Fall 2024

Vol. 51 No. 3

Fall

Cover Story

https://www.providermagazine.com/Issues/2024/Fall/Pages/Hope-for-Improving-Vaccination-Uptake.aspx

Hope for Improving Vaccination Uptake

<img src="/Issues/2024/Fall/PublishingImages/Vax.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Building a successful vaccination program for long term care providers is a mix of deploying both new and tried-and-true strategies and practices to ensure vital immunizations take place. Nursing staff in care communities are putting the COVID-19 vaccination debate to rest as much as possible and focusing anew on giving residents and staff of skilled nursing facilities (SNFs) and assisted living communities the support they need to get “shots in the arm” and hopefully avoid outbreaks of flu, RSV, pneumonia, and yes, COVID-19. Running every year from approximately October to February, the vaccination season exists in conjunction with the respiratory virus season and marks an annual test for clinical staff in nursing facilities to prevent infectious disease outbreaks. For assisted living communities, the season can be more about streamlining access for residents, often through pharmacies operating clinics on campuses. In speaking to vaccine delivery experts, a leading national pharmacy, and two operators experiencing higher than average vaccination uptake rates, it is clear there are lessons to be learned for all caregivers. Whether you are a community, vendor, resident, staff member, or family member, the fundamental goal—especially after the COVID-19 pandemic—is for residents to stay updated on their vaccinations for the big infection threats such as COVID-19 and flu. Other non-annual vaccine programs cover RSV, pneumonia, tuberculosis, Tdap, and shingles, among others.<h3>The Basics</h3>SNFs traditionally offer two paths for fulfilling residents’ vaccine needs. The first is on admission, when needs are identified and vaccine supplies are ordered from the pharmacy. The second is via a clinic, which is the most popular model for flu and COVID-19 vaccination. To be considered fully vaccinated against COVID-19, an individual must have received one shot of the updated COVID-19 vaccines. According to public health experts, an individual must receive the flu vaccine once a year, ideally in September or October, to be considered vaccinated against the flu. Finally, the CDC recommends an RSV vaccine for everyone ages 75 and older and adults ages 60 to 74 at increased risk of severe RSV, which includes residents of nursing homes or other long term care facilities.1 The RSV vaccine is not currently an annual vaccine, which means residents who have received the RSV vaccine do not need another one. The pneumonia vaccine recommendation for adults is that the vaccine be administered to those over age 65 or to adults ages 19 to 64 with certain risk conditions. Specific recommendations for the type of vaccine hinge on prior vaccination history and can be found at <a href="https://www.cdc.gov/vaccines/vpd/pneumo/index.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cdc.gov/vaccines/vpd/pneumo/index.html</a>. The Tdap booster is given once every 10 years,2 and the shingles vaccine is for those over age 50. Experts recommend vaccination with the recombinant zoster vaccine (Shingrix) in two doses given two to six months apart.3 <h3>The Good Samaritan Way </h3>To understand what works and what does not, DeeAndra Sandgren, chief nursing officer at Evangelical Lutheran Good Samaritan Society, explains how the nonprofit’s successful vaccination efforts, particularly in SNFs in North Dakota and South Dakota, demand a building-wide effort built on trust and communication. <img src="/Issues/2024/Fall/PublishingImages/DeeAndraSandgren_vax.jpg" alt="DeeAndrea Sandgren" class="ms-rtePosition-2" style="margin:5px;" />Overall, Good Samaritan serves more than 5,000 skilled nursing residents daily and approximately 2,000 assisted living residents, primarily in rural locales. Of the dozens of communities in Good Samaritan’s portfolio, the standout SNFs for vaccinations outperform the national averages for vaccinations by a wide margin. “We really try to make the vaccine clinics a big day. We are in rural locations, and we work with the local pharmacy to help and do these shot clinics,” Sandgren said. The buildings that have had more success than others at vaccination uptake are usually reflective of staff efforts to engage residents, families, and team members on the importance of getting vaccines, she explained. An 80 percent flu vaccine uptake for residents is the norm for Good Samaritan. Standout Good Samaritan locations for COVID-19 vaccine uptake include the following: <ul><li>Ottumwa, Iowa: 80 percent</li><li>Parsons, Kans.: 79 percent</li><li>Lakota, N.Dak.: 77 percent</li><li>Canistota, S.Dak.: 75 percent</li></ul>Sandgren said uptake for the pneumococcal vaccine is around 60 percent for Good Samaritan residents, which is in line with the national average. On this metric, these Good Samaritan locations stand out: <ul><li>Battle Lake, Minn., and Canton, S.Dak.: 96 percent</li><li>Ottumwa, Iowa: 94 percent</li><li>Bismarck, N.Dak.: 88 percent</li><li>Hays, Kans.: 80 percent</li></ul>“These locations have really built trust with residents and families over the course of the pandemic and now. They strive to be the one voice for families, who rely on the staff to get them information,” Sandgren said. “We are also part of a larger health care system, Sanford Health [the largest rural health system in the United States]. And they notice when patients need updates on their vaccines and inform us as they are sent out.” Some reasons residents and staff choose not to get vaccinated are the same as for the general population, she said, citing vaccine fatigue and a plethora of misinformation circulating on social media and other outlets about vaccines, notably COVID-19 shots. “It is unique to each individual, but we do our best to give them information and answer their questions,” Sandgren said.<h3>Smaller SNF Takes Team Approach</h3>Larae Dixon, director of nursing services, and Samantha Katz, assistant director of nursing services and infection preventionist at Pinnacle of North Berwick in Maine, said the positive results they record for their vaccination efforts stem from an all-hands-on-deck approach. Katz points to a team effort, starting at admission, to get the intended uptake of vaccines. “On admission, we get prior blanket consent, so we don’t have to chase anyone around for consent forms when the time comes for the shots. We also get prior immunization records, which helps to know the resident’s history of what they need or don’t have,” she said. The resident population at Pinnacle of North Berwick is 60. Out of that total, only eight people have refused vaccines, mostly due to religious beliefs or opposition to getting another COVID-19 shot. “Overall, we don’t get too much pushback,” Dixon said. For 2024, the facility is going to initiate the RSV vaccine after not doing so in 2023 due to supply and cost issues. With a number of vaccines to deliver, Pinnacle has identified a way to avoid doing too much at once. “We are a little concerned, with the flu and COVID shots out there already, to introduce RSV and possibly get some resistance. We are going to introduce that vaccine earlier so it won’t seem overwhelming to have all of them at once,” Katz said. COVID-19 and flu vaccines are given at the same time, a process that will kick into high gear this fall. The facility saw no flu cases last year as a result of the vaccine being mandatory for residents and staff. It is free for everyone, as well. After the pandemic, there is more attention paid than ever to quickly identifying and addressing any illness outbreaks, the nursing leaders said. “We really move fast on early testing of symptoms and administering COVID tests. We are current on guidelines on when to test and mask,” Katz said. Other common-sense practices are also helping to keep the spread of viruses to a minimum. “I also always tell people to keep their windows open as much as possible. We are a smaller and older building, and the ventilation is a priority. We are strict on limiting activities with other residents when anyone is showing signs of illness, and we keep people in small groups when it is the cold and flu season. It is the routines that matter, encouraging outside visits, washing hands, and those things,” Katz said. In the end, the success or failure of vaccine efforts and a broader infection-control program comes down to the clinical staff being proactive and armed with personal relationships that have built trust. “Honestly, I think the reason we do such a good job is that we do it together. It is not just on one person, and the same message is validated though each channel over and over. We also have a laid-back approach; we are not pushing anything on anyone. Our goal is to give information and provide facts,” Dixon said. Katz added, “We are both very hands on with residents, and they feel comfortable talking with us. I think that helps. The personal relationship is what it is all about.” <h3>Pharmacy Forging Ahead on Assisted Living Clinics </h3>From the long term care pharmacy point of view, the task for helping improve vaccination uptake has become a do-it-yourself endeavor, according to T.J. Griffin, chief clinical officer of PharMerica. In what he describes as an out-of-the-box idea for the 2024 vaccination season, the pharmacy will be standing up vaccination clinics at strategic assisted living partners so they do not have to rely on large retail pharmacy chains. <img src="/Issues/2024/Fall/PublishingImages/Griffin-vax.jpg" alt="TJ Griffin" class="ms-rtePosition-1" style="margin:5px;" />“We have more than 400 clinics scheduled already for the fall for flu, COVID, pneumococcal, and RSV vaccines. Our nurses and pharmacists will be managing the clinics,” Griffin said. Unlike at SNFs, streamlining access is a key factor in whether assisted living residents can and will get the vaccines they need. Residents will see their vaccines paid for mostly under Medicare Part B, but by doing the clinics at strategic partners, PharMerica will ensure the cost is free for the care community. As far as uptake, the flu vaccine gets much more business than the COVID-19 shot, Griffin said. Communities have budgeted for around 95 percent to 100 percent uptake for the flu shot and around 40 percent for the COVID-19 vaccination. There has been no hangover from the COVID-19 pandemic for residents getting the flu update, he noted. <h3>Pilot Assesses Vaccine Programs </h3>Outside of the care communities that are on the front lines of vaccination efforts, there are programs and studies in place to examine how to get better uptake among residents and staff in the long term care setting. Consider, for example, the work of Elizabeth Sobczyk, who is the associate executive director at AMDA – The Society for Post-Acute and Long-Term Medicine, and the project director for the Moving Needles program (movingneedles.org), funded by the Centers for Disease Control and Prevention (CDC). She said Moving Needles is all about improving immunization rates in post-acute and long term care (PALTC), with the goal of making routine adult immunizations a standard of care for PALTC residents and an expectation for employees. Sobczyk said the main parts of the program seek to align existing immunization policies and procedures in PALTC to make the system work better. To do this, Moving Needles has conducted pilots to test routine, standardized adult immunizations across PALTC settings, for both residents and staff. This allows researchers to establish baseline data and measure improvement, integrate routine immunization and reporting to state authorities into workflows and electronic health record systems for both staff and residents, and demonstrate both clinical benefits and operational/cost benefits to implementation. “We want to create a permanent resource on PALTC immunization,” she said. As part of the effort, a round-one pilot at nine long term care facilities from three chains occurred in Pennsylvania and North Carolina from July 2022 to June 2023. A round-two pilot in twelve facilities from four chains saw data collected from July 2023 to June 2024 in Alabama, California, Colorado, Iowa, Minnesota, Nebraska, Pennsylvania, and Washington State. The study tracked COVID-19, influenza, pneumococcal, Tdap, and shingles vaccines for residents. Staff vaccinations focused on COVID-19, influenza, and hepatitis B. <h3>Success and Challenges in Vaccination Efforts</h3>What the pilots discovered, according to the Moving Needles program, is that staffing turnover can impair vaccination uptake for residents, akin to what the providers discussed in reference to the need for nursing staff to have relationships with residents and their families in order to build trust. The pilots also showed the need for assigning a vaccine team in a facility and creating a vaccine calendar to spread out offerings and planning time, using state data for finding resident histories, reviewing data at quality assurance and performance improvement meetings, and introducing a multivaccine consent form on admission. “Consent requirements vary by facility and can be challenging, particularly when residents cannot assent for themselves,” Sobczyk said. <img src="/Issues/2024/Fall/PublishingImages/ElizabethSobczyk_vax.jpg" alt="Elizabeht Sobczyk" class="ms-rtePosition-2" style="margin:5px;" />A challenge related to vaccine fatigue in resident uptake centers, the pilots showed, is that more residents are asking why they need more shots with the latest COVID-19 vaccine. A barrier to making vaccine programs operate smoothly is that Medicare Part A stay residents can have Part B vaccines billed only by the facility, not the pharmacy, which some providers struggle with. This nuance can create workflow challenges to offering vaccines on admission for maximum protection. As for staff, standard operating procedures to check vaccination status on hire seems to work well, as does having a peer champion, researchers said. Offering vaccines outside of normal clinic times, more than once, to all shifts of staff also gets more positive uptake, as does offering shots to the resistant staff multiple times. A roadblock to driving staff immunizations higher is the inability of many facilities to offer vaccines on-site. “LTC [long term care] pharmacies contract with Medicare, and staff who have insurance are considered out-of-network. Facilities that absorb the cost of the flu vaccine cannot do so with the price of COVID. The end of Bridge Access further complicates access,” Sobczyk said. The CDC’s Bridge Access Program ended in August 2024. It provided free COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs.<h3>Mandates Are Out, Leadership Is In</h3>Post-pandemic, the pilot programs revealed a need for a mindset change on vaccination efforts. The culture during the pandemic centered on mandates and what people had to do to keep jobs (staff) or to remain in place (residents). With the emergency over, the mandates for staff are mostly out, and the need for leaders to lead by example and go outside the box, such as by offering incentives for getting vaccinations, is in. “Through the pilots, we saw the importance of building trust and community,” researchers said. “Incentives work in the context of building community and shifting to positive associations, like with t-shirts, barbecues with the night shift before a vaccine clinic, etc.” Strong leaders at the chain level produced good results, as well. This came in the form of vision-setting, acknowledging and encouraging efforts, providing operational and problem-solving support, being visible and supportive to facility staff related to the project, developing standardized guidance and processes, and supporting use of data in decision-making and quality meetings.<h3>Prevention Forum Stakes Out Key Role</h3>There is a fresh resource available to long term care stakeholders to keep current with the latest federal updates on vaccines. The National Infection Prevention Forum (NIPF) is a national forum for any infection preventionist or for infection prevention champions in long term care to share lessons learned and resources and get answers to questions. <img src="/Issues/2024/Fall/PublishingImages/CathyCiolek.jpg" alt="Cathy Ciolek" class="ms-rtePosition-1" style="margin:5px;" />NIPF’s Cathy Ciolek, a consultant and project manager for the American Health Care Association (AHCA), said the forum provides a mechanism to rapidly disseminate federal updates as they become available from the CDC, Centers for Medicare & Medicaid Services (CMS), or Occupational Safety and Health Administration (OSHA). AHCA partnered with the Association for Professionals in Infection Control and Epidemiology (APIC) with funding from CDC Project First Line to set up the NIPF, which is open to all long term care professionals focusing on infection prevention, regardless of their membership in AHCA or APIC, Ciolek said. NIPF’s collaborative nature is augmented by APIC and CDC subject matter experts who are available to address questions the group are unable to answer. Ciolek said updates are provided through Hot Topics, Ask the CDC Expert, and clinical skills tests using clinical-based scenarios.<h3>Hot Topics Focus on Safety, Administration</h3>Examples of recent vaccine updates that received NIPF attention include one from the CDC in late 2023 recommending that all residents in long term care facilities be vaccinated against COVID-19, flu, and RSV, which raised the issue of co-administration, or simultaneous administration, of all three vaccines. Ciolek said a study found that co-administration of the COVID-19 vaccine with the seasonal flu vaccine did not raise any red flags, thus making it safe to give both at the same time. An NIPF Hot Topic update noted that giving the vaccines at the same time prevents the need for multiple clinics and can help stem an infection if waiting to get one vaccine or the other. “That Hot Topic was all about what’s safe and who can administer the vaccines. We want the forum to stand out as an information resource, and that is what we do, bringing CDC experts and others to explain new guidance and requirements, in addition to the updates,” Ciolek said. According to NIPF updates, SNFs should provide a vaccine information statement (VIS) to recipients in their native language whenever possible, but they should not delay a vaccination while waiting for a VIS. Noting that uptake of the RSV vaccine is low, the CDC said there is nonetheless a need to protect nursing home residents against severe outcomes of respiratory illnesses. The CDC found that co-administration of the RSV vaccine with other vaccines is acceptable. “The vaccines should be administered in different body locations at least one inch apart based on the individual’s physical condition and specific needs. Frail residents of nursing homes with advanced age or those with certain chronic or underlying medical conditions are identified as likely to benefit from receipt of the RSV vaccine,” the CDC said. For more information on the NIPF and additional vaccination resources, visit AHCA/NCAL’s #GetVaccinated campaign at <a href="http://getvaccinated.us/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">http://getvaccinated.us</a>. Patrick Connole is a veteran journalist and a former senior writer and editor for Provider, where he gained experience reporting on the long term care profession. Connole previously worked for Dow Jones, Reuters, and McGraw-Hill covering business news.

Trust, communication, and ease of access increase vaccine program success as the respiratory virus season progresses.

2024-09-11T04:00:00Z

Clinical;Infection Control

Business Operations Keep the Long Term Care Engine Running	https://www.providermagazine.com/Issues/2024/Fall/Pages/Business-Operations-Keep-the-Long-Term-Care-Engine-Running.aspx	Business Operations Keep the Long Term Care Engine Running	<p><img src="/Issues/2024/Fall/PublishingImages/BusOps.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />While the clinical teams at post-acute and long term care facilities are working to provide excellent care for residents, the business operations staff are busy behind the scenes laboring to keep the engine running. Business operations teams face some of the same challenges their clinical colleagues face, plus a few of their own. Nonetheless, they are using technology, partnerships, and teamwork to keep things moving while planning for the future.</p><h3>A Short Story of Staffing</h3><p>Much like the clinical side of facilities, business operations staffing took a hit during the COVID-19 pandemic. Some people left the field and others retired. As a result, said Helen Bautista, LNHA, administrator at Bridgeway Senior Healthcare, “we have worked hard at our recruitment process, and we really try to promote from within.” <br></p><p>Recently, for instance, Bridgeway promoted a medical records staff member to a business office job. “She had been in medical records for years and wanted a new challenge. We thought she was a perfect fit,” Bautista said. While the new role required some training, she said, “we try to take this kind of approach to help combat the staffing challenges.” <br></p><p>She noted that even when outside applicants have experience in business operations, it is rare to find those with a background in or knowledge of long term care. “It’s hard to find people who can hit the ground running when they come in if they do not have any experience in long term care,” Bautista explained. “We have found that people from within our own organization or from within the industry have a higher probability of success in a new role because they understand our mission.” When training has to start from scratch, it can be time-consuming and expensive. <br></p><p>In the way that facilities and organizations partner with nursing and medical schools to attract clinical staff, some long term care providers are connecting with area schools to engage students interested in billing, purchasing, accounting, and other areas. “We partner with a few high schools in the area, where students come in for volunteer hours. These experiences had typically focused on interactions with residents, but we are now working toward the development of a program that gives students the opportunity to understand how various departments—including the business office—work together,” said Bautista. <br></p><p>Agility and flexibility are key in business operations. “We ensure that everyone in our business office and admissions department are cross-trained on key tasks and know the overall responsibilities of each team member,” Bautista explained. “This gives us some flexibility if someone is out sick, goes on vacation, or a position is vacated for some reason. This helps to ensure that the team can continue to function despite absences.” <br></p><p>During the pandemic, many business operations team members got used to working remotely, and now having employees come back to the office can be a challenge. “We live in an era when people just want to work from home,” Bautista said. “We have noticed during interviews that a work-from-home option is a frequently asked question. Our strategy is to accommodate this on an as-needed basis to give potential candidates the opportunity for flexibility when it is needed. However, we have seen that on-site work creates a teamwork environment and lets people engage with the residents.” </p><h3>To Outsource or Not</h3><p>Outsourcing is a viable option, especially for smaller organizations that don’t have in-house experts. This approach can be as broad or narrow as an organization chooses. It’s possible to outsource entire management teams or small segments of services, such as IT, food service, and accounts receivable/payable. Medical data entry is among the most common outsourced nonclinical services in nursing homes. Other outsourced services include billing and coding, receivables, IT support, and insurance claims processing.<br></p><p>Outsourcing can enable the organization to provide specialized expertise, cost savings, and enhanced services. It also enables organizations to scale services up or down based on demand. <br></p><p><img src="/Issues/2024/Fall/PublishingImages/JayBiere-BusOps.jpg" alt="Jay Biere" class="ms-rtePosition-2" style="margin:5px;" />However, it also can lead to a loss of control and cohesiveness, concerns about data security, and inconsistency in quality. Jay Biere, CEO of Plymouth Place, said that outsourcing is hit or miss in long term care. He offered, “I think you should outsource if there’s a situation where there are significant labor challenges or shortages or if you are having difficulties in a particular area.” <br></p><p>He added, “I eliminated outsourcing when I came here, but I know how it works and when it is useful or necessary.” He further shared that he wouldn’t hesitate to outsource again if Plymouth Place “didn’t have the skills or competency resources to do something, and I was assured of the quality we would receive.”<br></p><p>Biere also noted that partnerships and joint ventures might be valuable or necessary when an organization adds an entity or a service. For instance, Plymouth Place just launched Plymouth at Home, a new service offering care, home management, and home-improvement solutions for local residents. He explained, “We have two partners that we work with to provide the services, and they handle their own billing and business operations; so, in essence, it’s a joint venture. Our company provides a concierge manager to interact with the customers.” <br></p><p>This manager follows up with clients in their homes to make sure they are getting what they need and to make sure nothing falls through the cracks. <br></p><p>To ensure that the service partners share Plymouth Place’s values and mission, Biere said, “we vetted them years ago. They work here in our local community, and we know their quality, character, services, and commitment to excellence.”</p><h3>Taking Charge with Tech</h3><p>While we may not have high-functioning robots to do many office tasks as some old sci-fi movies suggested, technology is playing a key role in business operations. These tech innovations are streamlining and simplifying tasks, taking some of the potential for human error out of certain activities, enabling ease of data collection and analysis, and enhancing communication and information sharing. <br></p><p>“Much like the clinical staff, business operations is always looking for ways to be more efficient and accurate. Any time you can save a couple of clicks and a few minutes, it can add up to significant time savings,” said Tom Haithcoat, president of Ceptor Consulting, LLC. He stressed that one important role of technology is to ensure that everyone—business operations and clinical teams alike—have the ability to share and access information. </p><p>Increasingly, he suggested, facilities are using technology that prevents staff from having to waste time chasing people down for information and answers. <br></p><p>Haithcoat noted that larger organizations may be better positioned to create solutions on their own and have customized technology, while smaller companies may have to depend on “off the shelf” tech, so he stressed the importance of finding vendors with experience in long term care and who can offer the biggest bang for the buck. <br></p><p>“AI is prolific, and we’re hearing about it through the industry,” said Anthony Laflen, vice president of value-based care innovation at PointClickCare. Organizations are using AI predictive analytics to help forecast patient costs and needs. <br></p><p><img src="/Issues/2024/Fall/PublishingImages/AnthonyLaflen-BusOps.jpg" alt="Anthony Laflen" class="ms-rtePosition-1" style="margin:5px;" />There is an array of software solutions for the business of senior and long term care. The best of these is designed to streamline and connect programs like electronic health records, electronic medical records, marketing, and billing. They are often cloud-driven and include built-in analytics and a secure interface, and they are designed to reduce problems presented by human error. <br></p><p>For instance, there is billing software that flags missing information or issues that could cause a claim to be denied. These types of innovations, said Laflen, “streamline the ability for a patient to move from one setting to the next and make sure they land in the right place in a thoughtful manner.” This technology ensures the flow of information from the clinical to the business operations side and gives all team members the information they need to fill their roles. <br></p><p>Cloud-based platforms are no longer a luxury but a necessity. “Facilities need to make sure that when there’s a disaster or an emergency, it doesn’t disrupt the flow of communication, billing, and recordkeeping. Business operations and clinical teams both need to be able to access tools and data remotely, which,” said Laflen, “is an obvious function of being cloud-based and enables your teams to continue to work if they are out of the office for days or weeks.” <br></p><p>With technology comes the risk of cyberattacks, and business operations teams have to stay on top of these risks. This calls for everyone to be attuned to the importance of cybersecurity. “Our chief information officer is very on top of cybersecurity and making sure we are as secure as possible,” Bautista asserted. “We’re constantly running updates and tests.”</p><h3>Purchasing Prospects</h3><p>Group purchasing hasn’t changed much over the years, but facility teams are getting savvier about choosing partners. Biere said, “We have three partners for discounted pricing on items such as maintenance supplies and food. We try to look for partners that not only have competitive pricing but reliability and consistency.” <br></p><p>He added, “It’s important to reevaluate partners every other year or so to make sure that you’re getting the right dividends and rebates. There are a lot of companies out there that will make all kinds of promises and commitments, so we try to target those that have good price integrity and follow through on support, as well as the opportunity to earn some money based on our volume.”<br></p><p>AHCA/NCAL has partnered with Incite Strategic Partners to offer a group purchasing program to help providers save on food, medical supplies, services, equipment and other common supplies utilized by senior care communities. All facility and company sizes are welcome to join the GPO, and sign-up is free and easy. Learn more at <a href="http://www.incitesp.com/ahcancal" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.incitesp.com/ahcancal</a>. <br></p><p>According to the Healthcare Supply Chain Association (HSCA), group purchasing will save the health care industry up to $456.6 billion in the next 10 years. The HSCA also states that group purchasing helps organizations, such as nursing homes, that need to demonstrate their value to payers and patients alike. The vast majority of the nation’s hospitals and long term care settings belong to at least one group-purchasing organization. However, all nursing homes and other health care organizations can purchase off-contract, and many do.</p><h3>Planning for the Future</h3><p>As the industry moves into value-based care, business operations teams need to understand the implications of this care model on billing, purchasing, and the bottom line. “This likely means a shift away from traditional Medicare to Medicare Advantage plans, and everyone needs to know what this means for your organization. You need to understand the value you’re creating and be able to speak that language in clinical care and business operations alike,” said Laflen. <br></p><p>This information will benefit facilities seeking to partner with any risk-bearing entity, as the facilities can then say, for instance, “we have 80 patients in our facility and strong numbers in terms of reducing costs and readmission, as well as improving outcomes.” <br></p><p>Laflen noted that when business operations and clinical teams have the right information and analytics, they can be stronger players in value-based care. He added, “Time and time again, I’ve seen buildings close because they did not realize they were sitting on golden opportunities to quantify their value and confidently take on risk.”<br>Looking ahead, business operations teams need to be involved in planning for how the organization will reposition itself to move into value-based care models. “If you remain the same, you have difficulty staying in business,” said Biere. “You need to prepare for changes in the marketplace and labor force and shifts in mindset of the customers. You need leadership teams—including in your business operations—who can think outside the box.” </p><h3>The Clinical-Business Connection</h3><p>It is important to remember that the clinical and business sides of facilities don’t function in a vacuum. “Everything we do has a domino effect,” Bautista explained. “Everything from housekeeping and laundry to dietary and administration all go back to the resident. If things aren’t working efficiently in one area, it impacts others. Maybe it doesn’t directly affect the physical well-being of the resident, but it does trickle down to impact care.” <br></p><p>As a result, every department needs to be connected within the organization, and there must be mutual respect and an understanding of the goals and mission. This can be more challenging in larger organizations. Newsletters, email updates, stand-up meetings, and online dashboards, for example, enable people in different departments to see what is happening throughout the organization. “When everyone is on the same page, no one is getting blindsided or feels like other departments are getting more attention or information,” Bautista said. <br></p><p>Laflen shared, “When I began interacting with operators in different parts of the US, I was stunned how often they would not include the business office or even the admissions office in the clinical narrative. It’s only when you bring both sides together that the real magic starts to happen.” <br></p><p>Having a full view of a patient and the patient’s experience, as well as the cost impact on operations, is key. Laflen noted, “It is important to have business leaders in the building understand what is happening clinically in the facility, and the clinicians need to understand the nuances associated with costs of care and the impact on the facility’s bottom line.”<br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em></p>	Teamwork, partnerships, and technology help the business operations staff operate efficiently.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/BusOps.jpg" style="BORDER:0px solid;" />	Management	Cover Feature	Joanne Kaldy	51	3
Health Care in the Heartland	https://www.providermagazine.com/Issues/2024/Fall/Pages/Health-Care-in-the-Heartland.aspx	Health Care in the Heartland	<p><img src="/Issues/2024/Fall/PublishingImages/Rural.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Those who have lived in a rural area know there’s something special about these communities. People in rural areas can often count on each other, and they value hard work and collaboration. Nate Schema, president and CEO of the Good Samaritan Society, said of rural settings, “We’re serving retired teachers, farmers, pastors, business owners, and veterans. These are proud communities, where people wake up every day and think about how they can better not only their families but their communities.” <br></p><p>He added, “We are at a crossroads right now, but we have an opportunity to look at unique ways to continue to serve rural communities and ensure their sustainability.” </p><h3>The State of Rural Long Term Care</h3><p>In many ways, residents in rural long term care facilities are like their counterparts in urban and suburban communities. However, according to Nursing Homes in Rural America: A Chartbook, released by the Rural Policy Research Institute (RUPRI), rural residents are more likely to have their costs reimbursed by Medicaid, a diagnosis of dementia, psychiatric illness, mental or behavioral health needs, and/or depression. Interestingly, while most of these residents are over age 85, they are less likely to need assistance with activities of daily living than their urban counterparts. They also tend to require less complex care, although they have higher rates of cognitive impairment and behavioral issues. <br></p><p>As in many communities across the country, rural dwellers express a preference to age at home. In a survey from 2021, 62.5 percent of rural respondents said they prefer to receive long term care services in their homes. However, as in many parts of the country, access to home care services and support may be challenging to obtain. Lack of transportation often is the greatest barrier between older adults and their receiving care at home. Other challenges include lack of access to health care services and workforce shortages. Increased funding and improvements in health care and transportation are necessary to address these barriers, but it emphasizes the importance of long term care facilities continuing to serve elders in rural communities. <br></p><p>Unfortunately, many rural nursing homes are struggling to survive. According to a report from the RUPRI Center for Rural Health Policy Analysis, “a higher proportion of nursing homes in rural areas have closed compared to urban areas between 2008 and 2018. Many rural residents rely on rural hospitals with swing beds for both post-acute care and long term care services, but the closure of many hospitals in rural areas may potentially leave residents with few to no options to care.”<sup>1</sup> In the end, the report said, nursing homes remain the backbone of rural long term care and the only option for some older adults.</p><h3>The Challenges and Opportunities</h3><p>Rural nursing homes take their roles very seriously, despite the challenges they face. “We have often found that our Good Samaritan locations are a focal point and the health care hub within their rural communities. They are a vital part of the economic engine of the community. They work closely with the local pharmacy, which might be the only one in the area,” said Schema. <br></p><p><img src="/Issues/2024/Fall/PublishingImages/NateSchema-rural.jpg" alt="Nate Schema" class="ms-rtePosition-2" style="margin:5px;" />If a rural care facility closes, the nearest alternative might be hundreds of miles away. “We see our role as vital and our facilities’ sustainability as a top priority,” Schema said.<br></p><p>Yet, the challenges are real, especially when it comes to finding qualified caregivers in rural communities. For instance, Nikki Wegner, president of the North Dakota Long Term Care Association, said, “The staffing mandate is clearly a challenge. We simply don’t have enough RNs [registered nurses] to be on-site 24/7. States like North Dakota rely on contract nursing staff already, and that drives up costs even higher than they are already. If we could get the nursing staff we need through immigration that we’ve been waiting on since 2021, that would help us tremendously.”<br></p><p>Employing nurses and other workers from outside the United States is a key strategy to address staffing shortages in rural areas. However, that may be easier said than done. <br></p><p>Kenneth Scott Jr., DO, CMD, CEO of SilverSage Management Services, said, “We’re all ready to go on this, but we’ve been stymied by the federal government. It’s taking us three to four years to get somebody in from another country.” <br></p><p>More immigrant workers, he said, would provide an effective solution to staffing shortages in rural areas. For instance, he said, “we have a large pool of nurses in the Philippines who would love to come here and practice, and they’ve already passed U.S. boards.”<br></p><p>Brock Sherva, CEO of Northwood Deaconess Health Center in North Dakota, said that in rural areas, “you’re trying to walk this fine line between what your community needs and compliance with federally regulated scope of what you can offer, and then somehow try to pay for it all.”<br></p><p>He observed that there is also a push to embrace new technology to streamline various tasks and maximize data collection. “We’re all just trying to do the best for our communities and the residents we serve,” Sherva said.<br>With facilities unable to find staff to care for more residents or shutting down because they can’t stay financially feasible, it sometimes seems that families are playing musical chairs with their loved ones—especially in rural areas, where there are fewer and smaller nursing homes. <br></p><p>“We’re scrambling today because we have lost facilities around the nation, and, at the same time, consumers are starting to trust nursing homes again post-COVID and scrambling to get their loved one into a facility, where there are fewer beds,” said Sherva. Families in this situation often end up on a waiting list for a nearby facility, where it might take months for placement, or they have to take their loved one to a nursing home many miles away. <br></p><p>He added, “We’re just getting bombarded with referrals, but we can’t take everyone; and some people have to go elsewhere.” <br></p><p>Because rural facilities are so woven into the fabric of the community they serve, one key to their survival and the ability to provide excellent care and services involves community partnerships. Schema explained, “We want to make sure that we’re inviting other groups into our locations, whether that’s local schools, businesses, or others. We want this to be a source of pride for that local community, and we need our community support to be sustainable.” <br></p><p>For instance, Good Samaritan has a meals-on-wheels program that serves older adults in the area. “It’s a bit unconventional and doesn’t operate the same as it would in an urban area, but it keeps residents in the community a bit longer and helps ensure they get adequate nutrition,” he said.<br></p><p>Wegner stressed that rural facilities can’t function in a silo. “Our state chapter helps [the facilities] network with one another so they’re able to share their challenges, solutions, and best practices. They can talk about the successes they’ve had and resources they’ve found useful,” she said. “Our association does a lot of education for our providers, and we’re always trying to identify topics and content that are important to them.”</p><h3>Connections Across the Miles</h3><p>Often, rural families travel 30 minutes or more to visit a loved one in a nursing home. If the loved one’s facility closes, that hardship is exacerbated. Many rural facilities have come to rely on technology to help connect residents and families, but that’s not always an ideal solution. “One thing we learned through the pandemic is that technology is not a replacement for those one-on-one connections, and that residents suffer when they don’t have personal interactions,” Schema said. <br></p><p><img src="/Issues/2024/Fall/PublishingImages/Brock-rural.jpg" alt="Brock Sherva" class="ms-rtePosition-1" style="margin:5px;" />While his organization invested in one thousand iPads to enable residents to connect with their families by videoconference, Schema and his team continue to look at opportunities to facilitate personal engagement. For instance, they have guest suites and rooms where family members can stay when they travel for visits. <br></p><p>Sherva noted, “We have an independent apartment complex that’s attached to our building, and we have three that can be reserved at all times for families so they can stay here at no charge and spend time at the facility with their loved one.” He suggested the importance of helping families understand that even though they may be farther away from their loved one, that person will be in a facility getting the best possible quality of care, and personal well-being will be prioritized. <br></p><p>Schema shared, “We are constantly working with churches, schools, and other local groups to bring people in to ensure our residents feel like they’re part of the community. In many cases, our residents are people who helped build the community. We feel a responsibility and obligation to ensure that in their final years, they are valued.”<br>When visiting a loved one is challenging because of distance, Wegner suggested that families spread out visits. “One person can go this week, and someone else can go the next. Then they coordinate holidays to ensure their loved one isn’t alone without placing undue burden or stress on the whole family,” she said. <br></p><p>She added that there are reliable volunteers in many communities, so families can reach out to them and introduce themselves and their loved one. Facilities even can start programs to “adopt a grandparent” to ensure all residents have someone to connect and engage with regularly. <br></p><p>Of course, while all these ideas are useful, they are not a definitive answer to addressing time constraints when a loved one is in a rural nursing home. Sherva said, “We’ve always had a great group of volunteers from area churches, women’s clubs, etc., but everyone is busy and has limited time.” <br></p><p>Additionally, there is only so much volunteers can do. For instance, they can’t move a resident or perform some caregiving tasks because of liability risks. <br></p><p>Nonetheless, ensuring that families have connections with their loved one and that residents are engaged needs to be a focus in rural facilities as, unfortunately, this challenge is likely to increase—at least for the short term. Wegner said, “We have had six nursing homes close in a 35-month period. When these closures happen, it can create a significant hardship for families when the nearest setting for their loved one is hundreds of miles away.” <br></p><p>This may lead some families to bring their loved ones home; and while Wegner noted that there are growing resources for family caregivers and home care, one’s home often isn’t the best or safest setting for individuals with significant health care needs. </p><h3>Shortage of Services</h3><p>Getting specialists into rural communities has long been a challenge, and it continues to present an obstacle to accepting and attracting referrals. While some mental health and other services can be provided via telehealth, other efforts require in-person exams and treatments. <br></p><p>Schema said, “We partner with mobile dental services that visit residents at our locations regularly. We’ve had quite a bit of success with this.”<br></p><p>Some rural areas are starting their own specialty units. For instance, in Howard Lake, Minn., there is a specialized program to serve post-cardiac surgery patients. Outside of Sioux Falls, S.Dak., in Canistota, a town of about 600 people, specialized behavioral health services are offered. <br></p><p>Schema said, “We have to think about how we invest and ensure that those communities are sustainable and viable. We have to address the issue that it could take upwards of a year or more to fill a clinical position in a small rural community. We need a way to attract and keep good staff in these settings without a prescriptive, one-size-fits-all staffing requirement that hinders our ability to provide care in these rural areas.”<br></p><p>Sherva said, “You need to reach out and try to establish relationships with the closest dentist, optometrist, etc. It’s all about community building and making meaningful connections with practitioners, service providers, and others in the area. We also have a fleet of vans that drive patients and residents to appointments if we’re not able to get these in-house.” <br></p><p>Community leaders and employers also can partner to promote their rural community to dental, ophthalmology, medical, nursing, podiatry, and other schools as good places for graduating students to live and work. They could consider partnering with others in the community to offer incentives such as rental discounts and assistance with closing costs for homes. <br></p><p>“We’ve partnered with one of the big nursing schools in the state, and now a rural rotation is required. We need to establish something like this for dental and other students so they can see how they can truly make a difference in a rural community,” said Sherva. </p><h3>Seeking Solutions</h3><p>While rural facilities are surviving with the support of their communities, many also are working with state and national organizations on more permanent solutions. “We need states to invest in Medicaid reimbursement, especially in areas that have some of the lowest rates in the nation. We need to see increased investment in these rural areas where we’re seeing extraordinary inflation,” Schema said. <br></p><p>There is some awareness of the needs and challenges of rural facilities among policymakers. Schema noted that Governor Jim Pillen in Nebraska and Governor Kim Reynolds in Iowa started a letter signed by governors across the country warning the federal government about the negative impact a one-size-fits-all staffing rule is likely to have. In South Dakota, lawmakers convened a summer study to address the need to ensure rural communities are sustainable now and ten to fifteen years down the road. “We need sustained focus and energy on the state and federal levels to make sure we have the predictability all providers are looking for,” Schema said. <br></p><p>Partnerships and collaborations are showing promise. In North Dakota, a clinically integrated network called the Rough Rider High Value Network, comprising twenty-three independent critical-access hospitals, acts as an accountable care organization to change how care is delivered throughout the state, including in rural areas. “It’s relatively new, so I can’t say that we’re seeing benefits or drawbacks yet; but I think it’s a promising way to deliver care as we move more into the world of value-based medicine,” said Sherva. He noted that rural areas need to think outside the box for ways to keep from losing much-needed nursing homes and hospitals. </p><h3>Opportunities and Optimism</h3><p>Like their residents, many of whom have overcome challenges and faced adversity with courage and confidence, rural facilities look ahead with optimism. Schema said, “I think rural communities have an opportunity. They have to continue to look to engage the broader community. They can’t look inward and think they’re going to solve everything on their own.” <br></p><p>He suggested the importance of telling their stories, getting involved with local community organizations, engaging with state legislators, and inviting people into rural communities to meet and get to know residents. “We can’t put our heads in the sand and think that others will solve our problems for us. We need to be our own advocates for those we serve,” he said.<br></p><p>These connections are increasingly important, as more areas are seeing natural disasters such as tornadoes, floods, and wildfires. Schema said, “Recently we saw anywhere from seventeen to twenty-five inches of rain in southwest Minnesota and northwest Iowa. Fortunately, none of our Good Samaritan locations had to evacuate; but we had dozens of employees who were affected and many who couldn’t make it to work for days and upwards of weeks because of the devastation. During these times, we see the best in our rural communities. </p><p>We’ve been blown away by the lengths that people have gone to, whether it’s neighboring communities pulling up local food trucks and providing a free meal, to people coming in just to help with sandbags. You see the pride of rural communities coming together in those moments. We need to continue to engage and reach out and let everyone know how appreciative we are and how committed we are to caring for their loved ones. It is a privilege to serve them.” </p><h4><br>References<br>1. RUPRI Center for Rural Health Policy Analysis, Nursing Homes in Rural America: A Chartbook, (Rural Policy Research Institute, July 2022), https://rupri.org/wp-content/uploads/Nursing-Home-Chartbook.pdf</h4>	Rural long term care facilities are woven into the fabric of their communities yet ther sustainability might be in question.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/Rural.jpg" style="BORDER:0px solid;" />	Caregiving	Cover Feature	Joanne Kaldy	51	3

2024 AHCA/NCAL Awards Program Honorees	https://www.providermagazine.com/Issues/2024/Fall/Pages/2024-AHCANCAL-Awards-Program-Honorees.aspx	2024 AHCA/NCAL Awards Program Honorees	<p>The American Health Care Association/National Center for Assisted Living (AHCA/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 Delivering Solutions 24, the AHCA/NCAL Convention & Expo in Orlando, Fla.</p><div><br></div><p><span></span><strong>Alice Smith</strong><br>Highland Park Care Center and Highland Park Assisted Living, Alliance, NE<br><em>AHCA Leader of the Year Award</em></p><div><p><span><span><img src="/Issues/2024/Fall/PublishingImages/AliceSmith-awards.jpg" class="ms-rtePosition-1" alt="Alice Smith" style="margin:5px;" /></span></span>Alice Smith, the administrator of both Highland Park Care Center and Highland Park Assisted Living in Alliance, Neb., has been recognized as the 2024 AHCA Leader of the Year. This award honors a leader in a long term care facility who demonstrates outstanding innovation, achievement, and capabilities in providing high-quality, person-centered care.<br></p><p>Smith's leadership ensures high-quality care for residents and fosters a supportive environment for her staff. Her genuine connection with residents and staff highlights her servant leadership style.</p><p>Smith’s approach empowers staff to make decisions that prioritize resident care. This strategy has resulted in a high-performing team capable of creating enriching experiences for residents. Under her guidance, residents participate in activities such as riding motorcycles and in community parades, enhancing their quality of life.</p><p>Smith actively involves her facilities in community collaborations, partnering with local non-profits and organizing various drives to support those in need. These initiatives integrate community involvement into residents' daily lives and foster multi-generational connections.<br></p><p>During the COVID-19 pandemic, Smith adhered to stringent guidelines to ensure resident safety, worked in various departments, and obtained her nursing assistant certification to better assist the nursing staff. She also fundraised for adaptive bikes, allowing residents to safely enjoy outdoor activities.<br></p><p>Smith’s achievements include leading Highland Park Care Center to earn the 2024 Silver Quality Award and Highland Park Assisted Living to earn the 2024 Bronze Quality Award. Her dedication to enhancing the quality of life for residents, combined with her adherence to the facility’s mission, vision, and values, underscores her deservingness of this award.</p></div><div><span></span><strong>Ami A. Mendez</strong><br>Avista Senior Living North Mountain, Phoenix, AZ<br><em>NCAL Leader of the Year<br></em></div><p><span><span><img src="/Issues/2024/Fall/PublishingImages/AmiMendez-awards.jpg" class="ms-rtePosition-1" alt="Ami A. Mendez" style="margin:5px;" /></span></span>NCAL recognizes extraordinary leaders in assisted living who exemplify excellence, dedication, and innovation. This year's NCAL Leader of the Year Award goes to Ami A. Mendez, whose impact on her community and facility is profound.<br></p><div><p>Mendez, a certified nursing home administrator and assisted living manager, has set a remarkable standard of care over her nine-year tenure at Avista Senior Living North Mountain in Phoenix, Ariz. Her leadership has fostered a high-performing team that recently achieved a perfect score on its deficiency-free annual survey and was awarded the 2024 National Bronze Quality Award by AHCA/NCAL. <br></p><p>Mendez’s commitment to addressing the needs of an often-marginalized, elderly population who relies on Medicaid is evident through the specialized programs she has developed. Under her guidance, the community has become a beacon of hope for low-income seniors. <br></p><p>Mendez serves a dual role within her company, which has grown from three to thirty communities and in six states during her tenure. She is responsible for the daily operations of the 149-bed assisted living facility and is also a key player on the company's executive team. Saving the company thousands of dollars, she has a unique skill set that allows her to customize the company's electronic health record by building more satisfying, digestible, and efficient tools for caregivers and med techs. She is also responsible for writing network-wide policy and answering compliance-related and other questions from other assisted living managers. Through 33 years of experience, her ability to provide resources to her peers, company, and residents is unmatched. She has introduced and designed company-wide programs and risk-mitigating documentation tools. <br></p><p>Her dedication to ethical practices and protecting resident rights while simultaneously investing in the team is evident. She has embraced and implemented a leadership philosophy focusing on team members’ behavior toward others. She fondly calls this approach the "commitment to my coworker." Aiming to create a fun, vibrant, safe, and trusting work environment, this approach sets expectations for newly hired team members who must understand their role in another person's experience. They are taught ways to approach each other that demonstrate grace and mercy. Team members must demonstrate the tenets of this philosophy to stay on the team. She has never used agency assistance since being initially licensed in 2003. Her argument stands firm: "If you wouldn't let a stranger care for your own family members, why would I let strangers care for those entrusted to us.”<br></p><p>Mendez's dedication to mentorship is reflected in the fact that 100 percent of her leadership team has been promoted from within, creating career paths for multiple entry-level team members who have advanced to managerial roles.<br></p><p>Mendez has received company, community, and professional recognition throughout her career. She received the Eli Pick Facility Leadership Award for consistent quality outcomes and was recognized in 2023 and 2024 as one of the Top 50 Women Leaders in the state. Recently, her company awarded her the HERO award for her outstanding work, and she has been awarded the AHCA/NCAL Bronze Award two times in her administration. <br></p><p>Her dedication to enhancing the quality of life for residents underscores her deservingness of this award.</p><p><br></p><p><strong>Neil Pruitt, Jr.</strong><br>Chairman and CEO of PruittHealth, Inc., Norcross, GA<br><em>Mary K. Ousley Champion of Quality</em></p></div><div><p><span><img src="/Issues/2024/Fall/PublishingImages/NeilPruitt-awards.jpg" class="ms-rtePosition-1" alt="Neil Pruitt, Jr." style="margin:5px;" /><strong></strong></span>Neil Pruitt, Jr., chairman and CEO of PruittHealth, Inc., headquartered in Norcross, Ga., has been named the 2024 recipient of the Mary K. Ousley Champion of Quality Award by AHCA. This prestigious award honors individuals who have significantly advanced quality performance in long term and post-acute care.<br></p><p>Pruitt has been a long-standing champion for quality in long term care (LTC), making substantial contributions that have raised the importance of quality within the profession. As board chair for AHCA, he established the quality and regulatory divisions in 2011 and launched the Quality Initiative in 2012, leading to a nearly 50 percent reduction in antipsychotic use through a national partnership with the Centers for Medicare & Medicaid Services (CMS). He also advocated updating the LTC Trend Tracker platform and secured funding for the Center for Long-Term Care Quality & Innovation at Brown University in 2014.</p><p>Under Pruitt’s leadership, AHCA developed and sought endorsement from the National Quality Forum for post-acute care quality measures, including functional outcome measures in mobility and self-care, hospitalization, and discharge to the community. These measures influenced CMS’s Skilled Nursing Facility Quality Reporting Program and led to changes in how CMS measures discharge to the community. He also supported the Protecting Access to Medicare Act in 2014, establishing the CMS Hospital Value-Based Purchasing Program, and created the CoreQ satisfaction measure, now a standard for satisfaction measurement in skilled nursing and assisted living facilities.</p><p>Pruitt's contributions extend beyond policy. He set up the Quality Cabinet at AHCA/NCAL, bringing together all quality-related committees to develop the association’s position on regulatory, five-star, and payment issues. His efforts have significantly influenced national standards and the quality of care provided to residents, underscoring his commitment to improving resident outcomes within the LTC sector.<br></p><p>In addition to his role at AHCA, Pruitt served as chair of the Georgia Health Care Association. In 2013, he was appointed to the Commission for Long Term Care, a 15-member panel charged with developing plans for a comprehensive, coordinated, and high-quality system ensuring long term care for older adults and people with disabilities. He also served as chair of the board of trustees of the University System of Georgia Foundation and currently serves as a board member for the Georgia Regents Health System.</p></div><p><strong>Jayden Chandler</strong><br>Rock Creek of Ottawa, Ottawa, KS<br><em>NCAL Noble Caregiver</em></p><div><p><span><img src="/Issues/2024/Fall/PublishingImages/JaydenChandler-awards.jpg" class="ms-rtePosition-1" alt="Jayden Chandler" style="margin:5px;" /><strong></strong></span>Jayden Chandler, a caregiver from Rock Creek of Ottawa in Ottawa, Kans., has been honored with the 2024 Noble Caregiver Award by NCAL. This award recognizes frontline caregivers who significantly improve the quality of life for residents and create a better work environment for staff.<br></p><p>Chandler's compassion and dedication are evident in her daily interactions, as she ensures each resident feels at home with individualized care.<br></p><p>Her problem-solving skills, particularly in dementia care, have improved residents' daily lives. Chandler engages residents through activities they enjoy and maintains a positive attitude, even on challenging days. <br></p><p>Beyond her scheduled work hours, Chandler dedicates her time to assist with activities. She also volunteers at an animal shelter and brings pets into the facility to help soothe residents and address behavioral challenges.<br></p><p>Chandler has completed abilities expert training, specializing in dementia care, and has become the abilities care champion for her facility. In this role, she trains staff on various levels of dementia, ensuring comprehensive resident care.<br></p><p>Additionally, Chandler is pursuing further education in nursing with a focus on gerontology. She plays a vital role in training new staff, ensuring they understand residents' specific needs and care tasks. <br></p><p>Chandler’s commitment to person-centered care and improving residents' lives has enhanced residents' quality of life and strengthened her facility's community, making her a deserving recipient of this award.</p><p><strong>Rick Baldini</strong><br>Waters Edge Health & Rehabilitation, Kenosha, WI<br><em>AHCA Noble Caregiver</em></p><p><img src="/Issues/2024/Fall/PublishingImages/RickBaldini-awards.jpg" class="ms-rtePosition-1" alt="Rick Baldini" style="margin:5px;" />AHCA's Noble Caregiver Award recognizes frontline staff for their contributions to improving residents' quality of life and creating a better work environment. Rick Baldini, the maintenance director at Waters Edge Health & Rehabilitation in Kenosha, Wis., exemplifies exceptional dedication and person-centered care.<br></p><p>Baldini enhances the well-being of residents and overall morale at Waters Edge. His interactions go beyond routine maintenance tasks; he engages with residents personally, understanding their needs and preferences. His involvement in facility activities, such as fundraising events, demonstrates his commitment to fostering a supportive community.<br></p><p>Baldini’s commitment to residents’ quality of life is evident in his prompt attention to maintenance needs, even beyond regular hours. He proactively identifies and resolves issues, ensuring a well-maintained facility.<br></p><p>By maintaining and repairing essential equipment like mobility aids and beds, Baldini empowers residents to live as independently as possible. Baldini’s versatility is further demonstrated by his willingness to assist with tasks outside his typical responsibilities.<br></p><p>Additionally, Baldini's proactive problem-solving and support for new staff members contribute significantly to the facility's smooth operations.<br></p><p>Baldini's dedication to improving residents' quality of life, positive attitude, and unwavering commitment make him a standout caregiver in the long term care community.<br></p><p><strong>Gail Sheridan, RN</strong><br>Executive Vice President of Lifespark Senior Living, St. Louis Park, MN<br><em> Jan Thayer Pioneer Award</em></p><p><img src="/Issues/2024/Fall/PublishingImages/GailSheridan-awards.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />Gail Sheridan, RN, a recognized leader in person-centered care, has been awarded the 2024 Jan Thayer Pioneer Award by NCAL. As the executive vice president of Lifespark Senior Living in St. Louis Park, Minn., Sheridan has focused on enhancing clinical systems, quality improvement, and regulatory compliance. Her efforts have improved operational outcomes and created a supportive environment for staff and residents.<br></p><p>The Jan Thayer Pioneer Award honors individuals who have significantly advanced the senior care profession. Named after NCAL’s first board chair, Jan Thayer, this award recognizes dedication, leadership, and impactful contributions—qualities that Sheridan exemplifies.<br></p><p>Sheridan has played a key role through leadership roles in various organizations. Her involvement with Care Providers of Minnesota (CPM) includes serving on the board of directors for more than 10 years and serving as the chair of the board, as well as chairing the Quality Committee. Sheridan has also been a multiple winner of the CPM Member of the Year award. <br></p><p>At the national level, she has served on the NCAL Board of Directors, as AHCA/NCAL Quality Cabinet co-chair, chair of the AHCA/NCAL Workforce Committee, and on various AHCA/NCAL committees, including the Survey/Regulatory Committee and the Emergency Preparedness Committee.<br></p><p>Sheridan developed tools to help providers respond to adverse events and improve quality assurance and performance improvement programs. Her ability to harness collective knowledge has resulted in practical, widely supported recommendations, improving compliance and transparency in the sector.<br></p><p>Sheridan's hands-on approach is evident in her daily interactions with staff, residents, and families. Her leadership promotes excellence and person-centered care in senior living communities. She is also recognized as a catalyst for innovative approaches that enhance the overall customer experience in senior care.<br></p><p>In addition to her contributions, Sheridan served in the U.S. Navy, showcasing her lifelong commitment to service and excellence.<br></p><p>Sheridan's three decades of dedication to senior care and her extensive contributions at both the state and national levels have left a lasting impact on the profession, setting a high standard for quality and innovation in care. <br></p><br></div>	AHCA/NCAL pays tribute to the best and brightest in long term and post-acute care. Individuals and groups honored with awards will be recognized during Delivering Solutions 24.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/ahcancal_blk.jpg" style="BORDER:0px solid;" />	Caregiving	AHCA/NCAL Annual Awards
Inspiring Excellence and Improving Lives in Long Term Care	https://www.providermagazine.com/Issues/2024/Fall/Pages/The-AHCANCAL-National-Quality-Awards-.aspx	Inspiring Excellence and Improving Lives in Long Term Care	<p><img src="/Issues/2024/Fall/PublishingImages/Libby-Care-Center.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:150px;" />Long term care providers across the nation are dedicated to enhancing the quality of life for residents through the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) National Quality Award Program. Grounded in the Baldrige Criteria for Performance Excellence, this esteemed program drives improvement in leadership, strategic planning, workforce, customer service, operations, and knowledge management. Participants advance through three levels of recognition—Bronze, Silver, and Gold—each requiring a higher standard of performance excellence.<br></p><p>This summer, AHCA/NCAL announced the names of nearly 900 long term care organizations recognized with a <a href="/Issues/2024/Fall/Documents/4-bs_QualityAward%20PrvFall24.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img class="ms-asset-icon ms-rtePosition-4" src="/_layouts/images/icpdf.png" alt="" />2024 National Quality Award</a>—737 Bronze awards in 49 states, 139 Silver awards in 33 states, and an elite two Gold awards.</p><p style="text-align:center;"><img src="/Issues/2024/Fall/PublishingImages/Lofland.jpg" alt="" style="margin:5px;width:200px;height:200px;" /><br></p>	Grounded in the Baldrige Criteria for Performance Excellence, this esteemed program drives improvement in leadership, strategic planning, workforce, customer service, operations, and knowledge management.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/Lofland.jpg" style="BORDER:0px solid;" />	Quality Awards	National AHCA/NCAL Quality Awards
Feel Inspired at NCAL Day	https://www.providermagazine.com/Issues/2024/Fall/Pages/Feel-Inspired-at-NCAL-Day.aspx	Feel Inspired at NCAL Day	<p><img src="/Issues/2024/Fall/PublishingImages/NCALDay.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />This year’s NCAL Day is one that you do not want to miss! It will take place at the start of Delivering Solutions 24, the AHCA/NCAL Convention & Expo on Sunday, October 6 in Orlando, Fla. This year’s speakers are sure to leave you feeling inspired and full of fresh ideas. <br></p><p>The opening keynote speaker, Jerald Cosey, will present Become a Five S.T.A.R. Leader: The Journey to Excellence in Senior Living. He will guide you through the concept of five-star leadership and the need to strategically transform one’s actions to achieve results, uncover strategies to implement strong skill development, and identify the empowering value of Covid Conviction. <br></p><p>This year’s NCAL Day luncheon speaker, Maja Kazazic, will help harness the power of empathy to teach organizations how to cultivate positive and healthy work environments that thrive on teamwork. This includes how to become better leaders and create and foster healthy, meaningful relationships with coworkers, employees, and customers.<br></p><p>NCAL Day also offers a variety of other sessions designed to provide real-life and practical solutions for your greatest challenges. These include Using Data for Meaningful Intervention, Dementia Programming: Back to the Future, Developing Effective Approaches that Improve Performance and Outcomes, and much more. The closing fireside chat is always a great way to end the day and will focus on the future of assisted living. <br></p><p>You cannot afford to miss this year’s NCAL Day, which offers more opportunities to learn and earn more education credits than in previous years. Be sure to register now at <a href="https://deliveringsolutionsorg.eventscribe.net/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">NCALDeliveringSolutions.org</a>. </p><p>We look forward to seeing you in Orlando! <br></p>	NCAL Day also offers a variety of other sessions designed to provide real-life and practical solutions for your greatest challenges.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/NCALDay.jpg" style="BORDER:0px solid;" />	Caregiving	Convention
Behind the Program	https://www.providermagazine.com/Issues/2024/Fall/Pages/Behind-the-Program-.aspx	Behind the Program	<p>AHCA/NCAL applauds the hard work of the <a href="/Issues/2024/Fall/Documents/2-bs_Exam%20Judge%20PrvFall24.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img class="ms-asset-icon ms-rtePosition-4" src="/_layouts/images/icpdf.png" alt="" />2024 National Quality Award Examiners, Judges, and Quality Award Board</a> for their time and dedication to improving long term care through the Quality Award journey.</p><p>Explore incredible journeys of recipients and share your story on the new Quality Award Stories website <br>at <a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/Quality-Award-Stories.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">ahcancal.org/QualityAwardStories</a>.<br><br></p>	AHCA/NCAL applauds the hard work of the 2024 National Quality Award Examiners, Judges, and Quality Award Board for their time and dedication to improving long term care through the Quality Award journey.	2024-09-11T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/QualityAward_logos.jpg" style="BORDER:0px solid;" />	Quality	Convention
Exhibitors & Associate Business Members	https://www.providermagazine.com/Issues/2024/Fall/Pages/Exhibitors-&-Associate-Business-Members.aspx	Exhibitors & Associate Business Members	<p><a href="/Issues/2024/Fall/Documents/3-bs_PrvFall24%20Exhibitors%20ABM.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img class="ms-asset-icon ms-rtePosition-4" src="/_layouts/images/icpdf.png" alt="" />Exhibitors & Associate Business Members </a><br>(as of August 27, 2024)<br></p>	Here's a list of this year's Exhibitors and Associate Business Members.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/Florida.jpg" style="BORDER:0px solid;" />	Caregiving	Convention
Caring for Multiple Conditions Among Residents of Skilled Nursing Facilities	https://www.providermagazine.com/Issues/2024/Fall/Pages/Caring-for-Multiple-Conditions-Among-Residents-of-Skilled-Nursing-Facilities.aspx	Caring for Multiple Conditions Among Residents of Skilled Nursing Facilities	<p>In many cases, skilled nursing facilities (SNFs) care for more medically complex patients than home health agencies or other post-acute care facilities. For example, 47 percent of SNF residents have Alzheimer’s or dementia compared to only 26 percent of patients receiving home health agency care, and 28 percent in inpatient rehabilitation facilities. Also, SNFs have on average the second highest chronic condition risk score. </p><p>Here are the <a href="/Issues/2024/Fall/Documents/3-bs_BTN%20PrvFall24.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">top 10 chronic conditions</a> among SNF residents.</p>	In many cases, skilled nursing facilities (SNFs) care for more medically complex patients than home health agencies or other post-acute care facilities.	2024-09-11T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/senior_man_nurse.jpg" style="BORDER:0px solid;" />	By the Numbers	By the Numbers
Finding the Right Assisted Living Community	https://www.providermagazine.com/Issues/2024/Fall/Pages/Finding-the-Right-Assisted-Living-Community.aspx	Finding the Right Assisted Living Community	<p><img src="/Issues/2024/Fall/PublishingImages/Fall24_AL.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />In my last article, “<a href="/Issues/2024/Summer/Pages/The-Intangible-Values-of-Assisted-Living-Love-and-Innovation.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">The Intangible Values of Assisted Living: Love and Innovation</a>,” I highlighted the innovation that is happening in assisted living communities across the country. Providers are committed to meeting the needs of current and future residents, and they are doing this by offering enhanced services, new technologies, and modernized buildings. <br></p><p>While this work to move our profession into the future is amazing, it is important to recognize that every resident has different needs and wants. That is why finding the right community to call home is so important.<br></p><p>More and more families are relying on assisted living communities to care for their aging loved ones. Senior living providers understand the challenges families face when going through the process of choosing an assisted living community for their loved one and the impact of that decision. Finding the right community means peace of mind for family members and a safe, comfortable home for residents where they receive high-quality care. <br></p><p>The good news is there are many resources available to help families throughout the process, resources that will equip them with the knowledge to choose the best assisted living community for their loved one and the confidence to know they made the right selection. I encourage you to share these resources with potential residents and their families to support them in their journey. </p><h3>What Assisted Living Offers Compared to Other Settings</h3><p>Person-centered care is the foundation of assisted living communities. Residents receive increased supervision in a homelike setting. These are individuals who may have cognitive impairments or physical limitations, which make assistance with daily living activities necessary, but they don’t require 24/7 medical care. <br></p><p>Assisted living communities value independence while giving residents hands-on support that is tailored to their specific needs. They help residents with daily activities, such as bathing, getting dressed, cleaning, and eating. At the same time, they provide social and recreational activities. Most assisted living communities have an activities director or department that plans daily activities for their residents. Meeting the social, emotional, cultural, intellectual, and spiritual needs of the residents is just as important, and providers strive every day to bring a holistic approach to healthy living. </p><h3>Choosing the Right Community </h3><p>There are more than 30,000 assisted living communities serving more than 800,000 residents nationwide. When considering an assisted living community, there are resources available to help families find the community that meets their specific needs. <br></p><p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) created the <a href="https://ourseniorcare.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Our Senior Care</a> website to empower potential residents and families in their search. On this website, you’ll find several resources that will help educate families about long term care and answer commonly asked questions. One of the most valuable tools on Our Senior Care is the <a href="https://ourseniorcare.org/care-finder/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Care Finder</a>. The Care Finder allows you to type in your city or zip code and find assisted living communities in your area. The communities listed are current AHCA/NCAL members, and the Care Finder indicates active recipients of the AHCA/NCAL National Quality Award Program. <br></p><p>While online resources are helpful, they should be only one part of the research. To aid in the decision-making process, families should schedule in-person tours of the communities they are considering. Look at the living quarters. Try the food. Meet the staff and residents. Talk to other families. Ask detailed questions to get a clear picture of the services offered and the care a loved one will be receiving. <br></p><p>Remember that there is nothing more important than peace of mind. While loved ones receive the care of highly trained and dedicated staff, it’s critical to be confident and comfortable with the ultimate decision.</p><h3>The Value of Assisted Living Care </h3><p>Paying for assisted living care is a legitimate concern for many families. The average monthly cost is $5,350, and while this is less than the average cost for homemaker services ($5,720) or engaging a home health aide ($6,292), it’s still a considerable financial obligation. But it’s important to keep in mind that assisted living communities often take care of everything: housing, care services, meals, transportation, social events, and more. <br></p><p>The majority of assisted living residents use private funds to pay for personal care and room and board, as Medicare does not cover assisted living, and Medicaid coverage varies by state. When meeting with individual communities, it’s important for families to discuss in detail the available payment and coverage options.</p><h3>Celebrating Assisted Living </h3><p>Assisted living communities are a growing aspect of long term care, and NCAL is grateful for the hundreds of thousands of men and women who have chosen to serve seniors as their profession. We will be honoring them during National Assisted Living Week, September 8-14, 2024. <br></p><p><img src="/Issues/2024/Fall/PublishingImages/LaShuan-Bethea.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:150px;height:184px;" />Established by NCAL in 1995, National Assisted Living Week provides a unique opportunity for residents and their loved ones, staff, volunteers, and the surrounding communities to recognize the role of assisted living in caring for America’s seniors and individuals with disabilities. This year’s theme is “Inspiring Generations.” Learn more about how you can celebrate at <a href="http://www.nalw.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.nalw.org</a>. <br></p><p><em>LaShuan Bethea is the executive director of the National Center for Assisted Living (NCAL).</em><br></p>	Providers are committed to meeting the needs of current and future residents, and they are doing this by offering enhanced services, new technologies, and modernized buildings.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/Fall24_AL.jpg" style="BORDER:0px solid;" />	Assisted Living	Spotlight on Assisted Living
Hitting the COVID-19 Vaccine Up-to-Date Moving Target	https://www.providermagazine.com/Issues/2024/Fall/Pages/Hitting-the-COVID-19-Vaccine-Up-to-Date-Moving-Target.aspx	Hitting the COVID-19 Vaccine Up-to-Date Moving Target	<p><img src="/Issues/2024/Fall/PublishingImages/caregiving.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Starting October 1, 2024, the Centers for Medicare & Medicaid Services (CMS) will add a new item, O0350, to the Minimum Data Set (MDS) to indicate whether a resident’s COVID-19 vaccination is up-to-date. To code this item accurately, long term care staff will need to stay current with the recommendations from the Centers for Disease Control and Prevention (CDC) for COVID-19 vaccinations. These recommendations have changed over time and will likely be modified in the future. Thus, this situation creates a moving target that will require the close attention of long term care providers. This article reviews the instructions in the draft <em>Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual (RAI User’s Manual)</em><sup><a href="https://www.cms.gov/files/document/draftmds-30-rai-manual-v1191october2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">1</a></sup> and CDC recommendations as of June 2024. It offers tips on how the nurse assessment coordinator (NAC) can code this new item accurately.</p><h3>New to the MDS October 1, 2024</h3><p>The new item, O0350: Resident’s COVID-19 vaccine is up to date, asks for a simple yes or no response. But the coding instructions described in the draft are much more complex. CMS recognizes the importance of coding this item on the MDS, stating, “In 2020, persons aged 65 years or older accounted for 81 percent of U.S. COVID-19-related deaths.” CMS also provides care-planning considerations, such as a focus on an effective infection prevention and control program, as well as ensuring that residents and staff remain up-to-date with COVID-19 vaccines. <br></p><p>However, CMS also recognizes some risk, stating, “A vaccine, like any other medicine, could possibly cause serious problems, such as severe allergic reactions. Serious problems from the COVID-19 vaccine are very rare.” It suggests using the “Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States”<sup><a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">2</a></sup> CDC web page as a resource.<br></p><p>To determine whether a resident’s vaccine is up-to-date, the NAC may use information from the medical record or from an interview with the resident, family, or other caregivers or health care providers. However, the NAC must also follow this RAI User’s Manual’s definition of “up-to-date” for COVID-19 vaccines: “For the definition of ‘up to date,’ providers should refer to the CDC webpage ‘Staying Up to Date with COVID-19 Vaccines’ at <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html</a>.” This guideline means that the NAC must follow the recommendations in place at the time of the assessment reference date for the MDS item.<br></p><p>Additionally, if the resident’s COVID-19 vaccination is not current for any reason (e.g., resident refusal, religious exemptions, or medical contraindications), the MDS item should be coded “No,” indicating the vaccine is not up-to-date.</p><h3>CDC Recommendations</h3><p>The CDC provides complex guidelines for COVID-19 vaccines based on age, previous vaccinations, and immunocompromised status. But these guidelines may change as updated information is available or new vaccines are developed.<br></p><p>The CDC “Staying Up to Date” web page offered the following information as of July 2024:<sup><a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">3</a></sup><br></p><ul><li>CDC recommends the 2023–2024 updated COVID-19 vaccines—Pfizer-BioNTech, Moderna, or Novavax—to protect against serious illness from COVID-19.</li><li>Everyone aged 5 years and older should get one dose of an updated COVID-19 vaccine to protect against serious illness from COVID-19.</li><li>Children aged 6 months–4 years may need multiple doses of COVID-19 vaccines to be up to date, including at least one dose of an updated COVID-19 vaccine.</li><li>People who are moderately or severely immunocompromised may get additional doses of an updated COVID-19 vaccine.</li><li>People aged 65 years and older who received one dose of any updated 2023–2024 COVID-19 vaccine (Pfizer-BioNTech, Moderna, or Novavax) should receive one additional dose of an updated COVID-19 vaccine at least four months after the previous updated dose.</li></ul><p></p><h3>Tips to Code O0350 Accurately</h3><p>To code this new MDS item correctly, staff must stay current on CDC recommendations, including tracking any relevant changes, and clearly document vaccine administration, refusals, exemptions, and any related adverse effects.<br></p><ul><li>Stay up-to-date with vaccine recommendations:</li></ul><p>• Check the CDC “Staying Up to Date” web page frequently.<br>• Subscribe to the CDC’s “Advisory Committee on Immunization Practices (ACIP): Vaccine Recommendations” news and updates.<sup><a href="https://tools.cdc.gov/campaignproxyservice/subscriptions.aspx#subscribe" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">4</a></sup><br>• Watch for trainings offered by ACIP on vaccine recommendations and updates.<br></p><ul><li>Create a folder to document vaccine recommendations by time period, with clear indications of when changes occurred:</li></ul><p>• Print the COVID-19 ACIP vaccine recommendations.<sup><a href="https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">5</a></sup> <br></p><ul><li>Update policy and procedures for COVID-19 vaccines to align with CDC recommendations:</li></ul><p>• Create a facility policy for and/or form documenting the administration of COVID-19 vaccines, including the formula (e.g., 2023–2024 formula) and manufacturer.<br>• Create a facility policy for and/or form documenting any refusal, religious exemptions, or medical contraindications.<br></p><ul><li>Monitor and document any adverse effects from vaccine administration.</li><li>Ensure clear and consistent documentation practices to streamline data review for the NAC for accurate MDS coding.</li></ul><p>Creating a structured policy and a consistent location for documentation regarding vaccine administration or refusal/exemption will streamline the NAC’s data review for accurate MDS coding. Designating a specific location to track changes to CDC recommendations will also ensure the team is following current recommendations and provide support for accuracy during the specific time period.</p><h3>New Quality Measure</h3><p>The information collected at MDS item O0350: Resident’s COVID-19 vaccine is up to date, will also be used in a new Skilled Nursing Facility Quality Reporting Program (SNF QRP) measure, COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date. Data collection for this measure will begin October 1, 2024, and fourth quarter 2024 data will be used for the fiscal year (FY) 2026 SNF QRP program year. Thereafter, the measure will use a full calendar year (CY) of data (i.e., FY 2026 uses CY 2025).<br></p><p>Because this is also an SNF QRP measure, failure to report data at O0350 may result in a penalty. Dashing O0350 (implying the item was not assessed) counts against the reporting threshold and could result in a 2 percent reduction in the Medicare annual payment update if the facility does not report at least 90 percent of assessments with all of the required data.</p><h3>Conclusion</h3><p>The goal of the efforts described here is to protect residents from serious illness by ensuring ttheir COVID-19 vaccinations are up-to-date. This policy not only helps reduce the risk of severe outcomes but also contributes to the overall health and safety of the long term care community. As CDC recommendations continue to evolve, maintaining a proactive and organized approach will be key to meeting CMS requirements, coding the MDS accurately, and reporting required data for quality measure accuracy. <br></p><h4>References<br>1. <a href="https://www.cms.gov/files/document/draftmds-30-rai-manual-v1191october2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cms.gov/files/document/draftmds-30-rai-manual-v1191october2024.pdf</a><br>2. <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications</a><br>3. <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html</a><br>4. <a href="https://tools.cdc.gov/campaignproxyservice/subscriptions.aspx#subscribe" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://tools.cdc.gov/campaignproxyservice/subscriptions.aspx#subscribe</a><br>5. <a href="https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html</a><span></span></h4><p><em>Jessie McGill, RN, RAC-MT, RAC-MTA, is a curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). McGill can be reached at <a href="mailto:jmcgill@AAPACN.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">jmcgill@AAPACN.org</a>.</em><br></p>	To code a new vaccine MDS item, long term care staff will need to stay current with the changing recommendations for COVID-19 vaccinations.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/caregiving.jpg" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
TESSA the Talking Flowerpot Robot and Innovation in Long Term Care	https://www.providermagazine.com/Issues/2024/Fall/Pages/TESSA-the-Talking-Flowerpot-Robot-and-Innovation-in-Long-Term-Care.aspx	TESSA the Talking Flowerpot Robot and Innovation in Long Term Care	<p style="text-align:center;"><img src="/Issues/2024/Fall/PublishingImages/IS-ITCOP.jpg" alt="" style="margin:5px;width:669px;" /> </p><p style="text-align:left;">When I was invited to join policymakers, administrators, clinicians, researchers, and leaders at the International Summit on Innovation and Technology in Care of Older People (IS-ITCOP) at the Columbia University School of Nursing for two days in June, little did I know my most memorable takeaway would be TESSA the talking flowerpot robot. The purpose of the summit, funded under a National Institutes of Health grant, was to build a research agenda that will lead to safer, higher-quality, more accessible, and equitable long term post-acute care.<sup>1</sup> <br></p><p>Experts estimate that by 2050, the worldwide population of people at least age 60 will nearly double to 22 percent, or about two billion individuals.<sup>2</sup> Many of these people will require long term care (LTC) in the community or in facilities, such as assistance in their activities of daily living, as they age. Older adults’ activities may be supported by informal caregivers, such as family, friends, or neighbors, in addition to health care professionals, to ensure they maintain the highest quality of life with the greatest degree of independence, autonomy, participation, personal fulfilment, and dignity, while respecting their preferences. <br></p><p>What does this have to do with a talking flowerpot? With shifting demographics, an aging person’s support system may benefit from new care innovations leveraging technology. Care technology is not limited to electronic health records or telehealth, but includes a wide array of patient-monitoring, adaptive, and supportive technology that may be supplemented by artificial intelligence. Older adults in long term care systems have multiple medical conditions that are complicated by increasing functional decline and cognitive impairment and often accentuated by social risk factors related to financial resources and a safe environment. Can a talking flowerpot or other such innovation help address some of these needs?<br></p><p><img src="/Issues/2024/Fall/PublishingImages/Gregory-Alexander_tech.jpg" alt="Gregory Alexander" class="ms-rtePosition-1" style="margin:5px;" />Gregory Alexander, PhD, RN, FAAN, FACMI, FIAHSI, from the Columbia University School of Nursing, emphasized in the summit introduction, “One international strategy for improving the quality of care in the world’s long term care systems is the efficient and competent use of innovation and technology. Unfortunately, there are many gaps in our evidence base about how technology can be used to support the care of older people in long term care. IS-ITCOP serves as a beacon of collaboration and innovation, dedicated to exploring how technology can reshape the landscape of care delivery and improve outcomes for older adults in need.”<br></p><p>For the summit discussions, the IS-ITCOP participants, representing a range of perspectives and expertise from eight countries, referred to the World Health Organization’s definition of long term care: “national system that ensures integrated long term care that is appropriate, affordable, accessible, and upholds the rights of older people and carers alike.” Multiple keynotes and small-group discussions focused on the following four pivotal subjects, and related details listed below them lie at the heart of future long term and post-acute care needs, with an emphasis on leveraging technology that is accessible, acceptable to users, and actionable.<br><em>1. Emerging Models of Care and Technology in LTC</em><br><em>2. LTC Workforce of the Future</em><br><em>3. Transparency and Accountability in </em><br><em>Quality of Care in LTC</em><br><em>4. Safety and Privacy Considerations in LTC</em><br><br>I asked Dr. Alexander about how bringing together international perspectives of leveraging technology to improve care for older adults added value to the summit.<br></p><p>He shared that many countries face similar challenges associated with caring for older adults in their communities. However, we each have our own cultural and values-based perspectives that drive our decisions about how best to care for older adults. Sharing these perspectives helps us to realize differences between us. <br>For example, one international issue discussed was related to the emergence of robots to assist with activities of daily living, such as getting older adults to the bathroom. In 2009 in Japan, a robot was created that attached to the wall to lift the person up and out of bed and over the toilet so they could go to the bathroom. In a different discussion, cultural sensitivity issues in care of older adults were shared among attendees, including important aspects of equity while valuing a person’s culture.<br></p><p>These discussions were robust, sometimes intense, and very productive in highlighting the challenges of advancing technology and identifying opportunities to advance research in this area. The diverse perspectives of the summit participants from the worldwide community revealed several common themes that will serve as the foundation for the development of a formal research agenda. <br></p><p>How did an egg-shaped looking robot, which wears a woolen jacket and hat, has blinking eyes, and sports a flowerpot on its head fit into such a deep discussion? One advantage is that it is not scary like some technology can be perceived. Technology like TESSA is in use in thousands of care homes in the Netherlands and other European countries and offers support for people in their residence, whether in a home, assisted living residence, or nursing facility, and reminds users to do important daily activities, including taking medications, eating, and preparing for appointments. It also can offer routine guidance on tasks, provide social stimulation, learn common behaviors, and monitor for deviations, such as missing a meal. Technology like this can also provide health monitoring information to caregivers and health care providers as well as support the patient in preparing for health care visits.<sup>3</sup><br></p><p>It was fascinating to consider that innovations containing advanced health information and support technology can be creatively embedded into common pleasurable human experiences through talking flowerpots, robotic cats and dogs, or other nonintimidating everyday objects to maintain a more homelike environment. While the summit discussions covered all types of technology and the resultant research agenda will address them all, I believe that such user-friendly and “fun” technology innovations represent the cutting edge of person-centered technology advancement. <br></p><p>I also asked Dr. Alexander about his impressions of the exciting new opportunities for advancing research in this population that were identified during the summit.<br></p><p>He reiterated that the summit focused on four topical areas, including emerging technologies, workforce, transparency and accountability, and privacy and safety. In each area, there were many opportunities discussed to advance research among older adult populations who live in and want to live a vibrant life in the community. There were discussions about how improvements in long term care through technology could increase efficiency, accessibility, early identification, and interventions that could help people stay in the community longer. For example, attendees discussed the importance of exploring interoperability, benchmarking IT capabilities, and recognizing successful models of care that have good outcomes.<br></p><p>One participant’s assessment exemplified an important theme of the discussion: “Having technology, interoperability, and the ability to benchmark organizations means you can then look at those ones that are doing exceptionally well and ask, ‘What is it about these organizations and the models of care that they’re delivering that is good?’”<br></p><p><img src="/Issues/2024/Fall/PublishingImages/Dan-Ciolek_tech.jpg" alt="Dan Ciolek" class="ms-rtePosition-1" style="margin:5px;width:130px;height:160px;" />Many of these existing and potential additional functions of such care-support robots are relevant for discussions about how to address myriad social and care need gaps, technology capabilities and cost gaps, and ethical and legal issues. I appreciated the unique opportunity to participate in the IS-ITCOP summit and look forward to the future issuance of the research agenda resulting from this meeting seeking to leverage technology through innovation to lead to safer, higher-quality, more accessible, and equitable long term post-acute care. <br></p><p><em>Daniel Ciolek</em> is associate vice president of therapy advocacy for the American Health Care Association.</p><h4>References<br>1. NIH. Project Number - 1R13HS030051-01. A Roadmap for Research: The International Summit on Innovation and Technology in Care of Older People (IS-ITCOP). https://reporter.nih.gov/search/wOxfBSJNpEuAkcZS2UhaVQ/project-details/10906519#similar-Projects<br>2. World Health Organization. Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health<br>3. Ageing well in a digital world. TESSA. https://www.aal-europe.eu/tessa/<span id="ms-rterangepaste-end"><br></span></h4>	An aging person can benefit from innovation in patient-monitoring, adaptive, and supportive technology that may include artificial intelligence.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/TESSA.jpg" style="BORDER:0px solid;" />	Technology	Technology in Health Care
Quality at Its Core: The Manor at Elfindale’s Journey to Silver	https://www.providermagazine.com/Issues/2024/Fall/Pages/Quality-at-Its-Core-The-Manor-at-Elfindale’s-Journey-to-Silver.aspx	Quality at Its Core: The Manor at Elfindale’s Journey to Silver	<p><img src="/Issues/2024/Fall/PublishingImages/Elfindale.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />The Manor at Elfindale is a long term care center situated on 65 acres in Springfield, Mo. Managed by Vetter Senior Living (VSL) in Omaha, Neb., it is part of a continuing care retirement community. Elfindale was recognized with the 2024 Silver National Quality Award by the American Health Care Association and National Center for Assisted Living.<br></p><p>Matthew Gould, the administrator of Elfindale, began his career in long term care after working in hospitality. He switched careers after seeing an ad for a company that worked with long term care homes. This led him to obtain his nursing home administrator license.<br></p><p>Elfindale’s journey to the Silver National Quality Award started with VSL’s focus on quality. “VSL has always been about quality,” Gould said. “We saw it as a way to keep improving our residents’ quality care and quality life.” This award recognizes the team’s hard work throughout the year.<br></p><p>Gould and his team have learned that consistent processes are key to maintaining great results. Gould encourages other providers to apply for similar awards because it can lead to better care quality, stating, “Go for it! It will help provide better care.”<br></p><p>Elfindale plans to keep aiming for higher levels of recognition, supported by VSL’s 10 World-Class Standards and its mission, vision, and values.<br></p><p><img src="/Issues/2024/Fall/PublishingImages/Matt_Elfindale.jpg" alt="Matthew Gould" class="ms-rtePosition-1" style="margin:5px;width:125px;" />Specific practices that help Elfindale succeed include the use of a wireless call system, electronic medical records, and a computerized maintenance program. These technologies help staff focus more on direct patient care. <br>Staff alignment with the vision of excellent care is critical at Elfindale. Gould focuses on hiring team members who believe in the mission, vision, and values. <br></p><p>“It begins with hiring the team members who possess what I call the mission, vision, value heart,” he said. The center offers many growth opportunities through programs such as Take Time to Care, school loan reimbursement, and free online university classes, creating a positive work environment.<br></p><p>Engagement with residents and their families is also important at Elfindale. The “family serving family” environment and consistent staffing policy help build strong relationships, improving the quality of care. For example, consistent staffing has enabled personalized care plans that cater to individual resident needs, resulting in higher satisfaction scores from both residents and families.<br></p><p>Interdisciplinary teamwork is vital for achieving excellence at Elfindale. Team members from all areas work together to achieve the goals of quality care and quality life for each resident. For instance, the integration of physical therapists and nursing staff in care-planning meetings has led to more comprehensive and effective rehabilitation programs.<br></p><p>Workforce management has been a major area of improvement at Elfindale. Gould highlighted the importance of a positive culture in hiring and retaining great team members. The center has a retention rate of 74 percent for employees with over a year of service. Initiatives such as the PEP club and mentoring have improved the work culture. Additionally, the implementation of regular staff appreciation events has contributed to higher morale and lower turnover rates.<br></p><p>Gould finds his greatest inspiration in daily interactions with residents, their families, and team members. “The day-to-day interactions have made my life unbelievably rich,” he said. “I am blessed to work for a company that gives us the tools and resources to care for people who need our care.”<br></p><p>Elfindale’s recognition as a 2024 Silver National Quality Award recipient shows its commitment to quality and excellence in long term care. As part of Vetter Senior Living, Elfindale continues to set high standards and inspire other providers to strive for similar achievements.</p><h3>Stories of Excellence</h3><p>Explore more incredible journeys of award recipients and share your story on the new Quality Award Stories website at <a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/Quality-Award-Stories.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">ahcancal.org/QualityAwardStories</a>. <br></p><p><strong>INTERESTED IN APPLYING FOR A 2025 NATIONAL QUALITY AWARD?</strong><br>For applications and resources, visit <a href="https://www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">ahcancal.org/QualityAward</a>. Submit your intent to apply for 2025 by November 14, 2024. Final applications are due by January 23, 2025.</p><p><em>Andrea Todd is the director, public affairs at the American Health Care Association/National Center for Assisted Living.</em><br></p>	The team has learned that consistent processes are key to maintaining great results.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/Elfindale.jpg" style="BORDER:0px solid;" />	Quality Awards	Quality Awards

How NCAL Executive Director LaShuan Bethea Advocates for Residents and Communities	https://www.providermagazine.com/Issues/2024/Fall/Pages/How-NCAL-Executive-Director-LaShuan-Bethea-Advocates-for-Residents-and-Communities.aspx	How NCAL Executive Director LaShuan Bethea Advocates for Residents and Communities	<p>When LaShuan Bethea entered the senior living industry after graduating high school, she had no idea she’d spend the next 25 years in it—let alone that she’d become one of its most important advocates in Washington, D.C., as executive director of the National Center for Assisted Living (NCAL). </p><p>“I never knew that that would be my long-term career option,” she recalled of her first job as an licensed practical nurses at a nursing home. “But I found that as I tried a whole bunch of different types of nursing, I kept coming back to long term care.”<br></p><p>It was the human element of the job that pulled her back over and over again: the opportunity not just to take care of residents, but to spend quality time with them. “I loved engaging with the residents, hearing their story, and getting to know them as individual people and their history,” she said. “There was no other environment where I was able to get that same type of joy. Working with residents and their families, you get this immediate return on the investment that you make in caring for them, because they truly appreciate the work that you do.”<br></p><p>The longer Bethea spent working as a clinician, the more she came to recognize a tension between the realities on the floor and the regulations determining what happens there. However well-intentioned various rules may be, she realized, there was still a gap between the world regulators envisioned and the world as it exists. <br></p><p>“One of the things that became clear to me is there’s this disconnect between the people who write the regulations and what happens when you work in the industry,” she reflected. “I would often find myself saying, ‘There’s no way that a person who worked in our industry could have ever written a rule like this.’ Because they don’t. There’s a disconnect between them and what is happening at the bedside, what’s happening in the day-to-day work that we do.”</p><h3>From the Bedside to the Beltway</h3><p>Instead of navigating around that disconnect, Bethea decided to get to work bridging it. After years working in various nursing home roles—direct care nurse, unit manager, staff development coordinator, assessment coordinator—not to mention earning a JD and an MEd along the way, she started working at Genesis Healthcare in 2007, where she eventually became the operator’s vice president of legislative affairs. The role empowered her to draw upon her time with residents as she worked directly with policymakers, ensuring that the regulations they drafted helped the people they were meant to help. <br></p><p>“It allowed me to take my experience as a nurse and educate the people who make decisions—who make the laws, who make the regulations—about how we do what we do and how the legislation they write impacts us,” she said. “I always saw myself as an educator: I was there to help let them know that we are a resource, we want to collaborate, and we all want the same things—quality care and great outcomes for our residents.”<br></p><p>Having served in a wide range of positions and settings, from the memory care unit to the emergency room, Bethea has seen again and again that there truly is no one-size-fits-all approach to care. No two nursing homes are the same, no two units are the same, and no two care plans are the same, because no two residents are the same. This perspective has long informed her approach to advocacy work on a variety of critical issues, such as the new minimum staffing rule, which she describes as a blanket solution to a complex set of problems that does nothing to address the structural issues causing those problems. In other words, it’s exactly the sort of one-size-fits-all strategy that completely misunderstands how nursing homes work.<br></p><p>“We need a more deliberate approach to how we determine staffing needs, based on the needs of residents in each setting,” she explained. “It’s not the same in every single nursing home, just like it’s not the same in acute care versus post-acute care. A person who comes up with this rule doesn’t recognize that there is a variety of different residents in each of the types of settings that we have.”</p><h3>Being an Effective Voice</h3><p>When Bethea joined NCAL in 2021, her top priority was to hit the road. At Genesis, she advocated for almost 250 facilities in 22 states; now she represented thousands of facilities across every state. To be an effective voice for communities, residents, and employees, she’d have to meet them face-to-face, gaining a deeper understanding of their experiences and needs. <br></p><p>“I wanted to make sure that my voice is reflective of what’s happening in the various settings that I represent,” she recalled. “An assisted living facility in Oregon is very different from one in California, very different from Texas and Maryland. Going into those communities allows me to take that firsthand experience to legislators in D.C., and to make sure they’re aware that you can’t take one piece of legislation and use it to kind of paint that broad brush across the industry.”<br></p><p>Another priority is helping policymakers (and everyone else) understand what assisted living is and how it works. While the industry has received more attention in recent years, Bethea acknowledged that this attention often focuses on negative stories, isolated as they may be. <br></p><p>On one hand, the COVID-19 pandemic helped people understand what distinguishes assisted living from other care settings, such as home health and skilled nursing. On the other hand, common misconceptions remain prevalent—like the notion that assisted living isn’t regulated. The fact that it’s regulated at the state level, Bethea pointed out, is why it’s so misguided for policymakers to approach the sector with a broad brush. “Because it’s different in every state,” she argued, “it’s better to have hands that are closer to what it looks like at that level, rather than make a rule that would apply across all 50 states.”</p><h3>Fostering the Next Generation of Leaders</h3><p>As a leader, Bethea also considers it her responsibility to help cultivate and mentor other leaders. She thinks back to a former mentor at Genesis Healthcare, Marie Quinn, who once gave her some valuable encouragement before an anxiety-inducing presentation to senior executives. <br></p><p>“She said, ‘There’s no one better positioned to present this information than you,’” Bethea recalled. “‘If you go in the room and present as if you are uncomfortable or not confident, then people will receive it that way. But if you go into the room and present this information based on your own experience, the research that you’ve done that you’re confident about, people will walk away from that meeting understanding that you are the person that they need to go to with any questions; that you are the most knowledgeable person on this issue.’” <br></p><p>The pep talk was a game changer. Not only did it inform the presentation she was about to give, it stuck with her throughout every meeting she’s walked into since. “It’s something that I share with other people,” she said. “When I’m doing leadership presentations, I tell them about that experience, because it was so powerful and impactful for me.”</p><h3>‘It Warms Your Heart’</h3><p>Despite the challenges ahead, Bethea is looking forward to the future. She’s especially excited about the potential for new technology, such as wearable health trackers and AI solutions, to transform the assisted living space, making care workers’ lives easier and improving patient outcomes. <br></p><p>“Obviously we need the human touch; it’s a vital part of what we do,” she stressed. “But there are ways that we can complement the staff to be more efficient, and we can do that with AI. I’ve been visiting communities around the country and seeing some of the things that they’re doing, and it’s extremely exciting. We’re just scratching the surface of how technology will help us support our existing workers in our field.”<br></p><p>And, of course, she’s excited to continue doing her favorite part of the job: traveling the country and meeting the people she represents. “When you go into the communities and the nurses and the nurse aides and the other caregivers, like the environmental service and the housekeeping workers—when you see how they engage the residents, it warms your heart,” she concluded. “You can envision your own mom and dad there, enjoying themselves and having the best part of their life being in this community.” <br><br><em>Steve Manning is a freelance writer from New York City.</em></p>	Having served in a wide range of positions and settings, from the memory care unit to the emergency room, Bethea has seen again and again that there truly is no one-size-fits-all approach to care.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2024/Fall/PublishingImages/NCAL.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature	Steve Manning	51	3
How PharMerica Can Help Facilities Amid New Staffing Mandate Requirements	https://www.providermagazine.com/Issues/2024/Fall/Pages/How-PharMerica-Can-Help-Facilities-Amid-New-Staffing-Mandate-Requirements.aspx	How PharMerica Can Help Facilities Amid New Staffing Mandate Requirements	<p>The Biden Administration’s recently announced minimum staffing rule will require nursing homes to hire an estimated 102,000 nurses and nurse aides, costing approximately $6.5 billion per year. While AHCA/NCAL and other organizations are fighting to prevent the mandate from taking effect, long-term care providers across the country are readying themselves for the additional pressures it will place on their operations.<br></p><p>As a trusted partner to thousands of providers across the country, PharMerica understands that filling prescriptions is just one small part of its role. Its dedicated local account management teams, consultant pharmacists, and nurse consultants provide hands-on support for each client, offering training and resources, conducting monthly medication reviews, participating in QAPI meetings, and integrating themselves into their communities. PharMerica is well prepared to help providers contain costs, enhance efficiencies, and mitigate the negative impacts of new hiring requirements. </p><h3>Streamlining Onboarding and Training</h3><p><img src="/Issues/2024/Fall/PublishingImages/DalePadgett-Pharmerica.jpg" alt="Dale Padgett" class="ms-rtePosition-1" style="margin:5px;" />PharMerica has streamlined its client onboarding process and offers a comprehensive training program. “We not only engage direct stakeholders but also unit-level staff to ensure they understand how to order medications, use the EMR platform, communicate with the pharmacy, refill orders, and manage IVs,” Dale Padgett, senior vice president, client strategy and partnerships, explained. <br></p><p>“We provide essential training,” added Rebecca Wingate, vice president of clinical operations, “especially about pharmacy processes and medication management, policies and procedures, and compliance requirements with regard to anything from high-risk medications to specific disease states like diabetes, CHF, and hypertension.”<br>This training is especially important for facilities dealing with staffing shortages whose clinical infrastructure may be more interim or transitional in nature. PharMerica also enables facilities to address skills gaps among new hires with standard educational offerings that ensure inevitable workforce turnover doesn’t come with negative impacts. </p><h3>Identifying Savings Opportunities to Reduce Operational Costs</h3><p>Meeting new staffing requirements will force facilities to look at other areas to cut costs, and many could save up to 20 percent on pharmacy spend annually. PharMerica’s goal is to explore lower-cost alternatives that maintain equal efficacy, optimize medication usage in terms of dosage and duration, and design specific interventions based on its clients’ referral sources’ prescribing trends.<br></p><p><img src="/Issues/2024/Fall/PublishingImages/Creasy-Pharmerica.jpg" class="ms-rtePosition-2" alt="Stephen Creasy" style="margin:5px;" />PharMerica achieves this goal by developing a personalized approach for each partner facility, recognizing there is no one-size-fits-all approach. “We partner directly with the medical director and the prescribers in the facility, with our consultant pharmacist working hand-in-hand on ordering labs, recommending medication adjustments or gradual dose reductions, and providing education to nursing staff on whatever they may be challenged with,” Wingate said. “Since we’re a guest in that facility, we really try to build that trust and that ongoing collaboration.”<br></p><p>PharMerica develops customized solutions based on a client’s unique circumstances and other relevant factors. “We have a very robust therapeutic interchange program that we administer—where allowed by pharmacy rules and regulations—in which we’re looking for equally efficacious alternatives to higher-cost medications,” Stephen Creasy, senior director, clinical services, explained. “We’re constantly evaluating and looking for new opportunities because we do know how expensive some of these medications are.”<br></p><p>An important part of this approach is identifying and addressing a facility’s unique pain points. In one recent case, a client had a high number of residents using IV medications. “We needed to understand how they train their nurses, and they needed to understand how our nurses help support residents that have IVs,” Padgett recalled. <br></p><p>With 80 percent of nursing homes expected to have to hire more RNs to meet the 24/7 RN requirement, PharMerica’s cost-saving measures can be instrumental in enabling facilities to redirect funds to hiring to comply with the mandate. “By spending less money on medications when there are therapeutic equivalents or other alternatives, they can free up cash flow and regain efficiencies with the nursing staff,” Creasy concluded. “It’s about doing more with less.”</p><h3>An Eagle’s Eye for Compliance Issues</h3><p>In cases where facilities have larger staffing gaps at the nursing or unit levels, PharMerica steps in to help fill them. “We provide a variety of resources to make sure that the facility is able to continue operating compliantly,” said Padgett.<br></p><p><img src="/Issues/2024/Fall/PublishingImages/RebeccaWingate_Pharmerica.jpg" alt="Rebecca Wingate" class="ms-rtePosition-1" style="margin:5px;" />These resources include compliance recommendations, survey preparation and support, and detailed action plans to ensure compliance during transitions and turnover. Then there’s Illuminate, the online educational platform that PharMerica maintains for its partners. “We have webinars where we provide continuing education, clinical resources, quality digests, podcasts, newsletters, bulletins, guides, and comprehensive resources for compliance,” Wingate explained. “We’re very adept at staying ahead of the latest CMS changes and ensuring the success of our customers in regard to compliance changes.” <br></p><p>The regulatory landscape is in constant flux, forcing providers to navigate a complex and ever-changing web of rules and requirements. Last October, for instance, CMS imposed new requirements on the MDS coding of some high-risk medications—and it’s already updating these requirements effective this coming October. “We’re already modifying our reporting that will be available to our client facilities, so they will be able to do that portion of the assessment much quicker,” Creasy said.<br></p><p>By keeping abreast of developments at the state and federal levels, PharMerica helps ease the burden on its partners—an especially valuable level of support as they deal with the additional pressures of the new staffing rule. <br></p>	PharMerica develops customized solutions based on a client’s unique circumstances and other relevant factors.	2024-09-11T04:00:00Z	<img alt="" src="/Issues/2023/Fall/PublishingImages/Pharmerica.jpg" style="BORDER:0px solid;" />	Workforce	Special Feature		51	3

President and Chief Executive Officer	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=127	President and Chief Executive Officer	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%202024/Fall/Clif-Porter_potm.jpg" style="BORDER:0px solid;" />	Clifton J. Porter, II	American Health Care Association/National Center for Assisted Living
Medical Director	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=128	Medical Director	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%202024/Fall/Wesam-Moustafa_potm.jpg" style="BORDER:0px solid;" />	Wesam Moustafa, MD	Belmont Bay Rehabilitation & Healthcare Center
President and Chief Executive Officer	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=129	President and Chief Executive Officer	<img alt="" src="/PublishingImages/People%20on%20the%20Move/POTM%202024/Fall/David-Erickson_potm.jpg" style="BORDER:0px solid;" />	David Erickson	Covenant Living Communites and Services

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