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&#58;5px;width&#58;200px;height&#58;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&#58;//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 &amp; 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&#58; 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 &amp; 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&#58;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&#58;0px solid;" />Falls;CaregivingBrian LiebelReducing 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 &amp; 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&#58;5px;width&#58;137px;height&#58;178px;" />Sometimes the facility itself is the victim&#58; 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&#58; 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&#58;5px;width&#58;137px;height&#58;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&#58;0px solid;" />ManagementAllison Perrine and Warren CooperIn 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&#58;5px;width&#58;200px;height&#58;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. &#160;<br></p><p>The initial action steps were clear&#58; 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&#58;//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 &#160;</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&#58;<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&#58;0px solid;" />ClinicalTom GrapeProtector 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&#58;5px;width&#58;200px;height&#58;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&#58;<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&#58;<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&#58;0px solid;" />CaregivingJean FortgangSenior living administrators may turn their focus from infection prevention to the countless other pressing issues of the day.