| A Simple Fall Prevention Strategy Comes to Light | <p><img src="/Topics/Guest-Columns/PublishingImages/2022/BrianLiebel.jpg" alt="Brian Liebel" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />Reducing the number of falls in long term care facilities is a goal for everyone. Current strategies to reduce falls typically include complex, multicomponent interventions requiring significant resources, staff time, and resident education. To be sure, these measures help mitigate the risk and reduce the number of falls at nursing homes and senior care facilities; but there is one novel approach that has been theorized over the last decade that has been recently validated through research and come to light.<br></p><h3>126,000+ Patient-Days of Data Tell the Tale</h3><p>A recent <a href="https://pubmed.ncbi.nlm.nih.gov/35850166/" target="_blank">study</a> designed by Midwest Lighting Institute (MLI), funded by the Wisconsin Department of Health Services, and conducted by Brigham & Women’s Hospital Division of Sleep and Circadian Disorders—a division of Harvard University—has been published in <em>The Journal of American Medical Directors Association,</em> focused on how the positive effects of lighting on alertness, cognitive function, and sleep might affect falls. The study demonstrated that dynamic, tunable lighting systems reduced falls by 43 percent as compared to facilities that retained traditional lighting. The promising results of this study provide a method for reducing falls that is noninvasive, safe, passive, and relatively inexpensive. </p><p>The study compared two pairs of facilities, one control pair with typical fluorescent lighting and one intervention pair with tunable LED circadian lighting protocol (lights designed to change color based on time of day). Data was collected from all four facilities for one year prior to the intervention, where it was determined that there was no difference in the fall rates between the control facilities and the intervention facilities. After the new lighting was installed in the intervention facilities, a full year’s worth of data was collected to compare the number of falls in the control facilities to those of the intervention facilities, making this the largest study of its kind with over 126,000+ patient-days of data. </p><p>The results were illuminating, and the ramifications show a bright future ahead. </p><p>First, the reduction of falls is a significant improvement for the life and well-being of residents given that injuries and hospitalizations from falls can lead to higher morbidity and long-term complications. Second, when residents experience improved alertness and cognitive function during the day and better sleep at night, it not only improves their well-being, but also improves the working conditions for staff. Third and importantly, compared to many fall intervention methods, these tunable lighting systems don’t require additional labor costs and reduce the costs of staffing that would otherwise be attending to these falls. </p><h3>The Sound Science of Light</h3><p>How does lighting reduce falls in long term care facilities? First, we must explore lighting beyond our visual needs. Since the discovery of a novel photoreceptor in the eye more than 20 years ago, the intrinsically photoreceptive Retinal Ganglion Cell (ipRGC), researchers have made significant discoveries about the non-visual effects of lighting. These photoreceptors have been shown to affect alertness, cognitive function, and sleep, all of which are well-known factors associated with the risk of falls in older individuals. But for lighting to affect these positive outcomes, it must mirror our human evolution by mimicking the higher light level blue sky during the day; lower-level, warmer colored fire light in the evening; and extremely low light levels at night. For people who seldom get outside to experience daylight, this natural 24-hour cycle is missing, yet it is critical to their overall wellbeing.</p><p>How does this work? This natural diurnal cycle of light is received by the ipRGC photoreceptors that trigger melatonin suppression during the day when we are awake and alert, and darkness deactivates this response that then allows melatonin production to help us sleep. It’s important to realize that both phases—the awakened period and the sleep period—are critical components for improved sleep quality.</p><p>Digging a little deeper, it's important to analyze the three main variables in an automatic tunable lighting system that promote this diurnal cycle: light level, light spectrum, and time of day scheduling. Most importantly, the lighting system used in the MLI study provides a variation of lighting throughout the day that mimics the natural world to set and reset our circadian clocks to fit the naturally occurring 24-hour cycle. Typical electric lighting systems in long term health care facilities do not have any variation in light level or spectral composition and are kept at the same light-level day and night, resulting in too little light during the day and/or too much light at night. The key to successful lighting is to vary the lighting intensity and spectrum to keep people alert and awake during the day so they have a full daytime experience, in combination with lowered light in the evening that then allows them to sleep better at night. In other words, tuning the resident’s lighting to meet the needs of their natural circadian rhythms.</p><h3>Minimal Investment for Maximum Results</h3><p>In my nearly three decades designing lighting systems and studying the effects of lighting, I can say that this research conducted by Brigham & Women’s University may be one of the most impactful on the positive effects light can have on human health. But the study also brings the promise of other significant benefits from a health care provider perspective. Operationally, LED tunable lighting reduces energy and maintenance costs—in this study, an independent verification through the US Department of Energy GATEWAY project determined that this facility had a 60 percent overall reduction in lighting energy consumption! From a staffing perspective, reducing falls and improving the lighting creates a better environment and safer working conditions, and any reduction in falls will most certainly lower the liability for health care providers.</p><p>As our aging population begins entering skilled nursing or long term care facilities, it is important to consider not only the reputation of the clinical and medical staff, but the facility’s integrity and its use of today’s latest technologies. Minimal investments in tunable circadian lighting protocols can offer long term benefits for patients and staff while adhering to new environmental and societal initiatives. The benefits of these LED lighting systems in long term care facilities are compelling and have now been proven through sound, peer-reviewed science that is reliable and relatable. </p><p>Brian Liebel is the director of research at the Midwest Lighting Institute. Previously, Liebel was the director of standards and research at the Illuminating Engineering Society and has been involved with research investigating the effects of lighting spectrum on vision for more than 25 years. He can be reached at <a href="mailto:bliebel@midwestlightinginstitute.org" target="_blank">bliebel@midwestlightinginstitute.org</a>.</p> | 2022-09-27T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/BrianLiebel.jpg" style="BORDER:0px solid;" /> | Falls;Caregiving | Reducing the number of falls in long term care facilities is a goal for everyone. |
| A Crisis is Coming: How Will You Communicate About It? | <p>In the world of long term care, how leadership communicates about a crisis can be as fraught with reputational risk as the crisis itself. Being prepared with a robust crisis communications plan is as important as having an incident response plan ready.</p><p>The onset of the COVID-19 pandemic provided a prime example. Administrators of long term care centers were forced—nearly overnight—to respond to a virtual onslaught of evolving information and realities with strategies to protect staff and residents from the illness and its far-reaching impacts. Leadership was under pressure to draft and communicate consistent internal and external messaging to staff, residents, and their families—and often the media—about COVID-19 outbreaks, shortages of PPE or staff, COVID testing and vaccine availability, protocols, and so on, all while what was known and believed to be true was constantly in flux.</p><h3>A Plan for Any Crisis</h3><p>The pandemic highlighted the need for leadership to have a strategic plan to guide crisis communications. But the pandemic is also a useful example of the need for LTC leaders to have in place a communications plan for a variety of crises. A resident elopes. A staffer is accused of stealing residents’ property. A patient’s family claims the facility failed to protect their loved one from an assault by another patient. A Centers for Medicare & Medicaid Services (CMS) survey leads to an immediate jeopardy (IJ) determination, a falling CMS Five-Star rating, and a whopping fine. Don’t kid yourself. If it’s happened elsewhere, it can happen to you.</p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/AllisonPerrine.jpg" alt="Allison Perrine" class="ms-rtePosition-1" style="margin:5px;width:137px;height:178px;" />Sometimes the facility itself is the victim: A fire, flood, or power outage requires residents to be relocated. An infectious disease outbreak impacts staffing levels. An elected official unfairly targets the facility for political gain.</p><p>Facility leadership can and should have language drafted that speaks to an incident in general terms, before it happens. Communications professionals refer to these as “holding statements.” A pre-existing holding statement can be released quickly while the facility digs deeper to learn more, and it can be more easily tailored to address the actual circumstances than having to craft a statement from scratch. If you’re wondering why you need to respond to the inquiry at all, consider the mind of the public, “No comment” means “I’m guilty.” Keep in mind you can’t respond to inquiries from other residents, family members, or staff with “No comment.”</p><p>Communications missteps—whether by speaking too soon or too late or not at all, by giving competing messages to different audiences, or by a host of other means—can upend a facility’s good work, undermine employee relations and morale, and call into question leadership’s commitment to the welfare of its residents, patients, and their families. It can impact recruitment and retention of staff, and it can impact census.</p><p>It's equally important to communicate clearly and effectively internally. Often, when faced with a reputation-stressing crisis, the focus is external: the news media, for example. It’s crucial to communicate effectively with internal audiences as well. In a time of crisis those closest to the organization can also be its best supporters and advocate—if they feel included and valued. It’s critical that leaders prioritize internal messaging so that as soon as a situation arises, information can be sent out as appropriate—with consistency across messaging. This is key to ensure everyone gets the same information and that it is accurate.</p><h3>Coordinating Stakeholders</h3><p>Depending on the circumstance, additional stakeholders may need to get involved in a facility crisis such as fires, floods, or power outages. Facility leaders should be prepared to communicate with elected officials, emergency response agencies, and members of the media about the source and status of the event. Partner facilities and vendors may even need to be brought in if the incident requires that residents be temporarily relocated. Make a list in advance and come up with a plan for outreach. </p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/WarrenCooper.jpg" alt="Warren Cooper" class="ms-rtePosition-2" style="margin:5px;width:137px;height:175px;" />Establish relationships with local elected officials, hospital and emergency response directors (including law enforcement), and local reporters who cover seniors or long term care before a crisis occurs. Having those relationships set in advance can make the difference between positive and negative outcomes.</p><p>Additional stakeholders to keep in mind for communication outreach are referral partners. If a facility receives a low CMS score, an IJ, or a fine, for example, it may stir up hesitation from referral partners as well as donors, elected officials, and families who are deciding whether they want to entrust their loved ones in its care. On top of that, a low score can mean costly fines for the facility. Without swift, consistent messaging, complications may arise—and fast.</p><h3>Advance Planning Is Critical</h3><p>Not all crises are so extreme, but such communications need to be swift, accurate, and impactful. Even minor missteps are important to prepare for, such as delayed response times or poor food quality. Developing a crisis communications plan can be a sure way to check all the boxes. Who will be the media spokesperson? How will inquiries be passed up the food chain? Who will make decisions about how—or whether—to go public in advance of another agency sharing the news? These are all questions a proactive communications plan can address ahead of time.</p><p>A thoughtful communications strategy with the proper protocols in place in advance will help LTC leaders to successfully navigate the early stages of an actual or potential crisis. Legal and crisis communications consultants should be identified ahead of time. As with local elected officials and others, establishing a relationship before its needed can help accelerate an effective response when it’s most needed. Contact information should be at the ready, among your cell phone contacts, and in cellphone directories of your upper management team as well.</p><p>You may not need it today, or tomorrow. But you will, and likely sooner than you think.<br><br><em>Allison Perrine and Warren Cooper are principals at Kessler PR Group, the a New York-New Jersey metro public relations firm specializing in crisis communications, reputation management, litigation support and media relations.</em></p> | 2022-09-20T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/leadership.jpg" style="BORDER:0px solid;" /> | Management | In the world of long term care, how leadership communicates about a crisis can be as fraught with reputational risk as the crisis itself. |
| How a COVID Advisory Council Improved Infection Prevention Overall | <p><img src="/Topics/Guest-Columns/PublishingImages/2022/TomGrape.jpg" alt="Tom Grape" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />Protector is a role we accept as parents, spouses and partners, employers, and leaders, among other roles in our lives. It’s daunting, even on the good days. Introduce the unknown and this commitment to others becomes nothing short of frightening. <br></p><p>That’s how I felt when the pandemic turned the world upside down in 2020. How can I help Benchmark protect its 13,000 residents and employees? It kept me up at night.  <br></p><p>The initial action steps were clear: Find supplies (masks, gloves, gowns, etc.), train staff, track cases, and create policy. The nagging question, however, was whether the execution of these steps would be effective. Constantly changing—and often contradictory—local, state, and federal guidelines only contributed to my uncertainty. </p><p>I wanted a guide. Thus, the <a href="https://www.benchmarkseniorliving.com/news-article/benchmark-coronavirus-advisory-council/">Benchmark Coronavirus Advisory Council </a>was born. </p><p>At an absolute minimum, the council members would help ensure that the infectious disease prevention and containment protocols that we developed would be consistent with leading-edge thinking on COVID-19. </p><h3>National Health Leaders  </h3><p>In the fall of 2020, Benchmark asked several long-time, trusted medical advisors to help us recruit a team of medical and scientific experts to provide ongoing advice in responding to COVID-19. Soon after, nine esteemed members were in place:<br></p><ul><li>Alice Bonner, PhD, GNP, RN, FAAN, former Massachusetts Secretary of the Executive Office of Elder Affairs</li><li>Richard Carmona, MD, MPH, FAC, former U.S. Surgeon General</li><li>Brent P. Forester, MD, MSc, chief of the division of geriatric psychiatry, McLean Hospital, and past president of the American Association for Geriatric Psychiatry</li><li>David Ives, MD, the medical director of a large primary care practice serving skilled nursing facilities in Massachusetts</li><li>Michael R. Jaff, DO, chief medical officer at an international medical device manufacturer and former CEO of Newton-Wellesley Hospital</li><li>Timothy Johnson, MD, MPH, former medical editor for ABC News and a resident of a Benchmark community</li><li>Dr. Roger Schutt, DO, veteran geriatrician and executive lead for post-acute care at Beth Israel Lahey Health</li><li>Steve Schweon, RN, MPH, MSN, CIC, FSHEA, FAPIC, board-certified infection preventionist </li><li>David Shulkin, MD, former Secretary of the U.S. Department of Veterans Affairs<br></li></ul><p>It didn’t take long for lively and insightful conversations, as well as debate, to ensue among the group during our first virtual meeting. Issues have since ranged from COVID’s short- and long-term impact on seniors, advances in treatment and testing, and general health care—physical and mental—related to our workforce, to vaccine policies, COVID-19 subvariants, and the future of the virus and vaccines. </p><h3>Getting to Know Us</h3><p>Before our experts could help, they needed to understand assisted living, particularly how the business differs from nursing homes, where a higher level of medical care takes place. </p><p>They needed to understand that prior to the pandemic, assisted living was focused on the benefits of socialization and providing fine dining, beautiful grounds, and engaging programming. Infection control was not what it is today.</p><p>Benchmark’s leadership and clinical teams, who ultimately created and implemented COVID-19 policy in our 64 communities, credit the advisory council for giving us a roadmap for creating a comprehensive infection prevention program. </p><p>Today, Benchmark has a robust structure that is better prepared to identify and curb the spread of not only COVID-19, but also other infections such as norovirus, flu, and respiratory infections. </p><p>We expanded our infection prevention expertise by hiring an epidemiologist to serve as corporate director of infection prevention. This person provides community support and education, as well as helps update protocols based on regional and national trends. </p><p>We also added a vice president of quality resident services and nearly doubled the size of that team, with each member certified in infection prevention. Many of our regional nurses are also infection prevention-certified, while community nurses, and even some plant operations associates, participated in an infection prevention boot camp. Validating Concerns, Creating Solutions</p><p>The kneejerk decision to “lock down” residential care settings nationally at the onset of COVID-19 had a well-documented negative impact on the physical and mental health of seniors across the country. </p><p>The advisory committee acts as a sounding board for our concerns in this area, as well. They help fuel innovations made in our communities to better engage our residents, whether by using technology or by employing creative methods to keep residents connected to family, friends, and neighbors. </p><p>In fact, mental health dominates many of our council meeting conversations, including the impact stress and anxiety has on our employees. During the height of COVID, these dedicated professionals worked long hours caring for beloved residents who were getting sick and, in some cases, dying. Employees were also getting sick or overwhelmed with the fear of getting COVID-19 and bringing it home to loved ones. Many of these COVID challenges remain for frontline employees.</p><p>Advisory council member Dr. Forester, MD, MSc, the division chief of geriatric psychiatry at McLean Hospital, located outside Boston, and a Harvard Medical School adjunct professor, is passionate about this subject. He shares his expertise beyond council meetings by leading “support group” calls with our communities’ executive directors, offering advice to them and providing ideas and tools the community leaders could use to help frontline staff. </p><h3>Don’t Go It Alone</h3><p>The council helps lead us through the unknown and to navigate hurdle after hurdle, wave after wave. Their guidance reinforces that we are doing everything we can to protect our residents and the associates that care for them. </p><p>They are just one of several resources Benchmark has worked closely with throughout COVID-19. We also learn from and share advice with state and federal assisted living advocacy groups, other senior care providers, and all levels of government. </p><p>If the pandemic teaches the nation anything, I hope it’s the importance of shedding silos and facing the unknown together. It will help everyone sleep better at night. </p><p><em>Tom Grape is Founder, Chairman, and CEO of Benchmark Senior Living, a provider of senior living in the Northeast with 64 communities in seven states. </em><br></p> | 2022-09-12T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/TomGrape.jpg" style="BORDER:0px solid;" /> | Clinical | Protector is a role we accept as parents, spouses and partners, employers, and leaders, among other roles in our lives. |
| Advancing Infection Protection in Senior Living Communities | <p>With much of the population vaccinated and new medicines advancing the treatment of COVID-19, senior living administrators may naturally find themselves turning their focus from infection prevention to the countless other pressing issues of the day.</p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/JeanFortgang.jpg" alt="Jean Fortgang" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />But as the continual ebb and flow of the pandemic has shown, now is not the time to let our guards fall with our masks.</p><p>Instead, administrators should take advantage of lessons learned and turn what have become widely accepted COVID-19 prevention protocols into long-term plans that maintain simple, everyday controls for keeping residents healthy and in their communities.</p><p>Assisted living communities have always faced unique challenges in infection prevention because of their business model, which focuses on independent living and social engagement. That means residents often come and go as they please and interact frequently with people well beyond their senior living community.</p><p>This makes it much harder to monitor for outbreaks of everything from COVID-19 to colds, flu, and other common viruses that often send residents to the emergency room.</p><p>That’s why it is so important for senior communities to implement proactive infection prevention plans that build on the many—often simple—practices that communities have implemented over the past two years in response to COVID-19.</p><p>For workers, there are several simple steps communities can build into their long-term plans:<br></p><ul><li>Make infection control part of the employee onboarding process.</li><li>Educate and build into employee literature information regarding the importance of staying home if not feeling well. </li><li>Emphasize the need to use soap and water whenever possible, not just sanitizing gels.</li><li>Mandate masks and clean gloves for staff when dealing with residents (particularly in memory care) who aren’t feeling well. </li></ul><p>Effective infection prevention also involves staying alert and responding to new and ongoing threats. That means monitoring and engaging with staff and visitors:<br></p><ul><li>Take employee and visitor temperatures on arrival during flu or other outbreaks.</li><li>Remind residents to stay in and mask if they are not feeling well.</li><li>Post signage for staff, residents, and visitors about basic cleanliness.</li><li>Alert residents and families when there are community or regional outbreaks. </li><li>Send occasional reminders to residents and their families about basic infection prevention protocols.<br></li></ul><p>Senior communities can also tap outside experts and partners to help with staff education and prevention protocols—both on transmissible and other common infections that often send resident to the emergency room.</p><p>For instance, we recently did a big educational push with member communities on urinary tract infections (UTIs). A lot of times, people think they have a UTI. But maybe they just need to drink more water. Or maybe they need some assistance with hygiene.</p><p>Senior living centers can also partner with experts from their local communities to host wellness events for residents and their families that include a session on basic steps and the importance of infection prevention.</p><p>Early detection and awareness is key. If everyone on the team is educated, involved, and working together, we can slow the spread of the myriad of common infections among senior living residents through proactive planning.</p><p>Hopefully, these plans will never be needed for another pandemic. But following these simple steps can go a long way toward building a community culture focused on keeping residents, their families, and staff happy and healthy.<br><br><em>Jean Fortgang, NP-C, ACHPN, is the associate director of the Optum care model and United HealthCare<sup>®</sup> Assisted Living Plan and serves as director of the Assisted Living and Patient Connect programs with Optum. Fortgang has 23 years of clinical leadership with Optum.</em><br></p> | 2022-09-06T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/JeanFortgang.jpg" style="BORDER:0px solid;" /> | Caregiving | Senior living administrators may turn their focus from infection prevention to the countless other pressing issues of the day. |
| The Importance of Indoor Air Quality in Care Facilities | <p><img src="/Topics/Guest-Columns/PublishingImages/2022/AnthonyAbate.png" alt="Anthony Abate" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />The importance of indoor air quality (IAQ) has been at the forefront of many people’s minds in the last couple of years, given the severity of the pandemic and pollution in major cities. For those living in assisted living and memory care facilities, the need for proper ventilation and high-quality IAQ was a foundation of these properties far before the pandemic, but the need for well-supported infrastructure and comprehensive building systems has become all the more crucial now. <br></p><p>Just as COVID-19 affected everyone, so does air pollution and other airborne bacteria and hazards. Yet, the effects of these factors are much more severe in the elderly because they are more susceptible <a href="https://link.springer.com/article/10.1007/s40520-013-0001-5" target="_blank">and at greater risk for health issues </a>relating to poor IAQ. This is important to consider and mitigate in assisted living facilities as poor air quality can lead to, and worsen, chronic health conditions, such as lung disease, asthma, pulmonary disease, diabetes, heart disease, and other serious problems. Proper IAQ and ventilation are in turn smart and simple strategies to implement into properties to reduce the risk of health conditions and to support the safety and well-being of those in assisted living or memory care facilities. </p><p>In these facilities, residents are more at risk to serious illnesses and air-borne pathogens, such as MRSA and Norovirus. Indoor air purification systems can assist in preventing contaminants in a space, and have the potential to drive better health, wellness, and improved care with cleaner and healthier IAQ. Additionally, IAQ technologies also act to filter contaminants that prevent unwanted odors, which is of particular importance in a residential community facility. In this way, new technology can drive multiple solutions and new amenities for facilities, while improving the resident experience. </p><p>Moreover, as residents of these facilities and customers continue to adjust their expectations and requirements in light of recent years, property owners and operators will have to adjust accordingly as well. </p><h2>IAQ Challenges in Assisted Living</h2><p>However, there are obstacles implementing IAQ and ventilation solutions in the assisted living sector as it’s a fragmented market. Clean technology, and other process, product, or service that reduces negative environmental impacts, hasn’t been able to break through in the assisted living market due to this segmentation.</p><p>It is important to consider that many owners of assisted living facilities tend to own a small number of properties, which can also make it difficult to implement systems across facilities and make a broad impact in the market. Yet, the need for IAQ and modern HVAC systems is vital, and as occupancy rates continue to slowly increase from pandemic lows, the need for owners to be able to meet resident expectations will be all the more important. </p><h2>Operators Implementing IAQ Systems</h2><p>Owners and operators can support the health and safety of their residents by ensuring that their building systems are as high-quality and up-to-date as possible. One way is to partner with companies that offer clean technology. </p><p>For example, Lumenant, which provides air quality and lighting technology solutions that improve the quality of life in senior living communities, is working with an owner of 140 assisted living properties to install IAQ systems throughout their portfolio. Already, 17 of these communities have implemented systems across North Carolina, South Carolina, and Florida.</p><p>Owners and operators who take advantage and capitalize on access to IAQ technology may enjoy lower vacancy rates, improve health and safety for residents, and drive public and stakeholder confidence across properties and portfolios. The reported measurements from IAQ also provide information used to monitor and improve overall energy management and efficiency. Altogether, improving air quality can go a long way to improving the health and well-being for those living in assisted and residential living facilities while simultaneously increasing efficiencies for owners and operators.<br><br><em>Tony Abate is chief technology officer of Atmos Air.</em></p> | 2022-08-23T04:00:00Z | <img alt="Tony Abate" src="/Topics/Guest-Columns/PublishingImages/2022/AnthonyAbate.png" style="BORDER:0px solid;" /> | Caregiving | The importance of indoor air quality (IAQ) has been at the forefront of many people’s minds in the last couple of years, given the severity of the pandemic and pollution in major cities. |
| Skilled Nursing Facilities Must Keep Up with Multiple Quality Programs | <p><img src="/PublishingImages/Headshots/JessieMcGill.jpg" alt="Jessie McGill, RN" class="ms-rtePosition-1" style="margin:5px;width:175px;height:175px;" />There are over 40 different quality measures (QMs) that affect skilled nursing facilities (SNFs) across several programs. MDS 3.0 Quality Measures, SNF Quality Reporting Program (QRP) measures, SNF Value-Based Purchasing (VBP) Program measures, Nursing Home Compare (NHC) claims-based measures, and the Five-Star Quality Rating System are just a few of the quality measures nurse leaders must keep track of. </p><p>To add to the confusion, some measures are used in more than one program, like the Changes in Skin Integrity Post-Acute Care (PAC): Pressure Ulcer/Injury SNF QRP measure that also factors in the MDS 3.0 Quality Measures. The cross-over between programs may become even more complex if the Centers for Medicare & Medicaid Services (CMS) finalizes changes to the SNF VBP and SNF QRP programs as proposed in the fiscal year (FY) 2023 SNF Prospective Payment System (PPS) proposed rule. SNF leadership will need to recognize the key differences among each of the programs to understand how the measures will impact their facilities. <br></p><h3>MDS 3.0 Quality Measures </h3><p>The MDS 3.0 Quality Measures are the foundation of quality measurement for both short-stay and long-stay residents of all payer types. Facilities use these measures for quality improvement, while surveyors use them to identify potential problems. The MDS 3.0 measures are facility-reported using MDS assessment data submitted to the national database. The specifications for these measures can be found in the MDS 3.0 Quality Measures User’s Manual.<br></p><h3>Five-Star Quality Rating System Measures and NHC Claims-Based Quality Measures</h3><p>The Five-Star Quality Rating System publicly reports quality ratings for facilities’ health inspections, staffing, quality measures, and an overall star rating. The quality measure domain compiles ratings from MDS 3.0 measures, SNF QRP measures, and NHC claims-based measures to calculate a star rating for short-stay measures, long-stay measures, and an overall quality measure rating. Additionally, the staffing domain has recently developed two staffing measures, which are expected to be incorporated into the staffing star methodology in July 2022. </p><p>The Five-Star quality measures are publicly reported on the Care Compare website, along with outcomes from several other measures from both the MDS 3.0 and SNF QRP measures that are not used in the Five-Star QM domain methodology. Consumers use the Five-Star ratings when comparing nursing homes, and hospitals consider them when making referrals. Additionally, the Five-Star rating may impact the facility’s ability to obtain contracts with some managed care plans, or to participate in an Accountable Care Organization (ACO). <br></p><h3>SNF QRP Measures </h3><p>The SNF QRP is a reporting program. The Improving Medicare Post-Acute Care Transformation (IMPACT) Act requires SNFs and other post-acute settings to report standardized data elements on Medicare beneficiaries to enable comparison of outcomes across the different settings. Specifications and reporting requirements for each fiscal year are available on CMS’s <a href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information" target="_blank">SNF QRP Measures and Technical Information website</a>. This program penalizes facilities only if they fail to report the data needed to calculate the SNF QRP measures. Facilities are not penalized based on the outcomes of these measures. For the SNF QRP program, facilities must submit at least 80 percent of MDS assessments with 100<span> percent</span> of the required MDS data as well as 100<span> percent</span> of the data submitted to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Failure to submit the required data results in a 2<span> percent</span> reduction to the annual payment update for the SNF QRP program year. While facilities are only penalized if they fail to comply with the reporting requirements, it is important to note that the measure outcomes are publicly reported on Care Compare. <br></p><h3>SNF VBP Measures </h3><p>The SNF VBP program is a result of the Protecting Access to Medicare Act (PAMA) and connects Medicare reimbursement to quality outcomes. This program withholds 2<span> percent</span> of Medicare funds for the program year and redistributes 50<span> percent</span> to 70<span> percent</span> back to the SNFs as an incentive payment. Facilities are scored based on the higher of either an achievement score (facility compared to all facilities) or an improvement score (facility compared to its own baseline score). Since the inception of this program, it has been based on one Medicare beneficiary readmission measure; however, the Consolidated Appropriations Act of 2021 allows for up to nine additional measures to be added to the program. The poorest performing facilities may receive no incentive payment and lose the full 2<span> percent</span> that was withheld, while the best-performing facilities can earn incentive payments that could exceed the 2<span> percent</span> withholding. <br></p><h3>Understanding Measures in Multiple Programs </h3><p>CMS has proposed adopting two existing SNF QRP measures into the SNF VBP program: the Healthcare-Associated Infection (HAI) Requiring Hospitalizations measure for the FY 2026 program year and the Discharge to the Community measure for the FY 2027 program year. These two measures are both 100<span> percent</span> claims-based measures, meaning the data comes solely from hospital Medicare claims and not from the MDS assessments. This also means that facilities are not penalized in the SNF QRP program since the facility is not reporting the data. However, these measures are both publicly reported on Care Compare. Furthermore, the Discharge to Community measure also applies in the Five-Star quality star rating but uses the name “Rate of Successful Return to Home and Community from a SNF.” Currently, facilities face no direct penalty related to the reporting or outcomes of these measures. However, if the proposal is finalized, the outcomes of these measures would affect the incentive payments received under the VBP program. </p><p>Additionally, CMS has proposed a new measure for the FY 2026 VBP program year: the Total Nursing Hours Per Resident Day Staffing measure. In the proposed rule, this measure references the methodology for total nursing hours per resident day in the Five-Star staffing domain. However, this measure is different than the weekend staffing and turnover measures, which are also expected to impact the staffing domain starting in July 2022. While staffing hours and the star rating are publicly reported and historically may have impacted referrals and consumer perspective, if finalized, the staffing measure scores will also impact the SNF VBP incentive payments. </p><p>Overall, when an existing measure is adopted into another program, the measure specifications remain the same, but the data is used in a new way. This allows facilities to continue the quality improvement efforts currently in place for the measure, even if the measure’s impact on the facility has expanded. When the focus is on overall quality improvement, the facility and residents will benefit, regardless of which program the measure belongs to. <br><br><em>Jessie McGill, RN, RAC-MT, RAC-MTA, is Curriculum Development Specialist for the American Association of Post-Acute Care Nursing (AAPACN).</em><br></p> | 2022-08-02T04:00:00Z | <img alt="" src="/PublishingImages/Headshots/JessieMcGill.jpg" style="BORDER:0px solid;" /> | Caregiving;Management | The MDS 3.0 Quality Measures are the foundation of quality measurement for both short-stay and long-stay residents of all payer types. |
| Detecting and Treating Dementia Early | <p><img src="/Breaking-News/PublishingImages/740%20x%20740/senior_woman_daughter_2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:256px;height:179px;" />Dementia is staggeringly common, with an <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf" target="_blank">overall prevalence of 11 percent in people aged 65 and over</a>. This prevalence increases markedly with age, such that it affects over half of octogenarians and one in three will ultimately die in this condition. These statistics do not include mild cognitive impairment (MCI), mental changes that are measurable but not severe enough to affect daily function and are often but not always a precursor to dementia, or <a href="https://www.cdc.gov/aging/data/subjective-cognitive-decline-brief.html" target="_blank">subjective cognitive decline</a>, self-reported mental fogginess or memory depreciation that aren't able to be measured by a test.</p><h3>Detecting and Diagnosing Dementia</h3><p>Despite being widespread, official diagnosis lags behind the true prevalence, with only 3-4 percent of patients having “dementia" (let alone Alzheimer's disease or a specific type of dementia) written anywhere in their chart. This amounts to more than 3 million Americans lacking a diagnosis, a number which will double in the next decades if diagnosing doesn't catch up.</p><p>The early stages of dementia, particularly Alzheimer's disease, which most commonly manifests with short-term memory loss and difficulty navigating an environment, is not always obvious from a short interaction. Verbal abilities can be intact, and a patient can regale you with stories from their youth, masking the fact that when they are sent home from the doctor's office with instructions to take a medication once a day, they may not fully understand, remember, or have the capacity to follow instructions. Caring family members such as adult children living out of state may also take a long time to go from a subtle feeling or suspicion that something seems off or odd to the conclusion that there may be a real problem. This can obviously have catastrophic consequences—preventable adverse events and hospitalizations; missing the opportunity to reverse, slow, and mitigate disease; and treatment for symptoms that can improve quality of life and functional independence.</p><p>Improving detection and arriving at diagnosis before the onset of catastrophic events, more severe disease, and unmanageable symptoms begins with equipping clinicians on the front lines with validated tools to assess function rapidly, reliably, and comprehensively across <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772157/" target="_blank">cognitive domains</a>. Tools must be simple enough for the non-specialist to gain comfort with and fit reasonably within their established workflows. For example, a recent peer-reviewed study in the <a href="https://aging.jmir.org/2022/2/e36825/" target="_blank"><em>Journal of Medical Internet Research (JMIR) Aging</em></a> validates the efficacy of a computerized cognitive test. Conducted in-person or remotely, this type of assessment improves accessibility to testing while providing physicians with the tools necessary to diagnose and treat patients.</p><p>To better detect and diagnose dementia, physicians must go beyond patient interviews (i.e. do you feel like you are losing your memory?) and use formal assessment tools, looping in a specialist for complex cases when needed. If MCI is identified, the physician must further assess for functional impairment to arrive at a diagnosis of dementia and perform serial assessments for changes in cognitive status (improvement or decline) that could change diagnosis and management approach.</p><h3>Preventing Adverse Events and Hospitalizations</h3><p>People with dementia have much higher hospitalization rates than older adults without. According to a recent study, 40 percent of <a href="https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16636" target="_blank">hospitalizations in the dementia cohort could have been preventable</a> with proper identification, education, and outpatient care. When care teams are on the same page about a person's cognitive status, the individual can be given additional supervision or support to prevent adverse events. Consistency between caregivers is essential toward preventing trips to the hospital as well as reducing uncertainty and conflict around patient care and well-being.</p><h3>Ruling Out and Addressing Reversible Causes</h3><p>Cognitive impairment does not always spell dementia. Many cases of MCI are due to reversible causes, with the most common offenders being medication adverse events, depression, sleep apnea, infection, and thyroid disease. Long COVID is another major driver, with more than 70 percent of sufferers calling out brain fog as a chief complaint.</p><p>It is for this reason that the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772157/" target="_blank">American Academy of Neurology</a> cites ruling out and addressing reversible causes as a primary reason for performing cognitive assessment. Clinicians should perform a medical evaluation of common reversible causes.</p><h3>Addressing Risk Factors to Slow Progression</h3><p>The landmark FINGER study and subsequent <a href="https://pubmed.ncbi.nlm.nih.gov/32627328/" target="_blank">World-Wide FINGERS network</a> found that 40 percent of dementia is preventable by addressing certain modifiable risk factors. These include:<br></p><ol><li>high blood pressure,</li><li>smoking,</li><li>diabetes,</li><li>obesity,</li><li>physical inactivity,</li><li>poor diet,</li><li>high alcohol consumption,</li><li>low cognitive engagement,</li><li>depression,</li><li>traumatic brain injury,</li><li>hearing loss,</li><li>social isolation, and</li><li>air pollution.</li></ol><p></p><p>The physician is charged with the task of working with the patient and caregivers to put together a comprehensive cognitive care plan that addresses these modifiable factors in a holistic manner. By giving them the knowledge, resources, and motivation to see the patient through the long journey of cognitive change, they can slow dementia's progression and give the patient a better prognosis.</p><p>There are now few pharmaceutical options to treat dementia, with cholinesterase inhibitors showing efficacy in dementia's early stages. There are multiple medications at different stages of the drug development pipeline, and all of them depend on patients being identified as early as possible to have the best chance of success.</p><p>Behavioral and psychiatric symptoms are common in dementia, and an early and specific diagnosis enables clinicians to treat these with the best approaches available.</p><p><em>Yael Katz, Ph.D., is co-founder and CEO of BrainCheck. Katz received her Ph.D. in neuroscience from Northwestern University and conducted her postdoctoral work at Princeton University.</em><br><br></p> | 2022-06-23T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/YaelKatz.jpg" style="BORDER:0px solid;" /> | Dementia;Clinical | The early stages of dementia, particularly Alzheimer’s disease, which most commonly manifests with short-term memory loss and difficulty navigating an environment, is not always obvious from a short interaction |
| Supporting Caregivers’ Emotional Needs to Avoid Burnout | <p>Imagine walking into a health care facility and finding there were no housekeepers, nurses, physical and occupational therapists, recreation, dietary, social workers and nutritionists onsite? Imagine if residents were left to fend for themselves in the absence of these valuable and often forgotten heroes? Despite the setbacks of the past few years, health care heroes continue to not only make themselves available to our most vulnerable population, but also strive to go above and beyond. They continue to provide optimum care even when they themselves, or their loved ones, may need this same care. </p><p>Think about the fallen heroes that died on the frontline caring for our most vulnerable population during the pandemic. Think about those that continue to put on their game faces every day to go out and give the best of themselves to the elderly, veterans, children, and anyone in need at our health care institutions. Yet who provides the caregivers with what they need to continue giving? <br></p><p>We hear about the efforts to locate staff to cover various shifts, but we seldom hear about locating services to cover the physical and emotional needs of current caregivers. Some have physically recovered from COVID, but never had the opportunity to explore resources for psychological support. Some have experienced the loss of their loved ones and didn’t have the opportunity for a traditional burial and therefore lack closure.</p><h3>When Caregivers Need Support</h3><p>Recognizing when to reach out for support is important and is often missed by caregivers as they are often the beacons of support for others. According to the National Alliance on Mental Health (NAMI), one needs to check in with themselves frequently and reach out for support if experiencing symptoms of depressed emotions and/or burnout. These symptoms include irritability or anger, anxiety, depression, loneliness, sleep deprivation, new or worsened substance abuse, fatigue, and finding it difficult to empathize with others. <br></p><p>Jeff Grzybowski, Director of Rehabilitation at Boro Park Center, a 505-bed skilled nursing facility in Brooklyn, New York, took the initiative to recognize four to five therapy staff employees during his weekly team meetings. He uses the designation “hero” when recognizing these individuals for their outstanding work. <br></p><p>“I felt that I needed to come up with ways to at least lessen, or hopefully remove, that feeling of burnout and to inject that second wind, if you will,” said Grzybowski. “As a result, several people on my team became motivated to pay it forward and made efforts to help those around them as well.”</p><p>Grzybowski’s efforts showed gratitude and awareness of staff efforts and this led to further acts of support. Staff were bringing in donuts, checking in with other therapists, and reaching out to other department employees and their supervisors to ask, “How are you doing?” and offering words of encouragement. <br></p><p>Jocelyn Nackley, Director of Rehabilitation at Onondaga Center, an 80-bed skilled nursing facility in Syracuse, New York, also praises her staff members during her internal weekly team meetings and publicly when she works alongside her team on the unit. </p><p>“Rehabilitation directors are treating this growing and common situation throughout nursing facilities,” said Nackley. “My team particularly enjoys it when I bring in their favorite foods from local lunch and coffee chains. It brightens their day and helps them go the extra mile. They love their patients but we’re no use for them if we cannot get past that burned out feeling.”</p><h3>Going Further</h3><p>Bringing in food and expressing gratitude is a start in the right direction, but it’s certainly not the entire answer. It shows that leadership is paying attention. It is a focus on helping ourselves so that we can better treat the residents and their loved ones.</p><p>Several free services are available to assist caregivers including <a href="https://www.covidmentalhealthsupport.org/" target="_blank">COVID Mental Health Support</a> from the Pandemic Crisis Services Response Coalition. The <a href="https://emotionalppe.org/" target="_blank">Emotional PPE Project</a> is another support service that connects heath care professionals with licensed mental health professionals who can help. This service is free and does not require insurance. NAMI can also be contacted directly to access confidential professional support. In addition to these, there are other numerous support services available for health care professionals with both local and nationwide access.</p><h3>Self-Care Suggestions</h3><p>In addition to professional support, leadership should encourage caregivers to use self-care as another strategy to combat burnout. Ideas for self-care include:<br></p><ul><li>Humor can be used to cope. Seek out the things that make you laugh. Laughter is the best medicine.</li><li>Recognize you are vital and are critically important in the fight against the pandemic. You are doing the best you can with what’s available.</li><li>Sleep is important and one of the best ways to rejuvenate. Try to get at least 7 hours of sleep daily.</li><li>Eat to provide fuel to your body. Ensure you eat as balance of a diet as possible. Adequate hydration is essential as well.</li><li>Meditate to relax, reduce anxiety, and manage stress. There are online classes and apps available.</li><li>Exercise is hugely beneficial. Walking increases circulation and endurance and can be a great way to escape from the everyday. Simple muscle stretching and coordinated breathing techniques add to the benefits of exercise. You don’t have to join a gym to get going as many activities are available free of charge. </li><li>Reach out to family, friends, and coworkers for support. Don’t go at it alone—talk to others for support. Many facilities also offer more formal support programs that can be helpful. </li><li>Stay positive. Healing improves when the mind is relaxed and in a positive state. Try to see the positive in others and yourself. Provide positive reinforcements to others every chance you get. </li><li>Connect with your spirituality. Ask yourself how you are feeling each day. Ensure you listen to the voice within and act in ways to support it. Calming environments and music may aid this journey. Learn to appreciate what you have and be thankful to yourself and others that helped along the way</li><li>Take a trip. Travel to a place you want to explore. This can be anywhere from the new restaurant down the street to another state or even international travel. This helps you to focus and reflect as you explore other worlds outside your own.</li><li>Love yourself and others. Find ways to remember the good you’ve done and show compassion to others.</li></ul><p>The pandemic stressed health care providers to their limits. Now it is time for leaders to provide additional support to these caregivers in order to avoid burnout. <br><br><em>Dexter Vickerie, RN-BC, MSN, RAC-CT, is Corporate Director of Quality/Clinical Compliance and Risk Management at Centers Health Care.</em></p> | 2022-06-01T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/DexterVickerie.jpg" style="BORDER:0px solid;" /> | Caregiving | health care heroes continue to not only make themselves available to our most vulnerable population, but also strive to go above and beyond. |
| 5 Ways to Get Creative with Your Employee Referral Program | <p></p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/MadelineCecil.jpg" alt="Madeline Cecil" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />When it comes to the 2022 hiring market, cutting through the noise of job boards and reaching qualified applicants directly is a momentous task. The simplest way to do this is to tap into your employees' already existing networks of former colleagues, neighbors, and friends in the form of an employee referral program.</p><p>There is a myriad of reasons why companies are leaning heavily on employee referrals to keep fully staffed, including that referred applicants are hired at four times the rate of non-referral candidates. In addition, these programs allow candidates to move forward with the hiring process quickly, with an average hire being made eight days after starting the hiring process compared to 11 days with a non-referral. Employee referral programs produce the types of hiring results that businesses are looking for; in fact, out of Hireology's customers alone, referral programs drive one in eight hires.</p><p>Not all employee referral programs are created equal, however. Even if your company already has one in place, there's always room for improvement. To keep your employee referral program from going stale, here is a list of five ways to get creative with your employee referral program.</p><p><strong>1. Create multi-tiered ambassador programs.</strong><br>Tap into your employees' competitive side with a tiered ambassador program. With this type of program, you design multiple tiers that offer higher rewards and more payout the more referrals someone submits. For example, someone who refers one candidate might be entered into tier one, which pays out $500 per hire. But someone who refers three candidates might be entered into tier two, earning them $750 per hire and additional company swag.</p><p>This encourages your employees to refer as many qualified applicant leads as possible. Multiple levels in this arrangement motivate employees to actively recruit from their networks in order to move up in the tiers and then receive higher rewards—all while you receive applications that are already vetted.</p><p><strong>2. Utilize social media for referrals.</strong><br>Your employees are already spending time on social media, and most of them are connected to hundreds of other individuals on these profiles. Take advantage of this network by encouraging your team to share open roles on their social media profiles.</p><p>You could offer to enter folks into a lottery to win gift cards, cash prizes, or additional paid time off for every role they share on social media. Or, with modern employee referral platforms, you can even provide employees with a personal link that allows you to track exactly which post referral candidates come from, making it even easier for you to reward your employees for sharing roles and driving applicants.<br><strong> </strong><br><strong>3. Focus on values in your recruitment</strong><strong> </strong><strong>programs.</strong><br>Another way to get creative with your employee referral program is to build one designed to hire individuals who align with your company's values—widening your network of potential referral applicants.</p><p>With this type of program, you might broaden your employment parameters to candidates who meet certain values rather than your preferred list of skills and experiences. Many jobs can be learned, but values are hard to reshape; sometimes, encouraging your employees to refer folks who embody certain values over skills can help you find candidates who are a better fit in the long term. These types of programs can also be used to diversify your existing workforce.</p><p><strong>4. Renew messaging with seasonal pushes.</strong><br>With every season that passes, the world—and workforce—continues to change. Chances are your company is always in need of additions to your staff. People are always needed in some capacity. Some businesses experience temporary hires and labor shortages, but the perfect time to get ahead of being short staffed is before it affects your customers. That's why pushing an employee referral program seasonally with a simple rebranding can make all the difference in the hiring process and help keep your business running smoothly.</p><p>For example, during the holiday season, you could encourage employees to participate in this type of program by using messages like “Want to earn some extra cash for the holidays? Refer your friends to win $1,000," or “Use your vacation time to relax after earning $1,000 by referring a friend." With simple tweaks to the messaging, you use to incorporate the changing seasons, you can reuse the same reward program perpetually.</p><p><strong>5. Target specific locations.</strong><br>Say, for instance, that your branch in North Carolina is fully staffed, but the one in Kansas is in desperate need of employees. Instead of launching a company-wide referral campaign, you can tailor your employee referral messaging to receive only applicants from locations where you truly need them. By channeling your resources toward locations that need it most, you optimize your spending power and maximize ROI all in one go.</p><p>Employee referral programs work, so long as you put the effort into motivating your team to participate. Try one of the above strategies to breathe new life into your program today.</p><p><em>Madeline Cecil</em><em> is a content writer for Hireology.</em></p> | 2022-05-10T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/MadelineCecil.jpg" style="BORDER:0px solid;" /> | Workforce;Recruitment | Employee referral programs produce the types of hiring results that businesses are looking for; in fact, out of Hireology's customers alone, referral programs drive one in eight hires. |
| Cultivating Continuous Improvement in Senior Care and in Leadership | <p><em><img src="/Topics/Guest-Columns/PublishingImages/2022/JeraldCosey.jpg" alt="Jerald Cosey" class="ms-rtePosition-2" style="margin:5px 15px;width:175px;height:175px;" />Jerald Cosey is the Operational Leadership Development Director for American Senior Communities (ASC), the largest senior living and senior healthcare company in Indiana.</em></p><p><em> </em><em>His goal is to help develop leaders for the organization in three ways:</em><br></p><ol><li><em>Oversee the administrator-in-training cohort program that accepts both internal and external candidates.</em></li><li><em>Coach 10 emerging operational leaders from a non-reporting position.</em></li><li><em>Teach behavioral science for leaders, workforce behavior, and maximizing stakeholder communication and engagement.</em><br></li></ol><em>He also serves as an industry advocate outside of Indiana as a speaker, thought leader, and senior advocate. Cosey is passionate about communicating </em><a href="http://jeraldcosey.com/2020/05/senior-healthcare-workers-are-the-forgotten-frontline/" target="_blank"><em>the lessons learned</em></a><em> by leaders and frontline senior health care workers throughout the pandemic.</em><p></p><p><strong><em>Provider</em></strong><strong> magazine: How did you become interested in the health care industry, and specifically senior care?</strong></p><p><strong></strong><strong>Jerald Cosey:</strong> I started as a volunteer while I was a pharmaceutical sales manager. I was part of that industry for 18 years. I started a <a href="http://jeraldcosey.com/2019/03/senior-isolation-grace-church/" target="_blank">senior ministry focused on minimizing isolation</a>, named Graceful Moments, when I was downsized for the first time. The mission of Graceful Moments is to minimize isolation and listen, love, and learn from our revered elders.</p><p><strong><em>PM</em></strong><strong>: You previously served as Executive Director at Greenwood Meadows, with the organization winning a 2019 American Health Care Association's Silver Quality Award. What helped you the most on the journey to improve quality at Greenwood Meadows?</strong></p><p><strong></strong><strong>JC:</strong> My father often said nothing worthwhile in life is ever easy. During the process of applying for the award, I learned five lessons.<br></p><ol><li><em>The value of continuous improvement.</em> In such a highly regulated industry, it's easy to get overly concerned about documentation, root cause interventions, and the possibility of missing something important. The consequences can be unforgiving. It's imperative to always evaluate and audit systems used to maximize the care for others. A common trend throughout the application process requires providing details of how your facility captures, evaluates, and improves performance/outcomes. For every level of leadership and operational processes within an organization, continuous improvement and development is necessary and expected.</li><li><em>Just start.</em> In the beginning, I found the award application process intimidating. As operational and clinical leaders, our days are packed, leaving little time for non-mandatory tasks. I acknowledged that this application process would require time and effort. The action and effort slowly defeated the intimidation and sparked enthusiasm for capabilities of our facility.</li><li><em>It's not about winning.</em> With every advancement through the process, the pride for the facility, the care, and outcomes seem to bubble up daily. Early in the application process, we realized it was never about winning. The goal is to recognize the performance excellence of your facility; moreover, the performance excellence required to complete the application. When it's all said and done, we had already won by completing an application worthy of review.</li><li><em>You are part of a professional community.</em> The senior healthcare industry is loaded with resources and support. I will never forget being stumped by a question and calling a fellow administrator. She allowed me to vent, listened, and translated the question, helping me to understand. This industry is loaded with state health care associations and operational/clinical leaders, all of whom are committed to advancing quality healthcare and performance excellence.</li><li><em>The industry is honorable.</em> Professionally caring for people is a great responsibility and penetrates beyond business, careers, and professions. Honor comes from putting others' needs before your own. Moreover, caring for people who are held in high regard within a family can come with unreasonably high expectations. With that, continue doing your level best each day and performance excellence will follow.</li></ol><strong><em>PM</em></strong><strong>: What trends do you see on the horizon for the senior health care sector?</strong><p></p><p><strong></strong><strong>JC:</strong> Category or position excellence doesn't automatically translate to leadership excellence. I believe the number one trend or need in our industry is being intentional with the development of leaders. Senior healthcare is a very emotionally demanding industry, and the last thing we need to do is lose outstanding talent from a lack of investment in their leadership.</p><p>I see leadership evolving to maximize communication and effectiveness between stakeholders. For example, many leaders tend to lead as they like to be led. Understanding your key stakeholder drivers for work satisfaction is critical for it allows the leader additional tools to maximize communication, effectiveness, and job satisfaction.</p><p>At American Senior Communities, we have committed to using the Predictive Index as the source of gathering this insight and leveraging tools to maximize understanding. For me, I like independence and flexibility. It doesn't mean I can't accept direction or formalities. However, I want my key stakeholders to know I receive job satisfaction when I can meet these needs in the workplace.</p><p><strong><em>PM</em></strong><strong>: How do you describe your leadership style? How do you build and refine those leadership skills?</strong></p><p><strong></strong><strong>JC:</strong> My teachable point of view on leadership: A leader separates themselves in the ability to embrace the philosophy of team—a team that is built upon respect for people, continuous improvement, and a high regard for results. All of which allow a leader to empower.</p><p>I always have a developmental plan. Every leader should have a developmental plan throughout every organization. I also have mentors and follow their guidance to grow my leadership skills.</p><p><strong><em>PM</em></strong><strong>: What advice do you give to someone just beginning a career in health care?</strong></p><p><strong></strong><strong>JC:</strong> Make time to document why you want to lead in this space. Senior healthcare is a very emotional and intimate career choice. You must know your why and embrace it to the core. It will prove to be your foundation on the day when your career choice comes into question.</p><p>You can't do everything by yourself so take the time to establish your vision and allow leaders to contribute to the development of the vision. I was never an expert in a specific department. I hired the best, built next-up talent, and leveraged departmental excellence.</p><p><em>Hear more from Jerald Cosey in a keynote session at the 2022 AHCA/NCAL Quality Summit, May 16-18 in Kissimmee, FL. For more information and to register, </em><a href="https://www.ahcancal.org/Education-Events/Quality-Summit/Pages/default.aspx" target="_blank"><em>click here</em></a><em>.</em></p> | 2022-05-04T04:00:00Z | <img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/JeraldCosey.jpg" style="BORDER:0px solid;" /> | Caregiving;Quality | I like independence and flexibility. It doesn't mean I can't accept direction or formalities. However, I want my key stakeholders to know I receive job satisfaction when I can meet these needs in the workplace. |