Provider Magazine – covers nursing homes – assisted living - memory care – rehab - policy



AHCA, NCAL Call on Congress to Include LTC in Infrastructure Package<p>The American Health Care Association/National Center for Assisted Living is urging Congress to prioritize America’s seniors as it continues to negotiate a bipartisan infrastructure package.</p><p>Lawmakers must allocate support for providers to make capital improvements to nursing homes and assisted living communities across the country to ensure that residents receive the highest quality of care and additional protection against infectious diseases and other emergency events, the association says.</p><p>Too many facilities remain in dire need of upgrades, the group says. Nursing homes would like to evolve and make infrastructure investments, such as improving technology, indoor air quality, and energy backups, but many cannot afford to do so.</p><p>Chronic Medicaid underfunding left the average nursing home barely able to break even—even before the pandemic. Now, the industry is grappling with an economic crisis brought on by the COVID-19 pandemic.</p><p>Only <a href="https&#58;//">one-quarter </a>of nursing homes and assisted living communities are confident they will make it through to next year due to the financial strain caused by responding to the crisis, according to a new AHCA/NCAL survey. Facilities are struggling just to make ends meet—they cannot afford to provide much-needed infrastructure improvements without additional help from lawmakers, they report.</p><p>Significant upgrades are needed to ensure long term care residents are protected, connected, and well cared for. Specifically, AHCA/NCAL is advocating that the infrastructure package include funding for long term care to make improvements in&#58;</p><p>•&#160;Indoor Air Quality&#58; Upgrading heating, ventilation, and air conditioning systems, as well as humidification and air pressure, helps prevent the spread of airborne infectious diseases and reduces respiratory issues, improving the health and comfort of both residents and staff.</p><p>•&#160;Technology&#58; Expanding access to broadband would help rural long term care providers ensure residents stay connected with their loved ones as well as enhance telehealth options.</p><p>•&#160;Emergency Preparedness&#58; In the face of escalating, unpredictable weather events and other natural disasters, long term care facilities need back-up energy solutions to maintain day-to-day operations, such as enhanced generator capacity, additional battery power sources, and solar panels.</p><p>•&#160;Enhanced Sanitization and Monitoring&#58; Long term care facilities could implement more infection control best practices with UVC lighting and wastewater monitoring to catch and address potential risks more efficiently.</p><p>With the proper government support, nursing homes can invest in their workforce, clinical services, and infrastructure to continue to improve residents’ quality of life. AHCA and LeadingAge’s <a href="https&#58;//">Care For Our Seniors Act </a>includes immediate and long-term strategies to address Medicaid underfunding for nursing homes, as well as other reforms that will help boost the workforce, modernize physical structures, and enhance infection control procedures. </p><p>The country must learn from this pandemic and other national emergencies, AHCA/NCAL says. Congress must prioritize seniors in the infrastructure package and help provide critical funding so long term care facilities can provide better care and be better prepared.<br></p>2021-07-21T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/senior_man_nurse.jpg" style="BORDER&#58;0px solid;" />COVID-19Joanne EricksonOnly one-quarter of nursing and assisted living centers are confident they will make it through to next year.
Survey Supports Key Role of Attending Physicians in Quality Care<p>A recent article in JAMDA details a job analysis of attending physicians in long term/post-acute care that documents the unique and specific role they play in this setting.</p><p>“The pandemic highlighted the importance of engaged physicians to care for our residents, provide comfort measures, and prevent avoidable hospitalizations. This analysis bears out the importance of this involvement,” says Laura Morton, MD, CMD, one of the article’s authors. </p><p>The survey of attending physicians addressed a list of tasks, experience, and medical knowledge needed in their role in long term care. These items, developed and refined by a task force of subject matter experts, were written as statements that described distinct, identifiable, and specific practice-related activities. In all the survey consisted of 260 items.</p><p>The results showed that attending physicians supported statements related to ethical and culturally sensitive conduct, including applying principles of shared decision making, to achieve a patient- and resident-centered approach to care.</p><p>They also ranked highly knowledge relating to maintaining good facility coverage. Top medical care delivery statements related to recognizing, assessing, and treating patients and residents in a timely and nondisruptive manner, and ensuring continuous medical coverage. </p><p>Top-rated medical knowledge tasks centered on utilizing individualized information about comorbidities and risk factors to evaluate symptoms, as well as developing and following plans for additional and regular evaluation and re-evaluation. This includes deprescribing medications whenever possible. In support of these tasks, knowledge of differential diagnosis, deprescribing, pain management, multiple morbidity, and the use of decision-making tools were all highly rated.</p><p>“We hope that facility leaders will use this information to start a dialogue with attending physicians,” says Morton. “Talk about how you can work together to ensure the best possible care for residents.” Some physicians are more experienced than others, she notes, but there are numerous training and educational opportunities for all of them. “It is important to give physicians the tools and resources to succeed in this environment,” she says.</p><p>As new attendings come into facilities with little experience in this setting, it is important to ensure they understand the many unique aspects of long term/post-acute care, Morton says. “This requires training and education, and it will be useful to connect them with experienced practitioners who understand the specific regulatory environment, clinical evidence, and best practices for this space.”</p><p>More than ever, she says, “We understand the need for collaboration with all team members. These relationships will help us moving forward and prepare for future outbreaks. Our attendings are a key part of this.”</p><p>The job analysis was conducted for the American Board of Post-Acute and Long-Term Care Medicine. It is available online <a href="https&#58;//">here.</a><br></p>2021-07-15T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0120_News4.jpg" style="BORDER&#58;0px solid;" />CaregivingJoanne KaldyAs new attendings come into facilities, it is important to ensure they understand the unique aspects of long term/post-acute care.
Access to Remaining Relief Funds Needed to Keep Long Term Care Facilities Afloat<p>​Nursing homes and assisted living communities have received approximately $14 billion of the $178 billion in the Provider Relief Fund (PRF) established by the CARES Act. This funding has been instrumental for long term care facilities struggling to make ends meet during the pandemic, but the remainder of the funds must be released so providers can continue to provide quality care to the nation’s seniors, according to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

</p><p>A recent AHCA/NCAL <a href="https&#58;//" target="_blank">survey found</a> that 92 percent of nursing homes and 62 percent of assisted living communities said the PRF has been helpful during the COVID-19 pandemic. The same survey found facilities continue to face significant ongoing economic challenges.<br></p><p>Only one-quarter of long term care providers were confident they will make it through to next year. Without additional government support, facilities may be forced to close. In fact, a recent AHCA/NCAL <a href="https&#58;//" target="_blank">analysis found </a>that nearly 2,000 nursing homes could shut their doors for good over the course of the pandemic. </p><p>

Increased costs from the pandemic for personal protective equipment (PPE), testing, and additional staffing, among other necessities, have put a strain on providers. Coupled with fewer new residents and patients, as well as longstanding Medicaid underfunding, many facilities are struggling to stay afloat. These facilities are home to millions of frail seniors who cannot afford for them to abruptly shut down and be forced to find new care.

“</p><p>The Provider Relief Fund was a lifesaver for many in long term care last year,” said Mark Parkinson, president and chief executive officer of AHCA/NCAL. “Whether it helped acquire PPE to protect residents and staff from COVID-19 or allowed providers to offer hero pay to workers who went above the call of duty, we are grateful to the federal government for helping us during this historically challenging time.”<br></p><p>While overall the situation has improved, he said, this battle with the virus is not over, and now the sector faces a new battle.<br></p><p>“Our sluggish economic recovery puts thousands of facilities in danger of closing, threatening access to long term care for vulnerable seniors and individuals with disabilities,” he said. “We call on the administration to distribute the remaining aid that was intended for health care providers and help bring stability to our sector, so we can continue serving our residents.”</p><p>

The PRF aid allows for facilities to offset some of the exorbitant costs of care stemming from the pandemic and relieve some of the burden providers face on a daily basis. <br></p><p>The initial funding in 2020 has been the difference between many facilities closing or being able to stay open, Parkinson said, but in 2021, as the pandemic persists and the economic recovery of the industry is slow, more is needed. 
</p><p>Members of Congress agree that long term care facilities need more federal aid. A <a href="https&#58;//" target="_blank">letter</a> sent to the U.S. Department of Health and Human Services (HHS) led by Congresswoman Terri Sewell (D-Ala.), co-signed by more than 50 Democrat and Republican members of Congress, requested an additional $10 billion from the PRF to be allocated to long term care facilities. 

</p><p>The PRF aid has already made a major impact on facilities across the nation, but the road to recovery does not end here, AHCA/NCAL said. Continued support is needed to win the fight and protect long term care residents and staff. Lawmakers must make long term care a top priority, and that begins with HHS releasing the remainder of the PRF so the nation’s health care heroes can continue serving the nation’s most vulnerable.</p>2021-07-13T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/housing.jpg" style="BORDER&#58;0px solid;" />ManagementJoanne EricksonWithout support, nearly 2,000 nursing homes could shut their doors for good over the course of the pandemic.
Senior Housing Industry Continues to Feel Effects of Pandemic<p>Senior housing occupancy showed no overall change in the second quarter of 2021, maintaining at 78.7 percent, according to new National Investment Center for Seniors Housing &amp; Care (NIC) MAP® data, generated by NIC MAP Vision.</p><p>Although COVID-19 cases in senior living properties continued to drop significantly in the last quarter, overall occupancy has not increased, which NIC attributes to new inventory coming online.</p><p>Despite unchanged occupancy, demand for senior housing improved in the second quarter.</p><p>“Second quarter data confirm anecdotes that occupancy at many properties improved as move-ins accelerated, thanks to limited property-level COVID-19 infections,” said NIC Chief Economist Beth Burnham Mace. “However, inventory grew and outpaced demand, and that’s why we aren’t seeing an occupancy uptick.”</p><p>Both assisted living and independent living properties experienced little change in occupancy, with independent living holding steady at 81.8 percent, and assisted living rising slightly to 75.5 percent.</p><p>San Jose (83.7 percent), Portland, Ore. (83.4 percent), and San Francisco (83.4 percent) had the highest occupancy rates of the 31 metropolitan markets that encompass NIC MAP’s Primary Markets. The markets experiencing the lowest occupancy rates included Houston (73.0 percent), Atlanta (74.8 percent), and Las Vegas (74.9 percent).</p><p>Looking further at the data, occupancy increases are being reported by a growing number of operators. In the second quarter of 2021, without breaking down percentages by care settings, 47 percent of senior housing properties in the NIC MAP Primary Markets reported an increase in occupancy. During the height of the pandemic, only 22.5 percent of properties reported occupancy increases.</p><p>“Some areas of the country are seeing senior housing occupancy improve, but the data show that we haven’t fully turned the corner,” said Chuck Harry, NIC’s chief operating officer. “Senior housing occupancy remaining unchanged suggests that it will likely take more time to see broad, nationwide improvement to the levels prior to the onset of the pandemic.”</p><p>There is a wide gap in performance between markets in NIC MAP’s Primary Markets. In Atlanta and Detroit, 55 percent of properties reported overall occupancy improvement, compared with just 33 percent of properties in Chicago.<br></p>2021-07-13T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0320_News4.jpg" style="BORDER&#58;0px solid;" />COVID-19;ManagementJoanne EricksonDespite unchanged occupancy, demand for senior housing improved in the second quarter.



CNAs and Vaccination: An Issue of Trust and Vaccination: An Issue of Trust<p>​Although COVID-19 vaccination rates for certified nurse assistants (CNAs) have increased significantly since the beginning of the year, many CNAs remain unvaccinated, for a variety of reasons.<br></p><p>As someone who worked for many years as a CNA and who now heads the largest professional association for CNAs, I believe that doctors who serve as medical directors for nursing homes hold the key to persuading those CNAs who are persuadable to get vaccinated and protect residents, their co-workers, their loved ones, and themselves.<br></p><p>Why do I say that? Because trust is a huge issue for CNAs, and they are more likely to trust the medical directors at their facilities to give them accurate, honest information about the vaccines than just about anyone else.</p><h2>Medical Directors are Local Experts</h2><p>According to a <a href="" target="_blank">new guide</a> from the federal government for building CNAs’ confidence in the COVID-19 vaccines, CNAs who are most resistant to getting vaccinated also tend to trust their employers the least. Among those they trust most: local medical experts. This is critical, because CNAs get a lot of their information—and misinformation—on social media, especially Facebook.<br></p><p>Not only do CNAs view their medical directors as their local medical experts, but many also see them as their personal physicians. This is especially common in rural areas that are short on doctors.<br></p><p>CNAs typically have good working relationships with their facility medical directors, who respect their hands-on experience and expertise, as well as their compassion for the residents they care for. This respect is greatly appreciated by CNAs, who are among the lowest-paid workers in health care and who often feel underappreciated. In addition, medical directors aren’t nursing home employees, and CNAs see them not only as credible but also as more independent than other nursing home leaders.</p><h2>COVID Ups the Stakes</h2><p>CNAs have a tough time, and COVID-19 has made it tougher. Even before the pandemic, they worked long hours, often at multiple jobs. But this past year has been hell for them. Many have been sick themselves; they’ve also lost residents they cared for and co-workers as well. Their jobs have been incredibly stressful and demanding, even as the demands on them at home have increased.<br></p><p>There are many reasons why CNAs aren’t getting vaccinated. Some have taken a “wait and see” attitude, while others harbor fears and concerns that they feel haven’t been addressed. Some would like to get vaccinated, but they can’t afford to take unpaid time off from work, especially if they get sick from side effects, or they don’t have transportation or child care.<br></p><p>And remember: CNAs have been on the front lines of battling this virus and watching it unfold for over a year. Either they’ve gotten it and survived, or they haven’t gotten it at all.  The way they see it, they don’t need the vaccine. If they’ve gotten this far without it, why would they need it now?</p><h2>Meeting Early, Lingering Concerns</h2><p>I myself was wary of getting vaccinated at first. I thought those first vaccines came out too fast. They couldn’t be safe. But then my organization did a <a href="" target="_blank">vaccine education webinar</a> with AMDA, which represents medical directors serving long term care facilities and whose panelists were not only credible but open and respectful. They answered all my questions, so I came out in support of the vaccine and made my declaration to our members.<br></p><p>That’s who CNAs need to hear from: trusted medical experts at their facilities who will listen to their concerns about the vaccines and address them fully and respectfully. Very few administrators have time to do that—and I know, because I used to be a nursing home administrator, too.<br></p><p>I believe that the best way to persuade CNAs is to appeal to their desire to do good and protect others, especially their residents and co-workers. But they need to be heard out, and some of them may need logistical help as well.<br></p><p>Medical directors can play a strong role here. They can do one-on-ones with CNAs, either in person or virtually. They can speak at staff meetings or give webinars. They can be the go-to contact person at the facility for workers who have questions about the vaccines and respond via email or phone or in person.<br></p><p>To fully protect nursing home residents and workers against COVID-19, we need to vaccinate more CNAs. Medical directors of America, we trust you to answer our questions. When can we talk?<br></p><p><em><strong>Lori Porter </strong>is co-founder and chief executive officer of the National Association of Health Care Assistants (NAHCA). She can be reached at</em> <a href="" target="_blank"></a>. <br></p>Although COVID-19 vaccination rates for certified nurse assistants (CNAs) have increased significantly since the beginning of the year, many CNAs remain unvaccinated, for a variety of reasons.2021-06-29T04:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/LoriPorter.jpg" style="BORDER:0px solid;" />COVID-19;WorkforceLori Porter

 Take our Poll


Provider magazine will curate a series of thought-provoking talks. Known as LED — Lead, Engage, Discover — they are aimed at bringing you topics and ideas that are evocative, inspirational, and sometimes unsettling.