EBP and MDROs

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EBP and MDROs

6/1/2025

Caregiving

Policy

Infection prevention and control involves numerous interconnected elements, all of which must work together to keep residents, staff, and others safe and ensure regulatory compliance. One element closely connected to EBP use in nursing homes is antibiotic stewardship and efforts to prevent and manage multidrug-resistant organism (MDRO) transmission.

MDROs are bacteria or fungi that are resistant to some antimicrobial agents, primarily due to the overuse of antibiotics. Because they are resistant to antibiotics, MDROs can be difficult to treat. They also can be spread via direct contact with an infected individual’s bodily fluids and contaminated surfaces. MDROs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and some gram-negative bacilli. These can cause illnesses such as urinary tract infections, pneumonia, or blood or wound infections.

Clinical team leaders, including the consultant pharmacist, can help make sure staff understand the impact of MDROs and why preventing transmission is essential. Debbie Milito, PharmD, director of consultant and clinical services and chief antimicrobial stewardship officer at Diamond Pharmacy Services and American Society of Consultant Pharmacists board chair, said, “When I conduct education, I use the CDC core elements for an effective antibiotic stewardship program.” These elements are leadership commitment, accountability, drug expertise, action, and tracking.

“When you are educating everyone from the administrator to the CNA [certified nurse assistant], residents, and family members, you are more likely to get everyone on board and have successful outcomes,” Milito said. She stressed the importance of educating residents and their families, as they often don’t realize the limitations and risks of antibiotics.

For example, family members may expect antibiotics to treat a urinary tract infection when adequate fluid intake and other nonpharmacological interventions are safer and more appropriate. “When staff and families understand and support appropriate and responsible antibiotic prescribing and use, we can decrease antibiotic resistance,” she said.

Protecting against MDRO transmission is especially crucial in frail older adults. If facilities don’t practice consistent infection control and prevention practices, infections can spread rapidly. Milito suggested, “We need to consistently go back to the basics, including effective handwashing. This information is worth repeating.”

Monitoring data to track antibiotic prescribing is key, and the pharmacist is perfectly positioned to do this as part of monthly or targeted reviews. “I'm listening very intently to the infection preventionist report and hearing how many multidrug-resistant organisms there are and where they are in the building,” Milito shared. “This can help identify how and by whom the MDROs are being transmitted.”

Even when the numbers are good and there haven’t been any recent outbreaks, Milito stressed, “we can’t let our guard down.”

Cover Story

Boost Your Team’s Enhanced Barrier Precautions IQ

https://www.providermagazine.com/Issues/2025/Summer/Pages/Boost-Your-Team’s-Enhanced-Barrier-Precautions-IQ-.aspx

Boost Your Team’s Enhanced Barrier Precautions IQ

<img src="/Issues/2025/Summer/PublishingImages/Sum25_CFBarriers.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />Enhanced barrier precautions (EBP) are part of life in long term and post-acute care, but recent updates to the State Operations Manual (SOM) suggest this is a good time for a fresh look at EBP and how staff use them to protect residents, visitors, and themselves. It also presents an opportunity to review and update policies, procedures, and training, and to seek opportunities for quality-improvement activities related to infection prevention and control. <h3>ABCs of EBP</h3>The Centers for Disease Control and Prevention (CDC) introduced EBP as a new approach to using personal protective equipment (PPE) in 2019. The CDC defined EBP as “an <a href="/Issues/2025/Summer/Pages/Data-as-Infection-Control-Tool.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">infection control </a>intervention designed to reduce transmission of multidrug-resistant organisms (<a href="/Issues/2025/Summer/Pages/EBP-and-MDROs.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">MDRO</a>s) in nursing homes. Enhanced barrier precautions involve gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO as well as those at increased risk of MDRO acquisition (e.g., residents with wounds or indwelling medical devices).” In 2022, the CDC released updated EBP recommendations for nursing homes, stating that EBP “may be indicated (when contact precautions do not otherwise apply) for residents with wounds or indwelling medical devices, regardless of MDRO colonization status or infection or colonization with an MDRO.” The CDC also said that effective EBP implementation requires staff training on the use of PPE and hand hygiene supplies at the point of care, with standard precautions continuing to apply to all residents, regardless of suspected or confirmed colonization status. After the CDC’s announcement, the Centers for Medicare & Medicaid Services (CMS) updated its infection prevention and control guidance. In a 2024 memo, the agency stated, “The recommendations now include the use of EBP during high-contact care activities for residents with chronic wounds or indwelling medical devices, regardless of their MDRO status, in addition to residents who have an infection or colonization with a CDC-targeted or other epidemiologically important MDRO when contact precautions do not apply.” This language was included in revisions to SOM Appendix PP (QSO-25-14-NH), FTag 880 (Infection Prevention and Control) and went into effect April 28, 2025.It is worth noting the difference between EBP, standard precautions, and contact precautions. Standard precautions apply to care for all residents, calling for the use of PPE to protect against blood, body fluids, secretions, and/or excretions. For instance, gloves are recommended when there is likely to be contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, or contaminated equipment. Standard precautions still apply when using EBP. Contact precautions involve the use of gown and gloves every time team members enter a resident’s room, no matter what care they are providing. Ultimately, EBP are more specific than standard precautions but less restrictive than contact precautions.<h3>Time for Attention</h3><img src="/Issues/2025/Summer/PublishingImages/Calvin-Reynek.jpg" alt="Calvin Reynek, RN" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Calvin Reynek, RN, IP-BC, AS-BC, CADDCT, QAPI-BC, a nurse consultant for Pathway Health, observed that the revised guidance from CMS regarding infection prevention and control shouldn’t come as a surprise. “CDC has been recommending this for some time; then COVID-19 hit, and it got put on the back burner,” he said.However, he noted that complying with the SOM changes calls for facilities to get their teams—including frontline workers and family members—on board and engaged. “This is a big change for staff, and they need to feel confident about when they need to use EBP. You need to make sure your policies and procedures reflect these changes,” he added. Staff also need to know before entering a resident’s room what infectious illnesses or conditions the resident has and if EBP are required. To protect residents’ privacy, as well as their dignity, this notification may be a code posted on the person’s door and written in the chart that alerts staff that EBP are needed. It also is important for both residents’ families and the residents themselves to understand why staff are using EBP while working with them. “Family members often are challenged to understand the different types of precautions. For example, they will ask us why we are not using the same precautions that were used in the hospital. However, those are contact precautions, not EBP, which are less restrictive,” said Anna Fisher, PhD, Nebraska-based clinician and educator. Nursing homes are different from hospitals and have specific policies, protocols, and requirements designed to keep residents as safe as possible and to maximize the homelike environment. Fisher observed, “It is important for everyone to understand that infection prevention and control is vital in all aspects of health, and we all play a role. It is not a one-size-fits-all effort.”<h3>Educating and Auditing</h3>While training and education takes time, you don’t have to reinvent the wheel. There are numerous resources. For instance, the CDC has a page of links to videos, posters, and a pocket guide, as well as FAQs and other information and resources on enhanced barrier precautions in nursing homes. <img src="/Issues/2025/Summer/PublishingImages/Amy-Miller.jpg" alt="Amy Miller" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />The American Health Care Association (AHCA) has Infection Preventionist Specialized Training (IPCO) for individuals responsible for infection prevention and control in all long term care settings. The program, specifically tailored to train infection preventionists (IPs), covers COVID-19, other common pathogens, multidrug-resistant organisms, antibiotic stewardship, water management, and more. The National Center for Assisted Living has an Infection Preventionist Specialized Training (IPCO) for Assisted Living, a specialized course of study for health care professionals who are interested in serving as infection prevention control officers (IPCOs) in assisted living communities. <a href="https://educate.ahcancal.org/InfectionPrevention" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/Issues/2025/Summer/PublishingImages/IPCO%20logo_revised%202017.png" class="ms-rtePosition-2" alt="" style="margin:5px;width:150px;height:89px;" /></a>“With the Appendix PP guidance updates bringing increased attention to the use of EBP, now is an excellent time for nursing homes to review their policies, procedures, and training addressing enhanced barrier precautions,” said Amy Miller, RN, BSN, RAC-CT, CPC, director of clinical and regulatory services at AHCA. “Staff need to know the proper use of personal protective equipment for residents on enhanced barrier precautions, including proper hand hygiene practices,” she added, stressing that PPE must be readily accessible. She suggested that this presents a good opportunity to talk to staff and maybe even residents and families about multidrug-resistant organisms and antibiotic stewardship. After training, surveillance and audits will be needed to ensure staff are consistently compliant and to identify improvement opportunities. Facilities can then implement action plans based on their findings. “For example, auditing practices around care of residents with indwelling devices and use of enhanced barrier precautions is an important area to include,” said Miller. Training and education need to be consistent. “The team needs to be on the same page and supporting the IP in their efforts,” said Kristi Felix, MSN, RN, CRRN, CIC, LTC-CIP, FAPIC, an infection prevention manager in Nebraska. When audits or surveillance identify noncompliance or other issues, identifying the reason behind the issues and not playing the blame game is critical. Reynek, of Pathway Health, said, “If people aren't afraid of getting in trouble, they’re more motivated to do the right thing and report if they make errors or have problems. You also need a culture where team members aren’t afraid to ask for more training or education if they feel like they need it.” Staff need to be responsible for protecting their colleagues, as well. This means replacing PPE if the last piece is used. To help ensure compliance, added Colleen Toebe, MSN, CWCN, RAC-MTA, RAC-MT, DNS MT, vice president of clinical services at Pathway Health, “make sure you share the why with staff—that is, why they’re doing this, including the dangers of MDROs and the importance of protecting residents, as well as their staff and own families.” In training, Toebe shared, she puts powder on a mannequin and has participants pretend they are handling common care tasks without a gown. “I then turn on a black light that shows what they are taking with them to the next patients and to their families at the end of their shift,” she said. Reynek stressed that training for infection prevention and control, including EBP use, is for everyone in the building, not just clinical staff. “It doesn’t matter if you’re in the business office or in the kitchen,” he said. “We all have levels of contact with staff and residents. And this training must be continuous.” The instruction should start as part of onboarding and staff orientation, but it needs to be ongoing. Felix agreed, saying, “At some point, all staff members might perform some type of high-contact tasks.” The training and clear communication will help ensure everyone understands what to do, why, and how. The surveillance and audits will verify that staff members are putting that training into action. Ensuring the entire team has the knowledge, tools, and resources to successfully protect residents and others also helps promote engagement and job satisfaction. “If they have what they need to perform their jobs well and feel valued as team members, they are more likely to enjoy their work. This promotes retention,” said Fisher. <h3>The Proof Is in the Pudding—That Is, the Documentation</h3>When surveyors come in, they will be reviewing documentation for evidence of what has—and hasn’t—happened in the facility. Therefore, staff must understand what should be documented and where they need to document EBP use and other aspects of infection prevention and control. This should start with training. “We document when staff have been trained on infection and control policies,” Felix explained. “This shows that they understand these policies, have the knowledge and training to fill their roles, and know how and when to use PPE. This documents compliance for surveyors,” she added. Toebe suggested, “Review the clinical element pathways in the SOM, updated in April 2024, and check to determine that your team is documenting everything correct.” Audits that check to ensure that documentation shows what is actually happening in the building can help identify gaps. “I’ve seen places where staff are doing an outstanding job of infection prevention and control, but the documentation doesn’t reflect it,” she said. <img src="/Issues/2025/Summer/PublishingImages/KristiFelix.jpg" alt="Kristi Felix, MSN, RN" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Having a realistic, complete view of EBP use in your buildings is key to assessing quality. For instance, you need current and accurate information about how many residents you have with indwelling devices and wounds. You also need to know how many individuals have antibiotic prescriptions or infections such as Clostridium difficile, which affects people who have recently taken antibiotics and may indicate an MDRO. This can help determine what kinds of resources you need and what inventory of PPE you need to maintain. For instance, Felix noted, “We have a skilled ventilator unit with a number of residents on medical devices that are necessary to keep them alive. As a result, over half of our residents require EBP.” This can be costly and time-consuming, but if you have accurate, real-time data and can track trends, it is easier to stay on top of EBP use. If you discover there are gaps or red flags, this presents an opportunity for quality improvement. In one study, researchers implemented a quality-improvement effort using a “4E” process (engagement, education, execution, evaluation) to improve EBP use in four nursing homes. They found that implementing the 4E process resulted in increased glove and gown use. Participants indicated that one motivating factor to improve EBP use was the perception that it can help reduce the incidence of MDRO transmissions. Reynek said, “To bridge the gaps, you have to get your leadership team out on the floor and model the practices you want staff to follow. The more you practice effective, appropriate EBP use, the more it becomes second nature.” He added, “You should be able to see your staff don a gown and gloves as easily and naturally as they put on their shoes in the morning. When you do this, you always have that level of survey readiness.”<h3>All Hands on Deck</h3>CMS requires each nursing home to have an infection preventionist, part of whose work must be based on health care-associated infection risk assessment. While the IP has a key role in ensuring appropriate EBP implementation, this must be a team effort. Read more:<a href="/Issues/2025/Summer/Pages/Data-as-Infection-Control-Tool.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Data as Infection Control Tool</a><a href="/Issues/2025/Summer/Pages/EBP-and-MDROs.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">EBP and MDROs</a>

Recent updates to federal guidance make this an ideal time for long term care facilities to reassess and strengthen their EBP practices.

2025-06-01T04:00:00Z

Caregiving;Infection Control

News Currents

People On The Move

Chief Operations Officer	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=141	Chief Operations Officer	<img alt="Mark Iverson" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Summer/potm_Mark-Iverson.jpg" style="BORDER:0px solid;" />	Mark Iverson	Vetter Senior Living
Chief Human Resources Officer	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=142	Chief Human Resources Officer	<img alt="Judy Whitcomb" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Summer/potm_Judy-Whitcomb.jpg" style="BORDER:0px solid;" />	Judy Whitcomb	Covenant Living Communities and Services
Senior Vice President of Sales and Marketing	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=143	Senior Vice President of Sales and Marketing	<img alt="Christine Holt" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Summer/potm_Chris-Holt.jpg" style="BORDER:0px solid;" />	Christine Holt	Presbyterian Senior Living
Vice President of Resource Development	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=144	Vice President of Resource Development	<img alt="Bethanie Constant" src="/PublishingImages/People%20on%20the%20Move/POTM%202025/Summer/potm_Bethanie-Constant.jpg" style="BORDER:0px solid;" />	Bethanie Constant	Presbyterian Senior Living

The Power of Partnership with PharMerica	https://www.providermagazine.com/Issues/2025/Summer/Pages/The-Power-of-Partnership-with-PharMerica.aspx	The Power of Partnership with PharMerica	<p>Running a senior living community is a tremendous responsibility that’s becoming more challenging as residents’ medical needs increase and regulations rapidly change. Providers must not only hold themselves to the highest standards in quality care, but they must also find partners who adhere to the same principles. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Alexis-Martini-pharmerica.jpg" alt="Alexis Martini" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Two years ago, Ciel Senior Living, which has 14 communities in nine states, tapped PharMerica as its preferred provider of pharmacy services. PharMerica’s knowledge of nationwide industry trends and best practices, as well as its understanding of the intricacies of Ciel’s markets, helped cement the relationship. The two companies’ patient-centric approach to care is an essential element in the partnership.<br></p><p>“When you’re looking for a strategic partner, their vision and values need to align with yours,” said Alexis Martini, president and chief operating officer at Ciel. “We have an incredible amount of trust in our PharMerica partner.”<br></p><p>PharMerica’s passion for exceptional, personalized service and high standards for trust and lasting relationships made it easy for Ciel to choose PharMerica as a preferred pharmacy partner. </p><h3>Staying Current on Changes</h3><p>PharMerica’s dedication to helping Ciel provide the best care manifests itself in multiple ways. The company keeps Ciel’s staff updated on laws and regulations affecting its various locations, trains staff, provides time-saving technology, and quickly addresses problems. <br></p><p><span><img src="/Issues/2025/Summer/PublishingImages/Ashley-Guido-pharmerica.jpg" alt="Ashley Guido" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span>Martini said that whenever mishaps occur, PharMerica staff will jump on the phone or respond in person to correct the situation and determine how to prevent it from happening again. “That’s going above and beyond, and that’s a uniqueness that you don’t really find in this space,” Martini explained. <br></p><p>Another hallmark of PharMerica’s service is constant and clear communication with clients. Part of the messaging centers on the changing regulatory environment. <br></p><p>“The states do vary in their requirements for medication administration—not just the requirements for the training personnel, but processes,” said Ashley Guido, Ciel’s chief clinical officer. “There are a lot of nuances that PharMerica helps us navigate in terms of regulatory compliance.”</p><h3>Innovative Education and Initiatives</h3><p>Lisa McClure, PharMerica’s senior vice president, senior living general manager, said staying abreast of the changing health care landscape is not only part of the company’s educational responsibility, but also essential to its role as a thought leader in the industry. Also critical is providing information that is easy to understand, or as she puts it, delivering “snackable educational pieces” to support informed decision-making. McClure added, “We believe that knowledge is power, and PharMerica is a trusted resource that providers can easily tap into.”<br></p><p>Education comes in various forms, such as webinars, round-table discussions, live meetings, and written guides. It encompasses a broad spectrum of topics, including reducing medication errors, opioid use, antipsychotic reduction, and antibiotic stewardship. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Lisa-McClure-pharmerica.jpg" alt="Lisa McClure" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Guido heralded PharMerica’s Polypharmacy Initiative as especially useful and innovative. In this program, PharMerica’s pharmacists review residents’ medications to potentially reduce the number of prescriptions, prevent duplicative therapies, and reduce the risk of falls and adverse drug events. This contributes to resident safety and well-being and can help reduce out-of-pocket expenses. It can make dispensing medicines more efficient, allowing nurses to spend more quality time with residents. <br></p><p>McClure said that PharMerica prides itself on ensuring the highest standards of service and trust, with medication delivery that is correct and on time. Reconciling medications can consume precious time, but working with PharMerica can reduce the time needed for that task. “Reducing the time for medication reconciliation allows the nurses to focus on what’s important, and that’s patient-centered care,” said McClure.</p><h3>Picking a Preferred Provider</h3><p>Even though residents have the freedom to choose their pharmacy services provider, PharMerica works closely with Ciel Senior Living to increase resident adoption, as that increases safety as opposed to using a local retail pharmacy. Selecting PharMerica enhances safety, medication accuracy, and efficiency in prescription drug plans and billing. Providers also note increased operational efficiency and staff satisfaction.</p><h3>Reducing Staff Turnover</h3><p>A significant part of providing excellent care is satisfied, engaged staff. Turnover in the health care industry has been a challenge, though Martini said that Ciel’s partnership with PharMerica has led to greater staff retention. That’s because PharMerica’s educational platform helps support learning, training, and teaching at Ciel’s locations.</p><p>“We’re giving our staff opportunities to train, to grow,” said Martini. “That’s allowed us to reduce our turnover and keep people engaged in a career track that makes sense for them.”<br></p><p>PharMerica is a vital part of the local Ciel medication-management team, offering a local, dedicated team of account managers, billing specialists, nurses, and pharmacists who provide a wide range of valuable services to the community. They live and work near each facility, making them an integral part of the fabric of the Ciel community.</p><h3>A Bright Future</h3><p>Martini expects the partnership with PharMerica to continue flourishing. <br></p><p>“I see our partnership evolving through deeper integration and innovation, particularly in technology-driven solutions, enhancing clinical education with our teams, continuing to access real-time data, which PharMerica is tremendous in providing us with,” said Martini. “The data informs us to make smarter decisions.”<br></p><h3>About PharMerica Senior Living</h3><p>PharMerica Senior Living provides personalized pharmacy care through empowered local teams, serving communities nationwide. Combining the personal touch of a neighborhood pharmacy with the resources of a national network, PharMerica offers comprehensive clinical support to enhance resident safety, improve health and well-being, ease care team burdens, and foster thriving communities where seniors enjoy optimal quality of life. Its unwavering commitment to quality ensures the highest standards of service and trust. <br>Discover more at <a href="http://www.pharmerica.com/senior-living" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">pharmerica.com/senior-living</a>. <br></p><p style="text-align:center;"><a href="http://www.pharmerica.com/senior-living" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/Issues/2025/Summer/PublishingImages/PMC_SeniorLiving.png" alt="" style="margin:5px;width:200px;height:66px;" /></a><br></p>	PharMerica’s passion for exceptional, personalized service and high standards for trust and lasting relationships made it easy for Ciel to choose PharMerica as a preferred pharmacy partner.	2025-06-01T04:00:00Z	<img alt="" height="244" src="/Issues/2025/Summer/PublishingImages/PMC_SeniorLiving.png" width="740" style="BORDER:0px solid;" />	Management	Special Feature
2024 National Quality Award Recipients Honored	https://www.providermagazine.com/Issues/2025/Summer/Pages/2024- National-Quality-Award-Recipients-Honored.aspx	2024 National Quality Award Recipients Honored	<p><img src="/Issues/2025/Summer/PublishingImages/Libby%20Care%20Center.jpg" alt="Libby Care Center" class="ms-rtePosition-2" style="margin:5px;width:500px;height:328px;" />The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) honored the 2024 <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">National Quality Award</a> recipients in April during a special award ceremony at the Quality Summit in Atlanta. The ceremony, attended by more than 100 award recipients, was originally planned for October 2024 but had to be rescheduled when Hurricane Milton forced the cancellation of Delivering Solutions 24 in Orlando.<br></p><p>Skilled nursing and assisted living awardees from across the country gathered for an exciting evening of recognition that highlighted the 2024 recipients’ exceptional commitment to quality care and continuous process improvement. AHCA/NCAL celebrated the recipients’ journey as part of the National Quality Award Program, which is based on the Baldrige Criteria for Performance Excellence. This framework encourages member communities to improve performance in the areas of leadership, strategic planning, customers and workforce, operations, and knowledge management.<br></p><p>“Every step you take—every improvement, every effort—moves our profession forward and makes a difference in the lives of your residents, families, and communities,” said AHCA Vice Chair Chris Wright.<br></p><p>In 2024, more than 800 skilled nursing and assisted living communities nationwide received a Quality Award, the highest number ever in the program’s history. Of those, 737 organizations from 49 states earned the Bronze Quality Award, 139 organizations from 33 states earned the Silver Quality Award, and two organizations earned the Gold Quality Award. <br></p><p>The two Gold recipients for 2024 were Libby Care Center of Cascadia from Libby, Mont., and Lofland Park Center of Seaford, Del. The Gold Quality Award is the highest honor, recognizing the pinnacle of excellence in long term care. This award, which only 53 organizations have received, highlights excellence in leadership, strategic planning, and resident satisfaction. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Lofland%20Park%20Center.jpg" alt="Lofland Park Center" class="ms-rtePosition-1" style="margin:5px;width:500px;height:344px;" />“We accept this Gold Quality Award as a testament to the hard work and dedication of every team member, every day,” said Tawnya Dennis, senior administrator at Lofland Park Center. “But we also know our journey toward excellence doesn’t end here. We will continue to pursue quality improvement in every aspect of our work and find new ways to better serve our community.”<br></p><p>In a video message, Rachel Toland, administrator of Libby Care Center of Cascadia, echoed those sentiments. <br>“The growth I’ve seen in my team as they commit every day to being the best care providers they can be has been the most rewarding part of this journey.” <br></p><p>Each year, AHCA/NCAL is proud to honor centers that achieve a Quality Award for their dedication to quality, improvement, and success. The 2025 National Quality Award recipients will be recognized and celebrated in October at Delivering Solutions 25 in Las Vegas.</p><p><em>Erin Walsh is manager, public affairs at the American Health Care Association/National Center for Assisted Living.</em><br></p>	AHCA/NCAL celebrated 737 Bronze Quality Award recipients, 139 Silver Quality Award recipients, and two Gold Quality Award recipients.	2025-06-01T04:00:00Z	<img alt="Libby Care Center" height="486" src="/Issues/2025/Summer/PublishingImages/Libby%20Care%20Center.jpg" width="740" style="BORDER:0px solid;" />	Quality Awards	Quality Awards
AHCA's Better Way to Support an Aging America	https://www.providermagazine.com/Issues/2025/Summer/Pages/AHCA's-Better-Way-to-Support-an-Aging-America.aspx	AHCA's Better Way to Support an Aging America	<p>Our country has a growing elderly population. More people than ever will need long term care. It is critical that our nation’s leaders prioritize, support, and invest in America’s seniors and their caregivers.</p><p>Keep in mind that the oldest baby boomers turn 80 in 2025, and there are more than four million people turning 80 in the next five years. America will have 18.8 million people over the age of 80 in 2030. </p><h3>Obstacles to Progress</h3><p>Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage: workforce shortages, threats to reimbursement, and a broken oversight system.</p><h3>How We All Win</h3><p>At the American Health Care Association (AHCA), we believe there is A Better Way forward, and we stand ready to offer bold solutions that benefit all stakeholders. <br></p><p><img src="/Issues/2024/Winter/PublishingImages/CPorter_740_web.jpg" alt="Clif Porter" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />“There is a better way forward where we not only sustain the high-quality care that our nation's seniors deserve, but grow and transform it to meet the evolving demands of an aging population," said Clif Porter, president and CEO of AHCA. “Our 2025 policy priorities are proactive solutions that put residents and their caregivers first—without unnecessary bureaucratic hurdles that stifle progress and risk limiting access to care. These policies ensure residents are the center of all policy discussions, and quality is at the core of every solution. We stand ready to work with policymakers to protect access to care and continue delivering for America's aging population."<br></p><p>Seniors and their families need quality, choice, access, and clear information. Caregivers deserve jobs that grow with them, competitive pay and benefits, and opportunities to develop skills and careers. Providers are looking for sustainability and growth, support for improvements to modernize, and an environment to foster innovation. Policymakers must create efficiencies, ensure accountability and transparency, and provide a better return on investment. </p><h3>AHCA 2025 Policy Agenda</h3><p>Our work will remain centered on finding efficient and effective solutions that support the continued delivery of high-quality care to our nation’s seniors and individuals with disabilities.</p><p>To achieve those goals, we will prioritize the following:<br></p><ul><li>Strengthening the long term care workforce.</li><li>Protecting Medicaid.</li><li>Reaffirming the promise of Medicare Advantage.</li><li>Rationalizing the regulatory environment.</li></ul><h3>Strengthening the Long Term Care Workforce</h3><p>Nursing homes have been slowly recovering from historic workforce losses during the COVID-19 pandemic. Despite unprecedented efforts to recruit and retain workers, including the highest wage rate increases across health care, nursing homes struggle to compete for workers. While every other health care sector has rebounded, nursing homes still need more than 47,000 workers to return to our pre-pandemic workforce levels.<br></p><p>As the population ages, the demand for long term care is increasing, but younger population is not keeping pace, leading to a growing caregiver shortage. Meanwhile, retirements and COVID-19 are accelerating the shortage as many caregivers have left or are leaving the profession entirely. Across health care, approximately 100,000 registered nurses (RNs) left the workforce, and another 600,000 RNs intend to leave the health care profession by 2027. <br></p><p>It is estimated that by 2028, there will be a nationwide shortage of 100,000 health care workers. The biggest projected deficit is among nursing assistants, the backbone of the long term care workforce.<br></p><p>The shortage of caregivers is creating a challenge in access to care. Workforce shortages in long term care have forced many nursing homes and assisted living communities to limit or deny new admissions, downsize their facilities, or close altogether. Since 2020, 774 nursing homes have closed, displacing 28,000 residents. The overall decline in the number of nursing homes accelerated by nearly four times compared to pre-pandemic rates.</p><h4>A Better Way</h4><p>Our solutions for the workforce shortage are multipronged. They include building a stronger pipeline by addressing faculty shortages at nursing schools and streamlining legal pathways for international caregivers to work in the United States. To boost recruitment and retention, we support student loan forgiveness tax credits, affordable housing, and childcare incentives, along with subsidies and grants to schools whose graduates work in long term care.<br></p><p>Grants and scholarships should be available for ongoing training and career ladder programs should be expanded. We also need to expand the ability of nursing homes to offer in-house training programs to develop nurse aides. We will push Congress to help us permanently ban unrealistic staffing mandates and advance these more meaningful workforce solutions. </p><h3>Protecting Medicaid</h3><p>Medicaid is the lifeblood of long term care. Nearly two-thirds of nursing home residents rely on Medicaid to cover their care. In many states, Medicaid fails to cover the actual cost of nursing home care (on average, 82 cents on the <br>dollar), leaving providers with a significant financial shortfall. Chronic underfunding makes it difficult to invest in <br>the nursing home workforce, care services, and modernization. For some providers, it means closing their doors altogether.</p><h4>A Better Way</h4><p>We must protect and defend Medicaid from cuts. Federal policymakers should require that Medicaid rates be brought up to equal the cost of care and regularly updated to keep pace with increasing operational costs. </p><h3>Reaffirming the Promise of Medicare Advantage</h3><p>Medicare Advantage (MA) plans have seen tremendous growth, as more seniors are attracted to their many perks (out-of-pocket limits, vision, dental, hearing, and other supplemental benefits). More than half (54 percent) of eligible Medicare beneficiaries are enrolled in Medicare Advantage.<br></p><p>Yet, we’re hearing many concerns about MA plans, especially when it comes to access. As patients get sicker, MA plans are too often denying or delaying seniors’ access to necessary post-acute care, including in skilled nursing facilities. From 2019 to 2022, the top three MA insurers denied prior authorization requests for post-acute care at higher rates than for other types of care. As a result, the rate of seniors in the final year of their lives leaving MA plans for traditional Medicare doubled from 2016 to 2022, leaving taxpayers with the bill.</p><h4>A Better Way</h4><p>Seniors have earned the right to make choices and changes, and have timely access to medically necessary care. We must put the power to determine the course of care in the hands of medical professionals and patients, rather than in artificial intelligence or insurers. MA transparency and the rating system should be enhanced, so seniors can make informed decisions. <br></p><p>Market competition should be fostered, so seniors have options to select the best plan. And we need to make sure patients, policymakers, and taxpayers are getting the best deal by encouraging insurers to work with providers <br>to improve outcomes and reduce costs through shared savings programs. </p><h3>Rationalizing the Regulatory Environment</h3><p>We all want safe and high-quality nursing homes. But for decades, America has struggled with a broken oversight system that has failed to produce real change. Federal regulators pile on regulations, guidance, and penalties, while administering enforcement disproportionately. <br></p><p>The current system is inconsistent and ineffective. It does not drive quality improvement among nursing homes or enhance quality of life for residents. Stakeholders across long term care are unsatisfied with the results, and policymakers aren’t getting a return on their investment. </p><h4>A Better Way</h4><p>We must create more effective and balanced oversight that prioritizes quality care while maintaining safety, accountability, and transparency. We can do that by rationalizing the regulatory environment through a variety of areas, including: <br></p><ul><li>Updating the Five-Star Quality Rating System to provide more complete and useful information to consumers. </li><li>Expanding risk-based surveys nationwide to reduce survey backlog, recognize higher-quality facilities, and incentivize more facilities to qualify.</li><li>Improving access to the Civil Monetary Penalty Reinvestment Program to increase use of funds on quality-improvement initiatives and allow them to be used for workforce programs and technology investments to enhance care. </li><li>Strengthening the Special Focus Facility Program to help poorly performing facilities get better and out of the program. </li></ul><h3>Quality at the Core</h3><p>AHCA is dedicated to our mission of improving lives by delivering solutions for quality care. By showing policymakers A Better Way to prioritize, support, and invest in long term care, we can deliver for our residents and patients as well as those who care for them. <br></p>	Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Better-Way.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature
Commanding Through the Storm	https://www.providermagazine.com/Issues/2025/Summer/Pages/Commanding-Through-the-Storm.aspx	Commanding Through the Storm	<p><img src="/Issues/2025/Summer/PublishingImages/Sum_caregiving.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The word crisis can evoke scary thoughts of hurricanes, floods, and wildfires, all of which ravaged parts of the United States recently and forced many nursing homes into emergency mode. However, facility leaders also face other kinds of crises that might not seem as threatening—such as infection outbreaks, changes in ownership, and more—but still have a significant impact on both residents and staff. </p><p>Whatever the crisis, facility leadership must be able to manage it, and effective communication plays a large part in that management. The quality and timeliness of communication can significantly affect the well-being of residents, the efficiency of staff, and the overall success of crisis management.<br></p><h3>Four Reasons to Improve Communication Skills</h3><p>1. When a crisis occurs, the ability to communicate effectively is vital. Nursing home staff care for a vulnerable population. Clear, kind, and consistent interactions are paramount to ensure that residents receive care in a timely manner. Many residents have cognitive impairments or other barriers that may hinder their ability to understand complex information or changes in their routine. Thus, leaders must convey information simply, to allay residents’ anxiety and confusion as much as possible.<br>2. Honest communication engenders trust and the cooperation of family members and responsible parties. Facility leadership must both reassure family members and keep them apprised of their loved one’s progress. Consistent transparent communication builds trust and helps families understand how the crisis is being managed, and it reassures them about the safety of their loved one.<br>3. Good communication also ensures the safety of staff members. When leadership offers clear instructions, updates, and support, staff can perform their duties more effectively. It also helps leaders address the concerns and needs of staff who are working under increased stress during a crisis.<br>4. By communicating effectively, facility leadership can successfully manage external relationships with regulatory agencies, the media, and surrounding communities. Updates may be required on the crisis-<br>management process, and local media may seek information to share with their readers or listeners. Accurate and timely communication from leadership can mitigate misinformation and prevent confusion.<br></p><h3>How to Meet the Challenges in a Crisis</h3><p>Skilled nursing facility leadership may face obstacles that hinder communication. For example, information may change rapidly, overwhelming everyone involved. Further, determining what to communicate first might prove difficult.</p><p>Crisis situations evoke strong emotions. What is occurring may frighten residents and families, making it harder for them to absorb and process any new information the facility is presenting. Staff and facility leaders may be under extreme duress, as well, leading to a delay in communication or an inability to relay any news concisely.<br></p><p>The crisis may affect the facility’s technology. Should a cyberattack occur, communication for leaders may be compromised through such channels as the facility’s website, electronic health records, and even cell phones.</p><h3>The Five Cs of Communication</h3><p>The facility leader can become more adept at managing an emergency by keeping the five Cs of communication in mind: clear, concise, credible, consistent, and compassionate.<br></p><ul><li><strong>B</strong><strong>e clear:</strong> Describe the issue and what’s needed from the other person(s). Communicate the issue directly and non-defensively. Take ownership of the situation and be transparent.</li><li><strong>Be concise:</strong> Keep requests simple and direct. Focus on getting the point across as succinctly as possible, keeping in mind the capabilities of the person receiving the information.</li><li><strong>Be credible:</strong> Ensure all information relayed is correct. Verify facts and be honest about what is known. If information is unavailable, explain that the situation is fluid, and an update will be provided as soon as possible.</li><li><strong>Be consistent: </strong>To avoid confusion, ensure that everyone communicating information about the event is relaying the same information.</li><li><strong>Be compassionate: </strong>Offer emotional support, soothe fears, and promote a sense of security among residents, families, and staff.</li></ul><h3>Strategies to Improve Communication Skills</h3><p>No one can fully prepare for a crisis. However, there are ways to maximize communication skills so that when the time comes, everyone is ready. Harvard Division of Continuing Education, Professional and Executive Development, published the blog post “8 Ways You Can Improve Your Communication Skills.” The following suggestions are adapted from the article.<br></p><ul><li><strong>Be clear and concise.</strong> Before engaging in communication, define what needs to be conveyed and who needs the information. Outline the necessary information to help eliminate irrelevant details. Avoid unnecessary and complex words that can distract from the message. Repeat the message as necessary, but remember that people will tune it out if there is too much repetition.</li><li><strong>Prepare ahead of time.</strong> One of the best ways to ensure effective communication during a crisis is to prepare in advance. Before a crisis occurs, establish communication protocols to improve efficiency and effectiveness, such as predesignated roles for communication, clear guidelines for information dissemination, and established channels for contact. Facilities should have a list of emergency contacts, such as the local health department, emergency services, and family members. Train staff to communicate effectively with residents, families, and external parties during emergencies. This proactive approach can help mitigate confusion and streamline communication when a crisis arises.</li><li><strong>Be mindful of nonverbal communication.</strong> Body language says more than words do. People are more apt to believe nonverbal signals over spoken words. Nonverbal cues should always support the spoken message.</li><li><strong>Watch the tone.</strong> It can add extra power to words. Conversely, tone can also undermine the message. Being mindful of tone allows for alteration when needed.</li><li><strong>Use active listening.</strong> Listen for feedback to learn about concerns and potential issues. This can also help tailor communication strategies and improve satisfaction.</li><li><strong>Build emotional intelligence.</strong> Being aware of our own feelings enables us to manage them. </li><li><strong>Develop a workplace communication strategy. </strong>This framework outlines how and what is communicated and ensures everyone receives the correct information at the right time.</li><li><strong>Create a positive organizational culture.</strong> Communication will be easier and more effective in a positive environment. Without trust and transparency, even the smallest communication can be misconstrued. </li></ul><p><span><span><img src="/Issues/2024/Spring/PublishingImages/Denise-Winzeler.jpg" alt="Denise Wizeler" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span></span>Good communication can reduce anxiety, strengthen trust, and foster a supportive environment during difficult times. By using these strategies, facility leaders can navigate crisis communication with greater confidence and ensure the well-being of all involved.</p><p><em>Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT, is director of education and certification strategy for the American Association of Post-Acute Care Nursing (AAPACN).</em><br></p><p><img src="/SiteCollectionImages/logos/AAPACN.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:56px;" /><br></p>	The right communication at the right time plays a large part in managing a crisis. Practice ahead of time to be ready.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Sum_caregiving.jpg" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
Matching the Mindset of Active, Independent Baby Boomers	https://www.providermagazine.com/Issues/2025/Summer/Pages/Matching-the-Mindset-of-Active,-Independent-Baby-Boomers.aspx	Matching the Mindset of Active, Independent Baby Boomers	<p><img src="/Issues/2025/Summer/PublishingImages/SilverTsunami.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />With the so-called silver tsunami of aging baby boomers well on its way, long term care operators have no choice but to adapt to this new generation of customers—if they haven’t already. <br></p><p>One of the most important paradigm shifts is in the mindset of the new consumer base. Unlike previous generations, baby boomers don’t plan to slow down as they retire; they plan to continue living active, independent lives. <br></p><p>“They have a growth mindset and are looking for engagement and independence,” explained Rita Mabli, president and CEO at United Hebrew of New Rochelle. “They want to maintain their lifestyle, not give it up. They value living with purpose, lifelong learning, and staying connected to their communities through giving back and maintaining creative pursuits.”<br></p><p><span><img src="/Issues/2025/Summer/PublishingImages/Rita-Mabli.jpg" alt="Rita Mabli" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span>This means operators have to change their mindset, as well, down to the very words they’ve used for decades. As Moti Gamburd, CEO of CARE Homecare, pointed out, many boomers are “allergic to terms like ‘elderly’ or ‘retirement care.’” From their perspective, they’re not retiring but entering a transitional period. <br></p><p>“Many of our clients are still running businesses, going to music festivals, or raising grandchildren,” Gamburd explained. “The senior care format—like communal meals at set times, home activities, and transportation system—can feel infantilizing. If you don’t acknowledge that in your services and your messaging, you lose them.”<br></p><p>A 2023 American Seniors Housing Association (ASHA) report illustrated the growing aversion to that conventional format. Almost 100 percent of respondents indicated a desire to remain independent and self-sufficient, according to Senior Housing News, with roughly a third reporting that they don’t want or need help with activities of daily living. As Trilogy Health Services administrator Anthony Wilson wrote for the National Investment Center for Seniors Housing & Care (NIC) last year, the days of the one-size-fits-all approach to senior living are behind us. <br></p><p>“Instead, senior living operators need to embrace a more personalized approach, offering a variety of housing options ranging from independent living apartments to assisted living suites and memory care units,” Wilson wrote. “This allows residents to choose the level of support and assistance that best suits their individual needs, empowering them to maintain their independence while receiving the care they require.”<br></p><p>At the same time, more than 50 percent of respondents in the ASHA report said they’d prefer to receive care where they already are. This is the other side of the trend toward individualization. <br></p><p>“Many baby boomers are quietly, and increasingly, exploring in-home care options that give them the same benefits without giving up their home, their routines, or their independence,” explained home care entrepreneur and consultant Aaron Marcum. To win those older adults over, operators need to radically redefine their product. <br></p><p>“Baby boomers want autonomy, flexibility, and a lifestyle that aligns with who they are today, not a version of aging that feels institutional or outdated,” Marcum added. “Senior living communities that offer vibrant, resort-style amenities are going to be the winners in the future.”<br></p><p>“Resort-style” aptly describes Choreograph Gainesville, a new active living offering from Discovery Senior Living, which conducted extensive research into the boomer demographic as it developed the community. <br></p><p>“We know they seek to live independently for longer periods, so attracting them to senior living earlier could be challenging,” said Diana Ferrante Thies, Discovery’s executive vice president of brand management and corporate communications. “They’ve spent the last chapter of their life putting others’ purpose first—children, career, aging parents. Now they have the opportunity to shed responsibilities, to experiment, innovate…a sense of freedom to discover new things and invest in themselves.”</p><h3>Focusing on Lifestyle over Care</h3><p>Operators nationwide have already risen to the challenges posed by the aging population, increasing their emphasis on independent living options and other services tailored to active lifestyles. A recent report in The Daily Record, which covers business, legal, and legislative news in Maryland, offered a glimpse of the amenities available in communities across the Eastern Seaboard: arts centers, fitness centers with classes and personal training, pickleball courts, walking paths, libraries, and lecture series. A 2023 report in Multi-Housing News, meanwhile, described communities with on-site movie theaters, sports facilities, community gardens, bars, and salons. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Diana-Ferrante-Thies.jpg" class="ms-rtePosition-1" alt="Diana Ferrante Thies" style="margin:5px;width:150px;height:184px;" />The unifying thread isn’t necessarily luxury; it’s community in the sense boomers are most accustomed to—what Mabli, of United Hebrew of New Rochelle, describes as a marriage of “engagement and independence” that allows residents to lead their own lives while still feeling connected to others. “They want the freedom to age in place with the added benefit of access to health care services, social connections, and opportunities to stay active and engaged,” she said. “They’re looking for places that are modern and flexible—places that allow them to live fully among friends, not just safe and securely.”<br></p><p>No detail is too small. When New Jersey-based operator FellowshipLIFE set out to renovate the cultural arts center at its Applewood Village community, its leaders noticed something a little off about the auditorium space. <br></p><p>“When we looked at the room, everything looked great except for the fact that the flooring was wall-to-wall floral pattern, kind of ballroom-looking,” said Liz Fandel, FellowshipLIFE’s chief marketing and innovation officer. “It felt like an older hotel space. So we're going to put an engineered hardwood surface in and have areas around the perimeter with softer carpeting tiles.” Her comments reflect the broader shift away from traditional, stodgy notions of senior living toward more of a lifestyle product. <br></p><p>“For those considering senior living communities, the demand is for more than just a place to stay,” said Nicole Brackett, director of quality and care delivery at Homewatch CareGivers. “Boomers want customized care, fitness options, strong social connections, and access to high-quality health care partnerships.”<br></p><p>One other amenity they want: good food. “When it comes to dining, baby boomers expect a culinary experience, not just a meal,” wrote Jaime Pacheco, general manager at The Cardinal at North Hills, in McKnights last year. “From tableside service to farm-to-table ingredients to tasting menus with wine pairings, food has become cultural capital within communities, providing residents with a sense of belonging through food and social connection.”<br>Fandel phrased it a little more simply: “Who says that eating well has to be unenjoyable?”</p><h3>How to Market to Baby Boomers</h3><p>Of course, operators can’t adjust their models and expect the flood of baby boomers to immediately come calling. To meet the challenges—and reap the opportunities—of the aging population, they also have to rethink their marketing and branding strategies. <br></p><p>The change in messaging follows naturally from the change in mindset. To meet boomers where they are, marketers need to let go of the old ways of thinking about their product.<br></p><p>“Senior living providers need to shift from a care-first narrative to a wellness-and-lifestyle-driven model,” argued Mabli. “To resonate with boomers, marketing and messaging must reflect vitality and purpose, not just care. Operators who embrace innovation, cultivate community, and make clear what sets them apart will be best positioned to meet the expectations of this powerful generation.”<br></p><p>At United Hebrew, she explained, that means framing the campus as “a model of integrative senior living—one that is inclusive, future-focused, and empowering at every stage of aging.” In addition to modernizing its messaging, the operator has invested in community partnerships and technology while focusing on branding that showcases its inclusive, empowering environment. A video on its website prominently features residents engaged in activities such as painting, cooking, and attending a concert. <br></p><p>Digital marketing is key, especially for a generation that rarely owns a landline anymore. “Full digital-marketing channels, social media platforms, using influencers, and developing group forums online need to be an essential part of any marketing program,” said Discovery’s Ferrante Thies. “Connecting with them directly, knowing their likes and dislikes by developing much more edgy and creative advertising campaigns than ever before for seniors—focused on social lifestyles and choices and personalized programs that are true differentiators for your communities—will be attractive to them.”<br></p><p>Ron R. Browning, CEO of digital-marketing agency Intellibright who’s worked with senior living professionals, remarked, “Operators need to think like consumer brands. Start with a strong digital foundation: your website should be mobile-optimized, fast, and lead-generating. Offer virtual tours, transparent pricing, and tools to schedule visits without a phone call.”<br></p><p><img src="/Issues/2025/Summer/PublishingImages/Liz-Fandel.jpg" alt="Liz Fandel" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Fandel, at FellowshipLIFE, stressed the need to steer clear of branding that positions the operator as a care provider. Too many senior living community websites are adorned with photos of residents being supported by caregivers, she argued; too few highlight the active lifestyles residents continue to lead. One of FellowshipLIFE’s current direct mail campaigns features a woman with short, blonde hair wearing orange sunglasses and a leather jacket. “Who says getting older is boring?” the mailing asks. “Join us to learn what life is really like at Fellowship Village.”<br></p><p>At CARE Homecare, Gamburd’s team takes an approach that senior living communities may benefit from, as well—what he describes as serving residents’ lifestyle, not their age. “We made lighter terms that are easier to absorb, from how we describe our services to how we train our care managers,” he said. “We removed care plans and discussed their routines. To sandwich our approach, we asked about travel plans before medical history. <br></p><p>“We had a client in his late seventies who insisted we help him maintain his weekend motorcycle rides,” he added, “so a caregiver rides with him in a separate car in case anything happens.”<br></p><p>His comments echo Fandel’s descriptions of FellowshipLIFE’s prospective residents, who often aren’t even focused on a community’s care offerings. “They’re 100 percent focused on independent living; even when they tour assisted living or skilled nursing, they don’t want to look at it,” she said. “They’re like, ‘Yeah, but I want to see the apartments.’” <br></p><p>Crucially, that’s not to suggest operators should sideline the care aspect entirely. Rather, the idea is to engage with the potential resident’s plan to continue living life as they’ve lived it while giving them security in the knowledge that options from a trusted provider will be there later. <br></p><p>“It’s independent living; you truly are living independently,” said Fandel, “and if there's a need for a higher level of care later in your life, it will be here.” <br><br><em>Steve Manning is a journalist based in New York City.</em></p>	The second in an article series about the challenges and opportunities the silver tsunami will bring to long term care in the United States.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Sum25_Tsunami.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature
Medicaid is a Critical Lifeline for Residents in Long Term Care	https://www.providermagazine.com/Issues/2025/Summer/Pages/Medicaid-is-a-Critical-Lifeline-for-Residents-in-Long-Term-Care.aspx	Medicaid is a Critical Lifeline for Residents in Long Term Care	<p><a href="http://www.ahcancal.org/advocacy" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/Issues/2025/Summer/PublishingImages/BTN%20PrvSum25.jpg" alt="" style="margin:5px;" /></a><br></p>	As Congress debates a budget reconciliation package that includes possible Medicaid savings, now is an important time to reflect on the program’s role within long term care.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Sum25_BTN.jpg" style="BORDER:0px solid;" />	Caregiving	By the Numbers
The Benefits of Data in Assisted Living	https://www.providermagazine.com/Issues/2025/Summer/Pages/The-Benefits-of-Data-in-Assisted-Living.aspx	The Benefits of Data in Assisted Living	<p><img src="/Issues/2025/Summer/PublishingImages/Sum_AL.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Assisted living communities are at the precipice of a new era in which data plays a critical role in driving quality improvement and enhancing care. Many providers have already begun integrating data collection into their operations, leveraging technology to enhance resident outcomes.</p><p><em>The Importance of Data in Assisted Living,</em> a National Center for Assisted Living (NCAL) white paper, takes a closer look at data in senior living and addresses why it is important, considerations for success, and benefits of data aggregation. Engaging in national platforms, such as the American Health Care Association/National Center for Assisted Living Long-Term Care (LTC) Data Cooperative and LTC Trend Tracker, supports data collection and can help assisted living providers experience many benefits. <br></p><h3>Benefits of Aggregated Data in Assisted Living</h3><p>Aggregated data plays a pivotal role in transforming resident care and uncovering quality-improvement opportunities. By consolidating and analyzing data, communities can achieve more personalized, efficient, and effective care models. These are a few of the many potential benefits:<br><br><em>Enhanced resident care</em><br>Aggregated data provides a holistic view of residents’ needs and preferences, enabling personalized care plans. This leads to improved physical, mental, and cognitive health outcomes. Patterns in medications, vitals, and engagement levels help caregivers proactively adjust treatments, enhancing residents’ quality of life and reducing loneliness. <br><br><em>Proactive detection of health issues</em><br>Tracking trends across the resident population allows early detection of health declines, such as frequent falls or weight loss. This proactive approach enables timely interventions, reduces hospitalizations, and improves long-term outcomes by preventing complications from chronic illnesses.<br><br><em>Operational efficiency</em><br>Analyzing resource usage, such as staff time and medication patterns, enables communities to optimize operations. Predictive analytics can forecast high-demand periods, streamline scheduling, and reduce staff burnout, improving productivity while minimizing costs and waste.<br><br><em>Improved safety and risk management</em><br>Aggregated data identifies safety risks by monitoring activity patterns, such as wandering or fall trends. Real-time alerts help caregivers respond quickly to potential hazards, enhancing resident safety and reducing incidents.<br><br><em>Enhanced family communication</em><br>Aggregated data fosters transparency and trust with families by providing real-time access to health and wellness updates. This empowers families to stay informed and actively participate in care decisions, strengthening relationships and satisfaction.<br><br><em>Regulatory compliance</em><br>Data centralization simplifies compliance with regulations by streamlining tracking and reporting. Automated documentation reduces administrative burdens and ensures alignment with quality standards, supporting accountability and transparency.<br><br><em>Cost savings and financial management</em><br>Analyzing spending trends helps communities identify cost-effective strategies while maintaining care quality. Decision-making driven by data reduces unnecessary expenses, such as hospital visits, and optimizes resource allocation for long-term financial sustainability.<br><br><em>Personalized resident engagement and well-being</em><br>By identifying trends in physical and social engagement, communities can tailor activities to individual preferences. This approach improves mental health, reduces loneliness, and enhances overall well-being by promoting active participation in daily life.<br><br><em>Support for technological integration and innovation</em><br>Aggregated data forms the foundation for advanced care technologies, such as AI, predictive analytics, and wearable devices. These innovations enable real-time monitoring and personalized interventions, driving continuous improvement in care quality and safety. Electronic medical record systems further streamline data collection and analysis, ensuring staff can act on insights promptly. </p><p>The full white paper can be found on the <a href="https://www.ahcancal.org/Assisted-Living/Provider-Resources/Documents/NCAL%20WHITE%20PAPER_FINAL-1.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">NCAL website</a>. <br></p>	By aggregating data, providers can achieve more personalized, efficient, and effective care models.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Sum_AL.jpg" style="BORDER:0px solid;" />	Assisted Living;Caregiving	Spotlight on Assisted Living
The Wide World of CNA Training	https://www.providermagazine.com/Issues/2025/Summer/Pages/The-Wide-World-of-CNA-Training.aspx	The Wide World of CNA Training	<p><img src="/Issues/2025/Summer/PublishingImages/Sum25_CFTraining.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />Ideally, training to be a certified nurse assistant (CNA) is the start of a powerful journey in the world of caring. It is more than just classes and testing. It is about nurturing and growing skilled team players. It is about attracting great employees and retaining them over time. <br></p><p>“We have to make an investment in caregivers. There are multiple benefits that will positively impact our residents and our facilities,” said Robert Vande Merwe, executive director of the Idaho Health Care Association. <br></p><p>There are many options for CNA training. Some long term care organizations have their own programs, and there are programs provided by vocational schools and community colleges. There are online courses and in-person classes. Costs range from several hundred dollars to a few thousand. However, Vande Merwe pointed out, “This doesn’t come near the cost to replace and train new CNAs or the high cost of hiring agency staff.” </p><h3>In-House Programs: Targeted Training</h3><p>It can be challenging and expensive for communities to create and maintain their own CNA training program. But some do it and do it well. For instance, Deborah Rowe, MS, RN, PHR, CHCR, vice president of nursing workforce development at Genesis HealthCare, shared her organization’s experiences. <br></p><p>She recalled, “In 1999, Genesis created and received state approval for its nurse aide training program. This program consists of mandatory hours on the principles of nursing with supervised lab and clinical experience. At the successful completion of the training program, graduates are eligible to take their state competency examination for certification/licensure as a nursing assistant.” Genesis trialed one center in Maryland and expanded the model over time. <br></p><p>Rowe noted, “We offer the nurse aide training program primarily to students where there is an approved Genesis-affiliated training center and make it available to other affiliated centers. In the program, there is a dedicated nursing instructor to provide ongoing nurse aide training. We attract and hire candidates from the communities we serve while also offering incumbent team members the opportunity to advance and train employees for certification/licensure.” Currently, Genesis has more than 65 in-facility nurse aide training programs in more than 13 states. <br></p><p>“When training comes from the facility, it’s more focused on the facility’s needs,” said Vande Merwe—and this has benefits. </p><h3>Array of Options</h3><p>There are several options for CNA training. According to federal regulations, for a nurse aide training and competency evaluation program to be approved by the state, it needs to meet specific standards, including no less than 75 clock hours of training, 16 hours of supervised practical training, and instructors that have completed a course in teaching adults or with experience in teaching adults or supervising nurse aides. Other personnel from health professions may supplement the instructor, including, but not limited to, registered nurses, licensed practical nurses, nursing home administrators, physical and occupational therapists, and gerontologists.<br></p><p>The American Health Care Association offers a robust, federally compliant nurse assistant training program designed to support workforce development in long term care. Now in its 8th edition, the How to Be a Nurse Assistant curriculum is a comprehensive solution for facility-based CNA training that includes a textbook, workbook, skills DVD, and an instructor website that provides chapter specific objectives, teaching tools, and sample calendars. AHCA senior director of marketing Chip Henderson notes that “we publish a new edition every five years to adopt updated federal guidelines as well as incorporate feedback from our customers—nurse instructors who depend on our vetted curriculum to prepare their students for a rewarding career in long term care.”<br></p><p><img src="/Issues/2025/Summer/PublishingImages/Kristen-Knapp-Close.jpg" alt="Kristen Knapp" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />To build upon its curriculum offerings, AHCA partnered with Academic Platforms in 2016 to develop CNAonline, a hybrid training model. The program combines online coursework with in-person, facility-based skills training grounded in the How to Be a Nurse Assistant curriculum. “The hybrid model leverages proven technology to enhance the learning experience for students and to overcome the limited availability of qualified nurse educators,” says Julie Gdowski, RN, nurse instructor and vice president of clinical operations at Academic Platforms. “The flexibility of having the curriculum online allows students to engage with training 24/7 as their schedules allow.” Learn more at <a href="http://www.cnaonline.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">CNAonline.com</a>. <br></p><p>In Florida, a personal care attendant (PCA) program was started during the COVID-19 pandemic. Kristen Knapp, APR, CAE, senior director of strategy and communications at the Florida Health Care Association, said, “I like to call it an ‘earn while you learn’ program.” Essentially, an aspiring CNA can come into the nursing home, go through competency training, and learn alongside an experienced CNA. <br></p><p>“They’re basically doing not quite everything that the CNA does but many tasks that the CNA performs using many of the skills they need,” said Knapp. The program is designed to prepare participants to take the CNA exam. After 120 days, they are no longer PCAs, so they have to take the certification test or move into another position—such as dietary aide—if they decide they don’t want to be a CNA.</p><h3>Content Counts</h3><p>Of course, it’s not just the type of training course that comes into play; content counts. While most programs cover the basics, there likely are some variations. “Some caregivers have limited training in mental health or dementia,” Vande Merwe explained, “and the bulk of our residents have some kind of dementia, depression, or other mental illnesses and behavioral health issues. So we have to do on-the-job training and/or education in our own classrooms on those topics.<br></p><p>“The key to keeping good CNAs is to make sure they are competent and confident,” he said.<br></p><p><img src="/Issues/2025/Summer/PublishingImages/Robert-Vande-Merwe.jpg" alt="Robert Vande Merwe" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />It is important to know what competencies new hires have specific to the facility’s needs and identify any gaps that need to be filled. Vande Merwe observed, “Every facility has a slightly different population. Some have memory care units, some have more residents with behavioral health issues, some do mostly rehab, some have wound care programs, and so on. CNAs come out of training as generalists, so it’s up to each facility to make sure they have the special skills to deal with its population.” <br></p><p>He added, “This additional training is important because if you’re asking people to do tasks they’re not confident doing, it’s just a recipe for turnover.”<br></p><p>As with training for many other professions, CNA training doesn’t necessarily include nonclinical skills such as conflict resolution, having difficult conversations, leadership, and stress management. Vande Merwe noted, “Most CNAs come to us straight out of high school with little or no work experience, so they need some training on how to be an effective worker. This not only means information about conflict resolution and other skills; they also need to know the importance of punctuality, respecting your colleagues, and budgeting and financial management.”<br></p><p>CNAs should be encouraged to seek additional training and education over time. “We need to figure out how to use the skills they have and maintain a culture where CNAs are comfortable going to a supervisor and asking for additional or repeated training on issues that impact their work,” Vande Merwe said. <br></p><p>Team leaders and members also need to value CNA training, and this can be challenging when there are wide age gaps between staff members. Vande Merwe observed, “Most new CNAs are in their late teens or early twenties, and they may be working with nurses and others who have been on the job for twenty or more years. <br>When everyone sees CNAs as valuable members of the clinical care team and treats them as such, caregivers are more likely to take pride in their work. This is a strong contributor to retention.<br></p><p>Just this year, the National Association of Health Care Assistants launched the CareForce Academy, an education center for frontline direct care professionals. The organization recruits students and connects them with direct care education and training via curricula designed and taught by health care leaders. </p><h3>Beyond Training: Career Prep</h3><p>Vicky Castillo, MSNed, RN, CNE, president and founder of Facets Healthcare Training, said, “There’s been a lot of concentration in nurse assistant training and education, and I’ve started and worked with many different types of programs.” <br></p><p>For instance, she was a program coordinator/manager for a large nurse assistant instruction program in Arizona, where 650 to 800 students per year were trained. She discovered there was a dearth of certification test-preparation programs for nurse assistants, so she created one. Because testing and certification varies from state to state, this training has to be state-specific. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Charlene-Brown.jpg" alt="Charlene Brown" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Similarly, CNA Simulations works to ensure students succeed in their future roles in long term care while also helping them get ready for the CNA skills exam. Through partnerships with schools and employers, the company offers virtual clinical skills simulations for CNAs, home health aides, and family caregivers. Founder and CEO Charlene Brown, MD, MPH, explained, "We focus on essential clinical and critical thinking skills, allowing students to simulate real-life care scenarios. This helps them respond to unexpected challenges and refine the skills they've learned. CNA training programs use our simulations to enhance their teaching." <br></p><p>Brown emphasized that giving CNAs a chance to practice risk-free, realistic care before they start is crucial for retention. "I found that CNAs often wish they had more clinical experience, especially in areas like infection control and dementia care," she said. "Simulations help to bridge this gap. When CNAs start feeling prepared and know what to expect, they're more likely to thrive and feel confident in their roles."</p><h3>What CNAs Want</h3><p>Like most adult learners, CNAs prefer programs that are interactive and hands-on. Deborah Rowe said, “The nurse aide students I’ve worked with like working directly with the residents and patients. They enjoy the relationships they establish as they are practicing their skills in the clinical setting.”<br></p><p>Sherry Perry reflected, “I think a lot of CNAs would prefer a training program that enables them to be a well-rounded professional who can work anywhere.” She noted that when she was training, she and her fellow students especially appreciated learning about issues such as medical side effects, signs and symptoms of various illnesses and conditions, and various medical terminology. <br></p><p>Behavioral management is a huge issue in long term care today, and Perry said, “There are many residents with dementia and mental illness, as well as young residents who are there because of strokes, aneurysms, and head injuries. CNAs need to be prepared to help manage behavioral issues to protect residents, their colleagues, and themselves.”<br></p><p>Isaac Zralii, a longtime CNA who has worked in hospitals and nursing homes, has participated in multiple training programs, but the best, he said, was one offered through a high school vocational program. He explained, “I definitely felt like I had more hands-on learning. We also did clinicals in the hospital and nursing home. Our instructor was very good about conducting clinical debriefings that helped us learn.”</p><h3>Meeting an Ongoing Need</h3><p>Nurse aide training needs to be a priority, said Castillo. While there are many good programs, there are still some gaps. She said, “I’ve been to parts of Texas where they have one training program in a one-hundred-mile radius. This can be a significant deterrent for people who would like to be a CNA but can’t get to the training.” <br>While most training programs are relatively affordable (less than $2,500), paying for training can be difficult for many people. Working with students to make the finances doable is useful. One option growing in popularity is apprenticeships. <br></p><p>Vande Merwe said, “Apprenticeships present a great opportunity for people to preview the job they’re going to be doing. There actually are Department of Labor funds that can help pay for things like day care and transportation. These programs can help attract people to our industry.”<br></p><p><img src="/Issues/2025/Summer/PublishingImages/Vicky-Castillo.jpg" alt="Vicky Castillo" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Castillo said, “At least some students will still have to work another job while they are going through training, or they may be juggling school and family. Programs need to be flexible and not just nine-to-five Monday through Friday.” <br></p><p>It behooves facilities to help potential CNAs picture working in the field. Knapp said, “Before they spend the time and money to study, people want a better idea about what their job is and how it may be an important career step for them. I talked to one woman who worked as an amusement park train operator and wanted to do something else. She became a PCA and then a CNA, and she has goals to become a nurse. Our program gave her an opportunity to launch her health care career.” <br></p><p>Another woman was a stay-at-home mom looking to get back into the workforce. She went from a PCA to CNA. She landed in her facility’s business office in an administrative role and hopes to become a nurse. Not everyone who goes through a CNA training program will want that job for life, but it can be a stepping stone for someone who is a valuable employee in another role. <br></p><p>Vande Merwe said, “We have to figure out how to incentivize young people to choose a career or an entry level job as a CNA. There's just not enough bodies in America to care for all the boomers coming our way. If you don't think about how you're going to attract young people already, you better start investing in robots that can take care of seniors. And I don't think that's happening anytime soon.” </p><p><a href="https://ahcapublications.org/collections/nurse-assistant-8th-edition" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"><img src="/Issues/2025/Summer/PublishingImages/HTB-Textbook-3D.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:125px;height:138px;" /></a>AHCA/NCAL’s How to Be a Nurse Assistant training curriculum reflects current best practices, including updates on infection control, nutrition, resident rights, and care for individuals with intellectual and developmental disabilities, mental health conditions, and substance use disorders. <a href="https://ahcapublications.org/collections/nurse-assistant-8th-edition" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Learn more.</a><br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em></p>	CNA training serves as a crucial entry point into health care, combining flexible education options with practical skills to prepare and retain compassionate, competent caregivers.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Sum25_CFTraining.jpg" style="BORDER:0px solid;" />	Caregiving;Workforce	Cover Feature

The Power of Partnership with PharMerica	https://www.providermagazine.com/Issues/2025/Summer/Pages/The-Power-of-Partnership-with-PharMerica.aspx	The Power of Partnership with PharMerica	<p>Running a senior living community is a tremendous responsibility that’s becoming more challenging as residents’ medical needs increase and regulations rapidly change. Providers must not only hold themselves to the highest standards in quality care, but they must also find partners who adhere to the same principles. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Alexis-Martini-pharmerica.jpg" alt="Alexis Martini" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Two years ago, Ciel Senior Living, which has 14 communities in nine states, tapped PharMerica as its preferred provider of pharmacy services. PharMerica’s knowledge of nationwide industry trends and best practices, as well as its understanding of the intricacies of Ciel’s markets, helped cement the relationship. The two companies’ patient-centric approach to care is an essential element in the partnership.<br></p><p>“When you’re looking for a strategic partner, their vision and values need to align with yours,” said Alexis Martini, president and chief operating officer at Ciel. “We have an incredible amount of trust in our PharMerica partner.”<br></p><p>PharMerica’s passion for exceptional, personalized service and high standards for trust and lasting relationships made it easy for Ciel to choose PharMerica as a preferred pharmacy partner. </p><h3>Staying Current on Changes</h3><p>PharMerica’s dedication to helping Ciel provide the best care manifests itself in multiple ways. The company keeps Ciel’s staff updated on laws and regulations affecting its various locations, trains staff, provides time-saving technology, and quickly addresses problems. <br></p><p><span><img src="/Issues/2025/Summer/PublishingImages/Ashley-Guido-pharmerica.jpg" alt="Ashley Guido" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span>Martini said that whenever mishaps occur, PharMerica staff will jump on the phone or respond in person to correct the situation and determine how to prevent it from happening again. “That’s going above and beyond, and that’s a uniqueness that you don’t really find in this space,” Martini explained. <br></p><p>Another hallmark of PharMerica’s service is constant and clear communication with clients. Part of the messaging centers on the changing regulatory environment. <br></p><p>“The states do vary in their requirements for medication administration—not just the requirements for the training personnel, but processes,” said Ashley Guido, Ciel’s chief clinical officer. “There are a lot of nuances that PharMerica helps us navigate in terms of regulatory compliance.”</p><h3>Innovative Education and Initiatives</h3><p>Lisa McClure, PharMerica’s senior vice president, senior living general manager, said staying abreast of the changing health care landscape is not only part of the company’s educational responsibility, but also essential to its role as a thought leader in the industry. Also critical is providing information that is easy to understand, or as she puts it, delivering “snackable educational pieces” to support informed decision-making. McClure added, “We believe that knowledge is power, and PharMerica is a trusted resource that providers can easily tap into.”<br></p><p>Education comes in various forms, such as webinars, round-table discussions, live meetings, and written guides. It encompasses a broad spectrum of topics, including reducing medication errors, opioid use, antipsychotic reduction, and antibiotic stewardship. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Lisa-McClure-pharmerica.jpg" alt="Lisa McClure" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Guido heralded PharMerica’s Polypharmacy Initiative as especially useful and innovative. In this program, PharMerica’s pharmacists review residents’ medications to potentially reduce the number of prescriptions, prevent duplicative therapies, and reduce the risk of falls and adverse drug events. This contributes to resident safety and well-being and can help reduce out-of-pocket expenses. It can make dispensing medicines more efficient, allowing nurses to spend more quality time with residents. <br></p><p>McClure said that PharMerica prides itself on ensuring the highest standards of service and trust, with medication delivery that is correct and on time. Reconciling medications can consume precious time, but working with PharMerica can reduce the time needed for that task. “Reducing the time for medication reconciliation allows the nurses to focus on what’s important, and that’s patient-centered care,” said McClure.</p><h3>Picking a Preferred Provider</h3><p>Even though residents have the freedom to choose their pharmacy services provider, PharMerica works closely with Ciel Senior Living to increase resident adoption, as that increases safety as opposed to using a local retail pharmacy. Selecting PharMerica enhances safety, medication accuracy, and efficiency in prescription drug plans and billing. Providers also note increased operational efficiency and staff satisfaction.</p><h3>Reducing Staff Turnover</h3><p>A significant part of providing excellent care is satisfied, engaged staff. Turnover in the health care industry has been a challenge, though Martini said that Ciel’s partnership with PharMerica has led to greater staff retention. That’s because PharMerica’s educational platform helps support learning, training, and teaching at Ciel’s locations.</p><p>“We’re giving our staff opportunities to train, to grow,” said Martini. “That’s allowed us to reduce our turnover and keep people engaged in a career track that makes sense for them.”<br></p><p>PharMerica is a vital part of the local Ciel medication-management team, offering a local, dedicated team of account managers, billing specialists, nurses, and pharmacists who provide a wide range of valuable services to the community. They live and work near each facility, making them an integral part of the fabric of the Ciel community.</p><h3>A Bright Future</h3><p>Martini expects the partnership with PharMerica to continue flourishing. <br></p><p>“I see our partnership evolving through deeper integration and innovation, particularly in technology-driven solutions, enhancing clinical education with our teams, continuing to access real-time data, which PharMerica is tremendous in providing us with,” said Martini. “The data informs us to make smarter decisions.”<br></p><h3>About PharMerica Senior Living</h3><p>PharMerica Senior Living provides personalized pharmacy care through empowered local teams, serving communities nationwide. Combining the personal touch of a neighborhood pharmacy with the resources of a national network, PharMerica offers comprehensive clinical support to enhance resident safety, improve health and well-being, ease care team burdens, and foster thriving communities where seniors enjoy optimal quality of life. Its unwavering commitment to quality ensures the highest standards of service and trust. <br>Discover more at <a href="http://www.pharmerica.com/senior-living" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">pharmerica.com/senior-living</a>. <br></p><p style="text-align:center;"><a href="http://www.pharmerica.com/senior-living" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/Issues/2025/Summer/PublishingImages/PMC_SeniorLiving.png" alt="" style="margin:5px;width:200px;height:66px;" /></a><br></p>	PharMerica’s passion for exceptional, personalized service and high standards for trust and lasting relationships made it easy for Ciel to choose PharMerica as a preferred pharmacy partner.	2025-06-01T04:00:00Z	<img alt="" height="244" src="/Issues/2025/Summer/PublishingImages/PMC_SeniorLiving.png" width="740" style="BORDER:0px solid;" />	Management	Special Feature		52	2
AHCA's Better Way to Support an Aging America	https://www.providermagazine.com/Issues/2025/Summer/Pages/AHCA's-Better-Way-to-Support-an-Aging-America.aspx	AHCA's Better Way to Support an Aging America	<p>Our country has a growing elderly population. More people than ever will need long term care. It is critical that our nation’s leaders prioritize, support, and invest in America’s seniors and their caregivers.</p><p>Keep in mind that the oldest baby boomers turn 80 in 2025, and there are more than four million people turning 80 in the next five years. America will have 18.8 million people over the age of 80 in 2030. </p><h3>Obstacles to Progress</h3><p>Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage: workforce shortages, threats to reimbursement, and a broken oversight system.</p><h3>How We All Win</h3><p>At the American Health Care Association (AHCA), we believe there is A Better Way forward, and we stand ready to offer bold solutions that benefit all stakeholders. <br></p><p><img src="/Issues/2024/Winter/PublishingImages/CPorter_740_web.jpg" alt="Clif Porter" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />“There is a better way forward where we not only sustain the high-quality care that our nation's seniors deserve, but grow and transform it to meet the evolving demands of an aging population," said Clif Porter, president and CEO of AHCA. “Our 2025 policy priorities are proactive solutions that put residents and their caregivers first—without unnecessary bureaucratic hurdles that stifle progress and risk limiting access to care. These policies ensure residents are the center of all policy discussions, and quality is at the core of every solution. We stand ready to work with policymakers to protect access to care and continue delivering for America's aging population."<br></p><p>Seniors and their families need quality, choice, access, and clear information. Caregivers deserve jobs that grow with them, competitive pay and benefits, and opportunities to develop skills and careers. Providers are looking for sustainability and growth, support for improvements to modernize, and an environment to foster innovation. Policymakers must create efficiencies, ensure accountability and transparency, and provide a better return on investment. </p><h3>AHCA 2025 Policy Agenda</h3><p>Our work will remain centered on finding efficient and effective solutions that support the continued delivery of high-quality care to our nation’s seniors and individuals with disabilities.</p><p>To achieve those goals, we will prioritize the following:<br></p><ul><li>Strengthening the long term care workforce.</li><li>Protecting Medicaid.</li><li>Reaffirming the promise of Medicare Advantage.</li><li>Rationalizing the regulatory environment.</li></ul><h3>Strengthening the Long Term Care Workforce</h3><p>Nursing homes have been slowly recovering from historic workforce losses during the COVID-19 pandemic. Despite unprecedented efforts to recruit and retain workers, including the highest wage rate increases across health care, nursing homes struggle to compete for workers. While every other health care sector has rebounded, nursing homes still need more than 47,000 workers to return to our pre-pandemic workforce levels.<br></p><p>As the population ages, the demand for long term care is increasing, but younger population is not keeping pace, leading to a growing caregiver shortage. Meanwhile, retirements and COVID-19 are accelerating the shortage as many caregivers have left or are leaving the profession entirely. Across health care, approximately 100,000 registered nurses (RNs) left the workforce, and another 600,000 RNs intend to leave the health care profession by 2027. <br></p><p>It is estimated that by 2028, there will be a nationwide shortage of 100,000 health care workers. The biggest projected deficit is among nursing assistants, the backbone of the long term care workforce.<br></p><p>The shortage of caregivers is creating a challenge in access to care. Workforce shortages in long term care have forced many nursing homes and assisted living communities to limit or deny new admissions, downsize their facilities, or close altogether. Since 2020, 774 nursing homes have closed, displacing 28,000 residents. The overall decline in the number of nursing homes accelerated by nearly four times compared to pre-pandemic rates.</p><h4>A Better Way</h4><p>Our solutions for the workforce shortage are multipronged. They include building a stronger pipeline by addressing faculty shortages at nursing schools and streamlining legal pathways for international caregivers to work in the United States. To boost recruitment and retention, we support student loan forgiveness tax credits, affordable housing, and childcare incentives, along with subsidies and grants to schools whose graduates work in long term care.<br></p><p>Grants and scholarships should be available for ongoing training and career ladder programs should be expanded. We also need to expand the ability of nursing homes to offer in-house training programs to develop nurse aides. We will push Congress to help us permanently ban unrealistic staffing mandates and advance these more meaningful workforce solutions. </p><h3>Protecting Medicaid</h3><p>Medicaid is the lifeblood of long term care. Nearly two-thirds of nursing home residents rely on Medicaid to cover their care. In many states, Medicaid fails to cover the actual cost of nursing home care (on average, 82 cents on the <br>dollar), leaving providers with a significant financial shortfall. Chronic underfunding makes it difficult to invest in <br>the nursing home workforce, care services, and modernization. For some providers, it means closing their doors altogether.</p><h4>A Better Way</h4><p>We must protect and defend Medicaid from cuts. Federal policymakers should require that Medicaid rates be brought up to equal the cost of care and regularly updated to keep pace with increasing operational costs. </p><h3>Reaffirming the Promise of Medicare Advantage</h3><p>Medicare Advantage (MA) plans have seen tremendous growth, as more seniors are attracted to their many perks (out-of-pocket limits, vision, dental, hearing, and other supplemental benefits). More than half (54 percent) of eligible Medicare beneficiaries are enrolled in Medicare Advantage.<br></p><p>Yet, we’re hearing many concerns about MA plans, especially when it comes to access. As patients get sicker, MA plans are too often denying or delaying seniors’ access to necessary post-acute care, including in skilled nursing facilities. From 2019 to 2022, the top three MA insurers denied prior authorization requests for post-acute care at higher rates than for other types of care. As a result, the rate of seniors in the final year of their lives leaving MA plans for traditional Medicare doubled from 2016 to 2022, leaving taxpayers with the bill.</p><h4>A Better Way</h4><p>Seniors have earned the right to make choices and changes, and have timely access to medically necessary care. We must put the power to determine the course of care in the hands of medical professionals and patients, rather than in artificial intelligence or insurers. MA transparency and the rating system should be enhanced, so seniors can make informed decisions. <br></p><p>Market competition should be fostered, so seniors have options to select the best plan. And we need to make sure patients, policymakers, and taxpayers are getting the best deal by encouraging insurers to work with providers <br>to improve outcomes and reduce costs through shared savings programs. </p><h3>Rationalizing the Regulatory Environment</h3><p>We all want safe and high-quality nursing homes. But for decades, America has struggled with a broken oversight system that has failed to produce real change. Federal regulators pile on regulations, guidance, and penalties, while administering enforcement disproportionately. <br></p><p>The current system is inconsistent and ineffective. It does not drive quality improvement among nursing homes or enhance quality of life for residents. Stakeholders across long term care are unsatisfied with the results, and policymakers aren’t getting a return on their investment. </p><h4>A Better Way</h4><p>We must create more effective and balanced oversight that prioritizes quality care while maintaining safety, accountability, and transparency. We can do that by rationalizing the regulatory environment through a variety of areas, including: <br></p><ul><li>Updating the Five-Star Quality Rating System to provide more complete and useful information to consumers. </li><li>Expanding risk-based surveys nationwide to reduce survey backlog, recognize higher-quality facilities, and incentivize more facilities to qualify.</li><li>Improving access to the Civil Monetary Penalty Reinvestment Program to increase use of funds on quality-improvement initiatives and allow them to be used for workforce programs and technology investments to enhance care. </li><li>Strengthening the Special Focus Facility Program to help poorly performing facilities get better and out of the program. </li></ul><h3>Quality at the Core</h3><p>AHCA is dedicated to our mission of improving lives by delivering solutions for quality care. By showing policymakers A Better Way to prioritize, support, and invest in long term care, we can deliver for our residents and patients as well as those who care for them. <br></p>	Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Better-Way.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature		52	2
Matching the Mindset of Active, Independent Baby Boomers	https://www.providermagazine.com/Issues/2025/Summer/Pages/Matching-the-Mindset-of-Active,-Independent-Baby-Boomers.aspx	Matching the Mindset of Active, Independent Baby Boomers	<p><img src="/Issues/2025/Summer/PublishingImages/SilverTsunami.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />With the so-called silver tsunami of aging baby boomers well on its way, long term care operators have no choice but to adapt to this new generation of customers—if they haven’t already. <br></p><p>One of the most important paradigm shifts is in the mindset of the new consumer base. Unlike previous generations, baby boomers don’t plan to slow down as they retire; they plan to continue living active, independent lives. <br></p><p>“They have a growth mindset and are looking for engagement and independence,” explained Rita Mabli, president and CEO at United Hebrew of New Rochelle. “They want to maintain their lifestyle, not give it up. They value living with purpose, lifelong learning, and staying connected to their communities through giving back and maintaining creative pursuits.”<br></p><p><span><img src="/Issues/2025/Summer/PublishingImages/Rita-Mabli.jpg" alt="Rita Mabli" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" /></span>This means operators have to change their mindset, as well, down to the very words they’ve used for decades. As Moti Gamburd, CEO of CARE Homecare, pointed out, many boomers are “allergic to terms like ‘elderly’ or ‘retirement care.’” From their perspective, they’re not retiring but entering a transitional period. <br></p><p>“Many of our clients are still running businesses, going to music festivals, or raising grandchildren,” Gamburd explained. “The senior care format—like communal meals at set times, home activities, and transportation system—can feel infantilizing. If you don’t acknowledge that in your services and your messaging, you lose them.”<br></p><p>A 2023 American Seniors Housing Association (ASHA) report illustrated the growing aversion to that conventional format. Almost 100 percent of respondents indicated a desire to remain independent and self-sufficient, according to Senior Housing News, with roughly a third reporting that they don’t want or need help with activities of daily living. As Trilogy Health Services administrator Anthony Wilson wrote for the National Investment Center for Seniors Housing & Care (NIC) last year, the days of the one-size-fits-all approach to senior living are behind us. <br></p><p>“Instead, senior living operators need to embrace a more personalized approach, offering a variety of housing options ranging from independent living apartments to assisted living suites and memory care units,” Wilson wrote. “This allows residents to choose the level of support and assistance that best suits their individual needs, empowering them to maintain their independence while receiving the care they require.”<br></p><p>At the same time, more than 50 percent of respondents in the ASHA report said they’d prefer to receive care where they already are. This is the other side of the trend toward individualization. <br></p><p>“Many baby boomers are quietly, and increasingly, exploring in-home care options that give them the same benefits without giving up their home, their routines, or their independence,” explained home care entrepreneur and consultant Aaron Marcum. To win those older adults over, operators need to radically redefine their product. <br></p><p>“Baby boomers want autonomy, flexibility, and a lifestyle that aligns with who they are today, not a version of aging that feels institutional or outdated,” Marcum added. “Senior living communities that offer vibrant, resort-style amenities are going to be the winners in the future.”<br></p><p>“Resort-style” aptly describes Choreograph Gainesville, a new active living offering from Discovery Senior Living, which conducted extensive research into the boomer demographic as it developed the community. <br></p><p>“We know they seek to live independently for longer periods, so attracting them to senior living earlier could be challenging,” said Diana Ferrante Thies, Discovery’s executive vice president of brand management and corporate communications. “They’ve spent the last chapter of their life putting others’ purpose first—children, career, aging parents. Now they have the opportunity to shed responsibilities, to experiment, innovate…a sense of freedom to discover new things and invest in themselves.”</p><h3>Focusing on Lifestyle over Care</h3><p>Operators nationwide have already risen to the challenges posed by the aging population, increasing their emphasis on independent living options and other services tailored to active lifestyles. A recent report in The Daily Record, which covers business, legal, and legislative news in Maryland, offered a glimpse of the amenities available in communities across the Eastern Seaboard: arts centers, fitness centers with classes and personal training, pickleball courts, walking paths, libraries, and lecture series. A 2023 report in Multi-Housing News, meanwhile, described communities with on-site movie theaters, sports facilities, community gardens, bars, and salons. <br></p><p><img src="/Issues/2025/Summer/PublishingImages/Diana-Ferrante-Thies.jpg" class="ms-rtePosition-1" alt="Diana Ferrante Thies" style="margin:5px;width:150px;height:184px;" />The unifying thread isn’t necessarily luxury; it’s community in the sense boomers are most accustomed to—what Mabli, of United Hebrew of New Rochelle, describes as a marriage of “engagement and independence” that allows residents to lead their own lives while still feeling connected to others. “They want the freedom to age in place with the added benefit of access to health care services, social connections, and opportunities to stay active and engaged,” she said. “They’re looking for places that are modern and flexible—places that allow them to live fully among friends, not just safe and securely.”<br></p><p>No detail is too small. When New Jersey-based operator FellowshipLIFE set out to renovate the cultural arts center at its Applewood Village community, its leaders noticed something a little off about the auditorium space. <br></p><p>“When we looked at the room, everything looked great except for the fact that the flooring was wall-to-wall floral pattern, kind of ballroom-looking,” said Liz Fandel, FellowshipLIFE’s chief marketing and innovation officer. “It felt like an older hotel space. So we're going to put an engineered hardwood surface in and have areas around the perimeter with softer carpeting tiles.” Her comments reflect the broader shift away from traditional, stodgy notions of senior living toward more of a lifestyle product. <br></p><p>“For those considering senior living communities, the demand is for more than just a place to stay,” said Nicole Brackett, director of quality and care delivery at Homewatch CareGivers. “Boomers want customized care, fitness options, strong social connections, and access to high-quality health care partnerships.”<br></p><p>One other amenity they want: good food. “When it comes to dining, baby boomers expect a culinary experience, not just a meal,” wrote Jaime Pacheco, general manager at The Cardinal at North Hills, in McKnights last year. “From tableside service to farm-to-table ingredients to tasting menus with wine pairings, food has become cultural capital within communities, providing residents with a sense of belonging through food and social connection.”<br>Fandel phrased it a little more simply: “Who says that eating well has to be unenjoyable?”</p><h3>How to Market to Baby Boomers</h3><p>Of course, operators can’t adjust their models and expect the flood of baby boomers to immediately come calling. To meet the challenges—and reap the opportunities—of the aging population, they also have to rethink their marketing and branding strategies. <br></p><p>The change in messaging follows naturally from the change in mindset. To meet boomers where they are, marketers need to let go of the old ways of thinking about their product.<br></p><p>“Senior living providers need to shift from a care-first narrative to a wellness-and-lifestyle-driven model,” argued Mabli. “To resonate with boomers, marketing and messaging must reflect vitality and purpose, not just care. Operators who embrace innovation, cultivate community, and make clear what sets them apart will be best positioned to meet the expectations of this powerful generation.”<br></p><p>At United Hebrew, she explained, that means framing the campus as “a model of integrative senior living—one that is inclusive, future-focused, and empowering at every stage of aging.” In addition to modernizing its messaging, the operator has invested in community partnerships and technology while focusing on branding that showcases its inclusive, empowering environment. A video on its website prominently features residents engaged in activities such as painting, cooking, and attending a concert. <br></p><p>Digital marketing is key, especially for a generation that rarely owns a landline anymore. “Full digital-marketing channels, social media platforms, using influencers, and developing group forums online need to be an essential part of any marketing program,” said Discovery’s Ferrante Thies. “Connecting with them directly, knowing their likes and dislikes by developing much more edgy and creative advertising campaigns than ever before for seniors—focused on social lifestyles and choices and personalized programs that are true differentiators for your communities—will be attractive to them.”<br></p><p>Ron R. Browning, CEO of digital-marketing agency Intellibright who’s worked with senior living professionals, remarked, “Operators need to think like consumer brands. Start with a strong digital foundation: your website should be mobile-optimized, fast, and lead-generating. Offer virtual tours, transparent pricing, and tools to schedule visits without a phone call.”<br></p><p><img src="/Issues/2025/Summer/PublishingImages/Liz-Fandel.jpg" alt="Liz Fandel" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Fandel, at FellowshipLIFE, stressed the need to steer clear of branding that positions the operator as a care provider. Too many senior living community websites are adorned with photos of residents being supported by caregivers, she argued; too few highlight the active lifestyles residents continue to lead. One of FellowshipLIFE’s current direct mail campaigns features a woman with short, blonde hair wearing orange sunglasses and a leather jacket. “Who says getting older is boring?” the mailing asks. “Join us to learn what life is really like at Fellowship Village.”<br></p><p>At CARE Homecare, Gamburd’s team takes an approach that senior living communities may benefit from, as well—what he describes as serving residents’ lifestyle, not their age. “We made lighter terms that are easier to absorb, from how we describe our services to how we train our care managers,” he said. “We removed care plans and discussed their routines. To sandwich our approach, we asked about travel plans before medical history. <br></p><p>“We had a client in his late seventies who insisted we help him maintain his weekend motorcycle rides,” he added, “so a caregiver rides with him in a separate car in case anything happens.”<br></p><p>His comments echo Fandel’s descriptions of FellowshipLIFE’s prospective residents, who often aren’t even focused on a community’s care offerings. “They’re 100 percent focused on independent living; even when they tour assisted living or skilled nursing, they don’t want to look at it,” she said. “They’re like, ‘Yeah, but I want to see the apartments.’” <br></p><p>Crucially, that’s not to suggest operators should sideline the care aspect entirely. Rather, the idea is to engage with the potential resident’s plan to continue living life as they’ve lived it while giving them security in the knowledge that options from a trusted provider will be there later. <br></p><p>“It’s independent living; you truly are living independently,” said Fandel, “and if there's a need for a higher level of care later in your life, it will be here.” <br><br><em>Steve Manning is a journalist based in New York City.</em></p>	The second in an article series about the challenges and opportunities the silver tsunami will bring to long term care in the United States.	2025-06-01T04:00:00Z	<img alt="" src="/Issues/2025/Summer/PublishingImages/Sum25_Tsunami.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature	Steve Manning	52	2

The Wide World of CNA Training

https://www.providermagazine.com/Issues/2025/Summer/Pages/The-Wide-World-of-CNA-Training.aspx

The Wide World of CNA Training

<img src="/Issues/2025/Summer/PublishingImages/Sum25_CFTraining.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:400px;height:400px;" />Ideally, training to be a certified nurse assistant (CNA) is the start of a powerful journey in the world of caring. It is more than just classes and testing. It is about nurturing and growing skilled team players. It is about attracting great employees and retaining them over time. “We have to make an investment in caregivers. There are multiple benefits that will positively impact our residents and our facilities,” said Robert Vande Merwe, executive director of the Idaho Health Care Association. There are many options for CNA training. Some long term care organizations have their own programs, and there are programs provided by vocational schools and community colleges. There are online courses and in-person classes. Costs range from several hundred dollars to a few thousand. However, Vande Merwe pointed out, “This doesn’t come near the cost to replace and train new CNAs or the high cost of hiring agency staff.” <h3>In-House Programs: Targeted Training</h3>It can be challenging and expensive for communities to create and maintain their own CNA training program. But some do it and do it well. For instance, Deborah Rowe, MS, RN, PHR, CHCR, vice president of nursing workforce development at Genesis HealthCare, shared her organization’s experiences. She recalled, “In 1999, Genesis created and received state approval for its nurse aide training program. This program consists of mandatory hours on the principles of nursing with supervised lab and clinical experience. At the successful completion of the training program, graduates are eligible to take their state competency examination for certification/licensure as a nursing assistant.” Genesis trialed one center in Maryland and expanded the model over time. Rowe noted, “We offer the nurse aide training program primarily to students where there is an approved Genesis-affiliated training center and make it available to other affiliated centers. In the program, there is a dedicated nursing instructor to provide ongoing nurse aide training. We attract and hire candidates from the communities we serve while also offering incumbent team members the opportunity to advance and train employees for certification/licensure.” Currently, Genesis has more than 65 in-facility nurse aide training programs in more than 13 states. “When training comes from the facility, it’s more focused on the facility’s needs,” said Vande Merwe—and this has benefits. <h3>Array of Options</h3>There are several options for CNA training. According to federal regulations, for a nurse aide training and competency evaluation program to be approved by the state, it needs to meet specific standards, including no less than 75 clock hours of training, 16 hours of supervised practical training, and instructors that have completed a course in teaching adults or with experience in teaching adults or supervising nurse aides. Other personnel from health professions may supplement the instructor, including, but not limited to, registered nurses, licensed practical nurses, nursing home administrators, physical and occupational therapists, and gerontologists. The American Health Care Association offers a robust, federally compliant nurse assistant training program designed to support workforce development in long term care. Now in its 8th edition, the How to Be a Nurse Assistant curriculum is a comprehensive solution for facility-based CNA training that includes a textbook, workbook, skills DVD, and an instructor website that provides chapter specific objectives, teaching tools, and sample calendars. AHCA senior director of marketing Chip Henderson notes that “we publish a new edition every five years to adopt updated federal guidelines as well as incorporate feedback from our customers—nurse instructors who depend on our vetted curriculum to prepare their students for a rewarding career in long term care.” <img src="/Issues/2025/Summer/PublishingImages/Kristen-Knapp-Close.jpg" alt="Kristen Knapp" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />To build upon its curriculum offerings, AHCA partnered with Academic Platforms in 2016 to develop CNAonline, a hybrid training model. The program combines online coursework with in-person, facility-based skills training grounded in the How to Be a Nurse Assistant curriculum. “The hybrid model leverages proven technology to enhance the learning experience for students and to overcome the limited availability of qualified nurse educators,” says Julie Gdowski, RN, nurse instructor and vice president of clinical operations at Academic Platforms. “The flexibility of having the curriculum online allows students to engage with training 24/7 as their schedules allow.” Learn more at <a href="http://www.cnaonline.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">CNAonline.com</a>. In Florida, a personal care attendant (PCA) program was started during the COVID-19 pandemic. Kristen Knapp, APR, CAE, senior director of strategy and communications at the Florida Health Care Association, said, “I like to call it an ‘earn while you learn’ program.” Essentially, an aspiring CNA can come into the nursing home, go through competency training, and learn alongside an experienced CNA. “They’re basically doing not quite everything that the CNA does but many tasks that the CNA performs using many of the skills they need,” said Knapp. The program is designed to prepare participants to take the CNA exam. After 120 days, they are no longer PCAs, so they have to take the certification test or move into another position—such as dietary aide—if they decide they don’t want to be a CNA.<h3>Content Counts</h3>Of course, it’s not just the type of training course that comes into play; content counts. While most programs cover the basics, there likely are some variations. “Some caregivers have limited training in mental health or dementia,” Vande Merwe explained, “and the bulk of our residents have some kind of dementia, depression, or other mental illnesses and behavioral health issues. So we have to do on-the-job training and/or education in our own classrooms on those topics. “The key to keeping good CNAs is to make sure they are competent and confident,” he said. <img src="/Issues/2025/Summer/PublishingImages/Robert-Vande-Merwe.jpg" alt="Robert Vande Merwe" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />It is important to know what competencies new hires have specific to the facility’s needs and identify any gaps that need to be filled. Vande Merwe observed, “Every facility has a slightly different population. Some have memory care units, some have more residents with behavioral health issues, some do mostly rehab, some have wound care programs, and so on. CNAs come out of training as generalists, so it’s up to each facility to make sure they have the special skills to deal with its population.” He added, “This additional training is important because if you’re asking people to do tasks they’re not confident doing, it’s just a recipe for turnover.” As with training for many other professions, CNA training doesn’t necessarily include nonclinical skills such as conflict resolution, having difficult conversations, leadership, and stress management. Vande Merwe noted, “Most CNAs come to us straight out of high school with little or no work experience, so they need some training on how to be an effective worker. This not only means information about conflict resolution and other skills; they also need to know the importance of punctuality, respecting your colleagues, and budgeting and financial management.” CNAs should be encouraged to seek additional training and education over time. “We need to figure out how to use the skills they have and maintain a culture where CNAs are comfortable going to a supervisor and asking for additional or repeated training on issues that impact their work,” Vande Merwe said. Team leaders and members also need to value CNA training, and this can be challenging when there are wide age gaps between staff members. Vande Merwe observed, “Most new CNAs are in their late teens or early twenties, and they may be working with nurses and others who have been on the job for twenty or more years. When everyone sees CNAs as valuable members of the clinical care team and treats them as such, caregivers are more likely to take pride in their work. This is a strong contributor to retention. Just this year, the National Association of Health Care Assistants launched the CareForce Academy, an education center for frontline direct care professionals. The organization recruits students and connects them with direct care education and training via curricula designed and taught by health care leaders. <h3>Beyond Training: Career Prep</h3>Vicky Castillo, MSNed, RN, CNE, president and founder of Facets Healthcare Training, said, “There’s been a lot of concentration in nurse assistant training and education, and I’ve started and worked with many different types of programs.” For instance, she was a program coordinator/manager for a large nurse assistant instruction program in Arizona, where 650 to 800 students per year were trained. She discovered there was a dearth of certification test-preparation programs for nurse assistants, so she created one. Because testing and certification varies from state to state, this training has to be state-specific. <img src="/Issues/2025/Summer/PublishingImages/Charlene-Brown.jpg" alt="Charlene Brown" class="ms-rtePosition-1" style="margin:5px;width:150px;height:184px;" />Similarly, CNA Simulations works to ensure students succeed in their future roles in long term care while also helping them get ready for the CNA skills exam. Through partnerships with schools and employers, the company offers virtual clinical skills simulations for CNAs, home health aides, and family caregivers. Founder and CEO Charlene Brown, MD, MPH, explained, "We focus on essential clinical and critical thinking skills, allowing students to simulate real-life care scenarios. This helps them respond to unexpected challenges and refine the skills they've learned. CNA training programs use our simulations to enhance their teaching." Brown emphasized that giving CNAs a chance to practice risk-free, realistic care before they start is crucial for retention. "I found that CNAs often wish they had more clinical experience, especially in areas like infection control and dementia care," she said. "Simulations help to bridge this gap. When CNAs start feeling prepared and know what to expect, they're more likely to thrive and feel confident in their roles."<h3>What CNAs Want</h3>Like most adult learners, CNAs prefer programs that are interactive and hands-on. Deborah Rowe said, “The nurse aide students I’ve worked with like working directly with the residents and patients. They enjoy the relationships they establish as they are practicing their skills in the clinical setting.” Sherry Perry reflected, “I think a lot of CNAs would prefer a training program that enables them to be a well-rounded professional who can work anywhere.” She noted that when she was training, she and her fellow students especially appreciated learning about issues such as medical side effects, signs and symptoms of various illnesses and conditions, and various medical terminology. Behavioral management is a huge issue in long term care today, and Perry said, “There are many residents with dementia and mental illness, as well as young residents who are there because of strokes, aneurysms, and head injuries. CNAs need to be prepared to help manage behavioral issues to protect residents, their colleagues, and themselves.” Isaac Zralii, a longtime CNA who has worked in hospitals and nursing homes, has participated in multiple training programs, but the best, he said, was one offered through a high school vocational program. He explained, “I definitely felt like I had more hands-on learning. We also did clinicals in the hospital and nursing home. Our instructor was very good about conducting clinical debriefings that helped us learn.”<h3>Meeting an Ongoing Need</h3>Nurse aide training needs to be a priority, said Castillo. While there are many good programs, there are still some gaps. She said, “I’ve been to parts of Texas where they have one training program in a one-hundred-mile radius. This can be a significant deterrent for people who would like to be a CNA but can’t get to the training.” While most training programs are relatively affordable (less than $2,500), paying for training can be difficult for many people. Working with students to make the finances doable is useful. One option growing in popularity is apprenticeships. Vande Merwe said, “Apprenticeships present a great opportunity for people to preview the job they’re going to be doing. There actually are Department of Labor funds that can help pay for things like day care and transportation. These programs can help attract people to our industry.” <img src="/Issues/2025/Summer/PublishingImages/Vicky-Castillo.jpg" alt="Vicky Castillo" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />Castillo said, “At least some students will still have to work another job while they are going through training, or they may be juggling school and family. Programs need to be flexible and not just nine-to-five Monday through Friday.” It behooves facilities to help potential CNAs picture working in the field. Knapp said, “Before they spend the time and money to study, people want a better idea about what their job is and how it may be an important career step for them. I talked to one woman who worked as an amusement park train operator and wanted to do something else. She became a PCA and then a CNA, and she has goals to become a nurse. Our program gave her an opportunity to launch her health care career.” Another woman was a stay-at-home mom looking to get back into the workforce. She went from a PCA to CNA. She landed in her facility’s business office in an administrative role and hopes to become a nurse. Not everyone who goes through a CNA training program will want that job for life, but it can be a stepping stone for someone who is a valuable employee in another role. Vande Merwe said, “We have to figure out how to incentivize young people to choose a career or an entry level job as a CNA. There's just not enough bodies in America to care for all the boomers coming our way. If you don't think about how you're going to attract young people already, you better start investing in robots that can take care of seniors. And I don't think that's happening anytime soon.” <a href="https://ahcapublications.org/collections/nurse-assistant-8th-edition" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"><img src="/Issues/2025/Summer/PublishingImages/HTB-Textbook-3D.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:125px;height:138px;" /></a>AHCA/NCAL’s How to Be a Nurse Assistant training curriculum reflects current best practices, including updates on infection control, nutrition, resident rights, and care for individuals with intellectual and developmental disabilities, mental health conditions, and substance use disorders. <a href="https://ahcapublications.org/collections/nurse-assistant-8th-edition" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Learn more.</a> Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.

CNA training serves as a crucial entry point into health care, combining flexible education options with practical skills to prepare and retain compassionate, competent caregivers.

2025-06-01T04:00:00Z

Caregiving;Workforce

Cover Feature

Joanne Kaldy

52

2

Level Up Your Learning

https://www.providermagazine.com/Issues/2025/Summer/Pages/Editor's-Desk.aspx

Level Up Your Learning

Learning is a required skill when working in the health care industry. Whether it is changing regulations, updated science, technology innovations, or new mindsets, learning is the way we stay fresh and ready to perform at our highest level. Learning doesn’t necessarily mean schoolwork or book smarts. Being intentional about learning new skills, ideas, or strategies can be done through experience, critical thinking, problem-solving, and being adaptable. Certified nursing assistants (CNAs) are the backbone of the caregiving workforce, and long term care needs to appeal to young people as a career choice. New ways of <a href="/Issues/2025/Summer/Pages/The-Wide-World-of-CNA-Training.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">training CNAs</a> can help. This training can be targeted or a wide variety of skills, specific content plus career prep, or flexible hours with financial support. Updated federal guidance on <a href="/Issues/2025/Summer/Pages/Boost-Your-Team’s-Enhanced-Barrier-Precautions-IQ-.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">enhanced barrier precautions</a> (EBP) makes this the right time to ensure caregivers are current on regulations. This means assessing where you are, educating staff, and documenting along the way. EBP data will be important in your next survey. Learning also means keeping up with the wants and needs of potential residents. Baby boomers have an <a href="/Issues/2025/Summer/Pages/Matching-the-Mindset-of-Active,-Independent-Baby-Boomers.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">active and independent mindset</a> and want to keep that lifestyle as they age. Modernizing your marketing to appeal to potential residents can make a big difference. Another aspect of learning is working together in new ways. <a href="/Issues/2025/Summer/Pages/AHCA%27s-Better-Way-to-Support-an-Aging-America.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">AHCA’s 2025 policy agenda</a> includes bold solutions to benefit all stakeholders as we address workforce shortages, threats to reimbursement, and a broken oversight system. This issue also celebrates the <a href="/Issues/2025/Summer/Pages/2024-%20National-Quality-Award-Recipients-Honored.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">2024 National Quality Award</a> recipients, details the benefits of aggregated data in assisted living, and highlights how to be prepared to communicate in a crisis. The pace of change doesn’t slow down, yet we can face these changes with a growth mindset, curiosity, and resilience.

Learning doesn’t necessarily mean schoolwork or book smarts. Being intentional about learning new skills, ideas, or strategies can be done through experience, critical thinking, problem-solving, and being adaptable.

2025-06-01T04:00:00Z

Editor's Desk

Cover Story

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