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Eli Lilly Touts Antibody Treatments for Preventing COVID in Nursing Homes<p>Eli Lilly and Company on Jan. 21 said its neutralizing antibody bamlanivimab (LY-CoV555) prevented COVID-19 infections at nursing homes in its latest trial, called the BLAZE-2 trial, reducing risk by up to 80 percent for residents.</p><p>In a statement, the company said Bamlanivimab significantly cut the risk of contracting symptomatic COVID-19 among residents and staff of long term care facilities. The antibody treatment is not a vaccine for COVID-19, but a treatment.</p><p>“The Phase 3 BLAZE-2 COVID-19 prevention trial—conducted in partnership with the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, and the COVID-19 Prevention Network—enrolled residents and staff at skilled nursing and assisted living facilities,” Eli Lilly said.</p><p>In total, 965 participants tested negative for the SARS-CoV-2 virus at baseline (299 residents and 666 staff), while132 participants (41 residents and 91 staff) tested positive for the virus, adding to the growing body of evidence for treatment with bamlanivimab, the company said.<br>All participants were randomized to receive either 4,200 mg of bamlanivimab or placebo.</p><p>After all participants reached eight weeks of follow-up, there was a significantly lower frequency of symptomatic COVID-19 (the primary endpoint) in the bamlanivimab treatment arm versus placebo.</p><p>In addition, Eli Lilly said for the prespecified subgroup of just nursing home residents (no staff), there was also a significantly lower frequency of symptomatic COVID-19 in those treated with bamlanivimab versus placebo. </p><p>“These results suggest that residents randomized to bamlanivimab have up to an 80 percent lower risk of contracting COVID-19 versus residents in the same facility randomized to placebo,” the company said.</p><p>Results from exploratory analyses of viral load in the treatment group were consistent with previously disclosed data from BLAZE-1 evaluating bamlanivimab as an outpatient treatment for recently diagnosed COVID-19.</p><p>Eli Lilly said among the 299 residents in the prevention group, there were four deaths attributed to COVID-19, and all occurred in the placebo arm. There were no COVID-19 attributed deaths in the bamlanivimab arm. Over the entire trial, there were a total of 16 deaths reported, including deaths not related to COVID-19, and all deaths were residents (11 deaths in placebo arm and five in bamlanivimab arm).</p><p>“We are exceptionally pleased with these positive results, which showed bamlanivimab was able to help prevent COVID-19, substantially reducing symptomatic disease among nursing home residents, some of the most vulnerable members of our society,” said Daniel Skovronsky, MD, PhD, Lilly's chief scientific officer and president of Lilly Research Laboratories. </p><p>“These data provide important additional clinical evidence regarding the use of bamlanivimab to fight COVID-19 and strengthen our conviction that monoclonal antibodies such as bamlanivimab can play a critical role in turning the tide of this pandemic.”</p><p>An independent data and safety monitoring board oversaw the BLAZE-2 trial. In the trial, the safety profile of bamlanivimab was consistent with observations from the Phase 1 and Phase 2 trials. Serious adverse events were reported at a similar frequency in the bamlanivimab and placebo groups. </p><p>Across multiple clinical trials, Lilly now has collected safety and efficacy data in more than 4,000 patients treated with bamlanivimab, either alone or administered together with another antibody.</p><p>Bamlanivimab is authorized for emergency use by the Food and Drug Administration for the treatment of mild to moderate COVID-19 in high-risk patients. Visit <a href="https&#58;//"> </a>to find out more about antibody therapy.<br></p>2021-01-22T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0120_News4.jpg" style="BORDER&#58;0px solid;" />COVID-19Patrick Connole​Trial found new agent significantly cut risk of contracting COVID-19 among residents, staff in long term care facilities.
AHCA, NCAL Ready to Work With New President, Congress on LTC Solutions<p>​The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) congratulated President Joe Biden and Vice President Kamala Harris on their inauguration into office, declaring the long term and post-acute care profession is ready to work with the new administration and Congress to find solutions to issues like COVID-19 vaccine distribution.</p><p>“We congratulate President Joe Biden and Vice President Kamala Harris on their inauguration, and we look forward to working with the new administration and 117th Congress to develop meaningful solutions for the challenges long term care providers face—many of which have been magnified by the pandemic,” said Mark Parkinson, president and chief executive officer of AHCA/NCAL.</p><p>“There is still an immediate crisis in front of us. Long term care providers are working with pharmacies and state officials to help administer life-saving vaccines swiftly to residents and staff, and we are hopeful we have reached a turning point in our fight against the virus,” he said. <br>However, with record-breaking numbers of COVID cases among the general population and in long term care facilities, “we cannot let our guard down,” Parkinson said. </p><p>“Lawmakers must continue to ensure that long term care facilities are made a priority for the resources they need to protect our most vulnerable citizens and our health care heroes on the frontlines.”</p><p>At the same time, the nursing care profession must reflect on the lessons learned throughout the pandemic and apply them toward strengthening the health care system. </p><p>“We will work collaboratively with the Biden Administration and members of Congress to achieve our goals and create a better future for our nation’s seniors,&quot; Parkinson said.<br></p>2021-01-20T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/white_house_3.jpg" style="BORDER&#58;0px solid;" />COVID-19Patrick ConnoleAssociation leader says there is still a crisis, with record-breaking numbers of COVID cases among the general population and within the facilities.
Fourth Quarter 2020 Sees Record Low Occupancy for Senior Housing<p>Senior housing occupancy decreased 1.3 percentage points in the fourth quarter of 2020 to 80.7 percent, a record low, according to new data from NIC MAP® Data Service (NIC MAP) provided by the National Investment Center for Seniors Housing &amp; Care (NIC).</p><p>Since the first quarter of 2020 when the COVID-19 pandemic began, occupancy fell by 6.8 percentage points.</p><p>“Senior housing occupancy declines were less pronounced in the fourth quarter than the previous two quarters, though the fourth quarter decline is still quite large from a historic perspective,” said NIC’s chief economist, Beth Burnham Mace. “The surge in COVID-19 cases following Thanksgiving and Christmas suggests further disruption lies ahead. That said, the recent distribution of the vaccines should soon provide some relief.”</p><p>NIC data show large disparities between occupancy rates across metropolitan markets. For instance, San Jose, Calif. (88.5 percent), San Francisco (86.9 percent), and Seattle (84.8 percent) had the highest occupancy rates of the 31 metropolitan markets that make up NIC MAP’s Primary Markets, while Houston (73.5 percent), Cleveland (76.6 percent), and Miami (76.7 percent) recorded the lowest.</p><p>NIC said assisted living occupancy fell 1.3 percentage points to 77.7 percent in the fourth quarter, and independent living occupancy dropped 1.4 percentage points to 83.5 percent. Since March, assisted living and independent living occupancy have fallen by 7.4 and 6.2 percentage points, respectively.</p><p>“The COVID-19 pandemic has impacted move-ins and move-outs across senior living properties,” said Chuck Harry, chief operating officer of NIC. “Move-ins slowed as operators enacted moratoriums to keep residents safe and as safety protocols limited new leasing activity, while move-outs have been affected as residents moved to higher-acuity care settings.”</p><p>Separately, inventory growth slowed sharply for assisted living with 1,626 units added in the Primary Markets, the fewest since the third quarter of 2013.</p><p><a href="https&#58;//">Click here </a>for the Market Fundamentals report.</p>2021-01-14T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0920_News1.jpg" style="BORDER&#58;0px solid;" />Patrick ConnoleNIC data show large disparities between occupancy rates across metropolitan markets.
Telehealth a Silver Lining in Pandemic<p><span></span>Since the pandemic began, telehealth services—specifically meeting with physicians online—have been a time saver for&#160;one Massachusetts provider.&#160;In &quot;The Telehealth Phenomenon,&quot; learn how providers have made changes to protect residents and keep care running smoothly, learning lessons and seeing benefits along the way.&#160;To read more, go to <em>Provider's </em>just<em> </em>released first digital issue <a href="https&#58;//;i=687740&amp;p=1">here.</a></p><p></p>2021-01-12T05:00:00Z<img alt="" src="/Monthly-Issue/2021/January/PublishingImages/telehealth-0121.jpg" style="BORDER&#58;0px solid;" />COVID-19;CaregivingAmy MendozaIn its first ever digital issue, Provider reports on how COVID-19 has changed the supply and demand of telehealth services in long term and post-acute care.

  • Steven Chies says there is no let-up in the need for owners and operators to be on alert for attempts by criminal elements to hack into their computer systems.
  • Reflecting on the past year since the start of the COVID-19 pandemic, vendor partners have seen a boom in interest from providers in EMRs, remote monitoring, and patient-family engagement. 
  • The COVID-19 pandemic has been something of a tropical storm, bringing waves of behavior from long term and post-acute care providers riding out an unpredictable sequence of events.



Using Payroll-Based Journal Data to Compute Nursing Hours Payroll-Based Journal Data to Compute Nursing Hours<p>Starting in spring 2018, the Centers for Medicare & Medicaid Services (CMS) began using Payroll-Based Journal (PBJ) data to determine each nursing facility's staffing levels for the Nursing Home Compare tool used in the agency's Five-Star Quality Rating System.  Accurate reporting is essential to a fair rating.</p><h2>How PBJ Works</h2><p>The PBJ system provides the reported staffing hours for each quarter. These data, based on Minimum Data Set (MDS) assessments, are used for CMS staffing calculations and are the basis for a nursing facility's Five-Star Rating. There is an added complexity, since CMS adjusts the reported staffing hours before calculating the ratings.</p><p>The adjusted hours <img src="file://///Users/shevonajohnson/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg" alt="" style="width:1px;margin:5px;" />H<sub>a</sub> for each staff type are given by using the formula: <img src="file://///Users/shevonajohnson/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg" alt="" style="width:1px;margin:5px;" /><img src="/Topics/Guest-Columns/PublishingImages/2020/Formulas3.png" alt="" style="margin:5px;" /> where H<sub>r</sub> <img src="file://///Users/shevonajohnson/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg" alt="" style="width:1px;margin:5px;" />represents the reported hours. The adjustment is based on <em>h</em><img src="file://///Users/shevonajohnson/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg" alt="" style="width:1px;margin:5px;" />, the case-mix or expected nurse staffing hours per resident per day and the national mean <em>m</em> <img src="file://///Users/shevonajohnson/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg" alt="" style="width:1px;margin:5px;" />of case-mix hours for all facilities. </p><p>The case-mix values are derived from STRIVE, which is a CMS Staff Time Resource Intensity Verification Study (2006-2007) that measured the average hours per resident per day for each staff type: RN (registered nurse), LPN (licensed practical nurse) and CNA (certified nurse assistant) based on the associated Resource Utilization Group (RUG-IV) 66.</p><h2>Rating Methodologies</h2><p>The Rating Methodology Rules shown below in Table 1 (taken from Table 4) of the July 2020 CMS Technical Users Guide, “Design for Nursing Home Compare Five-Star Quality Rating System."  <br></p><p><br></p><p style="text-align:center;"><img src="/Topics/Guest-Columns/PublishingImages/2020/Table1.png" alt="" style="margin:5px;" /> </p><p style="text-align:center;"><br></p><h2>Nursing Levels Categorized</h2><p>It is important to note that two separate staffing level ratings are published by CMS. </p><p>One rating is for RN Staffing, and the other is the Overall Staffing. As illustrated in the table above, RN hours greater or equal to 1.049 will result in a Five-Star RN Rating. The combined sum of RN + LPN + CNA greater than or equal to 4.038 will give an Overall Five-Star Rating.  The combination of adjusted values that result in 5, 4, and 3 stars, respectively, are summarized in Table 2 below.</p><p><br></p><p style="text-align:center;"> <img src="/Topics/Guest-Columns/PublishingImages/2020/Table2.png" alt="" style="margin:5px;" /></p><p style="text-align:center;"><br></p><p>Harmony Healthcare International (HHI) has developed three simple algorithms to estimate the staffing levels necessary for a given Star Status. In the equations below, R, C, and L represent the RN, CNA , and LPN reportable nurse staffing hours per resident per day needed to guarantee a given Star Ratings Level. </p><p>The case mix hours symbol h is the expected hours per patient per day based on the composite of RUG-IV values over a quarterly time period. The quantity h is indirectly related to case-mix indices in a nonlinear manner and is distinct for each SNF. The symbol m is the mean of case-mix hours averaged over all SNFs.</p><p style="text-align:center;"><img src="/Topics/Guest-Columns/PublishingImages/2020/Formulas1.png" alt="" style="margin:5px;" /><br></p><p><img src="file://///Users/shevonajohnson/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image017.jpg" alt="" style="width:1px;margin:5px;" />Previous statistical data suggest that case-mix indices and adjustment factors vary very slowly over time for most facilities. Therefore, it is reasonable to assume that the values assigned in a given time period can be used to estimate the reported values in a subsequent time period to gain the desired star status. </p><p>As an example, consider the case-mix values for a given facility shown in Table 3 taken from the CMS Medicare Nursing Home Compare Website. </p><p><br></p><p style="text-align:center;"> <img src="/Topics/Guest-Columns/PublishingImages/2020/Table3.png" alt="" style="margin:5px;" /></p><p>The calculations to attain a Five-Star rating for the case-mix data listed in Table 3 are as follows:</p><p style="text-align:center;"><img src="/Topics/Guest-Columns/PublishingImages/2020/Formulas2.png" alt="" style="margin:5px;" /><br></p><p>The same technique can be used to determine the reportable hours per patient per day for 4- or 3-Star Ratings.</p><p><em>Kris Mastrangelo, OTR/L, LNHA, MBA, is chief executive officer and president of Harmony Healthcare International. She can be reached at </em><a href="" target="_blank"><em></em></a><em>. James E. Smerczynski has been with Harmony Healthcare since retiring from Raytheon in 2012. He has an extensive background in integrated weapon system engineering that includes the Patriot Air Defense System, Advanced Lightweight Torpedo, and Hawk Missile System. Smercznynski has considerable experience in applied mathematics that directly applies to the probability and statistics analytics of the health care industry. He also does analytics for the startup software company Hopforce.</em></p><p>​</p>Starting in spring 2018, CMS began using Payroll-Based Journal data to determine each nursing facility's staffing levels for the Nursing Home Compare tool used in the agency's Five-Star Quality Rating System.2020-12-14T05:00:00Z<img alt="James Smerczynski, Kris Mastrangelo" src="/Topics/Guest-Columns/PublishingImages/2020/SmerczynskiMastrangelo.JPG" style="BORDER:0px solid;" />Quality;CMSSmerczynski, Mastrangelo

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