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AHCA, NCAL Issue Statement in Support of the SKILLS Act<p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) have released the following statement in support of the <a href="https&#58;//">Strengthening Knowledge, Improving Learning, and Livelihoods (SKILLS) Act,</a> introduced by Congressman Fred Keller (R-Pa.). </p><p>The following statement is attributable to Mark Parkinson, AHCA/NCAL president and chief executive officer&#58;</p><p>“We thank Congressman Keller for introducing this important legislation. Today, nearly every nursing home and assisted living community is facing a workforce crisis due to the COVID-19 pandemic.</p><p>“A new <a href="https&#58;//">survey </a>of our members found that 86 percent of nursing homes and 77 percent of assisted living providers say their workforce situation has gotten worse over the last three months. Providers nationwide are struggling to fill vacant roles, and a lack of qualified candidates is one of the biggest obstacles in hiring workers.</p><p>“The SKILLS Act will help create a pipeline of essential workers for the long term care sector. Strengthening our workforce is critical to providing quality care for the millions of seniors in our nursing homes and assisted living communities, but we need federal resources to accomplish this. </p><p>“We appreciate Congressman Keller making the long term care workforce a priority, and we look forward to working with him to help pass this bill.”​</p>2021-09-24T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/1120_news1.jpg" style="BORDER&#58;0px solid;" />WorkforceJoanne EricksonA lack of qualified candidates is one of the biggest obstacles in hiring workers, association says.
Most Nursing Homes, Assisted Living Communities Face a Workforce Crisis<p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) have released a survey of nursing home and assisted living providers across the United States. Results from the survey highlight an urgent need for Congress to address the labor shortage facing the long term care industry.&#160; </p><p>Key findings include&#58;</p><p>•&#160;Eighty-six percent of nursing homes and 77 percent of assisted living providers said their workforce situation has gotten worse over the past three months.</p><p>•&#160;Nearly every nursing home (99 percent) and assisted living facility (96 percent) in the United States is facing a staffing shortage. Fifty-nine percent of nursing homes and nearly one-third of assisted living providers are experiencing a high level of staffing shortages. </p><p>•&#160;More than 7 out of 10 nursing homes and assisted living communities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff. </p><p>•&#160;Due to these shortages, nearly every nursing home and assisted living community is asking staff to work overtime or extra shifts. Nearly 70 percent of nursing homes are having to hire expensive agency staff. Fifty-eight percent of nursing homes are limiting new admissions.</p><p>•&#160;Seventy-eight percent of nursing homes and 71 percent of assisted living facilities are concerned workforce challenges might force them to close. More than one-third of nursing homes are very concerned about having to shut down their facility(ies).</p><p>“The survey demonstrates the severe workforce challenges long term care providers are facing due to the COVID-19 pandemic. Too many facilities are struggling to hire and retain staff that are needed to serve millions of vulnerable residents,” said Mark Parkinson, AHCA/NCAL president and chief executive officer.</p><p>“Lawmakers across the country must prioritize long term care, and that begins with providing resources to address workforce challenges. When facilities have the means to offer competitive wages and training programs, workers will follow,” he said. “We have laid out key proposals in our <a href="https&#58;//">Care for Our Seniors Act </a>that will allow us to boost our workforce, but without the help from Congress and state legislators, this will not be possible.”</p><p>Parkinson said the reconciliation package currently under construction is an appropriate vehicle for Congress to fund a long-term solution to address chronic staffing shortages in nursing homes and other long term care facilities. </p><p>“Congress has the opportunity right now, through budget reconciliation, to include meaningful investments in long term care, which will help address key staffing challenges,” he said.</p><p>“Our caregivers are the backbone of long term care, and they deserve the full support of our lawmakers. We cannot allow facilities to close because of these challenges, which will directly impact residents and their families, especially when lawmakers have the means to help solve this dire situation.”</p><p>Survey results can be found <a href="https&#58;//">HERE.</a></p>2021-09-22T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER&#58;0px solid;" />WorkforceJoanne EricksonFifty-eight percent of nursing homes are limiting new admissions due to worker shortages.
Blood Pressure Medication Could Also Treat Vascular Dementia: Study<p>​A new <a href="https&#58;//" target="_blank">study</a> published in the <em>Journal of Clinical Investigation</em> reports that a medicine used to treat high blood pressure could also be used to treat individuals with vascular dementia. Researchers at the University of Manchester discovered that the blood pressure drug amlodipine could help treat vascular dementia or stop it early on.<br></p><p>Small vessel diseases of the brain are considered the most common causes of memory loss, implicated in more than 40 percent of dementia cases, according to the study. The main risk factor for the development of the diseases is hypertension, and a number of clinical studies indicate that elevated blood pressure in mid-life is associated with cognitive decline in late-life. However, the cellular mechanisms linking hypertension to memory disturbance are not yet definitively established, the researchers said. <br></p><p>In the study, mice with hypertension were used to test the effects of two types of medicine—amlodipine, a calcium channel blocker that improves blood flow and dilates blood vessels, and losartan, which keeps blood vessels from narrowing, lowers blood pressure, and improves blood flow.<br></p><p>The test showed that chronic hypertension progressively disrupts on-demand delivery of blood to metabolically active areas of the brain (functional hyperemia) through diminished activity of the capillary endothelial cell inward-rectifier potassium channel called Kir2.1. Despite similar efficacy in reducing blood pressure, amlodipine, a voltage-dependent calcium-channel blocker, prevented hypertension-related damage to functional hyperemia, whereas losartan, an angiotensin II type 1 receptor blocker, did not. <br></p><p>“From a clinical perspective, these data suggest the need for new drug trials that exploit the greater efficacy of amlodipine relative to losartan in preventing vascular dementia in hypertensive patients,” the researchers said.<br></p><p>Further, the data collected suggest Kir2.1 as a possible therapeutic target in vascular dementia and indicate treatments may help to protect against late-life cognitive decline in patients with hypertension.<br></p><p>The study is supported by a number of organizations, including the American Heart Association, the Totman Medical Research Trust, and the British Heart Foundation.</p>2021-09-20T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News4.jpg" style="BORDER&#58;0px solid;" />CaregivingAmy Mendoza​Treatments may help protect against late-life cognitive decline, researchers suggest.
Long COVID Looms Large, But Objective Test Not Yet Available<p>The United States can expect at least 15 million cases of long COVID resulting from the COVID-19 pandemic, according to the Centers for Disease Control and Prevention (CDC). People with this condition will experience a variety of conditions, including risk of stroke and heart disease, chronic respiratory issues, brain fog, chronic fatigue, and more.</p><p>However, there aren’t currently any accepted objective diagnostic tests or biomarkers for the condition, and it is particularly challenging to diagnose in older adults, who have various chronic conditions with similar symptoms to long COVID.</p><p>“No one knows what the time course of long COVID will be or what proportion of patients will recover or have long-term symptoms. It is a frustratingly perplexing condition,” say authors of a recent article in the <em>New England Journal of Medicine.</em> They call for the development of a “health care framework and strategy based on unified, patient-centric, supportive principles.”</p><p>The authors further urge a coordinated national policy action and response based on five pillars—primary prevention, a well-funded international research agenda, application of lessons learned from experience with other post-infection syndromes, a holistic response to the clinical needs of long COVID patients, and health care providers who believe in research and can provide supportive care to their patients.</p><p>“Addressing this post-infection condition effectively is bound to be an extended and complex endeavor for the health care system and society, as well as for affected patients themselves. But taken together, these five interrelated efforts may go a long way toward mitigating the mounting human toll of long COVID,” say the article authors.</p><p>In long term and post-acute care, it is essential that all team members are trained and engaged to help identify patients with possible long COVID and address their care needs accordingly.</p><p>“Given the myriad symptoms involved with long COVID, it is important to integrate a multidisciplinary approach to care for these patients,” says Hanzla Quraishi, MD, a Chicago-based physiatrist. “This includes assessing and addressing deconditioning, respiratory issues, and long-term neurologic effects. These efforts are crucial to aiding in the recovery of patients suffering from this debilitating condition.”</p><p>For further information on the topic, go to <a href="/Topics/Special-Features/Pages/Long-COVID-An-Emerging-Threat.aspx">Long COVID&#58; An Emerging Threat.</a></p>2021-09-15T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0920_News1.jpg" style="BORDER&#58;0px solid;" />COVID-19Joanne KaldyResearchers are expecting more than 15 million cases in the United States, within an uncertain timeline.

  • During this past year, relationships and partnerships took on new significance. Local organizations with strong national connections were able to rise above the challenges and maintain a human touch when isolation was the norm.
  • What do ACOs, hospitals, and health systems participating in value-based payment models look for when referring patients to a post-acute care facility?
  • With the clinical crisis largely under control, it’s time for providers to assess what technical strategies they will need to adopt to rebuild census.



Putting the Care Back in Care Planning the Care Back in Care Planning<p>​F-tag 656, failure to develop and implement a comprehensive care plan, has been on the top 10 deficiencies list for years. Although this is not a new regulatory requirement, facility staff still struggle to achieve compliance with care planning during annual and complaint surveys. <br></p><p>Negative and siloed views such as, “No one looks at the care plan anyway” or “Only the nurse assessment coordinator is allowed to update the care plan,” serve only to further distance the care plan from its actual intent. While some may mistakenly view it as useless paper compliance, care plans should be viewed as a valuable tool for all staff.<br></p><p>The overall intent of the care plan is to articulate an approach to meet the resident’s goals and preferences and address medical, physical, mental, and psychosocial needs. However, care plans often look instead like lists of general interventions for nonspecific problems, which cannot actually drive resident care.<br></p><p>Refocusing the development and use of the care plan as a valuable tool for the interdisciplinary team (IDT) may help to provide more resident-centered care, improve outcomes, and reduce the risk of receiving an F656 citation during survey.</p><h2>Redefine the Care Plan as an Invaluable IDT Tool </h2><p>The guidance provided in the “State Operations Manual (SOM)” for §483.21(b) requires that “facility staff must work with the resident and his/her representative, if applicable, to understand and meet the resident’s preferences, choices, and goals during their stay at the facility.” However, the regulation allows the facility to determine how this process will be completed and to delegate to appropriate staff members.<br></p><p>The guidance continues that, “the facility must establish, document, and implement the care and services to be provided to each resident to assist in attaining or maintaining his or her highest practicable quality of life.”<br></p><p>While this regulation is well-known to most facility staff and is used to develop the comprehensive care plan, the final product often falls short of becoming an ongoing IDT tool to drive the care and services that the resident receives daily. The focus must be on developing the care plan to meet the needs and preferences of the resident, which will meet the regulatory requirements. However, if the focus is on checking a box for regulation, the team will miss critical elements or interventions. <br></p><p>If a physician asks, “What are we doing for Mr. Jones’ chronic obstructive pulmonary disease [COPD]?” The answer, from medication to diet, should be articulated in the care plan, providing the full holistic approach from the IDT. If Mrs. Johnson’s daughter asks what the facility is doing to prevent her mother from falling, all current interventions, from activities to rehabilitation, should be present in the care plan. <br></p><p>Using the care plan as a collaborative tool among all departments helps align the care and services the resident receives to assist them toward their goals. However, to achieve this, facilities must establish clear expectations regarding the level of detail and enforce and monitor timely updating.<br></p><p>If the team shifts its focus from meeting the minimums of regulatory requirements to instead elevate the purpose of the care plan, they can accomplish both by more effectively driving the care and services for the resident.</p><h2>Self-Identify Problems with Care Planning </h2><p>Care plans can come in various shapes and sizes; they may be handwritten on paper, completed electronically and printed, or maintained in electronic medical records (EMRs). Although EMRs have many benefits, they can also leave some gaps. Often, EMR users add interventions by simply checking an electronic box, which can lead to generic care plans that are not resident-centered.<br></p><p>Ready-to-go interventions often require individualization once added to the care plan. Failing to individualize results in confusing and incomplete care plans. <br></p><p>While direct care staff should frequently be accessing and updating the care plans, clinical leaders should also monitor for compliance and the quality of these updates. If a resident’s care or interventions have changed, did the team member responsible for the change update the appropriate care plan? Have resolved interventions been appropriately archived? Are the care plans easy to read for non-medical individuals? <br></p><p>Each time clinical leaders identify an incomplete or generalized intervention, or failure to timely update, they also identify a potential survey tag. While the process of monitoring and identifying these problems may be labor-intensive initially, as the facility’s culture adopts the care plan as a tool, the task becomes easier. </p><h2>Remove the Siloes </h2><p>Often, staff develop multidisciplinary care plans and believe they are creating interdisciplinary care plans. The key difference is that multidisciplinary care plans focus on the discipline, not the resident. One way to move toward a successful interdisciplinary care plan is to focus on the resident and their actual or potential needs. <br></p><p>For example, often the dietary department is responsible for completing section K of the Minimum Data Set, Swallowing and Nutritional Status. If a resident is coded as having a therapeutic diet, such as a diabetic diet, it will trigger the nutritional status care area assessment (CAA). This may result in the dietary manager or dietitian creating a care plan by focusing on the triggering reason. <br></p><p>The problem statement may read, “Mr. Jones receives a therapeutic diabetic diet due to having a diagnosis of diabetes.” This type of siloed care planning does not allow for an interdisciplinary approach because it does not focus on the resident’s needs. The resident’s need is not for a therapeutic diet, but rather, the management of his diabetes; the therapeutic diet is just one intervention the IDT provides the resident.<br></p><p>When the team shifts the focus to the resident’s needs and the resident’s goal is established with the team, the care plan becomes the IDT’s holistic approach to addressing these needs. As the road map to care, it is used to measure progress toward goals and ensure the resident’s preferences are being met.<br></p><p>The SOM, §483.21(b), states, “Care planning drives the type of care and services that a resident receives. If care planning is not complete, or is inadequate, the consequences may negatively impact the resident’s quality of life, as well as the quality of care and services received.” </p><h2>Include the Resident</h2><p>Among the tools available to surveyors are the Long-Term Care (LTC) Critical Element Pathways (CEPs). While there are over 40 tools, there is not one specifically for care planning. However, there are numerous pathways, from activities to behavior, and emotional status to nutrition.<br></p><p>All ask the same question: Did the facility develop and implement a comprehensive person-centered care plan that includes measurable objectives and time frames to meet the resident’s medical, nursing, mental, and psychosocial needs and includes the resident’s goals, desired outcomes, and preferences? <br>If this was not achieved, the facility will receive a F656 citation.<br></p><p>It is not enough to address what the IDT is doing for the resident’s needs—the resident must play an active part in developing the goals, expressing to staff what his or her desired outcome is, and the staff must understand his or her preferences for care. And just like updating the care plan when changes occur, the resident’s goals and preferences must be frequently reviewed with the resident to ensure it continues to reflect those goals and preferences. <br><br><em>Jessie McGill, RN, RAC-MT, RAC-MTA, is a curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). She can be reached at <a href="" target="_blank"></a>.</em></p>The overall intent of the care plan is to articulate an approach to meet the resident’s goals and preferences and address medical, physical, mental, and psychosocial needs. 2021-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/September/PublishingImages/0921_cgiving.jpg" style="BORDER:0px solid;" />CaregivingJessie McGill, RN

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