| Why the Right Hot Water System Matters in Senior Care | <p><img src="/Articles/PublishingImages/740%20x%20740/water.jpg" alt="hot water" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />Access to hot water is essential. We depend on it for comfort and for cleanliness, whether it’s for showers or for washing the evening’s dishes.</p><p>Senior living communities are no exception. In fact, access to reliably hot water may be especially important for these facilities, where it’s a major aspect of daily care routines.</p><p>From resident showers and laundry services to kitchen operations and infection control, access to hot water promotes a positive resident experience and allows caregivers to complete their work efficiently. To ensure that kind of access, it’s important to have the right equipment, including a water heating system that’s correctly sized to match the facility’s needs.</p><h3>When the Water Heater Is the Wrong Size</h3><p>When senior living communities have inadequate water heating systems, it can cause a number of unwanted complications.<br></p><ul><li>Inconsistent water temperatures can disrupt the daily routines of residents—leading to dissatisfaction and even hygiene concerns.</li><li>Similarly, there may be complaints from employees, whose ability to fulfill their daily caregiving functions can be compromised by inconsistent water temperatures.</li><li>Trying to serve the entire community with undersized or inefficient equipment can put a strain on the entire plumbing apparatus, contributing to expensive repair needs and premature equipment failure.</li><li>Outdated or poorly sized equipment may also elevate utility bills, meaning it can be an ongoing budgetary concern for the entire facility.</li></ul><p>For these reasons, it’s crucial for the management and facilities teams of any senior living community to verify that their water hearing system is appropriately sized to meet everyday needs.</p><h3>Key Considerations for Water Heater Selection</h3><p>When it comes to choosing the right water setup, there’s no one-size-fits-all solution. Different senior living communities will have different needs, and it’s important to work with a trusted installer who can provide some guidance.</p><p>One factor that will always prove determinative is demand. Water heater sizing depends on the number of rooms and appliances within the community, but also peak demand times—for example, if there are certain blocks of the day when most residents bathe or shower, it’s important to have a water heating system that can accommodate.</p><p>Setpoint delivery is a common concern when selecting a water heating system, and in most commercial contexts, a setpoint temperature of 140 degrees is recommended. Because senior living communities need water hot enough for sanitization purposes, a setpoint temperature of 180 degrees may be required.</p><p>Still another major concern is the footprint of the mechanical room itself. Simply put, it’s important to choose water heaters that can get the job done while still fitting in the allocated space—leaving some room for maintenance and servicing. Take into account piping, venting clearance and more, remembering that the spatial limitations of the mechanical room may dictate the number and size of tanks used (or in some cases, dictate the need for tankless heaters).</p><h3>Optimizing Hot Water Delivery in a Senior Living Community</h3><p>There are a number of things facilities managers can do to optimize the performance of their water heating system, both during the initial system setup and over the long haul.</p><p>First things first: For any kind of residential facility, water heater redundancy is highly recommended. Sharing the load between multiple units not only ensures greater consistency for residents, but it also means that if one unit malfunctions, there can still be at least some measure of hot water availability for the broader facility.</p><p>A particular concern in senior living communities is resident safety; scalding may be a real concern, but there are ways to minimize danger. Installing mixing valves can regulate water temperature before it reaches the tap, a critical way of averting potential accidents among the most vulnerable residents.</p><p>When investing in new water heating equipment, it’s always important to ask about maintenance—not just the required maintenance (necessary to keep the warranty valid) but also suggested maintenance, which can extend the unit’s longevity. Visual assessment and anode rod inspections are critical for keeping water heaters in good working order.</p><p>For larger facilities, integration with a building management system is another important way to remain vigilant about preventing significant issues—potentially addressing them before they become serious, and before they disrupt daily operations.</p><h3>The Right Hot Water System Is Key</h3><p>Having a dependable hot water source is necessary for any residential space—and it may be particularly important in senior living centers, where safety and sanitation concerns loom large. Facility managers have plenty of options to consider, including different fuel types, tank sizes and tankless options—and making the right choice for the facility can yield many long-term benefits.<br><br><em>Keith Kuliga is the mechanical sales support – commercial products for <a href="https://www.bradfordwhite.com/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Bradford White Water Heaters,</a> an American manufacturer and five-time ENERGY STAR</em><sup><em>®</em></sup><em> Partner of the Year.</em><br></p> | 2025-07-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/water.jpg" style="BORDER:0px solid;" /> | Caregiving | Keith Kuliga | From resident showers and laundry services to kitchen operations and infection control, access to hot water promotes a positive resident experience and allows caregivers to complete their work efficiently. |
| Why Orientation and Ongoing Training Matter for Reducing Turnover | <p><img src="/Articles/PublishingImages/2025/staff2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:300px;" />The long term care industry is no stranger to high turnover rates. In fact, according to the 2023 AHCA/NCAL survey, the average turnover rate for nursing staff in skilled nursing facilities hovers around 53 percent, with some facilities facing even higher rates. Yet behind every statistic is a resident waiting for consistent, compassionate care—and a team struggling to keep up.</p><p>Too often, we point fingers at wages or staffing ratios when part of the cause of turnover lies in how we onboard, support, and develop our teams. If we don’t give new hires the tools, mentorship, and ongoing training they need to succeed, they won’t stay. And when they leave, our residents and remaining staff pay the price.</p><p>It’s time to rethink our approach. Orientation and ongoing training aren’t optional extras; they are essential investments in quality care, staff engagement, and retention.</p><h3>Why Orientation Matters More Than Ever</h3><p>Onboarding isn’t just a checklist of HR paperwork and a quick tour of the building. It’s the first impression new employees get of the organization’s culture, and it can set the tone for whether they stay or leave. <a href="https://www.glassdoor.com/blog/hidden-costs-employee-onboarding-reduce/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteForeColor-2">Research indicates that 69 percent of employees</span></a> are more likely to remain with a company for at least three years if they experience a positive onboarding process.</p><p>Best practices for an effective orientation include:<br></p><ul><li>Customized role-specific training. Ensure that RNs, LPNs, CNAs, and ancillary staff each receive targeted content relevant to their scope of practice.</li><li>Peer mentorship. Pair new hires with experienced staff mentors who can provide hands-on support during the first 30-90 days.</li><li>Mission-driven integration. Introduce the facility’s values, resident population, and team expectations—not just policies and procedures.</li></ul><h3>Ongoing Training: The Secret to Retention</h3><p>Orientation is just the beginning. Ongoing training—both clinical and interpersonal—keeps staff engaged, competent, and connected. Facilities that invest in regular skill development, leadership pathways, and cross-training report lower turnover and higher staff satisfaction.</p><p>Strategies include:<br></p><ul><li>Quarterly in-services tied to real challenges, like dementia care techniques, infection prevention updates, and PDPM documentation skills.</li><li>Leadership development programs for CNAs and nurses interested in career growth.</li><li>Hands-on coaching. Administrators and DONs who round daily, offering real-time feedback and support, help staff feel seen and valued.</li></ul><p>For example, a 120-bed SNF in Texas saw a 22 percent reduction in CNA turnover after implementing a structured CNA career ladder program that included quarterly training sessions and mentorship opportunities. Another facility in Ohio embedded a “Culture of Learning” model, offering monthly education tailored to their quality priorities, and reported improved staff engagement scores and a 15 percent drop in overall turnover.<br></p><h3>The Cost of Inaction</h3><p>When facilities neglect orientation and training, they pay for it—literally. The estimated cost of replacing a single CNA is over $5,000, not to mention the impact on resident care and survey readiness. Multiply that across multiple roles, and the financial and human costs become staggering.</p><p><img src="/Articles/PublishingImages/2025/Veronica-Ceasar.jpg" alt="Veronica Ceaser" class="ms-rtePosition-2" style="margin:5px;" />If we want to create nursing homes where staff thrive—and residents receive the quality care they deserve—we must start by rebuilding our orientation and training processes. It’s not enough to hire people; we must invest in them.</p><p>Turnover is a symptom. Training is part of the cure.<br><br><em>Veronica Ceaser, MBA, MSN, LNHA, RN, GERO-BC, QCP, RAC-CT, is a long term care consultant and the founder of GEM Healthcare Consulting. With a background spanning bedside nursing to executive leadership, Ceaser specializes in MDS training, quality improvement, and regulatory readiness for skilled nursing teams across the U.S.</em><br></p> | 2025-06-17T04:00:00Z | <img alt="" height="740" src="/Articles/PublishingImages/2025/staff2.jpg" width="740" style="BORDER:0px solid;" /> | Turnover | Veronica Ceaser, RN | If we want to create nursing homes where staff thrive—and residents receive the quality care they deserve—we must start by rebuilding our orientation and training processes. It’s not enough to hire people; we must invest in them. |
| Long Term Care Voices in Research: What We Are Doing and Why | <p><img src="/SiteCollectionImages/logos/ahcancal_740.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />AHCA/NCAL helps shape and execute federally-funded research across the country that will deliver solutions to our members. We are action-oriented—we want to find out what works to achieve better outcomes in post-acute and long term care (LTC). Our involvement spans different levels of effort, and includes advising, recruiting research participants, and implementing new strategies to evaluate. We and our research partners, who are often universities, are funded by the National Institutes of Health (NIH), National Institute on Aging (NIA), the Patient-Centered Outcomes Research Institute (PCORI), and others. </p><h3>Why do we prioritize research on effectiveness?</h3><p><strong>1.    Most studies on the effectiveness of treatments do not include older adults.<sup>1</sup></strong>  Most clinical trials enroll a younger population. The under-representation of older, medically-complex adults in clinical trials has real-world effects. For example, the use of semaglutide (e.g., Ozempic) is on the rise, and not just among younger patients. Yet, we don’t fully know the effects on an older population. Additionally, individuals receiving care in long term care settings—particularly people living with dementia—are frequently excluded from clinical trials. Building the capacity to help test treatments in older adults with a wider range of conditions will yield better information to improve care delivered in long term settings. That is one of the reasons AHCA established the <a href="/Issues/2024/Winter/Pages/Celebrating-the-Center-for-Long-Term-Quality-%26-Innovation’s-10th-Anniversary.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Center for Long-Term Care Quality & Innovation</a> at the Brown University School of Public Health 10 years ago.<br><strong>2.    We want to deliver solutions.</strong> The bulk of published literature about the LTC setting focuses on analysis of trends in outcomes over time or for specific populations. These types of studies are just the first step. We often already know where the opportunities for improvement are, so we want to encourage more attention on evaluating what strategies and interventions can achieve different—and better—resident outcomes. <br><strong>3.    We want to increase learning and development opportunities for professionals working in LTC settings. </strong>Research that yields information on what works for improving outcomes for older adults, and how new clinical practices and treatments can be implemented in nursing homes and assisted living communities, will generate an evidence base that LTC setting professionals can use. This evidence base is just one piece of what is needed to create a learning health system<sup>2</sup> within LTC settings. A learning health system creates development and career opportunities for professionals, attracts and retains leadership and staff who are committed to continuous improvement, and identifies additional topics for future research.<br></p><h3>How is AHCA/NCAL supporting effectiveness research in LTC? Some examples:</h3><ul><li><strong><a href="https://www.ltcdatacooperative.org/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">LTC Data Cooperative.</a> </strong>The LTC Data Cooperative is a provider-led initiative that is funded by NIA and involves a partnership with Brown. It assembles electronic health record (EHR) data from the major LTC EHR vendors on behalf of provider organizations that choose to participate. This resource is developed with minimal burden to providers. The Research Review Committee, with a majority of providers as members, reviews proposals from researchers to use these data for two approved uses: observational, comparative effectiveness research or clinical trials. Data may be linked with Medicare and Medicaid claims for research purposes.</li><li>Led by Brown, the University of Pittsburgh, and Boston University with funding by NIH, <a href="https://sites.brown.edu/learrn/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Learning Health Systems Research Rehabilitation Network (LeaRRN)</a><strong> </strong>funded two types of projects: 12-month partnerships between rehabilitation researchers and health systems to research topics of interest to the health system, and pilot grants to research priority topics to test and improve rehabilitation science in LTC settings.</li><li><strong><a href="https://sites.duke.edu/prism/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Prevention of Injury in Skilled Nursing Facilities through Medication Optimization (PRISM).</a></strong> Funded by PCORI, this trial compares three evidence-based approaches to determine which is better at reducing falls with injury after a fracture, and which has fewest adverse side effects and other symptoms. A fracture nurse consultant identifies eligible patients at participating skilled nursing facilities and works with them (or their representatives) remotely to recommend potential ways to either (1) reduce medications that increase risk of falls, (2) increase osteoporosis medications, or (3) both. The study will compare the outcomes of people who received each of these approaches.</li><li><strong><a href="https://www.cdc.gov/project-firstline/programs/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Project Firstline and Building Trust Leadership Academy.</a></strong> Funded by the Centers for Disease Control and Prevention (CDC), AHCA has developed a library of infection prevention and control resources housed at the <a href="https://www.ahcancal.org/Quality/Pages/NIPF.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">National Infection Prevention Forum (NIPF)</a>. The NIPF invites Infection Preventionists in LTC to share questions and answers with each other in an online format. Similarly, AHCA has developed and evaluated the Building Trust Leadership Academy, which brings together LTC leaders in live online sessions to follow evidence-based practices in assessing and improving levels of trust within buildings.</li></ul><h3>Why is federal funding for research important to nursing home and assisted living owners and operators? </h3><ul><li>Increasing the evidence for what works to improve outcomes—whether it’s care practices, staff education, or treatments—can help guide policy, regulations, and operations, which could yield benefits both clinically and financially.</li><li>For example, we learned during the COVID-19 pandemic that getting faster, more accurate understanding of outcomes from real-world data like the EHR data in the LTC Data Cooperative can guide action and policy to save lives in LTC.</li><li>Federal funding for research helps to attract new scientists to study important questions that are relevant to our sector—and get answers to the challenges we will face as the older population expands and the demand for post-acute and LTC increases. </li></ul><div><h3>Key points:</h3><ul><li>Older, medically complex adults are frequently excluded from clinical trials, even if they will be frequent end-users of the treatments being tested.</li><li>AHCA/NCAL supports projects in LTC settings like the LTC Data Cooperative, LeaRRN, PRISM, and others that investigate the effectiveness of care and treatments for older adults – and create actionable findings for our members.</li><li>Protecting federal research funding conducted in the long term care sector is imperative to improve outcomes for the expanding older population.</li></ul><br></div><div><br></div><ol><li><span class="ms-rteStyle-Normal">Schwartz, JB. Current status of inclusion of older groups in evaluations of new medications: Gaps and implementation needs to fill them. J Am Geriatr Soc. 2024;72:2894–2902. DOI: 10.1111/jgs.18912.</span></li><li><span class="ms-rteStyle-Normal">Agency for Healthcare Research and Quality, Rockville, MD. About Learning Health Systems. Accessed at: </span><a href="https://www.ahrq.gov/learning-health-systems/about.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteStyle-Normal">https://www.ahrq.gov/learning-health-systems/about.html. </span></a></li></ol><div>Rev: 6.17.25</div> | 2025-06-10T04:00:00Z | <img alt="" src="/SiteCollectionImages/logos/ahcancal_740.jpg" style="BORDER:0px solid;" /> | Policy;Caregiving | AHCA/NCAL Staff | AHCA/NCAL helps shape and execute federally-funded research across the country that will deliver solutions to our members. |
| What You Can Do to Prepare for a Data Incident | <p><img src="/Articles/PublishingImages/740%20x%20740/dr_computer.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />While long term care and senior living organizations may not be able to prevent a data incident, there are many steps an organization can take to prepare.<br></p><h3>Know Your Data</h3><p>The first step in preparing for a data incident is to understand the landscape, including the applicable regulatory schemes, your organization’s contractual and other commitments, and the individually identifiable data it maintains and transmits.</p><p>A threshold question is whether HIPAA and its breach notification requirements will apply. HIPAA applies to health care providers billing federal or commercial payors or engaging in other “standard transactions” using prescribed forms, including electronic coordination of benefits or enrollment activities, which will include most skilled nursing facilities, home health agencies, hospices, and certain assisted living facilities. Vendors supporting long term care organizations will be regulated by HIPAA if their services involve using or disclosing protected health information.</p><p>Organizations falling outside of HIPAA that provide electronic health care offerings, including websites and apps that track fitness, sleep, and diet, as well as vendors that provide services to such organizations, may be subject to the breach notification requirements of the FTC’s Health Breach Notification Rule.</p><p>In addition, each state has a data breach notification law. While similar, the varying state provisions defining the types of data deemed to be personal information and the types of events that trigger a breach can pose challenges for organizations serving individuals across multiple states. For example, certain states consider health information to be personal information while others focus on Social Security numbers, driver’s license numbers, and financial account information.</p><p>In addition to understanding applicable laws and regulations, long term care and senior housing entities should understand their organization’s contractual commitments, as well as its policies and any public-facing commitments. For example, vendors in the long term care space should understand data incident reporting requirements of any HIPAA business associate agreements that they have executed, and an organization with a website privacy policy or a HIPAA Notice of Privacy Practices should take into account any commitments made in those documents regarding incident or breach notification.</p><p>Finally, in order to prepare for a data incident, a long term care or senior housing organization should understand what individually identifiable data it holds, where that data is maintained, and, to the extent applicable, where and how that data is transmitted. This will include resident and patient data as well as other types of sensitive data, including employee/board member/volunteer/vendor personal information, financial information on individuals or entities, and any data held by sponsors of self-insured health and welfare plans on plan beneficiaries. Your organization should understand on which servers or other locations it stores which data; which apps, systems, or other methods are used to transmit data; and the persons or entities who receive individually identifiable data from your organization.<br></p><h3>Analyze Risks and Make a Plan</h3><p>Your organization should take what you learned about your data, applicable laws and regulations, and relevant commitments and apply those elements to risk analysis and management and incident preparation. One of the best ways to prepare for a data incident is to conduct a comprehensive and enterprise-wide security risk analysis. This is a requirement for entities regulated under HIPAA and other cybersecurity compliance structures, such as an International Standards Organization (ISO) certification, and it is a vital best practice for every organization. </p><p>A risk analysis can be conducted internally by information security and compliance personnel or externally by a vendor to analyze risks and vulnerabilities to confidential data across the organization. This analysis should be conducted at least annually and should be a living document, updated to reflect any new service lines, processes, or technology.</p><p>Long term care and senior housing organizations should take the results of a security risk analysis and create a risk management plan, focusing on eliminating or mitigating areas of high risk and progressing down to areas of lower importance. This process can be structured in a manner that is manageable for the organization and that allows different individuals to tackle issues simultaneously under a centralized plan. <br></p><h3>Training Staff and Vendors</h3><p>As organizations look to address identified risks, it is important to ensure that their data security program addresses risks related to two common “weakest links”—personnel and vendors. HIPAA, certain state laws, and other certification requirements mandate that organizations implement data security training. While this can be accomplished with a template online module, providing personnel with focused, role-based data security training may result in greater security awareness. Entities also should provide training updates, reminders, and tailored responses to identified threats or actual incidents.</p><p>Vendor diligence and security controls also are critical to preventing data incidents, and vendor contracts can be used as a vehicle to require the vendor to maintain certain security standards to protect confidential data, to specify incident reporting requirements, and to require indemnification for data incident-related liability. <br></p><h3>Formulate an Incident Response Plan</h3><p>Another key component to preparing for a data incident is an organization’s incident response plan. Similar to a security risk analysis, the incident response plan must be a living document that is updated to account for personnel changes within the organization, new vendors, identified risks, and other organizational changes. It should outline your incident response team, including internal personnel and external vendors, as well as the responsibility allocated to team members. The plan should be structured in a way that describes how the organization will respond to specific types of incidents and the risks identified by your organization.</p><p>The incident response plan also should include template documents to facilitate a rapid response at the time of an incident. For example, your organization can prepare template data breach notifications for regulators, individuals, consumer reporting agencies, and the media. The plan also can include communication templates for internal and external stakeholder notifications.</p><p>The final implementation step is to ensure that your incident response team, as well as all of your organization’s personnel, understand the protocols in place for an incident or potential incident. The incident response team should conduct periodic tabletop exercises to simulate an incident and practice the organization’s response. Lessons learned and gaps identified should be addressed in an update to the incident response plan.</p><p><img src="/Articles/PublishingImages/2025/ValerieBreslingMontague.jpg" alt="Valerie Breslin Montague" class="ms-rtePosition-2" style="margin:5px;width:150px;height:184px;" />While your organization may not be able to thwart a data incident, resources invested into planning for one may result in greater security for confidential data, faster identification of a potential issue, and more efficient data event response.<br><br><em>Valerie Breslin Montague is partner at Nixon Peabody LLP and a Certified Information Privacy Professional/United States (CIPP/US), the preeminent credential in the field of privacy.</em><br></p> | 2025-06-03T04:00:00Z | <img alt="© <a href='https://www.123rf.com/profile_rawpixel'>rawpixel</a>, <a href='https://www.123rf.com/free-images/'>123RF Free Images<" src="/Articles/PublishingImages/740%20x%20740/dr_computer.jpg" style="BORDER:0px solid;" /> | Caregiving | | Your organization should take what you learned about your data, applicable laws and regulations, and relevant commitments and apply those elements to risk analysis and management and incident preparation. |