September/October

Vol. 49 No. 9

Sept/Oct

Cover Story

Creating a Path to Emergency Preparedness

https://www.providermagazine.com/Issues/2022/SeptOct/Pages/Creating-a-Path-to-Emergency-Preparedness.aspx

Creating a Path to Emergency Preparedness

“Death Toll in Kentucky Floods Rises to 28 as Area Braces for More Rain.” This headline from late July is all too common. Crises—natural disasters, active shooter situations, the pandemic, power grid issues, and more—are increasingly becoming the norm. While long term care facilities must have disaster preparedness plans, it’s time to revisit these and make them flexible enough to address whatever situation comes your way.<h3>All-Hazards Assessment</h3>“We have seen an increase in disasters—shootings, workplace violence, hurricanes, tornados, and more—in recent years. We need to think about potential hazards in our area,” said Betty Frandsen, MHA, RN, FACDONA, president of Med-Net Academy in Princeton, N.J. David Smith, MD, CMD, president of Geriatric Consultants in Brownwood, Tx., added, “The pandemic has sucked the majority of the oxygen from the room. We need to get back to addressing other issues related to emergency preparedness. This means looking at the full scope of assessments and where our highest risks are.” According to Stan Szpytek, president of Fire and Life Safety, Inc. in Mesa, Az., “The key to planning for crises of all shapes and sizes in any type of facility is a hazard vulnerability assessment. Once you identify risks, you can focus on how you will address them,” he said. There are several such tools, including one from AHCA/NCAL (<a href="https://www.ahcancal.org/News-and-Communications/Blog/Pages/Access-AHCA%20NCAL’s-Hazard-Vulnerability-Assessment-Tool.asp" target="_blank">https://www.ahcancal.org/News-and-Communications/Blog/Pages/Access-AHCA NCAL’s-Hazard-Vulnerability-Assessment-Tool.asp</a><a href="https://www.ahcancal.org/News-and-Communications/Blog/Pages/Access-AHCA%20NCAL’s-Hazard-Vulnerability-Assessment-Tool.asp" target="_blank">x</a>). This one was built on a foundation of established risk probability and assessments and designed specifically for the nursing home and assisted living environment. <img src="/Issues/2022/SeptOct/PublishingImages/911.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:300px;" />However, Szpytek stressed that while it is practical to address viable risks based on geocentric factors and past experiences, the emergency preparedness plan needs to be flexible enough to handle the unpredictable and unexpected. He said, “Prior to the COVID-19 pandemic, most people didn’t see this as a viable possibility.” He referred to one list that includes 80 possible disasters or crises, including a zombie apocalypse. “This may be tongue in cheek, but it just shows that we need to be active and forward thinking. There is always an unknown factor that we need to prepare for,” Szpytek said. Expecting the unexpected is good advice for a hazardous situation. For instance, he recalled a situation where there was a fire in a facility. “The fire was reported, and the police responded; but they quickly determined that it could have been intentionally set. When they got up to the stairwell, they were greeted by a resident with a gun who started firing on first responders. It was a routine call until it wasn’t.”<h3>Frameworks Need Flexibility</h3>Szpytek stressed, “The key to incident management is flexibility. You need to have a framework, but it needs to be flexible enough to pivot quickly with changing circumstances.” Typically, he said, “You have some warning, but not always. Wildfires, for example, move quickly; and you may have just minutes to evacuate.” In a true disaster, it is important to realize that you may be on your own and will have to make decisions very quickly with limited information. “Training, drills, and exercises can increase leaders’ ability to be flexible and take decisive action. At the same time, regular tabletop exercises can help develop a culture of preparedness,” said Szpytek. While someone needs to have the role of incident commander, all staff need to be involved. He noted, “Most facilities now have emergent infection diseases at the top of their list of potential emergencies, so people on the care side of the equation need to be involved with emergency management.” However, when they are involved in training, drills, and other aspects of emergency preparedness, any staff member can potentially make a significant difference and even save lives in a disaster. Don’t let optimistic bias overwhelm or interfere with your decision-making, Szpytek said. “Just because something never happened before doesn’t mean it can’t happen. Just because you’ve never had a fire in your facility, pull the fire alarm when you smell or see smoke. Don’t waste time tracking down maintenance staff.” This means creating a culture where staff feel confident responding to an emergency and know that they will never be punished for erring on the side of caution. Frandsen agreed, noting, “You can’t just sit back and think that something won’t happen here.” She explained, “A few years ago when I was an administrator, our facility was near a civic center where a gunman charged in and shot some people; but no one thought to tell us. We found out because someone saw the S.W.A.T. team in our parking lot. Until that point, we had an open door policy; but we now realized we had to rethink it.” When new or revised policies are created and instituted, it is essential to train every staff member and make sure they understand their roles. <h3>The Promising Prospect of Partnerships</h3>“You’ve got to have relationships developed in advance. But these can’t just involve paper compliance. You need to have real relationships that go 2-3 deep because everyone will need services at the same times. You need to have alternative sources for things like transportation and food service in a crisis,” Szpytek said. He stressed, “In my opinion, 70% of emergency planning is clerical in nature. Keep everything up-to-date and documented. Get your ducks in a row with vendors and other partners. Focus on contracts, letters of agreement, pricing frameworks, etc.” Smith suggested, “I have recommended to hospitals and facilities that they put all emergency planning information, alternate sources for water/power, and a complete and updated list of contacts on a computer that’s never connected to the Internet so it can’t be corrupted accidentally or intentionally.” Don’t forget to plan for recovery and restoration. You need relationships with these types of organizations so you’re not scrambling later and end up working with companies who take advantage of your desperation and urgency. Recovery/restoration people can help identify issues you need to be prepared for. For instance, as Frandsen noted, a flood isn’t over after the water is removed. You have to worry about bacteria and mold. When there’s a wildfire, the local watershed might be affected, making water unsafe to drink. At least one drill every year needs to be full-scale and communitywide, involving other facilities and stakeholders in the area. This will strengthen partnerships and relationships, as well as identify any gaps in communication or resource access. For instance, Smith said, “During the recent hurricane in Houston, all four lanes going out of the city were gridlock, while all lanes coming into the city were wide open.” A full-scale drill, combined with a good relationship with state and local agencies and leaders, could identify and address such issues to prevent them from reoccurring in the future. Read more: <a href="/Issues/2022/SeptOct/Pages/A-Staffing-Shortage-Is-an-Emergency.aspx" target="_blank">A Staffing Shortage Is an Emergency</a> Joanne Kaldy is a freelance writer and communications consultant based in New Orleans. Learn more: <a href="https://ahcapublications.org/products/emergency-preparedness-program?_pos=1&_sid=55cdea99f&_ss=r"><img src="/Issues/2022/NovDec/PublishingImages/911Prep.jpg" class="ms-rteImage-2" alt="" style="margin:5px;width:200px;height:256px;" /></a>

To be ready for what comes along, assess the dangers, be flexible, and find partners.

2022-09-01T04:00:00Z

Emergency Preparedness

Are We Doing Enough for Diversity, Equity, and Inclusion?	https://www.providermagazine.com/Articles/Pages/Are-We-Doing-Enough-for-Diversity-Equity-and-Inclusion.aspx	Are We Doing Enough for Diversity, Equity, and Inclusion?	<p>Even if you are confident that your organization is effectively addressing diversity, equity, and inclusion (DEI), there are likely opportunities to do more. “Perceptions matter; and if one person thinks a group or organization isn’t inclusive, we’re failing. We can always do better. We need to keep our minds open, be introspective, and recognize and overcome biases,” said Rajeev Kumar, MD, CMD, FACP, chief medical officer at Symbria in Illinois. “The work starts by empowering people who need to speak up. Unless we empower every member of our teams to speak their minds, we won’t identify opportunities and make change,” he suggested.</p><h3>What Is DEI?</h3><p>Diversity, equity, and inclusion are three separate concepts, but they are interrelated:<br>Diversity. This involves the presence of differences including gender, religion, sexual orientation, ethnicity, nationality, age, socioeconomic status, and other factors. <br></p><p>Equity. This involves promoting justice, fairness, and impartiality in treatment, rules, policies, procedures, resource distribution, etc. <br></p><p>Inclusion. This is the outcome of efforts to ensure diversity and equity and creates an environment/culture where people feel fully welcomed, engaged, and respected.<br></p><p>“Diversity is a mainstay in our world, and it is an essential requirement to promote equity and enable inclusivity. It is important to understand how these three concepts are interconnected. The three work masterfully together,” said Anna Fisher, CMDCP, CDP, QCP, director of education and quality at Hillcrest Health Services in Nebraska. </p><h3>Employees Care</h3><p>Even if your employees aren’t talking about DEI, it is likely on their minds. As Kumar said, “They see things <img src="/Issues/2022/SeptOct/PublishingImages/RajeevKumar.jpg" alt="Rajeev Kumar" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />like social injustices and the targeting of minorities in social settings. They may be frustrated at work and feel disengaged or marginalized.” When this happens, it’s not particularly surprising that they are tempted by higher wages at hospitals and other settings.<br></p><p>Employees consistently say that they care about DEI. For instance, in one national survey nearly 80% of workers said they want to work for a company that values DEI. However, it’s not that simple. While 60% of workers said they approve of organizational leaders speaking out about social and political issues, only 36% reported that they’re comfortable with their own leaders expressing their views. (<a href="https://www.cnbc.com/2021/04/30/diversity-equity-and-inclusion-are-important-to-workers-survey-shows.html" target="_blank">https://www.cnbc.com/2021/04/30/diversity-equity-and-inclusion-are-important-to-workers-survey-shows.html</a>)<br></p><p>To get a sense of what employees—as well as residents and other stakeholders—want from DEI efforts, it takes some talk. Fisher suggested, “We need to have increased dialogue. You need to get to know your staff, your resident population, and your customer base. Create this conversation and understand that it may not be comfortable for everyone. We need to make it clear that we are committed to supporting diversity, ensuring equity, making inclusion a key part of our cultures, and celebrating the rich differences that exist in our society and our facilities.”</p><h3>Employers Respond</h3><p>If you don’t yet have DEI on your radar, you are behind the curve. In a national survey conducted last year, 95% of employers said they had introduced new DEI measures during the previous year. These efforts have taken different forms, such as DEI plans, employee resource groups, and addressing DEI in strategic plans.<br>However, while employers said they’re addressing DEI, nearly half (45%) reported that it’s difficult to find diverse candidates for open positions. At the same time, only 16% of employers said they’ve engaged community or vendor partnerships to help increase diversity on their teams. These entities, such as women’s <a href="/Issues/2022/SeptOct/Pages/DELP-Can-Help.aspx" target="_blank">leadership organizations</a> or minority professional groups, can be valuable sources of diverse job candidates. (<a href="https://www.hrmorning.com/articles/dei/" target="_blank">https://www.hrmorning.com/articles/dei/</a>)<br></p><p>Clearly, addressing DEI means more than a general approach or even a single policy or strategy. However, it is important to start the journey with a commitment. As Fisher said, “When you have intent, that makes for a smoother road to equity and inclusion.” Kumar added, “DEI can be part of who we are. We can create greater awareness through education. We can look at our principles, behaviors, and attitudes that impact policies and service delivery. We can encourage learning between providers and communities, teaming up with local, regional, and state agencies for support.” Fisher further stressed, “DEI can’t be done in a silo. It calls for a collaborative effort.”<br></p><p>Kumar said, “You have to start by including everyone in your community interested in finding out more about issues related to DEI and identifying ways to look for inequities and biases.” The first step, he suggested, is looking inward at our own behaviors and how we design our policies and procedures. Then we need to find ways to tease out biases and inequities throughout our organizations. There is no other way around it. Unless you look for these things, you won’t find them.”</p><h3>Assessing Bias</h3><p>There are several steps you can take to assess biases in your organization. These include:<br>Retrospective approach. Review historical data on key indicators (such as the representation of different identity groups in the hiring process) that may provide evidence of disparities and biases.<br></p><p>Reactive identification of biases. Create a safe process to enable employees to report negative experiences or biases they witness. Understand that this will only work if you have created a culture where people feel safe reporting concerns and are confident that there won’t be negative repercussions.<br></p><p>Proactive identification of biases. This may be low hanging fruit and an easy place to start. It involves reviewing processes, policies, and best practices that are likely to influence employee experiences and satisfaction. Understand that just about any process, policy, or practice can be a source of bias, so make sure they’re all included in your review.<br></p><p>You may want to establish a DEI workgroup to conduct research and surveys, review materials, and draft strategies and recommendations, Kumar suggested, adding that an experienced external consultant can help look for inequities and biases in an objective and efficient manner.</p><h3>DEI in Action</h3><p>Of course, it’s not enough to develop DEI plans or initiatives. You need to make sure your employees know about them, understand what they mean to them, and see that management is fully behind these efforts. This means including news and information about your DEI efforts on your website, in employee newsletters, on your social media platforms, and elsewhere. People shouldn’t have to search for your DEI plans, policies, and values. They should be visible, clear, and consistent. <br></p><p>“Leaders need to stand up for DEI and model a commitment to diversity, equity, and inclusion,” said Kumar. “We need to build career ladders, ensure commensurate pay, etc. These are good ways to attract, retain, and empower our teams.”<br></p><p>Ultimately, Kumar said, “It is about empowering our staff. If you don’t seek them out, you may not know if they are experiencing something or having a problem. Make sure they know there won’t be repercussions.” He added, “We need to be receptive to their complaints and encourage them to come forward so we can act on them.” </p>	Employees care about DE&I. Organizations should be ready to respond.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/diversity.jpg" style="BORDER:0px solid;" />	Caregiving	Cover Feature	Joanne Kaldy	49	9
Balancing the Components of a Supply Chain	https://www.providermagazine.com/Articles/Pages/Balancing-the-Components-of-a-Supply-Chain.aspx	Balancing the Components of a Supply Chain	<p><img src="/Issues/2022/SeptOct/PublishingImages/supply.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:300px;" />During the pandemic, many nursing homes and other long term care facilities saw supply chain disruptions. While some of these shortages have eased, some supply chain challenges will continue and new ones will arise. There is no one solution, but creativity, partnerships, and some juggling will enable facilities to keep supply chains from breaking.<br></p><p>Before anyone had heard of COVID-19, no one was talking about supply chains, shortages, and the costs of securing or maintaining inventories. Then delays and interruptions made it difficult or even impossible to get basic items, such as N95 masks, gloves, and gowns. Suddenly, supply chain issues were wrecking havoc with staff and resident safety, budgets, workforce stability, and other aspects of care and operations.<br></p><p>“At the beginning of the pandemic, everyone had personal protective equipment (PPE) shortages. We established national and international partnerships. We booked vessels from China to get supplies of masks, gowns, and gloves,” said T.J. Griffin, RPh, vice president of long term care operations and chief pharmacy officer at PharMerica in Louisville, Ky. “This was our focus at the beginning of the pandemic, then our customers started to experience shortages of tests and testing supplies; then we moved from there to the vaccines. We partnered with Walgreens to ensure our facilities were properly scheduled, and we held thousands of clinics to administer boosters.” <br></p><p>Brad Mariam, executive vice president at Medline Post-Acute Care, further observed, “Throughout the pandemic, we focused on implementing new ideas to combat the national shortage of medical supplies.” </p><h3>Don’t Stockpile, Strategize</h3><p>During the pandemic, panic led to organizations and consumers alike trying to stockpile items in short supply. This included items such as masks, gloves, cleaning supplies, certain food items and medications, and various other staples. <br></p><p>“Stockpiling as a concept is common, and the pandemic taught us that it can be difficult to manage. Owning a stockpile requires capital and space to store products and constant visibility into inventory so products that are expiring can be rotated out,” said Mariam. “We are seeing a need to develop smarter stockpiles and a process for replenishing and managing stock on behalf of our customers.”<br></p><p>It’s not possible to stockpile supplies for every contingency. You can stockpile some PPE to be able to handle a certain amount of surge, but this can be an expensive proposition. At the same time, some things need to be stored in temperature-controlled environments, and this can be challenging as well.<br></p><p>There are steps that can help keep you from getting caught short-handed without excessive stockpiling:<br>Be alert and flexible. Have a “go-to” person on your staff, a vendor, or partner organization who has their finger on the pulse of trends and pending problems or crises. Have supply chain strategies that include several options, relationships, and supply sources for basic needs. For instance, Mariam said, “We have several hundred people throughout Europe and Asia who are our boots on the ground and experts in communicating what is happening that can potentially impact operations in the U.S.”<br></p><p>Know what you have. Stay on top of what supplies you have, where they are, and when (if applicable) they expire. Don’t let panic lead you to stockpile more supplies than you have the ability to store or that are likely to expire before you can use them.<br></p><p>Conduct regular supply reviews and needs assessments. Know what you have and what you might need moving forward at any given time. Budget carefully. Weigh the risks and benefits of using credit or reserves for supplies you may or may not need even if the worst-case scenario happens.<br></p><p>Establish and strengthen relationships with suppliers, government offices, and other entities that are likely to have supplies even when there are shortages. For instance, large companies like Medline can coordinate bulk buys and draw from that centralized inventory when they need supplies.<br></p><p>There are ways to help manage costs when supply chain issues send prices sky high. <a href="/Issues/2022/SeptOct/Pages/New-Rules-Require-Resiliency.aspx" target="_blank">Resiliency</a>, says Mariam, is key. “Resilience is a multi-pronged approach, from sourcing and logistics to products and technology. To help reduce the risk of supply shortages, health systems should look at clinical acceptability as well as clinical preferences,” he said, adding, “In other words, what are the acceptable product substitutions? Their health care supply partner can help by reviewing the clinically preferred products and creating a list of approved substitutions that are similar in nature to help ensure uninterrupted product availability.”<br></p><p>It is also more important than ever, said Mariam, for health care providers to follow proper formularies and guidelines. “Assuring that clinical staff have the proper education around the products they use is an important piece of managing utilization and controlling supply spend.”<br></p><p>This all requires a careful balance. Anna Fisher, CMDCP, CDP, QCP, director of education and quality at Hillcrest Health Services in Nebraska, observed, “At the height of the pandemic, we sometimes had to reuse N95 respirators that were meant to be used just once. We had to develop protocols for this, and we had to do so with a safety mindset that balanced tried-and-true infection prevention and control strategies with what PPE was available.”</p><h3>Collaborate Through Coalitions</h3><p>There’s safety and strength in numbers; and particularly during times of widespread supply shortages, sharing resources, supports, and connections can benefit everyone involved. For instance, states like Nebraska have health care coalitions, which are groups of individual health care and response organizations—such as hospitals, emergency medical service providers, emergency management organizations, public health agencies, and others—working in a defined geographic location to prepare for and respond to disasters and emergencies. <br></p><p>Such coalitions enable its members to collaborate and ensure each member has what it needs to respond to emergencies and planned events. This may include medical equipment and supplies, real-time information, communication systems, and educated and trained health care personnel. <br></p><p>Justin Watson, MPA, healthcare collation coordinator for the Omaha Metropolitan Healthcare Coalition, said, “During the pandemic, a lot of people thought the federal government would come in and save the day.” A coalition is important because it brings together individuals and organizations with a variety of strengths and resources for shared decision-making and action. <br></p><p>Early on, Watson said, “We put together a workgroup of infection preventionists to address PPE reuse and safety.” As a result, they implemented solutions such as setting up ultraviolet lights in communities that allowed for decontamination of N95 masks that enabled safe reuse.</p><h3>Are We Done Yet?</h3><p>While the pandemic has eased considerably, supply chain shortages continue to plague facilities. For instance, Griffin said, “We are battling some supply chain issues now regarding saline and saline flushes.” </p><p>These products are being rationed to a degree, with orders being set and limited by customers’ history of purchases, that is, you can’t order significantly more saline today than you have in the past. “We’ve partnered with vendors nationally and internationally to maximize our access to saline. We are able to move things around because we are a large company,” he said. This is an example where partnerships and relationships with large international organizations and those with a wide reach can help when there are supply shortages. <br></p><p>There are always some medications that are in short supply, but this is a bit easer to track. Griffin said, “The FDA sends out weekly notices showing the status of shortages, expected returns, etc. There also is a drug shortage database where you can search drugs alphabetically to see where things are.” At the same time, he said, “If there is a shortage that could affect patient care, the pharmacy can work with physicians to potentially get orders changed to viable, more easily accessible alternatives.”<br></p><p>Griffin cautions that availability of some products can turn on a dime. For instance, he said, “There may be a shortage of various sterile products because of manufacturing difficulties. All it takes is one manufacturing facility with a quality issue to disrupt supply.” Elsewhere, he observed, “Sometimes you run into drug shortages at year end, such as those medications with annual manufacturing and shipping limitations.”<br></p><p>To help prevent shortages of medications and related supplies, Griffin stressed the importance of communicating needs in advance with the pharmacy. For example, he said, “If you are going to dramatically increase your admission of IV patients or other high acuity residents with specific needs, it would be helpful to inform the pharmacy so they can make sure they have the medications and products you need.” <br></p>	Strategies, coalitions, and communication are the keys to a flexible supply chain.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/supply.jpg" style="BORDER:0px solid;" />	Management	Cover Feature	Joanne Kaldy	49	9

Impact of the Pandemic on SNF Admissions for Low Income and Low English Literacy Beneficiaries	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/Impact-of-the-Pandemic-on-SNF-Admissions-for-Low-Income-and-Low-English-Literacy-Beneficiaries.aspx	Impact of the Pandemic on SNF Admissions for Low Income and Low English Literacy Beneficiaries	<p><em>This is the fifth of a series of articles related to the implementation of a Patient-Driven Payment Model (PDPM) supported by examples of data trends reported by the Centers for Medicare & Medicaid Services (CMS), academic researchers, as well as analyses conducted by AHCA/NCAL. In this series, we will contemplate questions related to patient care delivery, outcomes, and payment model implications informed by observed PDPM data trends. For previous articles, visit providermagazine.com.</em></p><p>In the fiscal year (FY) <a href="https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities">2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule</a>, CMS issued a Request for Information (RFI) on Overarching Principles for Measuring Equity and Healthcare Quality Disparities across CMS Quality Programs. The goal of the RFI was to discuss key principles and approaches that CMS could consider when advancing the use of quality measure development and stratification to address these concepts across various programs. In the <a href="https://www.federalregister.gov/documents/2022/08/03/2022-16457/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities">FY 2023 SNF PPS Final Rule</a>, CMS summarized stakeholder feedback and indicated the input would be used to inform future measure development efforts.<br></p><p>As AHCA analyzed various Medicare claims, assessment, and other administrative data related to the implementation of the PDPM, it became clear that the COVID-19 pandemic and related public health emergency (PHE) created shifts in the social determinants of health (SDOH) and social risk factors (SRFs) characteristics of SNF Medicare Part A patients, which were most apparent in the early months of the pandemic. In this article we present examples of these shifts and discuss the potential implications of including equity and disparity data in future quality measure development efforts. <br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/PDPM-1.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />One indicator often used as a marker for income inequity is whether a Medicare beneficiary is also a recipient of Medicaid benefits (Dual Status). Figure 1 describes beneficiaries with traditional SNF Part A stays, and does not include admissions for patients with COVID-19 or patients admitted under the COVID-19 qualifying hospital stay waiver. As depicted in Figure 1, in FY 2019 and the first half of FY 2020 before the PHE (October 2018–March 2020), about 24.4– 24.8 percent of traditional SNF Medicare admissions were for dual eligible beneficiaries. During the first 6 months of the PHE from April through September 2020 (FY 2020 Q3 & Q4), the percentage of dual eligible beneficiaries increased to 27 percent, and then returned to near baseline in FY 2021 (October 2020–September 2021). We observed similar trends when looking at the percentage of zip codes below poverty level as well as zip codes with the lowest mean net worth. <br></p><p>It is notable that during the first 6 months of the PHE, overall SNF admissions dropped precipitously; therefore, those admitted to a SNF during this period appear to have been those individuals less likely to have the financial resources or social supports necessary to permit a hospital discharge to home. When more was known about the COVID-19 virus and vaccinations were initiated, the relative percentage of dual eligible SNF admissions returned to near baseline. <br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/PDPM-2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" />Another indicator often used as a marker for social inequity is preferred language or English proficiency. As depicted in Figure 2, In FY 2019 and the first half of FY 2020 before the PHE, about 3.4 percent of all SNF Medicare admissions (purple bars) were for beneficiaries from zip codes where residents speak little or no English. During the first 6 months of the PHE from April through September 2020, the percentage of beneficiaries from low English proficiency areas for traditional Part A admissions (green bars) increased slightly to 3.6 percent, and then returned to baseline in FY 2021. In contrast, during the first 6 months of the PHE, the percentage of beneficiaries from low English proficiency areas admitted with COVID-19 or under a PHE waiver (orange bars) increased to 4.2 percent, and then returned below baseline in FY 2021. <br></p><p>When considering all geographic locations, we observed a different pattern. As depicted in Figure 3, examining the month-to-month trends of SNF Minimum Data Set (MDS) patient SNF PPS 5-day assessment information of patients admitted without COVID in which the beneficiary requested interpreter services also revealed potential inequity impacts of the pandemic on people with low English proficiency. While the general trend for the need for interpreter services hovered around 2.2 percent, during the three significant COVID-19 surges beginning in March 2020, October 2020, and August 2021, the percentage of SNF Part A stays where the beneficiary requested interpreter services increased to around 2.7 percent. <br></p><p style="text-align:center;"><img src="/Issues/2022/SeptOct/PublishingImages/PDPM-3.jpg" alt="" style="margin:5px;" /> </p><p style="text-align:left;">While the absolute percentage changes in these examples appear to be small, when considered in a national perspective, the observed shifts can significantly impact the stability and accuracy of population-based SNF payment and quality measure models. Such impacts can be more apparent and can accelerate inequities in low-volume providers or in locations where these impacted populations are more densely concentrated if the models do not account for such shifts. <br></p><p>Indeed, from a payment policy perspective, CMS has considered the impact of the COVID-19 PHE-related shifting SNF admission demographics and took steps to minimize the impacts in its methodology to establish the PDPM parity adjustment adopted in the FY 2023 SNF PPS Final Rule. Similarly, CMS has revised the SNF Quality Reporting Program by modifying performance periods and adding COVID-19 risk adjustors and adopted temporary policies in the SNF Value-Based Purchasing Program to suppress unstable facility-specific performance scores due to the impact of the PHE. <br></p><p>As policymakers and the health care community explore the impact that SDOH and SRFs have on patient health and health outcomes, it will be necessary to identify those factors that can best address inequities and be responsive to sudden shifts in SNF patient care needs. <br></p><p>However, as AHCA stated in our FY 2023 SNF PPS Proposed Rule comments related to the <a href="https://www.regulations.gov/comment/CMS-2022-0069-2933">CMS Measuring Equity and Healthcare Quality Disparities RFI</a>, while we support the continued development efforts of measure concepts to address health equity and disparities across CMS quality programs, “we caution against advancing numerous and time-consuming structural and process measures that demonstrate an organization is good at ‘checking the box’ that they did what was asked on a quality measure checklist. We would prefer efforts be directed at exploring the thoughtful development of meaningful and risk-adjusted outcomes measures that demonstrate that the facility is showing progress at overcoming such historical barriers to quality care.”<br><br><em>Daniel Ciolek is associate vice president, therapy advocacy, for the American Health Care Association.</em><br></p>	We will contemplate questions related to patient care delivery, outcomes, and payment model implications informed by observed PDPM data trends.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/PDPM.jpg" style="BORDER:0px solid;" />	PDPM	PDPM Update
Exhibitor List	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/Exhibitors-List-73rd-Convention.aspx	Exhibitor List	<p>As of Aug. 2, 2022</p><p>Click to preview <a href="/Issues/2022/SeptOct/Documents/Exhibitors%20Prv0922.pdf" target="_blank" title="Exhibitor List">Exhibitor List</a>.</p>	Exhibitor List for the 73rd AHCA/NCAL Convention & Expo	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/Exhibitors.jpg" style="BORDER:0px solid;" />	Quality	Convention
Associate Business Members	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/Associate-Business-Members.aspx	Associate Business Members	<p>Preview this year’s exhibiting <a href="/Issues/2022/SeptOct/Documents/Prv0922_ABM_links.pdf" title="ABMs" target="_blank">Associate Business Members</a> (ABMs) that will be showcasing proven solutions on the expo hall floor. Plan your expo hall time by viewing companies by category and their corresponding booth number ahead of your Nashville arrival.</p>	Plan your expo hall time by viewing companies by category and their corresponding booth number ahead of your Nashville arrival.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/ABM.jpg" style="BORDER:0px solid;" />	Quality	Convention
Celebrating Joyful Moments & the Future of Assisted Living	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/Celebrating-Joyful-Moments-&-the-Future-of-Assisted-Living.aspx	Celebrating Joyful Moments & the Future of Assisted Living	<p><img src="/Issues/2022/SeptOct/PublishingImages/LaShuanBethea.jpg" alt="LaShuan Bethea" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />This year during National Assisted Living Week<sup>®</sup> (September 11-17), we celebrate “Joyful Moments.” This special observance honors assisted living staff, communities, residents, and families that come together as a large extended family and create happy, special memories together. <br></p><p>After the challenges of the past two and a half years, this theme is especially meaningful. Assisted living providers stepped up during that time to ensure their residents felt safe and loved and still had access to the care they need. They continued to create “Joyful Moments”—even when it wasn’t the easiest. <br></p><p>As we begin to emerge from one of the most challenging times in recent history, assisted living providers should evaluate new ways to continue delivering the highest quality care for residents going forward. <br></p><p>One strategy that may be relatively new to many within assisted living is population health management (PHM). PHM is the process of improving the health and quality of life for residents. It focuses on wellness, prevention, and proactive care coordination/management. <br></p><p><strong>What does that mean for assisted living providers, and why is it so important? </strong><br>Although a new concept for assisted living providers, other provider types—especially acute and primary care—have been leading the way under a multitude of PHM models for many years. PHM models deliver value-based care that helps improve outcomes and delivers better services to consumers. They help achieve the triple aim—the right care, at the right time, in the right place. The good news for assisted living providers is that a strong understanding of PHM can help you improve quality outcomes for your residents, position yourself well in the market, and manage risk within communities. <br></p><p>Assisted living is a natural setting for PHM. You offer meals, wellness programs, social engagement opportunities, transportation, supportive care, and other services focused on a whole-person approach while maintaining a home-like environment. You are positively influencing social determinants of health factors, thus being in a strong position to enhance outcomes, improve care, and lower costs. This is important because your community partners and referral sources are being held accountable to outcomes that you influence and are tracking your performance on these metrics—whether you are aware of it or not.<br></p><p>In addition, there has been growth in supplemental benefits offerings under Medicare Advantage. Many plans offer benefits such as companion services, which are currently out-of-pocket expenses for assisted living residents. Some plans go even further, helping with groceries and other traditionally non-health care-related benefits. Although fairly new and small in scope, the number of plans offering these benefits will increase. This could impact the amount of private-pay services in assisted living communities and will necessitate better coordination with health plans for covered services, as well as expand the options for innovations by assisted living providers themselves.<br><br><strong>What can assisted living providers do now to prepare for the changes ahead, such as a move towards PHM? </strong><br>First and foremost, collect important data. The health care landscape continues to change and evolve, and assisted living providers should begin now to track key data, such as hospital readmissions, emergency department visits, etc. Health plans and payors are already tracking these data and know how different providers compare. It is important to know where you stand and how you can improve. This will allow you to be a better partner with health plans and other providers in the future. It will also help you understand what is happening in your community and improve resident satisfaction by developing systems to reduce unnecessary hospitalizations and emergency transfers. Long Term Care Trend Tracker<sup>sm</sup> (<a href="https://www.ahcancal.org/Data-and-Research/LTC-Trend-Tracker/Pages/default.aspx" target="_blank">https://www.ahcancal.org/Data-and-Research/LTC-Trend-Tracker/Pages/default.aspx</a>) is a free tool offered to National Center for Assisted Living (NCAL) members. It allows you to start tracking immediately and trend yourself next to other providers in your area and across the country.<br></p><p>Additionally, start learning about what is happening in the health care space. What changes are occurring? What opportunities exist in value-based care? How can you partner with or become involved in provider-owned plans? Understanding the changing landscape puts you in a strong position to be successful in the future. <br></p><p>You should also plan to attend this year’s AHCA/NCAL Population Health Management Summit December 7-8 at the Gaylord National Harbor in Maryland. There will be several sessions focused specifically on assisted living, and this will be an invaluable opportunity to learn more about how to be successful utilizing PHM strategies and models in your communities. For more information and to register, go to <a href="https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank">https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx</a>.<br></p><p>Success means being able to deliver quality care for assisted living residents. It also means continuing to nurture the relationships that make your communities feel like home and create so many more joyful moments that are worth celebrating. <br></p><p>Enjoy National Assisted Living Week<sup>®</sup> (NALW), and be sure to share your celebrations on social media using the hashtag #NALW. Visit <a href="http://www.nalw.org/" target="_blank">www.NALW.org</a> for more information on National Assisted Living Week<sup>®</sup> (September 11-17). <br></p><p>Visit <a href="http://www.ncal.org/" target="_blank">www.ncal.org</a> to learn more about the National Center for Assisted Living. <br></p><p>Visit <a href="http://www.ahcancal.org/Reimbursement" target="_blank">www.ahcancal.org/Reimbursement</a> for more information on AHCA/NCAL’s Population Health Management efforts. <br><br><em>LaShuan Bethea is the executive director of the National Center for Assisted Living (NCAL). </em></p>	As we begin to emerge from one of the most challenging times in recent history, assisted living providers should evaluate new ways to continue delivering the highest quality care for residents going forward.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/AL.jpg" style="BORDER:0px solid;" />	Caregiving	Spotlight on Assisted Living
2022 AHCA Annual Awards	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/2022-AHCA-Annual-Awards.aspx	2022 AHCA Annual Awards	<p>The American Health Care Association (AHCA) pay tribute to the best and brightest in long term and post-acute care. Individuals and groups honored with awards will be recognized during the 73rd AHCA/NCAL Convention & Expo this month in Nashville, Tenn.</p><p><strong class="ms-rteThemeForeColor-5-0"><br></strong></p><p><strong class="ms-rteThemeForeColor-5-0">MyRon Zimmer, Bowdle Healthcare Center, Bowdle, SD</strong><br><span class="ms-rteForeColor-2">AHCA Volunteer of the Year Award</span></p><p><img src="/Issues/2022/SeptOct/PublishingImages/MyRonZimmer.jpg" alt="MyRon Zimmer" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />MyRon Zimmer has been a volunteer at Bowdle Nursing Home in Bowdle, SD, for many years, and has volunteered every day of the last four years. He can be described as the “textbook definition” of a passionate and caring health care volunteer. He interacts with every resident of Bowdle Nursing Home as if they are his own loved ones. His caring smile and outgoing personality bring joy to each and every resident he interacts with. Zimmer partners with Bowdle’s activities department for monthly “Painting with MyRon” sessions which residents enjoy and look forward to. As an extremely talented artist who loves to share that passion, Zimmer leads residents in painting free-hand creations that decorate the dining room and hallways at Bowdle.</p><p>At the height of COVID-19, Zimmer led the charge to continually bring joy to the residents to combat the fear and uncertainty many residents felt. He goes beyond above and beyond to ensure residents experience the highest quality of life, whether it be by planting and tending the luxurious garden that all residents enjoy in the back courtyard, giving haircuts, taking residents outside, or spending one-on-one time with residents who confide in him. Without a doubt, Zimmer is an extraordinary volunteer that the staff at Bowdle Nursing Home are honored to work alongside. </p><p><strong class="ms-rteThemeForeColor-5-0">Meera Riner</strong><br><span class="ms-rteForeColor-2">Mary K. Ousley Champion of Quality Award</span><br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/MeeraRiner.jpg" alt="Meera Riner" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" />Meera Riner, chief operating officer of Nexion Health Management, Inc., based in Sykesville Maryland, is the 2022 recipient of the Mary K. Ousley Champion of Quality Award. Riner is recognized for her outstanding contributions to quality in long term and post-acute care.<br></p><p>Over the last several years, Riner has worked to bridge the gap between regulators and long term care facilities. She was instrumental in the development of the Texas Coalition for Long-Term Care and the criteria for the Texas Quality Incentive Payment Program (QIPP), a performance-based program that incentivizes nursing facilities to improve the quality and innovation of their services. As a result, since 2019, the QIPP program has positively impacted quality in Texas nursing facilities by improving resident outcomes, with antipsychotic usage down in long-stay residents by 33 percent and improvement in long-stay residents’ ability to move independently up by 10 percent. <br></p><p>She is a Baldrige Program Fellow, the first person in long term care to achieve the honor. In 2020, Riner was awarded the McKnight’s Woman of Distinction Hall of Honor, and in 2020 she was recognized by McKnight’s Senior Living with an Innovation in Technology Award for her work during the COVID-19 pandemic. <br></p><p>Riner has served on the Texas Healthcare Association’s Board of Directors, and as an AHCA/NCAL National Quality Award Program Examiner, and on AHCA committees that address quality and workforce. <br>Each year, AHCA/NCAL presents the Mary K. Ousley Champion of Quality Award to an individual that has made significant national contributions to advancing quality performance in long term and post-acute care. Recipients display leadership in the development, promotion, and implementation of quality improvement initiatives that have resulted in measurable outcomes.<br></p><p>In 2011, the Friend of Quality Award was renamed the Mary K. Ousley Champion of Quality Award to honor the ongoing legacy and commitment to quality care demonstrated by its namesake, Mary Ousley, a licensed nursing center administrator and nurse who has dedicated her life to quality improvement programs in long term care.</p><p><strong class="ms-rteThemeForeColor-5-0">Mario Whitt, Harris Hill Nursing Facility, Williamsville, NY</strong><br><span class="ms-rteForeColor-2">AHCA Noble Caregiver</span><br></p><p>Mario Whitt has been part of The McGuire Group’s Harris Hill Nursing Facility for <span></span>over 20 years and currently <span><span><span><img src="/Issues/2022/SeptOct/PublishingImages/MarioWhitt.jpg" alt="Mario Whitt" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" /></span></span></span>chairs the Advisory Board Council. Whitt has been a beacon of inspiration throughout the COVID-19 pandemic and as the sector moves <span><span></span></span>forward. He continually contributes to the positive well-being of Harris Hill and displays leadership of the highest standards. Over the last year, Whitt has been instrumental in implementing of the State of New York vaccine mandate. He coordinated messaging to staff across McGuire Group’s facilities to help achieve some of the highest vaccination rates in the region. He served as a spokesman throughout the vaccine campaign and provided an in-depth overview of the vaccine, defining efficacy, best clinical practices, and debunking myths along the way. <br></p><p>Whitt also encourages employment for youth in health care. He introduced the concept of youth employment to reinvigorate workforce development, creating a pipeline of school-aged employees. In 2022, Harris Hill launched the program, which works primarily with inner-city high school students to develop health career tracks and valuable life skills for future employment. The first program of its kind within the Western New York Region, it is designed to be a paid internship for youth interested in health care and help them realize their dreams. <br></p><p>Additionally, Whitt is a true conduit bridging the gap between Harris Hill and the local community. In May 2022, following a mass shooting that took the lives of 10 individuals at a local grocery store, he coordinated efforts between local churches, community parishes, and The McGuire Group to hold numerous food drives and fundraisers. All of the food went to families of the victims, and proceeds funded the burial and funeral arrangements for the victims. <br></p><p>Whitt is closely tied with his community and continues to work toward a brighter future for the families, staff, and residents within the long term care community.<br><strong class="ms-rteThemeForeColor-5-0"><br></strong></p><p><strong class="ms-rteThemeForeColor-5-0">Larry Slatky, Shaker Place Rehab Nursing Center, Albany, NY</strong><br><span class="ms-rteForeColor-2">AHCA Administrator of the Year Award</span><br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/LarrySlatky.jpg" alt="Larry Slatky" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" />Larry Slatky has been the Administrator at Shaker Place Rehab Nursing Center in Albany, NY, since 2014. Prior to his arrival, Shaker Place was a one-star facility based on CMS’ Five-Star Quality Rating system. Under his leadership, the nursing home is now a four-star CMS Quality facility, an AHCA Silver Award recipient, and recently named the Best Senior Living Facility in the Capital Region by the Times Union, Albany’s local newspaper.<br></p><p>Slatky creates a team approach to manage Shaker Place, keeps lines of communication open, provides staff with the tools necessary for every department to reach its goals of operation, and always maintains an open-door policy. Understanding the importance of community, Slatky has established partnerships with educational institutions including BOCES, Siena College, St. Mary’s College, University of Albany, and the College of St. Rose that use Shaker Place for their various nursing, therapy, and dietician programs. Slatky also permits low-income families to send their young adults and other relatives to receive training in the trades, such as food services, maintenance, environmental services, and security.<br></p><p>Slatky leads from the heart with a passion to serve others, and with the highest degree of integrity and ethical behavior.</p><p><strong class="ms-rteThemeForeColor-5-0">Longevity Fun Run, Forest Hills of DC, Washington, DC</strong><br><span class="ms-rteForeColor-2">AHCA Program of the Year Award<br></span></p><p><img src="/Issues/2022/SeptOct/PublishingImages/Awards_run.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:150px;height:188px;" />After an annual city-wide AARP luncheon to honor centenarians was canceled due to COVID in May 2021, Forest Hills of DC established its Longevity Fun Run. Born out of the need to celebrate health care heroes and honor their residents during COVID, this event brings together residents, families, staff, volunteers, and community representatives, including DC Department of Health (DOH) Council members. The event takes place every May during Older Americans Month and National Skilled Care Week in a fun, inclusive, community-bonding running event connecting assisted living and nursing homes across the District of Columbia. <br></p><p>At this year’s Longevity Fun Run on May 12, 2022, DC Council passed a proclamation that May 2022 be decreed as “Old People Are Cool” month to honor seniors and residents, take a stance against ageism, celebrate the wisdom seniors have to offer, and to lift up those health care workers who care for the residents. The event builds a sense of greater community with and around Forest Hills’ residents, involves government council representatives, the DOH, skilled nursing facilities, assisted living facilities, board members, staff department heads, and CNAs all on a level playing field. <br></p><p>The energetic exchange between teams running and support from friends and family waiting to greet them when they arrived are reminders that the purposeful work of long term care connects everyone involved. <br></p>	AHCA pays tribute to the best and brightest in long term and post-acute care.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/Awards.jpg" style="BORDER:0px solid;" />	Quality Awards	AHCA/NCAL Annual Awards
73rd AHCA/NCAL Convention & Expo	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/73rd-AHCA-NCAL.aspx	73rd AHCA/NCAL Convention & Expo	<p>Nashville will get a new wave of energy when thousands of long term and post-acute care professionals arrive in the Music City for the 73rd AHCA/NCAL Convention & Expo on October 9-12, 2022. From its dynamic nightlife to its legendary musical history, Nashville is the perfect place to gather together as a sector and spend time learning, laughing, and advancing long term and post-acute care. There’s no shortage of ways to spend your time. We’ve outlined some of the must-know information to make the most of your participation in convention. <br></p><h3>Education Sessions for Operational & Leadership Skills </h3><p>At the core of convention is education, and this year’s lineup of more than 100 sessions is one of AHCA/NCAL’s most robust. Over four days, there will be experts and speakers offering highly specialized content in 15+ educational tracks. There’s something for everyone at convention, regardless of your area of expertise or number of years in the field. <br></p><p>The 2022 AHCA/NCAL Professional Development Workgroup designed an education program that addresses current and pressing operating and care challenges facing providers today. Critical workforce issues, census rebuilding, reimbursement constraints, regulatory changes, and much more set the stage for exceptional performances from the best talent in the industry. This year’s convention is a must-attend for professionals to take the opportunity to learn from experts and peers about the impact of these issues in our sector.<br></p><h3>Educational Tracks</h3><p>• Assisted Living<br>• Behavioral Health<br>• Clinical Care Practice <br>• Customer Experience<br>• Independent Owner<br>• Infection Prevention and Control<br>• Not for Profit and ID/DD<br>• Operational Analytics<br>• Person-Centered Care<br>• Post-Acute Care<br>• Quality Awards<br>• Quality Improvement<br>• Reimbursement<br>• Survey & Regulatory<br>• Technology & Innovation<br>• Workforce Solutions & Leadership</p><p>Click for complete <a href="/Issues/2022/SeptOct/Documents/convention%20Prv0922.pdf" target="_blank">convention lineup</a>.<br></p>	Dust off your boots & hang onto your hats— AHCA/NCAL Convention & Expo is heading to Nashville.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/convention.jpg" style="BORDER:0px solid;" />	Quality	Convention
2022 NCAL Annual Awards	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/2022-NCAL-Annual-Awards.aspx	2022 NCAL Annual Awards	<p>The National Center for Assisted Living (NCAL) pay tribute to the best and brightest in long term and post-acute care. Individuals and groups honored with awards will be recognized during the 73rd AHCA/NCAL Convention & Expo this month in Nashville, Tenn.</p><p><strong class="ms-rteForeColor-6">Doreen Locke, R.N., D.O.N.</strong><br><em>Assisted Living Nurse of the Year Award</em></p><p><span><img src="/Issues/2022/SeptOct/PublishingImages/DoreenLocke.jpg" alt="Doreen Locke, RN, DON" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" /></span>After 30 years with Odd Fellows’ and Rebekahs’ Home of Maine, RN Nurse Supervisor Doreen Locke has created an environment that makes this assisted living community the most sought-after facility in the region. <br></p><p>She knows each resident personally, their favorite things, health concerns, and their personal family dynamics. She communicates with staff daily. She is always accessible to staff without complaint – even while on vacation, recovering from an injury, and through the births of her nine grandchildren.<br></p><p>Locke works weekends, night-shifts, and whenever needed to make sure everything is covered. She has worked as a floor nurse, a CNA, a CRMA, and even in dietary. Recently, she held the kitchen staff together with four dietary aides and no cooks, herself cooking on weekends—including a double shift when there were two call-outs. She refused to ask for help from an aide who was available because she wanted him to have a day off after 10 days straight working. <br></p><p>She always makes everyone laugh. She has an infectious wit and gets credit for keeping staff from burnout during the past three years. She has shown what it means to put the resident first, even throughout the pandemic. She has maintained the best attitude and is a shining example of what a caregiver is all about.</p><p><strong class="ms-rteForeColor-6">Barbara Quezada</strong><br><em>NCAL Noble Caregiver in Assisted Living Award</em></p><p><img src="/Issues/2022/SeptOct/PublishingImages/BarbaraQuezada.jpg" alt="Barbara Quezada" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" />Barbara Quezada has served the residents of Beehive Homes of Taylor Ranch in New Mexico for the past 13 years as a Caregiver/House Manager. She consistently shows up for work when scheduled and is the first to pick up the extra shifts to make sure the residents get the care they need. She consistently demonstrates the community’s mission statement—“People are our business, improving the lives of all we touch”—in the humblest way.<br></p><p>When a new house manager and/or mentor is hired, Quezada is the first one called to educate and train this new position. She is always ready and willing to help, even when the training takes place away from her home in New Mexico. <br></p><p>She truly cares about her residents and her fellow staff. On one of her resident’s birthdays, the resident was scheduled to go out to lunch with her daughter. Quezada came in on her day off to help the resident shower, get dressed, and fix her hair. She made sure the resident looked and felt her best. <br></p><p>A fellow employee was having a family crisis, and she was there to help. She listened to the employee’s story and told her to go home and take care of the crisis. She then worked the employee’s 12-hour shifts on both Saturday and Sunday—even after completing her own 40-hour work week. <br></p><p><strong class="ms-rteForeColor-6">Nicole Ellis</strong><br><em>NCAL Administrator of the Year</em></p><p><img src="/Issues/2022/SeptOct/PublishingImages/NicoleEllis.jpg" alt="Nicole Ellis" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />Nicole Ellis started as a caregiver in 2010 and worked her way up to Administrator at The Cottages of Middleton in Middleton, Idaho in 2013. She did so through hard work, perseverance, and by living the company mission statement, “We Treat People Right.” She also recently took on additional roles of executive director and peer leader. <br></p><p>Ellis is motivated and positively engaged, serving as a true inspiration to her peers, co-workers, and other industry leaders. She has developed processes over the years to manage buildings in an impressively efficient manner. She has successfully built a positive culture in her communities and has maintained an AHCA/NCAL Quality Award-winning culture even through the challenges of the recent years. <br></p><p>Ellis cares deeply about delivering next-level quality of life to her residents. She has supported many efforts like Dream Flights and is always looking for ways to involve her residents in special events and opportunities. She is a true rock star and serves as a shining example within long term care.<br></p><p><strong class="ms-rteForeColor-6">Rod Burkett</strong><br><em>Jan Thayer Pioneer Award</em></p><p><img src="/Issues/2022/SeptOct/PublishingImages/RodBurkett.jpg" alt="Rod Burkett" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" />As Co-Founder/President/CEO of Gardant Management Solutions in Illinois, Rod Burkett has been pioneering accessibility and affordability for assisted living for nearly 25 years. His efforts have sparked awareness, conversation, and advocacy. <br></p><p>Burkett is a visionary who saw the value in Medicaid waiver supported/affordable assisted living. He and his co-founder were one of the first responsive operators approved by the state of Illinois for development and certification under the uniquely licensed Supportive Living Program. He co-founded the Affordable Assisted Living Coalition, which remains the driving force in advocating, promoting, and protecting the Illinois Supportive Living Program. Because of his vision, Gardant Management Solutions serves over 5,600 residents in the Midwest who receive dignified lifestyles and care through services supported by the Medicaid waiver program.<br></p><p>Burkett also developed and hosted two “National Summits” in 2016 and 2017 for key influencers in assisted living to focus on existing and future needs for Affordable Assisted Living (AAL). He partnered with other providers and developers to petition multiple state governor's offices to bring awareness to AAL. <br></p><p>Furthermore, Burkett embraces the quality measures identified in the AHCA/NCAL National Quality Award Program. Eighty-five percent of Gardant Management Solutions’ portfolio are Quality Award recipients, and one of the three assisted living communities nationwide to receive the Silver Award in 2022 is a Gardant managed community.<br></p><p>He is an action-driven advocate and leader at the national level. He has served on Argentum's CEO roundtable, chaired NCAL’s Finance & Policy Committee for five years, and served on the NCAL Board of Directors for three years. <br></p><p>Burkett earned his Bachelor of Science with honors in Community Health and his Master of Business Administration from Eastern Illinois University. He has also earned graduate hours toward his Master of Health Administration from St. Louis University.<br></p><p>The Jan Thayer Pioneer Award recognizes individuals who have moved the senior care profession forward, positively affecting the lives of those served and those who serve. Recipients must demonstrate dedication, leadership, and considerable contributions to the profession.<br><br></p>	NCAL pas tribute to the best and brightest in long term and post-acute care.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/ncal-awards.jpg" style="BORDER:0px solid;" />	Quality Awards	AHCA/NCAL Annual Awards
The Consequences of Using a Nurse Assessment Coordinator as Interim Clinical Staff	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/The-Consequences-of-Using-a-Nurse-Assessment-Coordinator-as-Interim-Clinical-Staff.aspx	The Consequences of Using a Nurse Assessment Coordinator as Interim Clinical Staff	<p><img src="/Issues/2022/SeptOct/PublishingImages/JenniferLaBay.jpg" alt="Jennifer LaBay" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />The nurse assessment coordinator (NAC) has a unique, highly specialized role in the skilled nursing facility (SNF) post-acute care setting. The NAC must possess knowledge that combines clinical, financial, and regulatory compliance information. From the <em>Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual </em>to the<em> Nursing Home Five-Star Quality Rating System: Technical Specifications</em> and all the related regulations in between, there are thousands of pages of federal regulation and guidance that the NAC must understand to succeed in the role—not to mention any state-specific requirements for minimum data set (MDS) coding and Medicaid payment. Because the position is so specialized, clinical leadership must weigh the risks of utilizing the NAC to cover open nursing positions against the benefits. While temporarily shifting the NAC to an open spot may solve an immediate problem, it could also negatively affect reimbursement, quality outcomes, and the facility’s Five-Star rating. </p><h3>Medicare and/or Medicaid Revenue</h3><p>The MDS drives payment for Original Medicare using the Patient-Driven Payment Model. This system consists of six components: five case-mix adjusted and one non-case-mix. The five case-mix-adjusted components derive almost exclusively from MDS coding. The NAC must be not only well-versed in the MDS coding instructions but also aware of the case management intricacies involved in assessment reference date (ARD) selection and Interim Payment Assessment determinations. Both of these factors can have a significant impact on a facility’s bottom line. <br></p><p>In case-mix states utilizing the legacy payment systems, the MDS drives Medicaid payment as well. A NAC working the floor is not managing the Medicare or Medicaid caseloads. When finally able to complete the MDS, he or she may not have adequate time for a comprehensive review of supporting documentation. This can lead to overlooking details, such as missing documentation to support intravenous fluids, selecting the wrong ICD-10-CM codes as the primary diagnosis, or not timely setting the ARD. All of these mishaps can lead to loss of revenue or provider liability. Who manages MDS responsibilities when the NAC is working the floor? If the facility is lucky enough to have someone covering the NAC’s duties, does that person have the knowledge to do it correctly? Does the substitute know the MDS coding instructions? Is he or she aware of the timeliness requirements for setting ARDs appropriately? Is the facility following ICD-10-CM coding guidelines? These are important questions to consider when attempting to manage the staffing crisis by utilizing the NAC in other roles.</p><h3>Quality Measures </h3><p>Quality measures (QMs) affect many aspects of the SNF world; they drive the facility’s quality improvement efforts, influence the survey process and the Five-Star rating, and are publicly reported for consumers. There are some claims-based QMs, but most of the measures are directly based on what is coded on the MDS. If there is a delay in completing assessments due to a staffing issue, rushing to complete assessments may cause inaccuracies when insufficient time is invested in researching records. Or inadequate training of the person completing assessments can lead to inaccurate coding, as well. It is important to monitor the QMs closely when backup NACs complete assessments to identify any errors and make modifications timely. </p><h3>Five-Star </h3><p>QM reports found on the CASPER and Care Compare websites contain historical data, so facility leadership may not immediately see the effects of their staffing decisions. Publicly reported and Five-Star QMs present four quarters of data, but because there is a full quarter of lag time in reporting, the data on these reports are 6 to 18 months old. Once the QMs are calculated for public reporting, facility staff cannot make any corrections to change the data. So the only things that can shift QM numbers are the passing of time, accurate assessments moving forward, and quality improvement efforts. <br></p><p>Additionally, the staffing star rating uses MDS data to determine the census for hours per resident day calculations. If discharge assessments are not completed in a timely manner, the facility census will appear larger in the Five-Star census than it actually is at the facility. This can result in the publicly reported staffing calculation showing that the facility is not staffing adequately for the census, when in reality, the MDS census was incorrect due to missing discharge assessments. <br></p><p>The QM and staffing ratings also affect the overall Five-Star rating. If a facility is rated at five stars for staffing, a star would be added to the overall star rating. If the facility has a one star in staffing, even if due to incomplete discharge assessments, this would subtract one star from the total. If a facility is at five stars for QMs, it adds a star to the overall star rating. Dropping to four QM stars or less due to a lack of oversight and management of the MDS process harms the overall star rating. Moreover, if a facility already not performing well with QMs drops from a two-star rating to a one-star in QMs, the facility will lose a star in the overall star rating. </p><h3>Managing MDS and Medicare Compliance</h3><p>Therefore, before turning to the NAC to cover an open shift, nursing home leadership must consider how that vacant or inadequately filled position will affect the facility in the long run. <br></p><p>However, when there is no alternative and the NAC must be used to provide resident care, there are some steps leadership can take to reduce declines in quality and revenue. Ample cross-training of duties by incorporating Resident Assessment Instrument (RAI) requirements and definitions into interdisciplinary team assessments positions more staff members to contribute to the MDS process. Leadership can also optimize facility software, when possible, to prompt nursing staff for documentation based on the ARD and assessment type. If the clinical team provides documentation with knowledge of how it is used in the RAI process, it is less likely information will be missed. Also, to decrease the risk of provider liability due to missed assessments, leadership can include ARD selection in the admitting nurse’s duties. Finally, they can ensure there is a backup NAC who periodically completes assessments to keep skills up, so that if assistance is needed with MDS completion, a trained person is available to assist. Many organizations utilize floating NACs or temporary NAC agencies to assist with MDS completion. While these steps require advance preparation, they can mitigate the unintended consequences of diverting resources from the NAC role. By recognizing the vital nature of the role and enhancing the facility’s ability to fulfill NAC responsibilities, leaders can prevent something they intend as a solution from causing additional problems. <br><br><em>Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, is curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).</em></p>	Temporarily shifting the NAC to an open spot may solve an immediate problem. It could also negatively affect reimbursement, quality outcomes, and the facility’s rating.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/caregiving.jpg" style="BORDER:0px solid;" />	Workforce;Caregiving	Focus on Caregiving
Special Needs Plans Improve Care and Access	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/Special-Needs-Plans-Improve-Care-and-Access.aspx	Special Needs Plans Improve Care and Access	<p><img src="/Issues/2022/SeptOct/PublishingImages/SteveFogg.jpg" alt="Steve Fogg" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" /><em>Steve Fogg, chief financial officer of Marquis Companies, has been in the long term care industry since 1986 as part of a multi-generational family business in Oregon. Marquis Companies became actively engaged in population health management (PHM) in 2015, which led to the launch of its institutional special needs plan (I-SNP) named Ageright Advantage Health Plan. </em>Provider<em> magazine spoke with Fogg to talk about the growth of SNPs, how SNPs improve care access, and validation of the care model during the pandemic. </em><br><br><em class="ms-rteForeColor-8"><strong>Provider</strong></em><strong class="ms-rteForeColor-8"> magazine:</strong> Despite the pandemic, long term care provider-led I-SNPs grew from 9 percent of all I-SNPs in 2015 to 33 percent in 2020 and 37 percent in 2021. What are you observing now about the prevalence of long term care provider-led I-SNPs? Where do you think the market will be in 5 to 10 years?<br><strong class="ms-rteForeColor-2">Steve Fogg: </strong>Provider-owned SNPs were probably the fastest growing segment in long term care prior to the pandemic. The desire for providers was to elevate physician services, advanced practice clinician services, and to be able to drive a better experience and outcomes. Provider-owned plans grew in terms of market share, but if you look at membership, the number of individuals that are insured under these plans, it’s not nearly as aggressive. During the pandemic, the rate of growth was not as high as it could have been. As we head out of the pandemic, there’s no reason why we won’t continue to see growth in this space with more providers wanting to enter into SNPs.<br><br><strong class="ms-rteForeColor-8">PM:</strong> How is the workforce crisis affecting long term care provider-led I-SNP availability?<br><strong class="ms-rteForeColor-2">SF: </strong>With the workforce shortage in general, the challenge has become so acute for providers that providers have deferred making the decision to start their own SNP. It’s slowing down the rate at which provider-owned plans and special needs plans are growing. <br></p><p>In the advanced practice clinician space, we’ve noticed that finding physicians and advanced practice clinicians hasn’t been nearly as difficult as finding nurses. We’ve found that there are physicians and advanced practice clinicians that are migrating to long term care because they like the day-to-day work environment versus a hospital or medical clinic environment. <br></p><p><strong class="ms-rteForeColor-8">PM:</strong> What challenges and opportunities in managed care do you see going forward?<br><strong class="ms-rteForeColor-2">SF:</strong> When I say managed care for long term care, I’m including not only the provider-owned SNPs, but also Medicare Advantage (MA) contracting. You’re going to continue to see managed care organizations increase their membership. Over the last 20 years, you’ve seen the over-65 population gradually migrating to managed care. There will be continued challenges in understanding what levels of reimbursement we need to be viable and to continue to provide services to our residents.<br></p><p>The other thing that you’re going to see around PHM is more MA plans subcontracting the management of population health. Those contractors will bring in automation, technology, and workforce to be more effective in managing the population health to provide better outcomes. <br></p><p>A huge opportunity or a challenge for certain providers will be that as MA plans continue to get greater and greater market share with those over 65, these subcontracting relationships could lead to limiting the network of facilities that they work with.</p><p><strong class="ms-rteForeColor-8">PM:</strong> What are the differences in rural vs urban long term care provider-led I-SNPs? Do these plans increase access to long term care in rural areas?<br><strong class="ms-rteForeColor-2">SF:</strong> Without a doubt, one of the significant advantages is the ability to bring a plan into rural facility locations. To bring in a physician or an advanced practice clinician that is in the building every day provides a resource where there may be no such resource in that rural community. In the counties where we have rural facilities, our membership penetration is almost 100 percent. It has improved the overall model of care and services provided to that rural group, so it’s a huge advantage. </p><p><strong class="ms-rteForeColor-8">PM: </strong>According to a 2021 report from ATI Advisory, successful long term care provider-led I-SNPs require strong leadership, accountability, and oversight. How can long term care leaders get buy-in and alignment to succeed with these plans?<br><strong class="ms-rteForeColor-2">SF: </strong>Without a doubt, the most important part is driving a culture of why this SNP will be beneficial for their facilities and for their residents. The team needs to understand that the physician or advanced practice clinician is there to give you a higher level of clinical capability to manage your residents in a more rapid and effective way as they have changes in condition and other issues.</p><p><span class="ms-rteForeColor-8"><strong>PM: </strong></span>Did COVID provide any lessons learned for the model of care for the future? Did it shift how managed care is/should be done?<br><span class="ms-rteForeColor-2"><strong>SF: </strong></span>We had two big lessons come out of the pandemic. First, having up-to-date and complete advanced care planning documentation in your facilities with your residents was critical during the pandemic. We were current and up-to-date on our advanced care planning with our residents, which allowed us flexibility and allowed us to make the right decisions that were best for the resident versus immediately sending an individual to the hospital. <br></p><p>The second thing we learned was the family members of our residents had security and comfort knowing that there was a physician or an advanced practice clinician in our buildings at a time that they were not able to come in and see their loved ones. Being able to talk to that level of professional if there were issues with their loved one was a huge benefit for them and us. It added to the family members feeling like their loved ones were in an environment that was more secure and capable of caring for them. <br></p><p>During the pandemic, there was not any reason to think that we should change the model of care, and in large part, COVID validated the importance of and why the model of care works well. </p><p style="text-align:center;"><img src="/Issues/2022/SeptOct/PublishingImages/MarquisCompanies_2c.jpg" alt="" style="margin:5px;width:125px;height:111px;" /> <img src="/Issues/2022/SeptOct/PublishingImages/MQ_AgeRight_Advantage.jpg" alt="" style="margin:5px;width:125px;height:37px;" /><br></p><p><br></p>	Provider spoke with Fogg to talk about the growth of SNPs, how SNPs improve care access, and validation of the care model during the pandemic.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/SteveFogg.jpg" style="BORDER:0px solid;" />	Population Health Management	Population Health Management
2022 AHCA/NCAL National Quality Awards Recipients	https://www.providermagazine.com/Issues/2022/SeptOct/Pages/2022-AHCA-NCAL-National-Quality-Awards-Recipients.aspx	2022 AHCA/NCAL National Quality Awards Recipients	<p>The American Health Care Association/National Center for Assisted Living is pleased to present the companies that have earned AHCA/NCAL National Quality Awards in the Gold—Excellence in Quality, Silver—Achievement in Quality, and Bronze—Commitment to Quality categories.</p><p><strong style="color:#cc9900;"><span style="color:#cc9900;">GOLD</span></strong><br>Gold recipients demonstrate through their approach, deployment, and consistency of results that they are achieving high levels of performance in health care, customer satisfaction, market, workforce, process, and leadership outcomes. At the Gold level, applicants must address the Health Care Criteria of the Baldrige Performance Excellence Program in its entirety.</p><p><span class="ms-rteThemeForeColor-1-4"><strong>SILVER</strong></span><br>Applicants that receive the Silver award provide an extensive assessment of their systematic approaches, performance measures, and sustainable organizational and process results that are linked to the key customer requirements, success factors, and challenges the applicants previously identified in earning the Bronze award. </p><p><strong style="color:#cc6600;"><span style="color:#cc6600;">BRONZE</span></strong><br>Applicants that receive the Bronze award are able to describe their vision and mission, outline plans to improve processes within their communities, identify key challenges, and recognize the relationship of these factors with their ability to achieve performance improvement.</p><p><a href="/Issues/2022/SeptOct/Documents/QualityAward%20Prv091022.pdf" target="_blank">2022 AHCA/NCAL National Quality Award Recipients</a><br></p>	AHCA/NCAL is pleased to present the companies that have earned National Quality Awards in the Gold, Silver, and Bronze categories.	2022-09-01T04:00:00Z	<img alt="" src="/Issues/2022/SeptOct/PublishingImages/QA_Maunalani.jpg" style="BORDER:0px solid;" />	Quality Awards	National AHCA/NCAL Quality Awards

America’s Assisted Living Communities Celebrate “Joyful Moments”	https://www.providermagazine.com/Articles/Pages/America’s-Assisted-Living-Communities-Celebrate-“Joyful-Moments”-.aspx	America’s Assisted Living Communities Celebrate “Joyful Moments”	<p>Beginning today and continuing through Saturday, Sept. 17, America’s assisted living communities are participating in National Assisted Living Week<sup>®</sup> (NALW). The national observance—which begins each year on National Grandparents’ Day and is supported this year by official sponsor First Quality—honors the individuals who reside, work, and volunteer in assisted living and residential care communities with special activities and events. </p><p>Created by the National Center for Assisted Living (NCAL) in 1995, this year’s NALW theme – “Joyful Moments” – reflects the strong connection between residents and staff and encourages them to join with their families and local communities to celebrate and create happy memories. This week also provides the opportunity to educate communities across the country about this sector of long term care and the dedicated, hardworking caregivers. </p><p>“Assisted living staff have continued to provide high-quality care to residents in senior living and should be celebrated for the incredible work they do every day,” said NCAL Executive Director LaShuan Bethea. “This year’s theme is special because it recognizes the extraordinary bonds built in assisted living communities. It recognizes the fact that residents, staff, and families are truly one big extended family finding joy in caring for each other throughout every moment in life – no matter how big or small.” </p><p>The annual observance encourages assisted living communities around the country to offer a variety of events and activities to bring together residents, staff, and volunteers, while adhering to infection control requirements and precautions in place for COVID-19. Participants are asked to share their celebrations throughout the week on social media with the hashtag #NALW. </p><p>For more information on National Assisted Living Week, please visit <a href="https://www.ahcancal.org/Education-Events/Pages/NALW.aspx" target="_blank">www.nalw.org</a>. </p><p style="text-align:center;"><img src="/SiteCollectionImages/logos/ncal_large_color.jpg" alt="" style="margin:5px;width:193px;height:135px;" /><br></p>	“Joyful Moments” – reflects the strong connection between residents and staff and encourages them to join with their families and local communities to celebrate and create happy memories.	2022-09-12T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/NALW.jpg" style="BORDER:0px solid;" />	Assisted Living
NCAL Report States Continue Strengthening Assisted Living Regulations	https://www.providermagazine.com/Articles/Pages/NCAL-Report-States-Continue-Strengthening-Assisted-Living-Regulations.aspx	NCAL Report States Continue Strengthening Assisted Living Regulations	<p></p><p>Assisted living regulations, statutes, and policies in 33 states were updated between 2020-2022, according to the National Center for Assisted Living's (NCAL) 2022 edition of the “<a href="https://www.ahcancal.org/Assisted-Living/Policy/Pages/state-regulations.aspx" target="_blank">Assisted Living State Regulatory Review</a>" released today. </p><p>“States continue to demonstrate their ability to respond to the evolving assisted living environment, foster quality improvement, support transparency for consumers, and maintain resident safeguards," said LaShuan Bethea, NCAL Executive Director. “NCAL supports ongoing collaborative efforts between assisted living providers, state regulators, and all stakeholders to properly balance oversight while continuing to honor residents' needs and desires." </p><p>The report also found the following: <br><ul><li>Forty-six states and the District of Columbia (92%) require a consumer disclosure, agreement, and/or bill of rights for residents. </li><li>All 50 states and the District of Columbia require a form of resident assessment and, at minimum, provide activities of daily living for residents.</li><li>Forty-nine states and the District of Columbia (98%) have provisions around, and allow, providing medication management to residents. </li><li>Forty-five states and the District of Columbia (90%) have minimum educational and/or training requirements for assisted living administrators/directors. </li></ul></p><p>“It is clear from the trends we have seen over the years that state regulations continue to increase in assisted living," said Jill Schewe, NCAL's director of policy and regulatory affairs and the report's author. “States are making changes as they determine how to best serve their specific resident populations in the years ahead, and we anticipate this trend will continue." </p><p>The “Assisted Living State Regulatory Review" summarizes key selected state requirements for assisted living licensure or certification. It provides information for every state and the District of Columbia on topics such as which state agency licenses assisted living, recent legislative and regulatory updates affecting assisted living, and requirements for resident agreements, admission and discharge, units serving people with Alzheimer's or other dementias, staffing, and training. </p><p>The report also includes requirements for communities that offer seniors and people with disabilities housing, supportive services, person-centered assistance with activities of daily living, and some level of health care but may use a different term than assisted living (such as residential care and personal care homes). </p><p>The full report along with summaries for each state are available on the <a href="https://www.ahcancal.org/Assisted-Living/Policy/Pages/state-regulations.aspx" target="_blank">NCAL website</a>. <br></p><p><br></p><p style="text-align:center;"><img src="/SiteCollectionImages/logos/ncal_large_color.jpg" alt="" style="margin:5px;width:200px;height:133px;" /></p>	AL regulations, statutes, and policies were updated, according to a new NCAL report summarizing key selected requirements for AL licensure or certification in every state and the DC.	2022-09-15T04:00:00Z	<img alt="" height="740" src="/Articles/PublishingImages/150x150/NCAL_reg.png" width="740" style="BORDER:0px solid;" />	Assisted Living
VOTE NOW! AHCA/NCAL's Mark Parkinson a Finalist for Modern Healthcare's Most Influential People	https://www.providermagazine.com/Articles/Pages/VOTE-NOW-AHCA-NCAL's-Mark-Parkinson-Finalist-for-Modern-Healthcare's-Most-Influential-People.aspx	VOTE NOW! AHCA/NCAL's Mark Parkinson a Finalist for Modern Healthcare's Most Influential People	<p><em>Modern Healthcare</em> recently published the <a data-linkto="http://" href="https://cl.exct.net/?qs=a425a1d0112b62ce8bac54265f8bafe0172664e307c495db39bc2d90197c1e88b8442d9e22fa34adba4cea43c5fab3b77a1f653db69cf232" title="finalists" target="_blank">finalists</a> for its annual listing of the 100 Most Influential People in Healthcare.</p><p>Among this year's list of finalists includes AHCA/NCAL's Mark Parkinson. He has received this recognition in previous years which continues to elevate the voice of AHCA/NCAL.</p><p>Voting is open to the public and members are encouraged to vote before the deadline on <strong>S</strong><strong>eptember 27, 2022. </strong><br></p>	He has received this recognition in previous years which continues to elevate the voice of AHCA/NCAL.	2022-09-20T04:00:00Z	<img alt="" src="/PublishingImages/Headshots/MarkParkinson.jpg" style="BORDER:0px solid;" />	Quality

A Model of Quality Care During Transitions	https://www.providermagazine.com/Articles/Pages/A-Model-of-Quality-Care-During-Transitions.aspx	A Model of Quality Care During Transitions	<p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><p>The Continue Care transitional care management program, created by PharMerica and BrightSpring Health Services, aims to address the gaps in care that exist when an individual is transitioning from a skilled care facility to their own home. Though the program officially launched in May 2022, its development has been underway for much longer, gaining evidence of its impact on the quality of care offered to individuals during critical times of transition. <br></p><p>At its core, Continue Care integrates seamlessly into a facility’s discharge planning process to extend care management into the home by offering a dynamic set of services and solutions that promote medication therapy optimization and nurse engagement at all levels of care. These include 44 days of medications provided post-discharge with most providers, including an initial 14-day supply of medications at the time of discharge; weekly check ins from a nurse starting within 48 hours of arriving home; in-home visits from nurse practitioners (NPs) where available; and 24/7 virtual nurse and pharmacist support for residents and families.<br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/ElizabethBurns.jpg" alt="Elizabeth Burns" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />Conceptually, the Continue Care transitional care management program has gained support from key industry leaders. To add more demonstrative proof of its impact on quality care, PharMerica partnered with Avamere, a leader in post-acute and senior living, to pilot Continue Care’s transitional care management program. Under the leadership of Dr. Elizabeth Burns, Chief Medical Officer at Avamere, the company launched Continue Care’s pilot program to support its goal of increasing quality care and the patient experience. <br></p><p>“One of the core missions of Avamere is to pursue innovation, not emulation,” said Dr. Burns. “That mission made the decision to join the Continue Care program an easy one.”<br></p><p>Like many centers, Avamere was seeking solutions to address key areas of quality care, including reducing hospital readmissions, improving medication adherence at home, preventing emergency hospitalizations, and providing care in the home for those who need a higher level of assistance. <br></p><p>“Our goal is to improve the quality of seniors’ lives,” said Dr. Burns. “That requires that we set each person in our care up for success whether they are staying at one of our senior living facilities or discharging from our post-acute care centers. The Continue Care program breaks down barriers for safe and effective transitions in the home while improving the well-being and experience of patients and residents.”<br></p><p>While the pilot overall has been a success thus far, three specific areas of Continue Care’s program are supporting Avamere’s goals of setting patients up for long-term success: <strong><br></strong></p><p><strong>Primary Care Hub:</strong> Where available, the Primary Care Hub offers NP-led care within the facility itself to partner with staff to develop a proactive care path.<br><strong>Clinical Nursing Hub:</strong> The Clinical Nursing Hub offers care navigation into the home, monitoring, and triage tools designed to address risks and improve outcomes in real time.<br><strong>Pharmacy Packaging:</strong> Continue Care provides convenient multi-dose pillow packaging of prescription medications organized by administration time, synchronized into 30-day cycles with clear instructions to increase adherence and reduce confusion.</p><h3>Primary Care Hub </h3><p>Honoring Continue Care’s goal of creating a model that positions individuals for the best care possible along all stages of the care continuum, Continue Care integrated aspects of BrightSpring’s home-based primary care services into Avamere’s trial through the Primary Care Hub. This in-facility service is a patient’s initial interaction with a care team, beginning the day of admission and continuing through discharge. From this early interaction, care providers can spend time getting to know the patient, their medical diagnoses, and complications, and better understand what the best proactive care plan should be for that specific individual. <br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/ArifNazir.jpg" alt="Arif Nazir" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" />“This partnership between home-based primary care and Continue Care is being developed to offer all care providers a great understanding of a patient,” said Dr. Arif Nazir, Chief Medical Officer, Primary Care, at BrightSpring Health Services. </p><p>“We’re focused on proactive care, which relies a lot on communication between care providers as well as taking time and resources to better educate patients about their own medical care.”<br></p><p>Based on initial observations, BrightSpring’s proactive care models within the Continue Care program can help better identify specific medical issues that need attention before they require reactive care. This is particularly important in the Continue Care program, where patients will have complex co-morbidities. While certain technological components are still being developed, BrightSpring’s team-based process requires collaboration between in-facility care teams and the transitional care management teams of Continue Care, as well as educating the patients themselves.<br></p><p>The Primary Care Hub overlay includes:<br></p><ul><li>A NP-led care program to partner with facility staff.</li><li>A risk-stratified, proactive care path-based model to meet individualized medical and psychiatric needs.</li><li>NPs/physician assistants (PAs) supported by care navigators to assure care path compliance.</li><li>Weekly grand-rounding processes to enhance staff competencies and to promote team learning.</li><li>Integrated, high-quality 24/7 call center to answer staff and family questions and prevent hospitalizations.</li><li>Timely outcomes reporting for all stakeholders.</li><li>Chronic disease management and behavior health integration programs.</li><li>Advance care planning on admission and then periodically.</li><li>Polypharmacy optimization and deprescribing.</li></ul><p>“Incorporating home-based primary care is what makes this model incredibly innovative in advancing the care delivery upon discharge, wherever you call home” said Dr. Burns of Avamere. “The Primary Care Hub with Continue Care allows a successful transition to home where patients will get the highest level of care at the right place at the right time along their care journey.”<br></p><p>The pilot program at Avamere is still on track, providing critical data points that will help other centers around the nation successfully integrate Continue Care into their facilities. For more information about the Continue Care transitional care management program, visit <a href="http://www.pharmerica.com/ContinueCare" target="_blank">www.PharMerica.com/ContinueCare</a>. <br></p>	Continue Care integrated aspects of BrightSpring’s home-based primary care services into Avamere’s trial through the Primary Care Hub.	2022-09-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/Special-Features/2022/ContinueCare_PharMerica.jpg" style="BORDER:0px solid;" />	Management	Special Feature		49	9
Insurance Corner	https://www.providermagazine.com/Articles/Pages/Insurance-Corner-Mason.aspx	Insurance Corner	<p><span class="ms-rteForeColor-2" style="">ADVERTORIAL</span></p><p>“When you take over a family business, there is a lot to think about. What was important to me was that Senior Housing Managers carried on the knowledge and legacy of smart decisions that was started by Chris Mason, our founder. <br></p><p>One area we needed to make new smart decisions was in managing our staffing challenges. We currently have 510 employees serving 600 beds. But several years ago, despite our best efforts, our turnover numbers were high, and we needed help.<br></p><p>After meeting Nick at the AHCA/NCAL Convention, we decided to partner with Compass Total Benefit Solutions. Our goal was to improve our employee retention rates. But, as many in our industry—including Nick—understand, it can be difficult to design a benefits package that is robust enough to retain employees without being burdensome for the employer.<br></p><p>Nick helped us through everything. He worked with our needs and helped us create a benefits solution that has truly helped Senior Housing Managers to improve our turnover numbers. On top of that, Nick identified several employer retention credits during the pandemic that will result in nearly $3 million dollars being returned to our business in cash.<br></p><p>I would recommend Nick and his team 100%. They go above and beyond the specific needs, and our partnership has exceeded our expectations for three years in a row.”<br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/Compass_CarlMason.jpg" alt="Carl Mason" class="ms-rtePosition-1" style="margin:5px;width:125px;height:156px;" /><strong>Carl Mason</strong><br>Chief Operating Officer<br>Senior Housing Managers, LLC <br><a href="mailto:carl.mason.shm@gmail.com" target="_blank">carl.mason.shm@gmail.com</a> <br></p>	It can be difficult to design a benefits package that is robust enough to retain employees without being burdensome for the employer.	2022-09-01T04:00:00Z	<img alt="" src="/SiteCollectionImages/logos/CompassTB.jpg" style="BORDER:0px solid;" />	Quality	Special Feature		49	9

President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=102	President				<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%202022/potm_PaulPeaper.jpg" style="BORDER:0px solid;" />	Paul Peaper	The Indiana Health Care Association/Indiana Center for Assisted Living
Vice President	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=103	Vice President				<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%202022/potm_LoriWhitney.jpg" style="BORDER:0px solid;" />	Lori Whitney	Life Care Centers of America

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