social media visits with loved ones.<br></p><p>Building on the theme, residents in many nursing centers created signs and posters with messages of advice for young people that ranged from humorous to profound. Another center adapted plans for a project connecting residents with high school students before COVID-19.<br></p><p>“Since then, it has taken on so much more meaning to all of us to get wonderful advice and insight from our seniors on how to handle life’s challenges,” says Becky Greenberg, director of activities at Bradford Ecumenical Home, where residents shared words of wisdom to graduating students via notecards. <br></p><p>Common advice themes included treating others with kindness, having patience, working hard, thinking positively, and having fun.</p><h2>Honoring Staff</h2><p>Looking toward the future, one center created and buried a time capsule with pictures and stories to be read 25 years from now. In many states, governors signed special NSNCW proclamations, and, in others, elected officials sent heartwarming videos and messages of gratitude and support to health care workers and nursing center staff.<br></p><p><img src="/Issues/2020/July/PublishingImages/MercerCollage.jpg" alt="Mercer College" class="ms-rtePosition-1" style="margin:10px;width:350px;height:263px;" />In the words of Pamela Fink, assistant executive director at Mercer Nursing & Rehabilitation Center, “The inspiration for [the collage, left] came from some of the negative reporting, or in a lot of cases, a lack of reporting on the endeavors of nursing homes to provide excellent patient care as well as prevent the current pandemic. <br></p><p>“Long term care employees do not chose this profession for love of the money, but rather because they have a calling: a calling to take care of others. We are guests in these residents’ homes, not places to work. We are blessed with taking care of someone’s grandparent, parent, uncle, aunt, friend, sibling. We are in long term care because we care.” <br></p><p>Although the week was recognized in many unique and creative ways, the primary focus in every center was to honor and recognize the commitment and dedication of nursing center staff, especially during these hard times, and to celebrate the lives of residents in their care. <br></p><p>To view all the many ways that NSNCW was recognized this year, please visit #NSNCW, <a href="https://www.facebook.com/hashtag/NSNCW" target="_blank">Facebook.com/#NSNCW</a>, and <a href="https://www.ahcancal.org/events/national_skilled_nursing_care_week/Pages/default.aspx" target="_blank">NSNCW.org</a>. <br><br><em>Lisa Hohenemser is marketing manager for the American Health Care Association.</em></p>	The observance is sponsored by AHCA and recognizes the role of skilled nursing centers in caring for America’s seniors and individuals with disabilities.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/balloons.jpg?RenditionID=5" style="BORDER:0px solid;" />	Caregiving;COVID-19	Special Feature	Lisa Hohenemser	47	7

AHCA/NCAL Tells House Panel LTC Still in Need of Resources to Fight COVID	https://www.providermagazine.com/Articles/Pages/AHCA-NCAL-Tells-House-Panel-LTC-Still-in-Need-of-Resources-to-Fight-COVID.aspx	AHCA/NCAL Tells House Panel LTC Still in Need of Resources to Fight COVID	<p>After a hearing on June 11 of the House Select Subcommittee on the Coronavirus (COVID-19) Crisis, the skilled nursing and assisted living profession told lawmakers that long term care (LTC) operators remain in need of vital resources like virus-testing capabilities and personal protective equipment (PPE).<br></p><p>Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said nursing facilities and assisted living communities have been on the frontlines of the fight against COVID-19 and appreciate today’s “robust” discussion about the pandemic and all they are doing to safeguard those in their care. <br></p><p>“Our heroic caregivers are working around the clock in the face of extraordinary circumstances to protect our residents. Thanks to their tremendous sacrifice, the majority of those who are infected—despite being extremely vulnerable to the virus due to ongoing health conditions—make a full recovery,” he said.<br></p><p>However, to ensure more recoveries and prevent future spread, LTC providers must have the resources they need, Parkinson said. <br></p><p>“Our greatest challenge remains lack of widespread testing, adequate PPE, and staffing support. We appreciate the renewed focus in prioritizing testing and PPE for nursing homes and assisted living communities, but more must be done,” he said. <br></p><p>“Lack of proper funding for these critical supplies puts our caregivers and the residents they care for at a severe disadvantage.” <br></p><p>Still, Parkinson told lawmakers it is not too late to make improvements. “The health and well-being of our residents and caregivers will always be our highest priority, and we look forward to continuing to work with lawmakers to help meet these critical needs.”<br></p>	Parkinson, president and CEO of AHCA/NCAL, said nursing facilities and assisted living communities have been on the frontlines of the fight against COVID-19 and appreciate today’s “robust” discussion about the pandemic and all they are doing to safeguard those in their care.	2020-07-01T04:00:00Z	<img alt="" src="/PublishingImages/Headshots/MarkParkinson.jpg" style="BORDER:0px solid;" />	COVID-19
Assisted Living Fights Coronavirus, Urges Access to Testing, Personal Protective Equipment	https://www.providermagazine.com/Articles/Pages/Assisted-Living-Fights-Coronavirus,-Urges-Access-to-Testing,-personal-protective-equipment.aspx	Assisted Living Fights Coronavirus, Urges Access to Testing, Personal Protective Equipment	<p>Assisted living communities continue to battle the COVID-19 pandemic by deploying the same limitations on visitors and other screening and infection control practices seen in skilled nursing facilities, but Scott Tittle, executive director of the National Center for Assisted Living (NCAL), says operators need access to testing and supplies to maintain high-quality resident care.<br></p><p>“The story is no different for our providers. There is not adequate access to PPE and testing in assisted living,” he tells <em>Provider</em>.<br></p><p>PPE refers to the personal protective equipment staff inside assisted living communities need to wear to prevent infections during the pandemic, including masks, gowns, and other supplies.<br></p><p>As for the issue of testing, Tittle says new data from the American Health Care Association (AHCA)/NCAL said the combined cost for COVID-19 testing of every resident and staff of assisted living communities in addition to nursing facilities would tally $672 million nationwide. For assisted living alone, the cost to do such testing would amount to $232 million.<br></p><p>AHCA/NCAL supports testing every resident and staff of skilled nursing facilities and assisted living communities, but ongoing testing carries unsustainable costs without continued support from federal and state governments, he says.<br></p><p>“With seniors among those most susceptible to the virus, the assisted living profession, in particular, is facing historic challenges when it comes to our most sacred charge—the health and safety of our residents,” Tittle says.<br></p><p>“Unfortunately, shortages of testing and PPE continue to be a challenge nationwide, and because assisted living communities are not medical facilities, they have not been prioritized for testing or supplies. We encourage our elected leaders to prioritize our most vulnerable and those who care for them in all long term care settings.”<br></p><p>Moving forward, he says, there is no doubt that fighting the pandemic has been “incredibly challenging” for operators. “The amount of resources that assisted living operators are dedicating to this crisis is immense. They have had to purchase high-priced PPE at unanticipated volume, adapt their operations for more one-on-one care to keep residents protected from spread, and offer ‘hero pay’ to caregivers as well as hire additional staff,” Tittle says.<br></p><p>In addition to the financial strain of operating buildings right now under tight visitation rules and precautions to prevent virus spread, AHCA/NCAL is very concerned about litigation issues.<br></p><p>“You think about the need for seeking immediate protection at the state and federal level from misguided lawsuits,” Tittle adds. “We understand that loved ones are grieving and looking for answers, but this is an unprecedented public health crisis, and caregivers are doing everything they can with limited resources and the information they have. Providers or individual staff members who were following government guidance should not be held responsible for their good faith efforts during this once-in-a-generation pandemic.”<br></p><p>Since the start of the current crisis, Tittle says assisted living has been on the frontlines working to manage, control, and eliminate the virus from buildings all across the country and will remain vigilant even as states gradually loosen lockdown protocols in the coming weeks and months.<br></p><p>“I think as we move forward, one thing that needs to be shared is this thought we’re not going back to the same normal that we were before. That’s acutely true in long term care. I know other business lines are very anxious to open up and have customers, but we are uniquely positioned in how this virus attacks and impacts the most vulnerable of our population.”<br></p><p>Tittle says assisted living, from owners to staff in the buildings, are doing everything that they can to persevere over the coronavirus, and “there are incredibly heroic stories about how staff are taking on double shifts or they’re actually moving into facilities and staying there overnight to help fight the battle.”<br></p><p>What about the future? Tittle says people looking at assisted living communities as a place to call home need to look beyond the headlines and explore the options themselves, as best as possible.<br></p><p>“I think the best thing people can do is to evaluate the amount of spread in their surrounding community and contact the facility directly to learn what’s going on inside the building and how they’re adapting to protect residents,” he says.<br></p><p>And, some facts about life inside assisted living communities play to the new normal that has taken hold with the virus, Tittle notes.<br></p><p>“Assisted living by its nature sees most residents in individual rooms, so that can help reduce spread already,” he says. “I know our operators are doing everything they can to be sure they are providing environments that are safe not only for residents and families but for their employees.”</p>	PPE refers to the personal protective equipment staff inside assisted living communities need to wear to prevent infections during the pandemic, including masks, gowns, and other supplies.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/0720_News3.jpg" width="612" style="BORDER:0px solid;" />	COVID-19;Workforce
COVID-19 Battle Shines Spotlight on Medicaid Funding Gap	https://www.providermagazine.com/Articles/Pages/COVID-19-Battle-Shines-Spotlight-on-Medicaid-Funding-Gap.aspx	COVID-19 Battle Shines Spotlight on Medicaid Funding Gap	<p>For Steve Miller, president of Bridgemark Healthcare, the challenges in leading a long term care operation during the COVID-19 pandemic have focused on providing the quality of care necessary to prevent virus infections in buildings and, if there are infections, to manage residents back to health without having further spread.<br></p><p>Bridgemark, which has a total of 19 skilled nursing and assisted living communities in Illinois and Missouri, has been fighting the COVID-19 pandemic like all of the other skilled nursing and assisted living communities across the nation, and, like many, the ability to care for residents and keep buildings and equipment up to par is a question of finances.<br></p><p>Miller says the payer mix, all-in, for Bridgemark, is 15 percent Medicare and 58 percent Medicaid, with a mix of other reimbursement coming from areas like veterans programs and private-pay. The company cares for about 1,969 residents.<br></p><p>As most understand in the long term care business, the difference in reimbursement between Medicare and Medicaid is stark, with many operators subsisting only because Medicare has paid enough to account for what has been a perennial problem of insufficient Medicaid payments to providers.<br></p><p>Miller says the rates in Illinois for his Medicaid skilled nursing facilities (SNFs) historically averaged $149 per patient, per day and $164 in Missouri, which both leave the provider with a $30 to $50 per patient/per day shortfall when comparing the reimbursement to the actual cost of caring for a long term care resident.<br></p><p>“I’ve never experienced consistent cost coverage from our Medicaid rates,” he says, noting this shortfall is before any additional costs are considered for caring for residents during the pandemic, such as huge increases in the use of personal protective equipment, extra staffing hours and pay, and changes in operations to prevent infections.<br></p><p>During normal times the Medicaid shortfall hits facilities hardest when it comes to daily decisions on upkeep of buildings, for instance. <br></p><p>“The financial adjustments that you make to account for the Medicaid shortfall are obvious when it comes to the physical plant. So, when you go into a Medicaid-driven nursing home in the markets where I operate you are going to see an older building with a lot of tired, worn-out parts, a lot of scrapes and scratches, and a lot of duct tape and bailing wire as they might say,” Miller says.<br></p><p>“You will see that all the time we are constantly behind the curve on physical plant updates and equipment replacement.”<br></p><p>He stresses that the core components of resident care are secure; there are no shortcuts on caring for people in Bridgemark facilities. “We protect the quality of care by ensuring that we put the money that we do have to nursing and CNA [certified nurse assistant] services, and then we try to manage as best we can on the nondirect care operations,” Miller says.<br></p><p>Given all of these shortcomings from the Medicaid payment system, the start of the COVID-19 pandemic just added to the problem. “It’s tough for sure,” Miller says. “The immediate effect we saw almost out of the gate was that short-stay return-to-community admissions essentially turned off overnight,” he says. These individuals are paid for mostly by Medicare and provide healthier payments to providers, he says.<br></p><p>“What that did was lay bare the Medicaid under-funding. The costs of caring for Medicaid residents rose because of the virus, but reimbursement did not, and meanwhile we had lost the offsetting Medicare margins,” Miller says.<br></p><p>One major area that was affected was the cost of staffing as workers are understandably concerned about working in a high-risk environment. Thus, Bridgemark provided premium pay structures to employees working on the frontlines “so that they would be compensated for the risks that they were taking and the stress and strain at a job which was being placed on them,” he says. <br></p><p>That has come at a cost obviously, increasing Bridgemark staffing costs 10 percent to 15 percent within 30 days of the pandemic emergency.<br></p><p>Across the long term care profession, there have been calls by government officials and the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) to test all residents and staff. That also would be costly as new data from AHCA/NCAL said the combined cost for COVID-19 testing of every resident and staff member in assisted living communities, in addition to nursing facilities, would tally $672 million nationwide.<br></p><p>What Bridgemark is experiencing when it comes to Medicaid payment is not new and has been the subject of study for years. For instance, a recent article in JAMA said COVID-19 has exposed longstanding issues in “how nursing home services are structured and financed.”<br></p><p>“Medicare is a relatively generous payer, whereas Medicaid often pays below the cost of caring for these frail and medically complex individuals. Thus, the economics of nursing home care hinges on admitting enough short-term Medicare beneficiaries to cross-subsidize the care of long-term residents with Medicaid coverage,” the JAMA article said. <br></p><p>With the COVID-19 pandemic, there has been a dearth of short-stay Medicare beneficiaries coming into facilities, as hospitals “are not performing elective procedures like joint replacements so patients who would ordinarily require post-acute care are not being referred to nursing homes,” the article said. <br></p><p>This has resulted in increasing difficulty for nursing facilities because of decreased Medicare revenue and the higher COVID-19 costs tied to managing residents, it added. <br></p>	Bridgemark, which has a total of 19 skilled nursing and assisted living communities in Illinois and Missouri, has been fighting the COVID-19 pandemic like all of the other skilled nursing and assisted living communities across the nation, and, like many, the ability to care for residents and keep buildings and equipment up to par is a question of finances.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/0720_News1.jpg" style="BORDER:0px solid;" />	COVID-19
First Data Factoring in Coronavirus Show SNF Occupancy Lower in Spring	https://www.providermagazine.com/Articles/Pages/First-Data-Factoring-in-Coronavirus-Show-SNF-Occupancy-Lower-in-Spring-.aspx	First Data Factoring in Coronavirus Show SNF Occupancy Lower in Spring	<p>Data released by the National Investment Center for Seniors Housing & Care (NIC) offered the first glimpse of the negative impact the coronavirus (COVID-19) has had on seniors housing and, more specifically, skilled nursing facility (SNF) occupancy.<br></p><p>According to the NIC MAP Data Service for April, the first full month of the COVID-19 pandemic in the United States resulted in seniors housing occupancy sliding by a 1.1 percentage point decrease to 88.7 percent, while SNF occupancy was down 2.2 percentage points to 84.7 percent.<br></p><p>The data are featured in NIC’s Intra-Quarterly Snapshot, a new monthly publication developed from NIC MAP data to increase transparency about seniors housing and care during an unprecedented time for the sector, NIC said.<br></p><p>In addition to the latest seniors housing and SNF occupancy data, NIC’s Intra-Quarterly Snapshot shows the percentage change in stabilized occupancy in both property types during the past 13 months, provides key takeaways from NIC’s Chief Economist Beth Burnham Mace, and puts the data in context with broader economic indicators, such as national unemployment, consumer sentiment, and the S&P 500.<br></p><p>“Some of the sharp decline in skilled nursing occupancy is likely driven by fewer hospitals discharging patients to post-acute care settings for rehabilitative therapy as hospitals defer elective surgeries due to the pandemic,” Mace said.<br></p><p>She added that the drop in stabilized occupancy identifies the effects of the COVID-19 pandemic on existing operators without the impact of new competition on market conditions.<br></p><p>NIC said it intends to expand its NIC MAP occupancy data set to include additional metrics, metro-level data, and property type cuts later this summer. Select data will continue to be summarized in NIC’s Intra-Quarterly Snapshot with each data release, they added.<br></p>	Data released by NIC offered the first glimpse of the negative impact the coronavirus (COVID-19) has had on seniors housing and, more specifically, SNF occupancy.	2020-07-01T04:00:00Z	<img alt="" src="/Issues/2020/July/PublishingImages/0720_News2.jpg" style="BORDER:0px solid;" />	COVID-19
HHS Tags $15 Billion in Relief for Medicaid Providers	https://www.providermagazine.com/Articles/Pages/HHS-Tags-$15-Billion-in-Relief-for-Medicaid-Providers.aspx	HHS Tags $15 Billion in Relief for Medicaid Providers	<p>New funds have been allocated for providers reimbursed under the Medicaid program, including long term care operators, as part of the administration’s COVID-19 relief effort. <br></p><p>On June 9, the Department of Health and Human Services (HHS) said it released $15 billion in additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. <br></p><p>“HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation,” the agency said. <br></p><p>In response, Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said, “We applaud the administration for providing specific funding for long term care facilities and other providers who do the valiant work of serving Medicaid beneficiaries.”<br></p><p>He added that “not only are our residents—seniors and those with underlying conditions—most at-risk if they contract COVID-19, but of these individuals, those who also rely on Medicaid are especially vulnerable due to the program’s notorious underfunding for care.”<br></p><p>These nursing care centers, assisted living communities, and intermediate care facilities for individuals with intellectual disabilities urgently need these resources from the federal government to acquire testing, equipment, and staffing to protect their residents, Parkinson said. <br></p><p>“We appreciate the administration recognizing this need and hope they expedite the aid to our heroes on the frontlines.”<br></p><p>In announcing the new funding, HHS Secretary Alex Azar said, “health care providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19.” <br></p><p>At the same time, HHS said it is also launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. <br></p><p>The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data are submitted, including information about the number of Medicaid patients these providers serve.<br></p><p>For updated information and data on the Provider Relief Fund, visit <a href="http://hhs.gov/providerrelief" target="_blank">hhs.gov/providerrelief</a>.<br><br></p>	New funds have been allocated for providers reimbursed under the Medicaid program, including long term care operators, as part of the administration’s COVID-19 relief effort.	2020-07-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/healthcare_finance.jpg" style="BORDER:0px solid;" />	COVID-19;Finance

Vice President of Culinary Experience and Operations	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=26	Vice President of Culinary Experience and Operations				<img alt="" src="/Issues/2020/July/PublishingImages/MohamedTarawneh.jpg" style="BORDER:0px solid;" />	Chef Mohamed Tarawneh	Senior Living Community
President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=27	President				<img alt="" src="/Issues/2020/July/PublishingImages/DavidNace.jpg" style="BORDER:0px solid;" />	David Nace, MD, MPH, CMD	AMDA – The Society for Post-Acute and Long-Term Care Medicine

July 2020

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People On The Move