November 2020

Vol. 47 No. 11

November

Cover Story

https://www.providermagazine.com/Issues/2020/November/Pages/Helping-the-Heroes-of-Long-Term-Care.aspx

Helping the Heroes of Long Term Care

There is no shortage of heroes in long term and post-acute care. The moments they shine span from when a resident has a happy moment in their day to when a patient heads back home recovered. The COVID-19 pandemic may be their biggest trial yet, challenging their super strengths personally and professionally. The leaders who stand with them have found creative ways to support them, encourage them, and cheer them on to the virus’ finish line. <h2>An Unprecedented Time</h2>Rosedale Green, a 176-bed nursing facility located in Covington, Ky., was hit hard by the COVID-19 pandemic before there was testing. It started when a patient returned from the hospital with some respiratory issues, and it ended up being COVID-19. “We assume that’s where the initial outbreak started,” says Londa Knollman, executive director of Rosedale. “Our Memory Support household was significantly impacted in a very short time frame. As staff members and residents became sick with COVID, we had several staff just walk out because they were afraid to be in this career.” It was very scary in the beginning; no one knew anything about it, she says, “but we made it through on all this positive community support.” Rosedale Green has been a staple of the greater Covington community for 50 years. “We were overwhelmed by the encouragement we received,” says Knollman. “Our families, local hospital, and community at large supported our efforts in responding to the pandemic crisis.”<h2>Sweeping Through</h2>In Talladega, Ala., the virus started a little later at Rehab Select at Talladega, a 236-bed skilled nursing facility, but like Rosedale, it swept through quickly. <img src="/Issues/2020/November/PublishingImages/1120_RehabSelect.jpg" alt="Rehab Select" class="ms-rtePosition-1" style="margin:5px;width:292px;height:202px;" />At the beginning of the COVID-19 pandemic in March, the center did not have any cases. After the July 4th holiday, however, that changed. “We had a blossom,” says Suellen Tobler, administrator. “It just started going through the building. We wound up having quite a few residents who tested positive.” Tobler and her team opened an isolated COVID-19 unit. A smaller number of staff than residents also tested positive. The center also opened a persons-under-investigation unit for those who are running a fever or who have been exposed; the team monitors and tests residents in the unit. “Once we had testing in place and these units set up, we were able to get it to where we could manage it,” says Tobler. In recent weeks Talladega has had four residents and three staff members test positive. The community rate for COVID-19 in Talladega is high, at 11.8 percent. “Because of that, we are testing our staff twice a week, and that helps us identify anything quickly,” says Tobler. “Any staff members who may have caught it in the community, we can catch that and keep that staff member from coming into the building, so that also helps a lot.” The community rate for COVID is tested on a weekly basis, says Tobler, which then determines how often the center is required to test. Screening processes are in place at the door, and any staff member who displays a fever or symptoms is tested and sent home. “The test goes out at 1 p.m. and the results come out by 3 a.m., so we get this back before the next day, within 24 hours,” says Tobler. Those staff members who receive a positive result receive a phone call letting them know and begin a 14-day quarantine in which they are not allowed back into the center. The staff member is tested on day 14 and then 72 hours later, and both tests must be negative in order for the person to return to work.<h2>Pay for Heroes</h2>One way Knollman and her team helped staff was by offering Pandemic Pay, an additional hourly incentive, to all frontline workers. “This was to help staff with all they were dealing with—the amount of time they are putting on PPE [personal protective equipment], working with two and three layers of it on, in addition to the burden that some of them were staying away from their families or their families were staying in other places,” says Knollman. “So we offered an hourly incentive for them dealing with all the emotional issues that were going on while they were working during the pandemic.” Talladega also provides Hero Pay, an additional hourly incentive, for all staff and provides meals in house so staff members do not have to go out in the community. “We’ve also done staff education about community exposure to the virus and how to stay safe,” says Tobler. Staff are asked to report back if they have attended events such as funerals or weddings or traveled out of town, and they are tested accordingly. <h2>Community Steps In</h2><img src="/Issues/2020/November/PublishingImages/1120_staff-sundae-bar.jpg" alt="Sundae bar" class="ms-rtePosition-1" style="margin:5px;width:214px;height:278px;" />Rosedale Green also provides staff with free lunches, and Knollman says Northern Kentucky community groups have overwhelmingly donated snacks, drinks, full meals, and even an ice cream sundae bar. On Mother’s Day, the center hosted a family parade where a number of family members drove their cars by the center while residents looked on from their windows. Signs were posted in the windows allowing family members to find their loved ones and see where they were located. One of the residents had put a sign in her window that read, “Bring Chick-fil-A.” The resident’s grandson snapped a photo of the sign, and it went viral, says Knollman. A mother’s group from the Covington community took notice and called Rosedale, sharing that one of their members had a connection with Chick-fil-A and wanted to help. The group then organized a complete line station that included a catered meal for every staff member and resident. The vendor community also wanted to step in. One vendor put together relaxation baskets for the staff, and a Mary Kay representative collected donations and presented staff with hand lotions to combat hand dryness from hand-washing, says Knollman. “It was really something to see how everyone rallied around the staff,” she says. Staff also band together to plan activities to foster fun and relaxation during this stressful time. Rosedale has a Fun Bunch—a cross-section of employees who meet and plan activities for staff on an ongoing basis. One of those activities was Taco Tuesday where staff ate tacos from Taco Bell and enjoyed games with prizes. At Talladega Rehab Select, Tobler puts on Fun Fridays every week to recognize staff for their hard work and dedication. It’s complete with giveaways, prizes, and encouragement to show staff they are appreciated. “We had fortune cookies Friday and talked about how fortunate we are to have the staff,” says Tobler. “This is really about letting the staff know that we’re here, we know this is hard, and we are going to help them through it.”<h2>Getting Better</h2>In a world where the COVID-19 pandemic is a terrifying reality, some things have gotten better for staff, says Knollman. The availability of COVID testing has made a big difference. Whereas in the past staff would try to determine if a resident had COVID or some other condition, such as allergies or the flu based on symptoms, now testing is readily available in Kentucky. “The state of Kentucky is paying for all of the testing for us right now, and we are very fortunate,” says Knollman. <img src="/Issues/2020/November/PublishingImages/1120_family-staff-thank-you.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:232px;height:345px;" />“Today, we can test quickly and receive results in less than 48 hours.” For staff, testing is completed and delivered to a lab that runs the test and provides the results. Testing occurs every week for staff, and new hires, essential medical personnel, and others allowed in the building must go through the center’s testing procedures first. “Anyone who hasn’t been a part of our weekly testing we test in advance before they are allowed in,” says Knollman. Recently, Talladega adopted the Rapid Test, provided by the Centers for Medicare & Medicaid Services (CMS). Instead of sending the test to a lab and waiting for a result, the swab used in the test is placed on a card, and after 15 minutes, the result appears. <h2>Rising to the Occasion</h2>Staff at Rosedale not only rose to the challenges brought on by COVID but asked what else they could do. “When you go through a crisis, you really figure out where your team is,” says Julie Price, community relations director at Rosedale. “People who would stay normally until 4 p.m. or 5 p.m. would stay till 9 p.m. or 10 p.m. just checking in on others. Our governor’s tagline through this entire time was, ‘We will get through this together,’ and we certainly adopted that here. We had Kentucky blue t-shirts that featured the quote made for all staff members.” For a period of time, Price was mostly focused on doing thoughtful things for the staff. This included finding a cartoonist to draw portraits of the staff as superheroes. It was a superhero-themed day featuring snacks, lunch, and other activities. Staff were surprised to find Healthcare Hero signs in their yards at home. Rosedale hosted wellness events for staff that offered information on how to deal with stress, focus on one’s own needs, and other self-care topics. A walking program was also created, and staff could log their miles in an app and enter to win prizes for their progress. <h2>Becoming Everything</h2>“Through all this, a couple of the staff members all of a sudden become your everything, and they are there to do whatever you need them to do,” says Knollman. “It’s those staff members who, when they are done with their shift, are standing outside your office asking, ‘What else can I do so you can get home, too?’” <img src="/Issues/2020/November/PublishingImages/1120_Taco-Tuesday.jpg" alt="Taco Tuesday" class="ms-rtePosition-1" style="margin:5px;width:214px;height:272px;" />Like many centers, Rosedale now manages a majority of doctor visits via telehealth platforms, and it’s been an adjustment for staff. Social visits with families take place online, too, and Rosedale purchased additional iPads with a grant from CMS. “Coordinating these visits became pretty much everyone’s role,” says Knollman. “If you were going into a resident’s room, you were likely going to be using an iPad and FaceTime.”<h2>Keeping Up the Momentum</h2>Being a health care superhero comes at a cost, especially when taking extreme precautionary measures with the most vulnerable people and going the extra mile are the new normal. Questions arise, such as how a leader helps to keep the momentum going. Knollman says it takes leaning on the leadership team. “This affects everyone, including leaders,” says Knollman. “We all have down moments, which is why it takes recognizing that you have to lift each other up and look out for each other. “That could be a nurse saying, ‘OK, this is going to be my down day,’ or ‘John needs a down day.’ Or it could be an administrator who says to a staff member, ‘I’m going to ask you to stay home so that you can be a cheerleader tomorrow.’ “When everybody is going 24/7 at 115 miles an hour, everyone’s going to get burned out at the same time. What we have to do is look out for each other and say, ‘As much as I know it’s going to be hard for you not to be here or to leave early, you are tired and you need to go rest.’” Tobler sees parallels with COVID-19 and HIV, and staff need ongoing encouragement. “There’s a little bit of fear that echoes back years ago when we dealt with AIDS and HIV,” she says. “So we are out front with education and communication. If someone tests positive, we say it. We encourage them to keep up the great work with handwashing and using PPE. We always say, let us know about any issues, no matter what they are. It’s making sure that the staff know that knowledge and communication are powerful, and these things are here to protect you.” The best advice Tobler has is to keep up the communication with staff on changing regulations and praise for staying on top of it all, because it’s a lot. “We recognize when cases are identified, when people recover, everything,” she says. “We say, ‘Great job on disinfecting those high-touch surfaces, on wearing your PPE.’ It’s staying on top of their progress and letting them know they are doing a good job.” READ MORE: <a href="/Issues/2020/November/Pages/Need-Necessitates-Changes-in-Protocol.aspx" target="_blank" title="Need Necessitates Changes in Protocol">Need Necessitates Changes in Protocol</a>

Leaders share how they support caregivers on the frontline of the COVID-19 pandemic.

2020-11-01T04:00:00Z

Workforce;COVID-19

Taking Care of the Heroes	https://www.providermagazine.com/Issues/2020/November/Pages/Editor's-Desk.aspx	Taking Care of the Heroes	<p>Staff members of long term and post-acute care facilities have been severely challenged ever since the advent of the COVID-19 pandemic, and their no-less-besieged leaders have gone to great lengths to support them, says Managing Editor Amy Mendoza in this month’s cover story. COVID or Hero Pay supplements are offered, as well as meals and events to recognize and reward staff for their hard work and dedication. Community groups have also contributed with relaxation baskets and snacks, drinks, and full meals.<br></p><p>In a new Best Practices feature, Greg Dowdy takes on leadership and team building during times of crisis. He explains the advantages of versatility in core leader strengths, how to find reinforcements from within the ranks, and the value of providing hands-on assistance to the frontline team.<br></p><p>With CMS guiding states toward reinstating the full annual survey process, Management author Kris Mastrangelo takes readers through the Facility Wide Resource Assessment elements, from census and types of care needed for the facility population, to resources, both physical and personnel. She also suggests visual aids to help the surveyor gain a quick understanding of the resident demographic.<br></p><p>In spite of the pandemic, many communities were able to celebrate National Assisted Living Week—sponsored by the National Center for Assisted Living—in September. In a special feature, Lisa Hohenemser describes some of their imaginative events: facemask fashion shows, ice cream truck deliveries, community caravans, cook-outs, dress-up days, and window visits from families and friends.</p>	Staff members of long term and post-acute care facilities have been severely challenged ever since the advent of the COVID-19 pandemic.	2020-11-01T04:00:00Z	<img alt="" src="/SiteCollectionImages/Joanne-Erickson.jpg" style="BORDER:0px solid;" />		Editor's Desk
Nursing Home Surveys and the Facility Assessment	https://www.providermagazine.com/Issues/2020/November/Pages/Nursing-Home-Surveys-and-the-Facility-Assessment.aspx	Nursing Home Surveys and the Facility Assessment	<p><img src="/Issues/2020/November/PublishingImages/1120mgmt_bar-graph.jpg" alt="All facility CMI trend 2020" class="ms-rtePosition-2 ms-rteImage-0" style="margin:5px;width:595px;height:208px;" />Earlier in the days of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) issued a March 23 Quality, Safety, and Oversight memo that limited annual state survey activity to focused infection control surveys.<br></p><p>However, CMS’ latest Aug. 17 directive instructed states to return to the normal survey process as soon as resources in the state allowed and in accordance with states’ COVID-19 reopening plans. <br></p><p>As states move forward in reinstating the original survey process, it is important to prioritize the comprehensive completion of the Facility Wide Resource Assessment (F490).</p><h2>Be Ready</h2><p>When state and federal surveyors arrive on site for annual inspections and immediately request multiple pieces of information, the facility should be ready to hand them an organized Facility Assessment binder or PDF version with table of contents containing current, concise, and precise information about the facility’s patient population, resources, and risk assessments.<br></p><p>Per the regulations, the Facility Assessment is beneficial to determine the:<br></p><ul><li>Appropriate resources to care for residents during day-to-day operations and in emergencies; and</li><li>Specifics consisting of census, facility resident capacity, types of care considering resident population, types of diseases, staff competencies required with emphasis on resident population, cultural aspects, resources (personnel and equipment), services provided (therapy, pharmacy), contracts, memorandums of understanding, and health information technology resources, to name a few.</li></ul><p>Think about it this way: The provider is handing the surveyors everything they need to know about the clinical needs of the patient population and the descriptions of what resources are needed to care properly for the residents in that facility. </p><h2>Specifics Matter</h2><p>Effort and completion of the Facility Assessment vary across the country. Sometimes, the document is revised once per year. Other times, the document is updated on a regular basis, that is, multiple times within a year. Either way, be sure the content is accurate. Otherwise, surveyors may perceive the entire process with biased impressions that are not in the favor of the facility. <br></p><p>For example, take the patient population section. The patient population is the facility’s resident population, including but not limited to:<br></p><ul><li>Both the number of residents and the facility’s resident capacity; </li><li>The care required by the resident population considering the types of diseases, conditions, physical and cognitive disabilities, overall acuity, and other pertinent facts that are present within that population; </li><li>The staff competencies that are necessary to provide the level and types of care needed for the resident population; </li><li>The physical environment, equipment, services, and other physical plant considerations that are necessary to care for this population; and </li><li>Any ethnic, cultural, or religious factors that may potentially affect the care provided by the facility, including but not limited to activities and food and nutrition services. </li><li>Some questions to ask about the information in the assessment include:</li><li>How does the facility provide a depiction of the overall clinical and acuity conditions? </li><li>Is it represented in a user-friendly manner?<br></li></ul><h2>Population Distribution</h2><p>It might be helpful to start describing the patient population broadly and then offer more details, like showing the percentage distribution of Resource Utilization Group (RUG) categories for the entire patient population. <br></p><p>Summarizing, the percentage of each RUG category and complementing the table with another visual aid may also significantly help the surveyor gain a rapid understanding of the resident demographic. <span><img src="/Issues/2020/November/PublishingImages/1120mgmt_pie-chart.jpg" class="ms-rtePosition-2" alt="Case mix RUG by major categories" style="margin:5px;width:245px;height:245px;" /></span><br></p><p>Granted, with the inception of the patient-driven payment model (PDPM), this metric will morph into Case Mix Groups (CMG) over the next few years.<br></p><p>Coupled with the above RUG distribution, the facility should also track and depict the Case Mix Index (CMI). Each RUG level has an assigned CMI.<br></p><p>The graph above portrays the CMI over a period of time.</p><h2>All Facility Case Mix Index</h2><p>Each PDPM Case Mix Group (CMG) also has an assigned CMI. The higher the number, the higher the complexity and resources required to care for the resident.<br></p><p>Currently, the different insurance payers use different systems, that is, different CMI systems. PDPM CMG is used for Medicare Part A, and RUG Levels are used for Medicaid case mix levels in certain states. <br></p><p>So, when trying to portray the entire facility acuity, providers need to convert the acuity level to one system for all patients. <br></p><p>Next, consider resources, which include:<br></p><ul><li>All buildings and/or other physical structures and vehicles; </li><li>Equipment (medical and nonmedical); </li><li>Services provided, such as physical therapy, pharmacy, and specific rehabilitation therapies; </li><li>All personnel, including managers, staff (both employees and those who provide services under contract), and volunteers, as well as their education and/or training and any competencies related to resident care; </li><li>Contracts, memorandums of understanding, or other agreements with third parties to provide services or equipment to the facility during both normal operations and emergencies; and </li><li>Health information technology resources, such as systems for electronically managing patient records and electronically sharing information with other organizations. </li></ul><p>The Payroll-Based Journal (PBJ) Five-Star Staffing Domain says a lot about the facility. A score lower than four stars creates the impression to the surveyors that the facility is understaffed, when in fact a low PBJ Domain star rating may be a product of:<br></p><ul><li>Late transmission;</li><li>Missed transmission;</li><li>Incorrect transmission;</li><li>Data errors; or</li><li>Noncompliance with the PBJ Audit Requests, to name a few.</li></ul><p>Be sure to properly show the staffing pattern and schedules by unit. Then, it is critical to ensure that the PBJ submission is currently reported and reflected in existing staffing.<br></p><p>In closing, at a minimum, the Facility Assessment requires revisions on an annual basis. However, best practices include ongoing refinements and updates to the document to properly define the patient population and staffing. Obviously, adjustments are necessary in situations in which the facility encounters significant changes in census or services (such as COVID-19). <br></p><p>Harmony Healthcare International highlights the importance of continued Facility Assessment revisions given the direct impact the content has on the survey process. The more accurate the information, the easier it is for surveyors to understand the services provided and perform an appropriate assessment of the quality of care rendered in the facility. <br><br><em>Kris Mastrangelo, OTR/L, LNHA, MBA, is chief executive officer and president of Harmony Healthcare International. She can be reached at <a href="mailto:Kmastrangelo@harmony-health%20care.com" target="_blank">Kmastrangelo@harmony-health care.com</a>.</em><br></p>	With full annual state surveys on their way to reinstatement in the states, it may be time to update the Facility Wide Resource Assessment.	2020-11-01T04:00:00Z	<img alt="" src="/Issues/2020/November/PublishingImages/1120mgmt_pie-chart.jpg" style="BORDER:0px solid;" />	Management;Survey and Certification	Management

Communities Celebrate National Assisted Living Week	https://www.providermagazine.com/Articles/Pages/Communities-Celebrate-National-Assisted-Living-Week.aspx	Communities Celebrate National Assisted Living Week	<p>Held annually since 1995 and kicking off on Grandparents Day, National Assisted Living Week (NALW) was recognized during the week of Sept. 13-19 this year.<br></p><p>This annual observance, sponsored by the National Center for Assisted Living (NCAL), provides a unique opportunity for residents, their loved ones, staff, and volunteers to recognize the role of assisted living in caring for America’s seniors and individuals with disabilities.<br></p><p>During NALW, assisted living communities around the country are encouraged to host events and activities to celebrate the residents they serve.<br></p><h2>Caring is Essential</h2><p>Along with their sister nursing homes, assisted Living communities have been hit hard by the COVID-19 crisis. Despite the devastating stories of loss and social isolation many residents have experienced due to COVID-19, there are also many heartwarming stories about the dedication and compassion of staff members devoted to protecting the residents in their care. <br></p><p><img src="/Issues/2020/November/PublishingImages/1120NALW_BerthaBunny.jpg" alt="Betty Bunny" class="ms-rtePosition-1" style="margin:5px;width:255px;height:255px;" />To acknowledge this commitment, NCAL announced in June that this year’s theme for NALW would be Caring is Essential. Perhaps more relevant now than in any year before, this theme highlights the role of essential caregivers in assisted living—the certified nurse assistants, nurses, food service workers, volunteers, and others—for their unwavering commitment and hard work.<br></p><h2>Honoring Residents</h2><p>While not all senior living facilities were able to celebrate the week, many communities adapted activities and found new and creative ways to honor both staff and residents during NALW. <br></p><p>Through social media posts, pictures, and videos, they shared their NALW stories. Many events were imaginative and fun, such as facemask fashion shows, tattoo and dress-up activities, fall farmer’s markets and pie-throwing contests, window visits from dairy cows to owls, and ice cream truck deliveries.<br></p><p>Other events focused on community connections such as adopt-a-grandparent programs and special messages, posters, and videos from local school children.<br></p><h2>Ingenuity Reigns</h2><p>In previous years, residents of Somerby Franklin Senior Living, Franklin, Tenn., were invited to the Moore Elementary School for a performance. As this was not possible due to COVID, teacher Amber Anderson encouraged her second-graders to create messages of love on posters to “add cheer into the residents’ hallways, rooms, and hearts.”<br></p><p>Connections were also made via community caravans and window visits, in some cases through specially constructed transparent visiting booths. One family even brought a forklift to raise family members to the residents’ windows on the second floor.<br></p><p>Perhaps the most amazing of all were the innovative “hugging devices” constructed in several facilities. These specially designed plastic curtains enabled residents to safely receive a warm embrace from their loved ones.<br></p><h2>Recognizing Staff</h2><p>Honoring assisted living staff members also took many forms during NALW, from pizza parties and cook-outs to dress-up days, dance contests, and games. The week also offered an opportunity for residents to express their appreciation for staff members through notes, cards, and videos with heartfelt messages of gratitude.<br></p><p>At Chandler Park Assisted Living, caregivers received a special video from residents thanking them for their work and proclaiming staff members “a blessing” and “an essential part of their lives.” Similar messages of thanks for essential caregivers came from administrators, local leaders, and government officials.<br></p><p>In many communities, staff members were presented with special goody bags, fun treats, prizes, t-shirts, and other tokens of appreciation.<br></p><h2>Honoring Those Lost to COVID<span><span><img src="/Issues/2020/November/PublishingImages/1120NALW_JulieScott.jpg" class="ms-rtePosition-2" alt="Julie Scott, Omni West" style="margin:5px;width:350px;height:350px;" /></span></span></h2><p>NALW also provided an opportunity to honor the memory of those loved and lost to COVID. A display of 2,428 pinwheels, set up in a Youngstown, Ohio, meadow, was created by staff members at Omni West Assisted Living in memory of assisted living and nursing home residents who have died from the coronavirus in Ohio. <span></span></p><p>“I wanted to honor their memory in a way that would be touching; each pinwheel represents someone’s life,” Omni West Activity Director Julie Scott says.<br></p><p>At Maple Pointe in Rockville Centre, N.Y., a special Rock Garden was created to honor community members lost to COVID. New York Assemblywoman Judy Griffin attended the unveiling of the garden and expressed her gratitude for the “compassionate, diligent, and dedicated staff who worked tirelessly during these challenging times to ensure the safety and well-being of residents,” noting that the new garden was a “beautiful way to honor each resident’s legacy and truly seemed to comfort the community in attendance.” <br></p><h2>Spirit Endures</h2><p>The week was recognized in many wonderful and deeply moving ways with the primary focus of honoring the commitment and dedication of caregiving staff and celebrating the lives of residents in their care.<br></p><p>Despite having opened its door five months into a pandemic, NALW activities at Evergreen Village in Fort Wayne, Ind., went full speed ahead. After a week of celebration, Administrator Amanda Palace noted that “…it takes a village to do just about anything these days, and the village being built here on a foundation of love, compassion, and dignity was solidified last week, and the happiness and positivity was palpable to all who helped us make it a success.” <br></p><p>To learn more or view the many ways that NALW was recognized this year, please visit #NALW, Facebook.com/#NALW, and <a href="http://nalw.org/" target="_blank">NALW.org</a>. <br><br><em>Lisa Hohenemser is marketing manager with the American Health Care Association/National Center for Assisted Living. She can be reached at <a href="mailto:lhohenemser@ahca.org" target="_blank">lhohenemser@ahca.org.</a></em></p>	Across the country, residents and staff honor each other and also have some good times.	2020-11-01T04:00:00Z	<img alt="" src="/Issues/2020/November/PublishingImages/1120NALW_MooreElem.jpg" style="BORDER:0px solid;" />	Quality;Caregiving	Special Feature	Lisa Hohenemser	47	11
Leadership and Team Building During Times of Crisis	https://www.providermagazine.com/Articles/Pages/Leadership-and-Team-Building-During-Times-of-Crisis.aspx	Leadership and Team Building During Times of Crisis	<p>Early in 2020, the long term care world suddenly faced its greatest crisis ever—COVID-19. This crisis quickly changed everything about the way day-to-day activities, care, and business took place in a dramatic fashion.<br></p><p>In the blink of an eye, residents lost traditional group meals and activities and those critical family visits. Now they had “drive-by visits” or “outside the window” visits instead of a good-quality, face-to-face meeting, one that could begin and end with a hug. The one thing that residents now need to be able to count on is the team of caregivers watching over them.<br></p><p>While others were fleeing in panic at the start of the COVID crisis, these heroes got up every day, left their families, and walked into a facility to take care of residents in need. They knew the dangers, including the potential to take the virus home to their own family members. But these caregivers were dedicated, so they got up, geared up, and headed in to work.<br></p><p>So, how does an organization take care of those heroes who, in turn provide quality care for the residents? Here are four suggestions for leadership and team building during times of crisis.<br></p><h3>1. Structure of the Leadership Team</h3><p>Build a versatile, talented, and dedicated leadership team. Leaders are not people who can do everything. But the good ones put together a versatile team that can pretty much do everything. Start by avoiding “yes” folks—those who always agree with the leader. Especially during times of crisis, multiple thoughts are needed; having the traditional “devil’s advocate” onboard is key. Multiple ideas (and plans) must be available to survive in this ever-changing environment. A variety of talents is critical. The detailed planner—the spreadsheet guru, has a place beside the one who “can make just about anything happen in five minutes.”<br></p><p>Leaders all have a variety of talents; one must carefully build a team that has all the traits needed for success. So, the perfect team has the planner and the “make it up on the fly champion,” the driver and the thinker, the creator and the calculator, all making up a complete set of very necessary talents. If one is missing, see section #3 below.<br></p><p>Finally, but most importantly, leaders must leave all their troubles at the door. Nothing should come from a leader as she or he circles the building but positive energy. Negativity will only find its way to the staff and, ultimately, to the residents.<br></p><h3>2. Spirit of the Leadership Team</h3><p>Some organizations thrive on competition. In certain ways, under the correct circumstances, it can help drive results and be a positive motivator. But during times of crisis, it has no place. <br></p><p>Under the COVID crisis, regional directors have needed to cover the building needing their help the most, not ones in their traditional region. Nursing consultants need to go wherever they are needed. This means pushing a med cart on a Saturday night on the COVID hot unit in scrubs, not sitting in a conference room offering advice. <br></p><p>Remember those heroes? They need someone to look up to. It is easy to look up to someone who is fighting beside them to provide quality care.<br></p><p>Tough times do not last, but tough people do. Find those tough, hardworking leaders and promote them. During crisis, teams find out who will rise up and lead. Unfortunately, those who cannot be counted on also become apparent. The team judges what an organization values by who gets promoted. The consultant who puts a resident on a commode is a leader, the one sitting in the conference room, not so much.</p><h3>3. Reinforcements for the Leadership Team</h3><p>Reinforcements may be the most important point. It is certainly the one that most organizations fail to accomplish. The current crisis has taxed every health care organization. There are those leaders who worked 16-hour shifts in a hot COVID building for 10 straight days. They are exhausted, and the best of them will keep going, keep serving, until they fall over if something isn’t done. So how and where does one find the second wave of help?<br></p><p>In every facility there are folks wanting to be recognized, wanting to grow. To this point, fate has not presented them with an opportunity; the time for that opportunity is now. The administrator, or director of nursing (DON), or regional director find themselves out of options.<br></p><p>But, right in front of them is someone praying for the chance to show what they can do. Give them a piece of this problem. The results are often a pleasant surprise. It could be the nurse who always wanted the chance to run a unit, or always wanted to be an assistant DON. It could be the administrator-in-training who jumps in the car and travels to a hot COVID building to help the team survive a crisis.<br></p><p>Those are the moments that help teach and grow leaders better than any other experience. Certified nurse assistants (CNAs) become lead CNAs, supply clerks with a talent for organization rise up and keep day-to-day critical schedules working. <br></p><p>During the time of COVID, an entire group of nurses has taken on the Infection Control mantle and (where empowered) led teams through crisis. Potential DONs with one organization are found through an internal DONUT (director of nursing under training) program. This training work can include special assignments, projects, or critical leadership in a COVID-active building. All of them are leaders waiting for a chance to shine.<br></p><p>Another often ignored factor is cross training. In one hot COVID building the dietary manager, assistant manager, and several other team members were suddenly out of work after testing positive for COVID. Without cross training of department heads, this entire department could have been shut down. This training is not a chore to do—in fact folks enjoy learning new things. Afterward, as an additional benefit, the department heads have more understanding and respect for each other.<br></p><h3>4. Care for the Team That Cares for the Residents</h3><p>With all of this in place, it is time for the leaders to lead. It begins, as already mentioned, with positive energy. That is followed with C.A.R.E.—Communication, Appreciation, Respect, and Empowerment. During times of crisis, communication with the team (and families) is critical. Don’t wait—give information as soon as possible—that helps avoid harmful rumors.<br></p><p>The team needs to be appreciated: with leaders working on the front lines, a daily “thank you,” and food. With limited places to eat and the desire to keep staff in the building, providing food is important. It doesn’t all have to be facility food; outside restaurants and other companies also want to help during times of crisis, and they will often provide staff meals.<br></p><p>Respect is shown by providing help with stress, listening to staff members’ ideas, and giving them a chance to grow. No one is in a better position to see the best way through a problem than the folks working on the front line. <br></p><p>Leaders (and their family members) can also take the free, eight-hour online Temporary Nurse Aide training course offered by the American Health Care Association/National Center for Assisted Living during the COVID crisis to be in a position to really offer a helping hand.<br></p><p>Finally, empower the team to help the residents with their quality of life. Have every staff member be a part of resident activities. Free up every one of them for just 15 minutes a day to go do something special for a resident. Trust them (by relaxing cell phone rules) to use their phones to help a lonely resident FaceTime with a family member. <br></p><p>One leader alone has little chance of surviving a crisis. But a well-led, balanced team can help an organization pull through these challenging times. <br><br><em>Greg Dowdy is the chief operating officer for American HealthCare, which has 18 facilities in Virginia. He has been in long term care for 38 years, in which time he may have accidently learned a thing or two. He can be reached at <a href="mailto:gdowdy@ahc.cc" target="_blank">gdowdy@ahc.cc</a>. View Dowdy’s <a href="https://www.youtube.com/watch?v=Y42Ob5nGiM4" target="_blank">Provider LED Talk</a> posted on YouTube. </em></p>	Keys to success include versatility in core leader strengths, finding promising reinforcements from within the ranks, and offering hands-on assistance to the team on the line.	2020-11-01T04:00:00Z	<img alt="" src="/Issues/2020/November/PublishingImages/1120feature.jpg" style="BORDER:0px solid;" />	Management;Workforce	Special Feature	Greg Dowdy	47	11

AHCA/NCAL Elects Boards for 2020-2021 Term; Meade and Crunk Remain Chairs	https://www.providermagazine.com/Articles/Pages/AHCA-NCAL-Elects-Boards-for-2020-2021-Term;-Meade-and-Crunk-Remain-Chairs.aspx	AHCA/NCAL Elects Boards for 2020-2021 Term; Meade and Crunk Remain Chairs	<p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) have elected AHCA’s Board of Governors and NCAL’s Board of Directors for the 2020/2021 term, confirming Debbie Meade of Georgia’s re-election as AHCA chair and Helen Crunk of Nebraska’s re-election as NCAL chair. <br></p><p>“I am proud to work alongside these extraordinary titans in our sector,” said Mark Parkinson, president and chief executive officer (CEO) of AHCA/NCAL. <br></p><p>“This has been our most challenging year, and their leadership is critical as they guide us through this unprecedented time.”<br></p><p>New AHCA Board members include Randy Bury, CEO of the Evangelical Lutheran Good Samaritan Society; Sarah Schumann, vice president of operations at Brookside Inn; and Heath Boddy, president and CEO of the Nebraska Health Care Association and president of the Affiliated State Health Care Association Executives (ASHCAE).<br>Members of AHCA’s 2020-2021 Board include: <br></p><ul><li><img src="/Articles/PublishingImages/740%20x%20740/1120DebbieMeade.jpg" alt="Debbie Meade" class="ms-rtePosition-2" style="margin:5px;width:230px;height:230px;" />Debbie Meade of Health Management (Georgia), AHCA Chair</li><li>Phil Fogg of Marquis Companies (Oregon), AHCA Vice Chair</li><li>Phil Scalo of Bartley Healthcare (New Jersey), Secretary/Treasurer</li><li>J. Mark Traylor of Traylor Porter Healthcare (Alabama), Independent Owner Representative</li><li>Steve Flatt of National Healthcare Corp. (Tennessee), Multifacility Representative</li><li>Randy Bury of The Evangelical Lutheran Good Samaritan Society (South Dakota), Not for Profit Representative</li><li>Derek Prince of HMG Healthcare (Texas), At-large Representative</li><li>Joe Mitchell of Summit Care (Florida), At-large Representative</li><li>Sarah Schumann of Brookside Inn (Colorado), At-large Representative</li><li>Julianne Williams of Dycora Transitional Health (California), At-large Representative</li><li>Chris Wright of iCare Health Network (Connecticut), At-large Representative</li><li>Helen Crunk of Pemberly Place Management & Archer Place Medical Clinic (Nebraska), NCAL Representative</li><li>Heath Boddy of Nebraska Health Care Association (Nebraska), ASHCAE Representative</li><li>Betsy Rust of Plante Moran (Michigan), Associate Business Member (ABM) Representative; and</li><li>Michael Wylie of Genesis HealthCare (Pennsylvania), Immediate Past Chair.</li></ul><p>The NCAL Board of Directors welcomed newcomers Todd Dockerty, CEO of Dockerty Health Care Services; Stacy Hejda, vice president of regulatory compliance at Assisted Living Partners; and ASHCAE Vice President Jesse Samples of the Tennessee Health Care Association.</p><p dir="ltr" style="text-align:left;"><img src="/Articles/PublishingImages/740%20x%20740/1120HelenCrunk.jpg" alt="Helen Crunk" class="ms-rtePosition-2" style="margin:5px 20px;width:230px;height:230px;" />The members of NCAL’s 2020-2021 Board of Directors include: </p><ul><li dir="ltr" style="text-align:left;">Helen Crunk of Pemberly Place (Nebraska), Chair</li><li dir="ltr" style="text-align:left;">Gerald Hamilton of BeeHive Homes of Albuquerque (New Mexico), Vice Chair</li><li dir="ltr" style="text-align:left;">Mark Maxfield of The Cottages (Idaho), Secretary/Treasurer</li><li dir="ltr" style="text-align:left;">Patricia Giorgio of Evergreen Estates (Iowa), Immediate Past Chair</li><li dir="ltr" style="text-align:left;">John Bolduc of Odd Fellows’ and Rebekahs’ Home of Maine (Maine), At-large Representative</li><li dir="ltr" style="text-align:left;">Rod Burkett of Gardant Management Solutions (Illinois), At-large Representative</li><li dir="ltr" style="text-align:left;">Megan Campbell of IntegraCare Corp. (Pennsylvania), At-large Representative</li><li dir="ltr" style="text-align:left;">Sue Coppola of Sunrise Senior Living (Virginia), At-large Representative</li><li dir="ltr" style="text-align:left;">Ana de la Cerda of Aegis Living (Washington), At-large Representative</li><li dir="ltr" style="text-align:left;">Todd Dockerty of Dockerty Health Care Services (Michigan), At-large Representative</li><li>Darryl Fisher of Mission Senior Living (Nevada), At-large Representative</li><li>Denise German of Medicalodges (Kansas), At-large Representative</li><li>Stacy Hejda of Assisted Living Partners (Iowa), At-large Representative</li><li>Barbara Mitchell of Magnolia Manor (Georgia), At-large Representative</li><li>Sean Mockbee of Sunshine Village (Arizona), At-large Representative</li><li>Gail Sheridan of Tealwood Care Centers (Minnesota), At-large Representative</li><li>Sarah Silva of Avamere Health Services (Oregon), At-large Representative</li><li>Elizabeth Wheatley of Five Star Senior Living (Arizona), At-large Representative</li><li>Doug Farmer of Colorado Health Care Association (Colorado), State Affiliate Representative</li><li>David Voepel of Arizona Health Care Association (Arizona), State Affiliate Representative; and</li><li>Shawn Scott of Medline Industries (Illinois), ABM Representative.<br></li></ul><p>The ex-officio members on the NCAL Board of Directors include Meade as the AHCA chair and Fogg as the AHCA vice chair, as well as ASHCAE Vice President Jesse Samples.<br></p><p>“This year’s NCAL Board incorporates leaders from across the nation that will go above and beyond to help our assisted living members succeed,” said Scott Tittle, executive director of NCAL. <br></p><p>“Now more than ever, we need strong individuals to lead us in this fight against COVID-19, and this group is prepared to do just that.”<br></p><p>Members of the AHCA Board of Governors are elected by the association’s governing body, the Council of States. The NCAL Board of Directors is elected by current members of the NCAL Board and by NCAL State Leaders.<br></p>	AHCA/NCAL have elected AHCA’s Board of Governors and NCAL’s Board of Directors for the 2020/2021 term, confirming Debbie Meade of Georgia’s re-election as AHCA chair and Helen Crunk of Nebraska’s re-election as NCAL chair.	2020-11-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/1120DebbieMeade.jpg" style="BORDER:0px solid;" />
Coalition Works to Avert Major Medicare Payment Cuts	https://www.providermagazine.com/Articles/Pages/Coalition-Works-to-Avert-Major-Medicare-Payment-Cuts.aspx	Coalition Works to Avert Major Medicare Payment Cuts	<p>An effort to protect Medicare payments to long term and post-acute care providers continues on Capitol Hill and in official Washington, according to a source with the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), who says the Calendar Year (CY) 2021 Medicare Physician Fee Schedule Rule is a top priority.<br></p><p>Daniel Ciolek, associate vice president for therapy advocacy at AHCA/NCAL, says the proposed rule has been out of mind for many providers due to the attention required for battling the COVID pandemic. If finalized, he says the rule could result in significant payment cuts in 2021 for Part B therapy and other cuts to skilled nursing facility (SNF) physicians and portable X-ray providers that may impact the service residents in SNFs may receive.<br></p><p>The proposed cuts could also negatively impact assisted living (AL) communities and access to care for residents with intellectual/developmental disabilities (ID/DD).<br></p><p>For more than a year, Ciolek says AHCA/NCAL has worked with a coalition of 47 provider organizations to head off the cuts with the Centers for Medicare & Medicaid Services (CMS). In addition, the coalition has worked on the issue with Congress since part of the problem with the proposed rule is a result of statutory budget-neutrality restrictions.<br></p><p>“We recognize that part of the problem is that statutory budget neutrality limits placed on the Medicare Part B physician fee schedule payment methodology create a situation that CMS is forced to ‘rob Peter to pay Paul,’” he says.<br></p><p>By way of background, in the CY 2020 Physician Fee Schedule (PFS) Final Rule (84 FR 62568), CMS finalized broad changes related to physician evaluation and management (E/M) services to reduce administrative burden, improve payment rates, and reflect current clinical practice.<br></p><p>The health care community supported restructuring and revaluing the office-based E/M codes, which will increase payments for primary care and other office-based services. Unfortunately, by law, any changes to the PFS cannot increase or decrease expenditures by more than $20 million. To comply with this budget-neutrality requirement, any increases must, therefore, be offset by corresponding decreases, Ciolek says.<br></p><p>As reflected in Table 90 of the proposed rule, payments for common PFS services furnished to residents in SNF, AL, and ID/DD residences will be cut 9 percent for physical therapy (PT) and occupational therapy (OT) services and 6 percent for portable X-ray services. In addition, the proposed rate tables for individual procedures indicate that speech language pathology (SLP) services as well as physician E/M services furnished to SNF residents will be cut up to 11 percent.<br></p><p>Speaking on the overall payment cut proposal, Ciolek says AHCA/NCAL realizes that in asking for the changes, CMS wants to improve the fairness of payments to physicians who manage patients with complex conditions in their offices.<br></p><p>“However, the solution, especially during a worldwide pandemic that most impacts patients in our AHCA/NCAL member facilities that are older and have multiple comorbidities, is not to cut payments to providers including physicians, portable X-ray providers, and therapists who furnish care to these individuals,” he says.<br></p><p>Ciolek adds that the association and coalition are hopeful that CMS will be responsive to the massive number of submitted comments from 42,640 provider and consumer stakeholders as well as members of Congress and put a pause on the planned payment cuts.<br></p><p>“While CMS may be able to offer some relief in the upcoming Final Rule, Congress will need to step up to the plate to fix this permanently,” he says.<br></p>	An effort to protect Medicare payments to long term and post-acute care providers continues on Capitol Hill and in official Washington.	2020-11-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/1120_news1.jpg" style="BORDER:0px solid;" />	Capitol Hill
COVID Only Halfway Over, Government Support Must Extend Into 2021, Parkinson Says	https://www.providermagazine.com/Articles/Pages/COVID-Only-Halfway-Over,-Government-Support-Must-Extend-Into-2021,-Parkinson-Says-.aspx	COVID Only Halfway Over, Government Support Must Extend Into 2021, Parkinson Says	<p>Long term and post-acute care providers are tired and drained from their continuing battle against the still-raging COVID-19 pandemic, says Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).</p><p>The battle against the virus is a marathon, he says, and only around one-half over, with next spring being the most logical time a vaccine can start to bring relief for residents, families, and caregivers who have been on the frontlines since March.</p><p>In a wide-ranging talk with Provider, the longtime association leader presented a no-nonsense assessment of where skilled nursing, assisted living, and other settings of care for the nation’s elderly and people with disabilities stand heading into the final months of a year that has marked thousands of residents dying from a virus that keeps challenging facilities even as most take every precaution to keep it out.</p><p>“I think that the unfortunate reality of the pandemic has been to expose that older people are not held in the same priority as younger people,” he says. “Older people are not held with the esteem that they should be, and so political decisions were made that led to the deaths of tens of thousands of people.”</p><p>“I think that we are about halfway through, maybe a little over halfway. I am optimistic that there will be a vaccine by the end of the year and that we [long term care] will be prioritized. Even with that it will take a couple of months for our staff and residents to be fully vaccinated.”</p><p>Providers Make Progress, But Public Limits Success<br>Parkinson says the way in which providers have learned to keep the infection out of facilities, and if not able, to treat those infected, has improved dramatically since the crisis started in March.</p><p>“Providers have gotten really good at taking care of people with COVID. We started with absolutely no knowledge of how to treat this virus, and they quickly demonstrated that given the proper PPE [personal protective equipment], therapeutics, and resources that they can get most people well,” he says.<br>“There have been hundreds of thousands of recoveries of residents in our buildings, and the success rate is growing all the time.”</p><p>The problem, however, is not limited to what happens inside nursing homes and assisted living communities. “Unfortunately, the public has proved to be completely incapable of social distancing and of wearing masks, so the incidence of COVID in the general population has not declined, and in fact in some parts of the country it continues to increase, which puts enormous stress on long term care facilities and makes containing the virus very hard,” Parkinson says.</p><p>He adds that he does not think the public is suddenly going to get more disciplined, and, therefore, for the next five or six months providers will continue to fight COVID before there is a vaccine.</p><p>“It is going to be just as challenging as it has been for the last six or seven months,” Parkinson says.</p><h3>Fatigue Has Set in</h3><p>The association leader says it is important to realize that these next months will be even harder because of the fatigue factor, born from the long days and nights logged by all involved in the battle.</p><p>“Providers are tired. Whether you are a frontline CNA or a CEO, all these folks have worked basically nonstop for the last seven months. And, fatigue has set in, and for them to be able to continue this fight for the next six months as I think will be required is going to be very, very tough for them,” Parkinson says.</p><p>As head of AHCA/NCAL, he thinks the most important thing the organization has done for the past seven months is being very effective at getting provider members the resources that they need. “The government relations team led by Clif Porter has been really effective in convincing Congress and HHS [Department of Health and Human Services] that our members need support, and the support has been provided.”</p><p>Parkinson says when combining the federal support with the state aid that has been provided, “we are probably well over $20 billion in relief that has been provided so far.” But the assistance cannot stop now as he says the continued challenge for the next six months is to keep Congress and HHS focused on “that continual need that providers have.”</p><h3>Money Issues Hit All</h3><p>Every provider, he notes, has been negatively affected in that they have had significant COVID in their buildings or if not then because census is down across the board.</p><p>Providers that have been hit hard by COVID have been able to stay afloat from the federal and state assistance, but if there is not more help in 2021 some people will be in real financial trouble. “So far the funds have been adequate, but the challenge right now is to keep them going in 2021,” Parkinson says.</p><p>“If we had not had federal funding that we have received so far there would have been hundreds of buildings that were already closed. That funding kept those buildings open, and similarly we need that continued funding in 2021 or hundreds of buildings will close.”</p><p>Who makes many of the high-level decisions could be impacted by the election results that occur on Nov. 3. Normally, Parkinson says the election outcome affects the profession in a very dramatic way, but in 2020 with the pandemic there has been bipartisan support for taking care of older people and supporting long term care.</p><p>“Regardless of the outcome of the election, we are going to get a good response for continuing assistance. The changes may be bigger on the regulatory side, as some may look at what has happened at nursing homes and look to overregulate or penalize more. Others who get elected want to be more collaborative [with the long term care sector]. We are hopeful members who get elected to Congress want to be collaborative,” he says. </p><h3>When Will Census Recover?</h3><p>Providers are also hopeful for a return of normal business in order to recover census and fill beds with people who need long term and post-acute care. Parkinson says the “when will we recover” question is the most important one.</p><p>“Census in nursing homes dropped about 10 percent very quickly in April and May and seemed to bottom out on June 1. But it has not gotten any better,” he says.</p><p>“For the sector to truly recover financially, census has to recover. My view is that once we have a vaccine, people will renew their confidence in our care setting, and there will be a slow recovery of census. It will not snap back immediately; it will be more like half a percent or 1 percent a month for a year or two, and then census will recover.”</p><p>Parkinson says he does not believe “we will have a permanently lower census as a result of the pandemic. Our services are necessary for people. The people who live in our buildings are just not capable of living at home, so once we get their confidence back, our census will recover, but it will take a year or two.”<br></p><p></p>	The battle against the virus is a marathon, he says, with next spring being the most logical time a vaccine can start to bring relief for residents, families, and caregivers.	2020-10-16T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/1120MarkParkinson.jpg" style="BORDER:0px solid;" />	COVID-19
NIC Expert Says Occupancy Will Evolve as Owners, Operators Look for Recovery	https://www.providermagazine.com/Articles/Pages/NIC-Expert-Says-Occupancy-Will-Evolve-as-Owners,-Operators-Look-for-Recovery.aspx	NIC Expert Says Occupancy Will Evolve as Owners, Operators Look for Recovery	<p><em>Provider</em> posed a series of questions to Beth Burnham Mace, chief economist and director of outreach at the National Investment Center for Seniors Housing & Care (NIC), on issues tied to the COVID-19 pandemic and occupancy levels across the seniors housing sector.<br><br class="ms-rteForeColor-1"><em class="ms-rteForeColor-1"><strong>Provider:</strong></em> What is the current trend for occupancy, and which of the market segments is showing the most negative impact from the pandemic?<strong class="ms-rteForeColor-3"><br></strong></p><p><strong class="ms-rteForeColor-3">Mace: </strong>The distinction between nursing care/skilled nursing and seniors housing is especially important to consider in discussing occupancy performance because the frailest elderly are often patients of skilled nursing’s higher acuity setting with around-the-clock nursing attention. And, it has been these elderly patients with significant pre-existing conditions that have seen the highest rates of COVID-19 incidence and fatalities. <br></p><p>Partially as a result, according to data from the NIC MAP® Data Service, the occupancy rate for skilled nursing properties fell more than other segment types with a 6.5 percentage point decline from the first quarter to 80.2 percent in the second quarter of 2020.<br></p><p>This was significantly more than the 2.8 percentage point drop in seniors housing properties to 84.9 percent, and when the aggregated seniors housing category is broken down into its subcategories, there was a 3.2 percentage point decline seen in assisted living properties to 82.1 percent and a 2.4 percentage point decline in independent living properties to 87.4 percent from the first to second quarters.<br><span><br class="ms-rteForeColor-1"><em class="ms-rteForeColor-1"><strong>Provider:</strong></em> </span> A big if, but if the pandemic is under control and vaccines available to all, what do you expect the occupancy outlook to be once this terrible time abates? <span><strong class="ms-rteForeColor-3"><br></strong></span></p><p><span><strong class="ms-rteForeColor-3">Mace: </strong></span> As you point out, the pandemic holds the cards. At this point, the outlook for the sector is tied to the path of the pandemic, its infection and penetration rate within properties, and the impact of the pandemic on broad economic growth. The seniors housing and nursing care industry as well as the broader national economy will be negatively affected by the COVID-19 virus until a vaccine is available and widely distributed. <br></p><p>And, whenever that happens, I do not believe that we will go back to business-as-usual. I believe that there is a transformational change in the seniors hosing and care industry and that the change will continue to evolve. Occupancy will eventually return to pre-pandemic levels, but the industry will be changed.<br><span><br class="ms-rteForeColor-1"><em class="ms-rteForeColor-1"><strong>Provider:</strong></em> </span> And, we have the demographics to consider?<span><strong class="ms-rteForeColor-3"><br></strong></span></p><p><span><strong class="ms-rteForeColor-3">Mace: </strong></span>: Yes, more broadly, the underlying fundamentals and drivers of seniors housing remain in place. First, the demographics alone support the growing need for care and housing for seniors. Today, there are seven adult children aged 45 to 64 to care for every senior over the age of 80. By 2030, this ratio shrinks to 4:1, and by 2050, it becomes 3:1. Fewer caregivers suggest that community-based congregate settings will be needed more than ever. <br></p><p>Second, with nearly two of every three properties built before 2000, the inventory of senior housing properties is relatively old, and often a property refresh is needed for design, functionality, and efficiency. And, as obsolescence increases, new supply is needed at least in some markets. <br></p>	Provider posed a series of questions to Beth Burnham Mace, chief economist and director of outreach at NIC, on issues tied to the COVID-19 pandemic and occupancy levels across the seniors housing sector.	2020-11-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/housing_2.jpg" style="BORDER:0px solid;" />	Management;COVID-19
Occupancy Will Evolve as Owners, Operators Look for Recovery, Says NIC Expert	https://www.providermagazine.com/Articles/Pages/Occupancy-Will-Evolve-as-Owners,-Operators-Look-for-Recovery,-Says-NIC-Expert.aspx	Occupancy Will Evolve as Owners, Operators Look for Recovery, Says NIC Expert	<p><em>Below is the first of a two-part interview. Keep your eyes out for the <a href="/Articles/Pages/Lessons-from-COVID-19-Experience-Will-Impact-Senior-Housing-for-Years.aspx">second part</a> coming to you next week in another Provider News Alert.</em></p><p><em>Provider </em>posed a series of questions to Beth Burnham Mace, chief economist and director of outreach at the National Investment Center for Seniors Housing & Care (NIC), on issues tied to the COVID-19 pandemic and occupancy levels across the seniors housing sector.</p><p><em>Provider</em>: What is the current trend for occupancy, and which of the market segments is showing the most negative impact from the pandemic?</p><p>Mace: The distinction between nursing care/skilled nursing and seniors housing is especially important to consider in discussing occupancy performance because the frailest elderly are often patients of skilled nursing’s higher acuity setting with around-the-clock nursing attention. And, it has been these elderly patients with significant pre-existing conditions that have seen the highest rates of COVID-19 incidence and fatalities.</p><p>Partially as a result, according to data from the NIC MAP® Data Service, the occupancy rate for skilled nursing properties fell more than other segment types with a 6.5 percentage point decline from the first quarter to 80.2 percent in the second quarter of 2020.</p><p>This was significantly more than the 2.8 percentage point drop in seniors housing properties to 84.9 percent, and, when the aggregated seniors housing category is broken down into its subcategories, there was a 3.2 percentage point decline seen in assisted living properties to 82.1 percent and a 2.4 percentage point decline in independent living properties to 87.4 percent from the first to second quarters.</p><p>This placed the occupancy rate for assisted living at its lowest level since NIC began reporting the data in late 2005. In general, residents in independent living tend to be healthier than those in assisted living and nursing care, and hence the lesser decline.</p><p>NIC MAP’s Intra-Quarterly data show further declines in occupancy beyond the second quarter. In the August report period, defined as the three-month rolling average June, July, and August, the assisted living occupancy rate was 79.5 percent, independent living was 85.6 percent, and nursing care was 76.5 percent.</p><p><em>Provider</em>: A big if, but if the pandemic is under control and vaccines available to all, what do you expect the occupancy outlook to be once this terrible time abates?</p><p>Mace: As you point out, the pandemic holds the cards. At this point, the outlook for the sector is tied to the path of the pandemic, its infection and penetration rate within properties, and the impact of the pandemic on broad economic growth. The seniors housing and nursing care industry as well as the broader national economy will be negatively affected by the COVID-19 virus until a vaccine is available and widely distributed. And, whenever that happens, I do not believe that we will go back to business-as-usual (BAU).</p><p><em>Provider</em>: What do you mean by not going back to BAU?</p><p>Mace: The new normal will not revert to the old normal, and the new normal is here now and will continue to evolve. Flexibility, responsiveness, and readiness are new standards for successful operators.</p><p>To answer your question directly, I believe that there is a transformational change in the seniors housing and care industry and that the change will continue to evolve. Occupancy will eventually return to pre-pandemic levels, but the industry will be changed.</p><p><em>Provider</em>: And, we have the demographics to consider?</p><p>Mace: Yes, more broadly, the underlying fundamentals and drivers of seniors housing remain in place. First, the demographics alone support the growing need for care and housing for seniors. Today, there are seven adult children aged 45 to 64 to care for every senior over the age of 80. By 2030, this ratio shrinks to 4:1, and, by 2050, it becomes 3:1. Fewer caregivers suggest that community-based congregate settings will be needed more than ever.</p><p>Second, with nearly two of every three properties built before 2000, the inventory of seniors housing properties is relatively old, and often a property refresh is needed for design, functionality, and efficiency. And, as obsolescence increases, new supply is needed at least in some markets. Moreover, COVID may have accelerated obsolescence, as building design is moving front and center for improved safety and health outcomes.</p><p>Third, seniors housing is increasingly recognized as a critical part of the solution for population health management and health care cost containment—a growing social, economic, and political reality.</p><p><em>Provider</em>: Any other factors in play for occupancy recovery and trends post-pandemic?</p><p>Mace: The need for care and housing is especially acute for middle-income seniors. NIC’s Forgotten Middle study highlights that point, with only 46 percent of middle-income seniors capable of affording seniors housing and care by 2029. It’s likely that, as a result of the pandemic and the secondary impact it has had on the economy, more Americans than ever will slip into the Forgotten Middle-income cohort, making the need for affordable care and housing ever more pressing.<br></p>	Provider poses a series of questions to NIC’s Beth Burnham Mace on issues tied to the COVID-19 pandemic and occupancy levels across the seniors housing sector.	2020-10-20T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0920_News1.jpg" style="BORDER:0px solid;" />	COVID-19

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November 2020

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People On The Move