| Combining Our Voices for Effective Advocacy | https://www.providermagazine.com/Issues/2023/Summer/Pages/Combining-Our-Voices-for-Effective-Advocacy.aspx | Combining Our Voices for Effective Advocacy | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_advocacy.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Opportunities to make a difference and to have a say in policymaking on the state or national level are all around you every day. Taking advantage of them may seem challenging, but you can integrate advocacy into your daily routine and be effective without undue burdens on your already busy schedule. Ultimately, you can take the steps that get you in the door and give you a seat at the table.</p><h3>Small but Mighty</h3><p>“I am a small provider, so I don’t have a dedicated staff for advocacy; and a lot of us are in the same boat. However, I have some invitations pending right now for representatives from New Mexico and Nevada to visit our facilities and residents,” said Gerald Hamilton, owner, operator, and leader at BeeHive Homes. “Until they come and talk face-to-face with our residents and staff, they really can’t understand what we are doing and the challenges they are facing.” <br></p><p>These facility visits can make a powerful difference. Hamilton said, “We point out the difference in payors between skilled nursing and assisted living [AL]. Some policymakers are surprised to learn that Medicare doesn’t pay for AL. They also talk to residents and families about what care costs and how they pay.” <br></p><p>Additionally, legislators get to hear residents’ stories firsthand and learn about the challenges they face and how legislative efforts and federal funding can help them. They also can talk to staff about why they like working in this field and what positive changes might improve staffing and care.<br></p><p>Legislators may come with information and data about the long term care industry, Hamilton said, but they leave with a real picture of the people—their constituents—who live and work in these settings.<br></p><p><img src="/Issues/2022/JuneJuly/PublishingImages/GeraldHamilton.jpg" alt="Gerald Hamilton" class="ms-rtePosition-1" style="margin:5px;width:175px;height:175px;" />Like his other AHCA/NCAL colleagues, Hamilton has a more-than-full plate, yet he makes time to arrange tours, visit legislators in their offices, and attend the annual AHCA/NCAL Congressional Briefing. He said, “Every interaction is an opportunity to educate policymakers. We have a chance to correct some misperceptions and help them see a true picture of what we do to care for our residents and address the challenges we face and work to overcome. They also get to see how committed our teams are to providing quality care.” This effort may take more of a relationship than can be developed in one tour or meeting, he admitted, but each interaction opens the door and starts a dialogue. <br></p><p>Hamilton said, “We have been able to have open conversations about what we do in assisted living and the importance of keeping regulations for this sector at the state level. I think we’ve had some success on that front, as well as on preserving the Medicaid benefit in some states.” <br></p><p>During the pandemic, Hamilton and other AHCA/NCAL members had great successes dealing in a collaborative way with policymakers regarding such issues as vaccination guidelines. “Those relationships were productive for our residents. Working collaboratively was key to getting the resources we needed,” he observed.</p><h3>How to Become an Advocate</h3><p>Relationships are a big part of advocacy. Start by identifying who you need to engage at the state and federal levels. Then you can request to meet with legislators through their district offices. You don’t have to travel to Washington, D.C., or the state capital. In fact, you’re likely to have greater success if you offer to meet legislators in their home office during congressional recesses. <br></p><p>Know in advance what you want to accomplish. Do you want to introduce yourself to establish a relationship? Do you want to invite policymakers for a tour or to attend a special event? Do you want to introduce legislators and their staff to a professional issue impacting your industry and their constituents? Or are you asking them to support or oppose a particular piece of legislation that has been or is about to be introduced? </p><h3>Help Is Here</h3><p>While it’s true that advocacy is challenging, there is help available to make it easier. For instance, AHCA/NCAL has a webpage dedicated to advocacy at <a href="https://www.ahcancal.org/Advocacy/Pages/default.aspx" target="_blank">https://www.ahcancal.org/Advocacy/Pages/default.aspx</a>. It includes an advocacy toolkit, a guide to political action and grassroots lobbying, tips on how to craft an effective message, and steps for meeting with a member of Congress. It also includes a how-to guide to facility tours for elected officials and steps for a successful facility tour. <br></p><p>“AHCA/NCAL has been helpful to us in setting up our invites for visits,” said Hamilton. Staff at the association and state affiliates know the players on Capitol Hill and the procedures for setting up appointments and arranging facility tours.</p><h3>Leverage Connections</h3><p>Whatever your goal, stressing your constituent connection is important. The best way to gain traction in Washington, D.C., is to connect with congressional offices where you are a voting constituent. This ultimately brings your issues “close to home and will get priority attention,” said Leigh Davitian, JD, founder and chief executive officer of The Dumbarton Group, based in Washington, D.C. <br></p><p>Once formal communication with your elected representatives begins, address your direct connection—where you live, where you went to school, and where you work. When discussing your work, be sure to comment on how many people you employ in their district, and how many constituents you care for within their district or state. Elected representatives are grateful to help their constituents because they can reap the rewards of helping with issues directly impacting their home district or state. <br></p><p>Personal connections are key, however, “if you want to meet with a congressional official from another district or state where you have no connection,” Davitian said, “It is doable and beneficial.” <br></p><p>First, identify other congressional officials who sit on germane committees leading ongoing health care initiatives. Then, reach out to their offices. Remember to make a connection between their interests and positions and your specific health care advocacy issue. Focus on both the House and Senate members who sit on committees that directly deal with Medicare, Medicaid, and, specifically, long term care.</p><h3>Prioritize Preparation</h3><p>“Preparation is huge. An organized meeting will make a huge impression,” said Davitian. “You don’t have to be an expert on the issues you’re advocating for, but you need to know the basics, including how [those issues] impact their district and state, as well as their constituents and other stakeholders. Cover all the bases.”<br></p><p>To make your meeting successful, know your audience. Davitian suggested, “Do some research and educate yourself about the elected official you’ll be meeting with. Study their legislative initiatives and know what committees they sit on so you have a sense of where their expertise lies. Do they sit on any committees impacting health care, and if so, how do they approach health care issues, and ultimately how do they seem to vote?” These are all important questions to research, said Davitian.<br></p><p>It will be important to know if the policymakers have a history of supporting the post-acute and long term care industry. If they don’t seem to have experience working on health care issues, be prepared to provide some background and education. Alternatively, if they have a health care background or focus, you don’t want to talk down to them or waste their time sharing information they already know. </p><h3>Staffers Matter</h3><p>If you make an appointment with your legislator, don’t be disappointed if your meeting turns out to be with a staffer. “Staff are the gatekeepers. Their primary role is to gather all the information and synthesize it into key points to present to the elected official. It some ways, it’s more important to meet with them than your representative,” said Davitian. These individuals have been tasked with learning the issues, asking questions, weighing the risks and benefits of various issues, and making recommendations to their boss. <br></p><p>Whether you meet with your representative or a staffer, be prepared to keep it short and sweet. “Understand you are trying to sell something to a very busy person. You have to find a choreographed way to present your elevator speech about the strength of an issue and what your ask will be,” said Davitian. </p><h3>When Conflict Arises</h3><p>In an ideal world, your legislator will be as enthusiastic about your issues as you are. However, Davitian suggested, “be prepared for retorts. They may not see eye to eye on your issue, and there could be some weaknesses in it or opposition to it.” <br></p><p>If your pitch gets derailed, you can offer some additional information that might help your case and get back to your legislator or staffer with answers to their questions or concerns. It’s OK to say, “That’s an interesting perspective. I will take your comments into consideration and give it some thought.”<br></p><p>If it becomes clear that you and your representative are on opposite sides of an issue and reach a stalemate, don’t push or try to force a discussion. In this case, it may be best to back off and find another issue or topic on which you have common ground. <br></p><p>Hamilton said, “If you can’t agree on something, maybe you can find something else you can work on together. Don’t be so laser-focused on one issue that it disrupts the conversation or your relationship.”<br>He suggested, “The most effective thing I’ve found is to focus on the real lives of residents no matter which political party they’re with. The human aspect resonates with most people, and it makes an impression.”<br></p><p>Ultimately, Hamilton said, “from my experience, most congressional representatives and staff will react positively to your input. They will take the time to listen, even if they don’t agree.”</p><h3>Ongoing Advocacy</h3><p>In some ways, advocacy is a 24/7 job. As a member of your community and industry, you can connect with policymakers and other decision-makers on an ongoing basis. This means:<br></p><ul><li>Getting involved in local politics, including town halls, meetings, and fundraisers.</li><li>Getting to know county, city, state, and federal officials. Find out if you have common interests or activities—you go to the same church, your kids go to school together, you share a love of golf or tennis, you support the arts, etc. </li><li>Participate in town council meetings, the chamber of commerce or Rotary Club, and other community organizations. Build on relationships you establish through these.</li><li>Organize events and invite legislators to attend. For instance, invite them to a county fair day or a resident art show at your facility.</li><li>Participate in letter-writing campaigns. Contact your representatives when issues arise that you want to have a say in. Let them know if you can provide them with information or support about an issue they’re working on.</li></ul><p>In the end, said Kathy Gallin, vice president of legislative affairs and health policy at Signature HealthCARE, “If we are truly going to impact change and make a difference, we must be effective industry leaders with a strong political voice, actively engaged in building and developing proactive solutions.” She added, “Follow-up is vastly important once we get our foot in the door so our legislators remember us, the conversations we have had, and the stories we have shared. We must continue developing and maintain those key relationships with our elected officials.” </p> | Forming relationships with legislators and having a say in policymaking might seem intimidating, but the benefits for facilities, staff, residents, and
the industry overall are worth it. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_advocacy.jpg" style="BORDER:0px solid;" /> | Caregiving | Cover Feature |
| A New Dawn in Behavioral Health Management | https://www.providermagazine.com/Issues/2023/Summer/Pages/A-New-Dawn-in-Behavioral-Health-Management.aspx | A New Dawn in Behavioral Health Management | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_behavior.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Behavioral health has been on the radars of long term care facilities and their teams for years, but the COVID-19 pandemic brought it front and center. According to data from the American Geriatrics Society, between 65 percent and 90 percent of nursing home residents have a mental or behavioral health issue. <br></p><p>“We’ve learned that facilities have to prioritize mental health as well as physical conditions,” said Lisa Lind, PhD, ABPP, chief of quality assurance and compliance at Deer Oaks – The Behavioral Health Solution. This requires a person-centered, team approach to care with an eye toward innovative interventions and tools. </p><h3>Changing the Paradigm</h3><p>Long gone are the days when behavioral health management meant picking up the phone and asking a physician for medication. This was a quick fix that often had negative implications and didn’t have good long-term outcomes. To determine the best solution for sustained results, “you have to know the resident, the staff, the system, and geriatrics,” said Elizabeth Santos, MD, MPH, DFAPA, DFAAGP, clinical chief, Division of Geriatric Mental Health and Memory Care at the University of Rochester School of Medicine and Dentistry.<br></p><p>Lind said, “There is a tendency to assume a behavior is mental health-related, but we need to look at all factors—changes in medications, unrecognized pain, infections, etc.” It is essential to look at medical reasons for behaviors, as well as possible trauma-related triggers. The good news, she said, is that “facilities are asking questions they weren’t asking a few years ago. We’re moving in the right direction.”</p><h3>Moving the Needle</h3><p>Lind suggested several steps that can improve behavioral health care:<br></p><ul><li>Be proactive instead of reactive. She said, “We often get referrals for crisis situations, such as a resident expressing suicidal ideation or becoming significantly agitated or hostile. When we do our evaluation, we often find that the individual has a long-standing history of a mental health condition, but they weren’t initially referred for mental health services because they appeared stable on admission.” </li></ul><p>It is important to identify and document a mental health history on admission and refer residents for psychiatric services as necessary. The consultant pharmacist should be engaged to review the individual’s medication regimen, paying special attention to psychotropics or other psychiatric drugs the resident may be taking. It also is important to identify and communicate with the team any situations that may trigger a change in emotional status, such as the loss of a loved one.<br></p><ul><li>Respond calmly. “As in most areas of our life, using a calm approach when communicating with others will be more beneficial in obtaining the achieved outcome and will also minimize anxiety for anxious residents. Staff should never respond in an angry, defensive, or demeaning manner, as this can easily trigger a negative response from residents,” Lind said.</li></ul><ul><li>Focus on person-centered care. There is no question that residents have their own unique life experiences, personality traits, coping strategies, medical conditions, mental health history, levels of support and family connections, job history, and so on. Lind said, “It is important to refrain from making generalizations based on age, observed cognitive level, cultural background, diagnoses, or other characteristics.” Instead, the care team needs to get to know residents as individuals, and this information needs to be shared as necessary and appropriate so clinicians and caregivers know what interventions have been tried, which ones have worked, and which ones haven’t.</li></ul><ul><li>Communicate and document. “One of the most common situations is being told of a resident’s perceived maladaptive behaviors and then finding no documentation of the events in nursing notes and a lack of consistent communication among staff,” said Lind. When there are gaps in communication and/or documentation, it is more time-consuming for staff to identify and address behavioral issues successfully, and it increases the risk of survey citations and concerns from family members.</li></ul><ul><li>Refrain from unintentionally reinforcing unwanted behaviors. Residents sometimes learn that negative behaviors get the attention they want. For instance, say a resident who is a former coach blows a whistle when he wants something. Instead of ignoring him, chastising him, taking away his whistle, or jumping every time he makes noise, consider reminding him to use the call light and explaining that when things get busy, it may take a few minutes to respond. Thank him for his patience and cooperation.</li></ul><h3>Nonpharmacologic Focus</h3><p>A focus on nonpharmacologic efforts to manage behaviors takes time. When you’re short-staffed and everyone already has a full plate, this can be challenging. However, there are many fairly simple activities, interventions, and ideas that can be integrated into daily routines. At best, these can help prevent behaviors. At the least, they can help staff address behaviors before they become problematic.<br></p><p>On admission, consider working with the family to create the resident’s life story. This can be as simple as completing a worksheet or one-pager that offers information about the resident’s former occupation, hobbies and preferred activities, morning and evening routines, pet peeves, and favorite foods, music, and movies. This information can be kept secured in a book, and people who care for the residents should review this information before interacting for the first time and when there is an issue or problem. <br></p><p>This knowledge of the resident also can be integrated into the care planning process with efforts such as pet visits, headsets with a music playlist, art therapy sessions or classes, and personalized videos (e.g., clips of Fred Astaire and Ginger Rogers for a woman who loved dancing). <br></p><p>Small details can make a big difference. For instance, one facility had a woman who got very agitated when her caregiver tried to put socks on her. Talking to her family, caregivers discovered that she always put her socks on inside out because she hated the way the seam felt on her toes. Once they accommodated this personal preference, she became cooperative.<br></p><p>Happy memories can be positive distractions and can help improve mood when someone gets agitated. For instance, Lind suggested hanging a shadow box on the resident’s wall with important reminders of the past or providing a photo album to peruse. Let residents hold things that seem to bring them comfort, such as a war medal, favorite blanket, trophy, doll, or stuffed animal. Have families leave recorded messages that you can play for residents when they get upset or agitated. <br></p><p>It is important to remember that people’s interests and tastes may change, especially as their cognition declines. For instance, a resident who used to love her doll now throws it in the corner and says it’s not her baby. In this case, instead of correcting or arguing with the resident, try to pivot the conversation and find something else that makes her happy or brings her comfort.<br></p><p>Don’t forget that even people with dementia need a sense of purpose. Lind suggested, “Provide active engagement that is meaningful. Assign roles to residents who could benefit from a sense of usefulness and purpose while reducing idle time and boredom.” Consider having activity stations throughout the building where residents can do things such as putter in a play kitchen or workshop, arrange flowers, or play games.<br></p><p>It is important for staff to realize that well-intentioned efforts can have negative consequences. Lind recalled a normally docile nonverbal resident in memory care who started yelling, scratching at her legs, and covering her head with her blanket. A chart review indicated no infection or other issues that could explain the behavior. Lind noticed that there were paper spiders and cotton cobwebs in the corner of the resident’s room, put there by staff as Halloween decorations, and she was able to confirm the decorations were put up right before the resident’s behaviors started.<br></p><p>Lind instructed staff to take the spiders and webs down with the resident in the room to watch them and tell her they were taking the paper spiders away. They then replaced the spiders with flower decorations. Lind said, “The next time I was at the facility, I was told that her yelling and swatting had stopped, and she was no longer putting the blankets over her head.”</p><h3>When Medications Are Needed</h3><p>While behaviors should be managed with nonpharmacologic interventions whenever possible, this doesn’t mean medications will never be necessary. However, the care team can work with clinicians to make sure the right drugs are being used in the right doses. <br></p><p>For instance, one facility had a resident who was screaming in the middle of the night and accusing staff of trying to kill her. She also claimed that she had killed someone. Talking to her family, Santos discovered the resident had been sexually assaulted as a young woman, and she had stabbed one of her attackers. </p><p>Ultimately, it was determined that the woman had undiagnosed post-traumatic stress disorder. Santos treated her with antidepressants and cognitive therapy, a type of psychotherapy that seeks to alter unwanted behavior patterns. The resident stopped screaming and acting out and seemed more content.<br></p><p>Another resident with schizophrenia and a history of violence was on multiple antipsychotics. Santos and her team were able to reduce her regimen to a low dose of one antipsychotic by providing staff with behavioral techniques and encouraging them to be consistent in their care. They also played the resident’s favorite music when they came in her room to take her to activities or bathe her. Staff were provided with scripts so they could use language that was comfortable for the resident. </p><p>Read More: <a href="/Issues/2023/Summer/Pages/Telehealth-Increases-Access-to-Specialists.aspx" target="_blank">Telehealth Increases Access to Specialists</a>
<br></p> | A person-centered approach to behavioral health,
including nonpharmacologic efforts, integrated medication programs, and access to telehealth, creates better long-term outcomes for residents. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_behavior.jpg" style="BORDER:0px solid;" /> | Management;Behavioral Health | Cover Feature |
| Advancing Policies That Support Real Workforce Solutions | https://www.providermagazine.com/Issues/2023/Summer/Pages/Advancing-Policies-That-Support-Real-Workforce-Solutions.aspx | Advancing Policies That Support Real Workforce Solutions | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_workforce.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Nursing homes are currently grappling with a historic labor crisis. Over the course of the pandemic, nursing homes lost more than 200,000 caregivers, or about 15 percent of the workforce. This job loss is worse than the losses incurred by any other health care sector, and, at the current pace, it is not expected to rebound until 2027. Workforce challenges in long term care existed prior to the outbreak of COVID-19, and the pandemic exacerbated them into a full-blown crisis. Caregivers are burned out after fighting the virus for more than two years, and nursing homes lack the resources to compete for workers due to chronic government underfunding.<br></p><p>As a result of these labor shortages, more than half of nursing homes are limiting new admissions, and nearly two-thirds are concerned their facility may have to close due to the staffing crisis. More than 450 nursing homes have closed over the course of the pandemic—many due to staffing shortages—and hundreds more may soon close. <br></p><p>The domino effect on seniors, their families, and our entire health care system is troubling. Seniors wait for days or weeks in hospitals for a space at a facility, and families are having to travel farther to visit their loved ones in long term care. Many hospitals are overwhelmed with patients who are ready to be discharged to receive post-acute care, but nearby skilled nursing centers cannot admit them. </p><h3>The Challenges of a Staffing Minimum</h3><p>Nursing homes would love to hire more nurses and nurse aides but are currently grappling with a historic labor crisis, and the workers are not there. Increasing staffing requirements at a time when facilities can’t find the people to fill open positions is poor public policy. Nearly every nursing home in the country is having trouble hiring staff due to a lack of interested or qualified candidates. Providers have dedicated numerous resources to recruiting and retaining caregivers, including increasing wages and offering bonuses. But nursing homes still struggle to compete with hospitals, other health care providers, and private businesses for qualified workers. Chronic underfunding by Medicaid causes current soaring labor costs to be unsustainable. Complying with an unfunded federal staffing mandate would be impossible under current conditions. <br></p><p>Increasing staffing minimums will make it harder for seniors to find the long term care they need. Ultimately, setting minimum staffing ratios without corresponding resources will further limit access to care for seniors. Nursing homes will have to continue to reduce the number of patients they can serve in order to meet ratio requirements, or close entirely. Hundreds of thousands of residents could be at risk for displacement as facilities would be forced to reduce their census to meet staffing ratios or close entirely.</p><h3>Advocating for Solutions</h3><p>A federal staffing mandate requires a significant, ongoing investment in our front-line caregivers. An analysis found that staffing minimums would require billions of dollars to hire nearly 200,000 additional nurses and nurse aides. These proposals need to be fully funded, and with proper resources, nursing homes can offer front-line caregivers more competitive wages and benefits.<br></p><p>However, the long term care industry also needs a comprehensive approach to recruit and retain long term caregivers. An enforcement approach will simply not solve this long term care labor crisis. Meaningful solutions that address the root causes of these chronic staffing challenges are needed. <br></p><p>The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) encourages long term care professionals to advocate for direct aid and policies that will help us build a pipeline of dedicated caregivers. AHCA’s Care for Our Seniors Act includes thoughtful workforce policies that will help address nationwide nursing shortages, attract more caregivers to the profession, and support care professionals in developing a career in long term care. It includes proposals such as loan forgiveness, tax credits, affordable housing, child care assistance, and immigration reform.<br></p><p>Additionally, there needs to be a comprehensive approach to staffing beyond numbers. Every resident and nursing home is different, and a one-size-fits-all approach is not the solution. Nursing homes need to be able to assess the appropriate staffing levels based on their number of residents and specific needs. <br></p><p>Moreover, providers must advocate for policies that invest in full-time, dedicated caregivers, not just increase the use of costly agency or temporary staff in order to fill quotas.</p><h3>Building a Pipeline of Caregivers</h3><p>One proposal supporting a more comprehensive approach and our caregivers is the Building America’s Health Care Workforce Act (H.R. 468). This bill provides an extension in the time allowed for temporary nurse aides (TNAs) to become certified nurse assistants (CNAs). <br></p><p>During the pandemic, the 1135 waiver on training and certification of nurse aides allowed vital support to critical staffing needs for care of residents in nursing homes. Hundreds of thousands of individuals answered the call to serve our seniors in their hour of need and supported them with nonclinical tasks, such as helping with activities of daily living; delivering meals; assisting with dining, ambulation, and range of motion; and offering companionship to help residents stay connected and engaged. <br></p><p>The TNA role has attracted individuals who have wanted to serve in direct care capacities but might not have had a pathway previously. The TNA role also supports our nation’s refugees and immigrants in receiving vital training to enter the long term care field.<br></p><p>Over the course of the pandemic, TNAs have gained thousands of hours of on-the-job, supervised training and experience in providing critical services and support to residents in nursing homes and assisted living communities. The 1135 waiver ended June 6, 2022, and only four months were given for TNAs to become CNAs or they would not be able to continue working in long term care communities. <br></p><p>State capacities were not sufficient to accommodate the training and testing needs of thousands of TNAs in this short time frame. H.R. 468 would extend the time to 24 months for TNAs to train and test to become CNAs. </p><h3>Take Action</h3><p>Advocating for meaningful, supportive solutions to the workforce challenges facing long term care facilities is critical. Let’s rebuild and strengthen the long term care workforce and protect seniors’ access to care. <br></p><p>1. Tell key decision-makers (i.e., the Centers for Medicare & Medicaid Services and the Biden administration) that an unfunded nursing home staffing minimum requirement won’t solve the long term care labor crisis and will only threaten access to critical long term care for our nation’s seniors. Recommend AHCA’s Care for Our Seniors Act as a better policy for our industry. <br></p><p>2. Advocate for the passage of H.R. 468 to allow time for TNAs to train and test to become CNAs, a vital part of the caregiver workforce. <br></p><p>For more information on AHCA/NCAL advocacy efforts and how you can help, go to <a href="http://www.ahcancal.org/Advocacy" target="_blank">www.ahcancal.org/Advocacy</a>.<br></p> | An unfunded staffing minimum would place a heavy burden on long term care providers. But there are other options to help build the workforce. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_workforce.jpg" style="BORDER:0px solid;" /> | Workforce | Special Feature |
| Ensuring Resident Coverage During the Medicaid Unwinding | https://www.providermagazine.com/Issues/2023/Summer/Pages/Ensuring-Resident-Coverage-During-the-Medicaid-Unwinding.aspx | Ensuring Resident Coverage During the Medicaid Unwinding | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_unwinding.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Since March 2020, states have been prohibited from disenrolling any Medicaid beneficiaries from the Medicaid program. The freeze on redeterminations and prohibition on disenrollment were based on federal statutory requirements states had to meet to receive the increased federal Medicaid funding of 6.2 percent over the course of the pandemic. Now, with the public health emergency ended, states are returning to “regular” Medicaid redetermination schedules. <br></p><p>State Medicaid agencies have over 87 million redeterminations to conduct before May 2024. Most states have not conducted redeterminations in over three years. During that time, beneficiary information (contact information, financial information, etc.) might have become out of date and state agencies have had significant staff turnover and shortages. In many states, state and/or county eligibility units may have few or no staff members with redetermination expertise. Despite Centers for Medicare & Medicaid Services’ guidance and support, this could result in notable breaks in Medicaid coverage.<br></p><p>If a beneficiary loses Medicaid eligibility, Medicaid payments stop, and beneficiaries have very clear federal protections for when these breaks occur despite the loss of Medicaid payments. For example, beneficiaries must be given 30 days’ notice before discharge steps are taken, families and beneficiaries may not be billed for care, and a clear discharge plan must be explained and shared in writing. Failure to follow these steps can result in survey deficiencies and may make providers vulnerable to legal action. <br></p><p>At first glance, waves of nursing facility (NF) and assisted living (AL) Medicaid redeterminations may seem of little concern. However, they are cause for concern if staff turnover in NF and AL business offices has resulted in workplaces staffed with personnel who have little to no Medicaid redetermination experience. While older adults’ and persons with disabilities’ functional criteria to meet Medicaid levels of care are unlikely to change, the people involved with managing residents’ finances likely have changed. </p><h3>AHCA/NCAL Resources</h3><p>The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has prepared an array of resources aimed at supporting NFs and AL facilities to manage significant numbers of Medicaid redeterminations. Working with partner organizations, AHCA/NCAL has developed three modules and related tools. Many members have used these resources to educate admissions and business office staff on unwinding and to provide refreshers on financial care planning, as well as the basics of Medicaid eligibility determination. These AHCA/NCAL members-only resources are available at <a href="https://educate.ahcancal.org/" target="_blank">https://educate.ahcancal.org/. </a>Search for Medicaid unwinding or visit <a href="https://educate.ahcancal.org/products/medicaid-unwinding-return-to-regular-medicaid-redetermination-ensuring-resident-medicaid-coverage" target="_blank">https://educate.ahcancal.org/products/medicaid-unwinding-return-to-regular-medicaid-redetermination-ensuring-resident-medicaid-coverage</a>.<br></p><p>For state-specific Medicaid eligibility requirements and processes, members should work with their state affiliates, since those policies and features are state specific. </p> | Since March 2020, states have been prohibited from disenrolling any Medicaid beneficiaries from the Medicaid program. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_unwinding.jpg" style="BORDER:0px solid;" /> | Quality | Special Feature |
| Industry Employment Remains Below Pre-Pandemic Levels | https://www.providermagazine.com/Issues/2023/Summer/Pages/Industry-Employment-Remains-Below-Pre-Pandemic-Levels.aspx | Industry Employment Remains Below Pre-Pandemic Levels | <p>National employment data for the long term care industry shows a continuing struggle to regain pre-pandemic levels of staffing. Data from the U.S. Bureau of Labor Statistics details the change between employment levels from February 2020 to September 2022.</p><p>Click to view <a href="/Issues/2023/Summer/Documents/Summer23_BTN.pdf" target="_blank">Industry Employment Remains Below Pre-Pandemic Levels</a>.</p> | National employment data for the long term care industry shows a continuing struggle to regain pre-pandemic levels of staffing. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/BTN.jpg" style="BORDER:0px solid;" /> | COVID-19;Workforce | By the Numbers |
| Spotlight on a National Quality Award Provider | https://www.providermagazine.com/Issues/2023/Summer/Pages/Spotlight-on-a-National-Quality-Award-Provider.aspx | Spotlight on a National Quality Award Provider | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_QA.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Quality care is at an all-time high. Long term care providers have led the way in making changes to improve quality of care and quality of life for residents and staff. Since 2020, more than 1,400 providers have earned a National Quality Award from the American Health Care Association/National Center for Assisted Living (AHCA/ NCAL) National Quality Award Program, which recognizes facilities that meet progressively rigorous standards of performance. <br></p><p>Data shows award recipients perform better than the national average in areas such as hospital readmissions and off-label use of antipsychotics. They also have higher ratings regarding surveys, staffing, and quality metric.<sup><a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Documents/QA_fastfacts_2020.pdf" target="_blank">1</a></sup> <br></p><p>Lakewood Health System in northwest Minnesota is one of 46 providers that earned a Silver award for quality in 2022. Lakewood received the Bronze award in 2016.<br></p><p>Kathleen Dobson, vice president of senior services at Lakewood Health System, shares the inspiration behind their commitment to strive for quality excellence and offers advice on taking the next step. </p><h3>Tell us about Lakewood Health System.</h3><p>We are part of an integrated health system in northwest Minnesota, which includes a 25-bed critical access hospital, six clinics, a geriatric behavioral health unit, and our senior services division, which includes a 100-bed skilled nursing facility, two assisted living facilities, home health, palliative care, and hospice services. <br></p><h3>How did you get into long term care? </h3><p>I began my career as a licensed social worker. In 1996, I took a part-time position in Lakewood Health System’s Care Center, planning for a short-term position, with a long-term goal of getting into a local school system. The role quickly developed into full time, assisting in our hospital and clinics. I was hooked on working in the medical field. After many years as the director of social services, activities, and spiritual health for our system, I was offered the opportunity to transition into the open position of vice president of senior services in 2014. This required me to return to school and become a licensed nursing home administrator and later a licensed assisted living director.<br></p><h3>What started the Quality Award journey for your center? </h3><p>We had a very passionate quality manager who worked for many years to ensure we provided exceptional care and educated all of us on the importance of quality in our everyday practice. She was a mentor to me for over 10 years. When she brought up the idea of starting the journey to achieve the different levels for the AHCA/NCAL Quality Award, it made perfect sense. She had taught us all so much, and we were very proud of our facility and performance record. She assisted with the Bronze application and then volunteered (after retirement!) to help us with our Silver award.<br></p><h3>What has the award meant to you and your team? </h3><p>It has been an ongoing learning experience. It heightened our awareness of what we were doing well and where there were gaps. It helped us celebrate the wins but acknowledge the work still needing to be done. It was inspiring to attend the awards ceremony at the convention. We felt the energy and excitement of all the different facilities. It continues to resonate with us that we are doing really great things in our state and country. We are very proud of this!</p><h3>What lessons have you learned along the way?</h3><p>Never accept “good enough,” and always be sure your processes are hard-wired. Be OK with what worked before but is not working now. The pandemic truly shook our industry to the core and perhaps created some pauses in our journey, but I am convinced that the quality work we had done prior made a significant difference in our successes through the pandemic. I am very proud of the grit and determination of our residents, families, and staff. <br><br>What advice would you give to a provider that is considering applying for an award but is not sure? <br>It is worth the work. It sparked a lot of conversations at our facility. You will be surprised at what you will learn about yourself, your team, and your facility’s strengths and opportunities. Some things will make you proud and other things may give you pause. But that is the point.<br></p><h3>Do you plan to continue the journey and apply at the next level? </h3><p>Definitely. It is a little daunting, to be honest, but I know we are worth it.<br></p><h3>Finally, what inspires you the most? </h3><p>The fact that we at Lakewood Health System live our values of integrity, compassion, high quality, accountability, and innovation. It sounds cliche, but working for a rural health care system means we are taking care of our friends, family, neighbors, and each other. Our leadership team has consistently remained driven by our values, and that makes everyone want to be better and do better. There is amazing energy here, and I love being a part of that.<br></p><p>Visit the National Quality Award Program website at <a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/default.aspx" target="_blank">https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/default.aspx</a> for more information about the upcoming application year. </p><p>1. <a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Documents/QA_fastfacts_2020.pdf" target="_blank">https://www.ahcancal.org/Quality/National-Quality-Award-Program/Documents/QA_fastfacts_2020.pdf</a><br></p> | Lakewood Health System received Silver and Bronze National Quality Awards for their hard work, but the staff is not stopping there. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_QA.jpg" style="BORDER:0px solid;" /> | Quality Awards | Quality Awards |
| Strategies to Decrease Workplace Bullying in Nursing Homes | https://www.providermagazine.com/Issues/2023/Summer/Pages/Strategies-to-Decrease-Workplace-Bullying-in-Nursing-Homes.aspx | Strategies to Decrease Workplace Bullying in Nursing Homes | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_caregiving.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Nurse bullying is a well-known issue that creates difficult work environments. Staff are less likely to stay in a workplace where they are belittled or unsupported, whether bullying behaviors are obvious or subtle. This article describes examples of bullying behaviors and provides strategies to decrease this conduct. <br></p><p>Workplace toxicity can become a pervasive problem. What leaders tolerate often spreads. Consider the following example.<br></p><p>Sara is a long-time nurse at the nursing home. When a new employee approaches her to ask questions about a process, Sara responds by stating that it isn’t her job to train staff. The new employee walks away still unclear on the process and questioning whether he wants to continue his employment at this nursing home. Later that day, a nurse from another unit asks Sara a question about a medication, and before walking away, Sara replies, “Do I look like the pharmacist?” The director of nursing overhears this conversation and offers to help the nurse with medication questions. <br></p><p>Situations like these happen frequently. Sara’s rude, abrupt, and unhelpful behavior puts the facility at risk for increased turnover and decreased patient safety. The director of nursing is now aware there is a problem but isn’t sure what to do. <br></p><p>The American Nurses Association defines nurse bullying as “repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient.” While bullying and incivility may seem similar, they differ slightly. Incivility is “any rude or disrespectful behavior toward another with or without the intent to harm.”<sup><a href="https://voice.ons.org/%20news-and-viewsrecognize-and-respond-to-incivility-in-nursing" target="_blank">1</a></sup> Both can make a workplace toxic.<br></p><p>Staffing shortages may cause nurse leaders to downplay bullying among staff, yet hoping the bullying will resolve on its own rarely succeeds. It is more likely that the toxic work environment will drive away nurses who otherwise love their jobs, exacerbating staffing burdens. The longer situations continue unaddressed, the more they become part of the culture of the facility. Instead of tolerating incivility, in the earlier scenario, the director of nursing should have addressed the behavior as it occurred in a firm but non-accusatory manner. Recognizing behavior as bullying or incivility—and naming it—is often the first step in eliminating it. <br></p><p>Newer nurse managers or directors of nursing may struggle to address these types of issues. Nursing education focuses more on clinical aspects of nursing, not on interpersonal issues. Therefore, organizations may benefit from training on navigating difficult conversations. Addressing these issues can be uncomfortable, but giving the leader tools to guide caregivers in the right direction reduces the challenge. </p><h3>The Many Faces of a Bully</h3><p>It is important to recognize that bullying can take many forms. These include backstabbing; refusing to help; threatening, intimidating, or excluding; being physically violent; sabotaging or withholding information; gossiping; giving unfair assignments; or nonverbal expressions, such as eye-rolling. <br></p><p>While nurses are known for being kind, compassionate caregivers, that doesn’t prevent them from bullying or being uncivil. With most bullies, there are larger issues at play. They may be insecure, feel threatened by others, or have learned this behavior early in life. Nurse leaders must model professionalism in their own interactions and clearly establish the expectation that bullying isn’t allowed. </p><h3>When the Inappropriate Behavior Is Not Obvious</h3><p>In the scenario at the beginning of this article, the unacceptable behaviors were overt. But what about not-so-obvious situations? Take this example. <br></p><p>Christy, a nurse at the facility for five years, picks up many vacant shifts. She regularly comes in early and stays late to help. Nursing leaders count on her to pick up shifts so they can avoid having to staff shifts themselves when on call. Christy also likes to tell residents that she is the only nurse who really cares about them. She often shares information, sometimes untrue, about other nurses with resident family members. </p><p>She often brings treats to the nurse aides when she works weekends and tells staff that if the other nurses liked them as much as she does, they, too, would bring treats. Other nurses have complained to the director of nursing and the administrator, but leadership has not acted; staff believe Christy gets away with her behavior because she picks up so many hours. <br></p><p>In a Nursing Administration Quarterly article, the authors describe Christy as a PGR nurse: one who uses put-downs, gossip, and rumors (PGR) to bully other nurses.<sup><a href="https://doi.org/10.1097/NAQ.0000000000000353" target="_blank">2</a></sup> This bullying may not have been obvious to nursing leadership, but once nurses complained about Christy’s behavior, leadership should have addressed it. Be aware that even individuals who leadership views as essential can still create issues with other staff. Investigate all concerns brought forth about incivility and rude behavior. <br></p><p>Ensure human resources is aware of the concerns and investigations. Involve this team to help address the issue as soon as possible. </p><h3>Workplace Culture</h3><p>Here’s how to build a workplace environment that reduces bullying or incivility:<br>1. When bullying or incivility occurs, address it immediately. <br>2. Have and enforce zero tolerance policies. Include examples of the type of behavior the organization rejects, and clarify how to report incidents. Such policies can include opportunities to improve, but the facility should not permit those who do not change their behavior to continue to harm or demean others.<br>3. Provide zero tolerance policies during the interview process, and reiterate expectations during orientation. <br>4. Investigate every reported incident of bullying or incivility.<br>5. Educate nurse leaders on recognizing and addressing bullying behaviors.<br>6. Expect respect and model that behavior as a leader. <br>Applying these strategies helps create a workplace environment that is less likely to include bullying, but it doesn’t mean bullying won’t occur. The emotionally charged, high-demand work that nurses perform may prompt some to lash out with bullying as a result of their own poorly managed stress. Setting expectations early and taking bullying accusations seriously every time decreases the behaviors. <br></p><p>Moreover, equipping nurses to confront challenges productively can avert bullying before it occurs. This does not necessarily require additional resources—though reducing workload often helps. Increasing nurse autonomy or flexibility can prevent feelings of powerlessness that can lead to bullying. Investing in staff’s conflict-resolution skills and emotional well-being can help defuse underlying causes.<br></p><p>All staff deserve a safe and respectful workplace. Nurse leaders can cultivate such an environment by addressing behaviors that undermine it, even when they come from within. </p><p><em>Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, is vice president of education and certification strategy for the American Association of Post-Acute Care Nursing (AAPACN). </em></p><p><br></p><p><span class="ms-rteStyle-References">References</span><br class="ms-rteStyle-References"><span class="ms-rteStyle-References">1. Frankenfield, R. (2019). Recognize and respond to incivility in nursing. </span><a href="https://voice.ons.org/%20news-and-viewsrecognize-and-respond-to-incivility-in-nursing" target="_blank"><span class="ms-rteStyle-References">https://voice.ons.org/</span><br class="ms-rteStyle-References"><span class="ms-rteStyle-References">news-and-viewsrecognize-and-respond-to-incivility-in-nursing</span></a><span class="ms-rteStyle-References"><br></span></p><p><span class="ms-rteStyle-References">2. Edmonson, C. & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing </span><br class="ms-rteStyle-References"><span class="ms-rteStyle-References">Administration Quarterly, 43(3), 274-279. <a href="https://doi.org/10.1097/NAQ.0000000000000353" target="_blank">https://doi.org/10.1097/NAQ.0000000000000353</a></span><br></p> | Nursing leaders must recognize and address workplace toxicity to maintain a safe and respectful environment. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_caregiving.jpg" style="BORDER:0px solid;" /> | Workforce | Focus on Caregiving |
| The Institutional Equivalent Special Needs Plan | https://www.providermagazine.com/Issues/2023/Summer/Pages/The-Institutional-Equivalent-Special-Needs-Plan.aspx | The Institutional Equivalent Special Needs Plan | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_PHM.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The hallmark of the institutional special needs plan (I-SNP) model is proactive, preventive, person-centered primary care provided by advanced practice professionals such as nurse practitioners in long term care facilities, where seniors reside. The ability to design a model of care tailored to the needs of long term care (LTC) beneficiaries—thereby delivering the right care at the right time in the right setting, reducing avoidable hospitalizations—makes the I-SNP an attractive alternative to traditional Medicare Advantage (MA) plans. <br></p><p>Provider-led I-SNPs continue to grow as LTC providers look to assume full responsibility for the health and outcomes of their residents and meaningfully participate in value-based care. I-SNPs, by design, restrict enrollment to only individuals who reside in a skilled nursing facility (SNF), a nursing facility (NF), an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility. </p><h3>The Institutional Equivalent Special Needs Plan</h3><p>For providers looking to extend the benefits of the I-SNP model to residents beyond the long term care facility, an institutional equivalent special needs plan (IE-SNP) provides the pathway. The IE-SNP’s model of care, flexibility, and services are very similar to an I-SNP’s; the main difference is where the plan members reside. IE-SNPs are available to beneficiaries who meet the state definition for institutional level of care but aren’t in an LTC facility. This includes those residing in assisted living (AL), memory care (MC) communities, and even independent living and private homes.<br></p><p>“Increased membership potential explains part of the push into IE-SNPs, but IE-SNPs are also a way to extend a plan’s model of care and supportive services,” said Amy Kaszak, executive vice president of strategic initiatives at Curana Health. “For example, an LTC provider who also operates AL or MC facilities may offer an IE-SNP to AL/MC residents, so they have access to additional care coordination and preventive services provided through existing I-SNP providers and infrastructure. The AL and MC communities benefit from a potentially longer length of stay for plan members who—through preventive care and use of skill-in-place services—require fewer hospitalizations and are able to live in AL/MC communities safely for a longer period of time.”<br></p><p>Steve Fogg, chief financial officer at Marquis Companies and Consonus Healthcare, said, “We entered the IE-SNP space to offer a plan design that gave us the ability to better meet the needs of our non-dual-eligible population in our AL facilities. We happen to operate a plan that has a tangible number of members that reside in non-SNF settings, such as an AL facility or MC. We offered some additional benefits in the over-the-counter/medical supplies area, increased the maximum allowable benefit for dental, and heightened non-emergent transportation benefits. We did all of this with only a $1 per month increase in monthly premium to the member, compared to our I-SNP.” <br></p><p>Other providers see offering an IE-SNP to Medicare beneficiaries with complex, chronic conditions as a way to build a trusted relationship with potential residents. Many providers own home health, personal care, and therapy lines of business, which can be used to support an IE-SNP model of care outside of an LTC facility. <br>“From a business standpoint, this enables them to take the I-SNP model and expand it out into other settings,” said Fred Bentley, managing director at ATI Advisory. “More importantly, IE-SNP participants benefit from the plan because there are customized offerings that they wouldn’t get from a regular MA plan.” <br></p><p>Kaszak explained, “For LTC provider-owned or provider-led plans, IE-SNPs may also allow LTC providers to leverage existing resources, such as home health companies or primary care relationships, which can improve the model of care and resident outcomes for AL, MC, and independent living residents, and can be a way for LTC providers to begin to provide more services in the community at large.”</p><h3>Potential Challenges for IE-SNPs</h3><p>Since IE-SNPs primarily target senior living residents, many of whom are Medicare beneficiaries, residents are less inclined to enroll in MA plans. “Enrollment tends to be more challenging for this population to see a compelling offer and switch out of their Medicare fee-for-service care. If enrollment is low, you can’t deliver on the product,” Bentley said. <br></p><p>Medical management is another challenge for IE-SNPs. AL residents’ preferred network and eligibility do not depend on members’ residing in contracted facilities, so residents are more likely to continue seeing specialists with whom they have established relationships.<br></p><p><img src="/Issues/2023/Summer/PublishingImages/NatalieVisnick.jpg" alt="Natalie Visnick" class="ms-rtePosition-2" style="margin:5px;" />“Providers with I-SNPs who expand to an IE-SNP may find that they need to add new ‘preferred’ network providers to their panels. While all MA plans have the same CMS [Centers for Medicare & Medicaid Services] network adequacy requirements, Medicare beneficiaries living outside of a SNF most likely will want to access a different set of primary care doctors and sometimes even different specialist groups than their SNF counterparts,” Kaszak said. “Contracting with these ‘preferred’ providers may be important for plan membership.”<br></p><p>Despite these hurdles, IE-SNP plans and enrollment are projected to grow. Provider-led plans will continue to evolve to best meet the needs of their residents. IE-SNP providers are optimistic about the future and encourage physicians in the fee-for-service realm to partner with provider-led plans to enhance the quality of care and outcomes for beneficiaries. </p><p><em>Natalie Visnick is senior manager of public affairs for the American Health Care Association.</em><br></p> | As provider-led I-SNPs grow, the next step to reach residents beyond a long term care facility is an IE-SNP. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_PHM.jpg" style="BORDER:0px solid;" /> | Population Health Management | Population Health Management |
| The Quality Improvement Journey in Assisted Living | https://www.providermagazine.com/Issues/2023/Summer/Pages/The-Quality-Improvement--Journey-in-Assisted-Living.aspx | The Quality Improvement Journey in Assisted Living | <p><img src="/Issues/2023/Summer/PublishingImages/sum23_AL1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />In a caregiving landscape that has shifted significantly, the one constant is the commitment of long term care providers to continue delivering the highest quality care for residents.<br></p><p>That has never been more apparent than through the record number of applications received for this year’s AHCA/NCAL National Quality Award Program, a rigorous three-level process that evaluates an organization’s capacity and capabilities against nationally recognized standards for excellence. It is the most comprehensive and cost-effective performance assessment available.<br></p><p>But what does that really mean? It means your organization has a unique opportunity to participate in a meaningful quality-improvement journey to help identify strengths, weaknesses, and areas for development. It can also help elevate your organization as a visible leader in providing quality care.<br></p><p>That’s exactly what it is: not just an award, but a journey. Organizations that accomplish each level of the program (Bronze, Silver, and Gold) receive a physical award for reaching each level and special recognition at the AHCA/NCAL Convention & Expo. However, the journey starts by identifying a foundation that supports continued growth and development throughout each level.<br></p><p>Assisted living communities are uniquely positioned to benefit from this journey. Quality improvement is not going away, and getting in front of existing and potential regulatory requirements at both the state and federal levels is vital. Furthermore, stakeholders, state agencies, potential customers, and referral sources want proof that assisted living communities are providing quality care and services to residents. This is an extremely competitive marketplace, and quality improvement must be a priority.<br></p><p>Performing at the highest level as a result of this journey can set assisted living providers up for success in many ways. <br></p><p>Going through the program can support positive workforce outcomes. It guides organizations in exploring recruitment and retention, and it guides the culture of high-performing teams through a continuous improvement process that fosters open communication, equity, inclusion, engagement, learning, development, and evaluation. This can help with team building, pride, and improved satisfaction. <br></p><p>It also supports staff engagement. When employees feel more connected to the work they do and why they are doing it, and they understand and are motivated to achieve the goals of the organization, they become more engaged and create improved satisfaction within the organization. There is a connection between job satisfaction, motivation, and effectiveness—and that point is where the employee becomes engaged. The Quality Award journey helps create this connection. Organizations that have engaged employees have higher productivity, customer satisfaction, retention, quality, and innovation. <br></p><p>The Quality Award Program helps organizations become stronger and more resilient. Learn to anticipate, prepare for, and recover from disasters, emergencies, and other disruptions by working through the rigorous application process. Organizations will identify areas of strength and opportunities for improvement. This results in an enhanced workforce, customer engagement, organizational productivity, and community well-being during times of change.<br></p><p>Organizations that go on this journey receive an outside perspective from trained experts. This is an important opportunity to learn from expert feedback on both areas of strength and opportunities for improvement based on an examination of the award application against the nationally recognized Baldrige Criteria for Performance Excellence. <br></p><p>It will help an organization get the recognition it deserves. High-performing organizations enjoy well-earned acknowledgment when they receive a Quality Award. This recognition can be shared with potential residents and other stakeholders, including hospital and referral providers.<br></p><p>NCAL has made quality improvement a priority and is working closely with assisted living members on this important effort. More information and resources about the Quality Award Program can be found on the AHCA/NCAL website at <a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/default.aspx" target="_blank">https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/default.aspx</a>. Don’t hesitate to reach out to NCAL if we can support you in your quality-improvement journey. </p><p><em>Pam Truscott is director of quality improvement at the National Center for Assisted Living (NCAL).</em><br></p> | Embarking on a quality-improvement journey can result in recognition but also creates other positive outcomes. | 2023-05-30T04:00:00Z | <img alt="" src="/Issues/2023/Summer/PublishingImages/sum23_AL2.jpg" style="BORDER:0px solid;" /> | Assisted Living | Spotlight on Assisted Living |