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.
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.
New Rules Require Resiliency<p>Recently, the Centers for Disease Control and Prevention has mandated enhanced barrier precautions in nursing homes to prevent the spread of multidrug-resistant organisms. This includes the use of gowns and gloves during high-contact resident care activities, such as “providing hygiene” (e.g., brushing teeth, combing hair, and shaving). This new requirement will increase the need for facilities to obtain and maintain an inventory of gloves, gowns, and other supplies. At a time when profit margins are razor thin and budgets are being slashed, this can present a significant challenge. <br></p><p>Justin Watson, MPA, healthcare coalition coordinator for the Omaha Metropolitan Healthcare Coalition, said, “This is where the value of coalitions and partnerships is key. It’s all about building relationships, but you can’t build these overnight.” He added, “It is important to have leaders who are willing to stay ahead of the curve and make tough decisions, and there’s a value in having people who have dealt with these issues before.”<br></p><p>Moving forward, lessons learned during the pandemic will help address or even help prevent supply chain challenges that result from regulatory requirements or other issues&#58;<br></p><p>Be open and transparent with staff about supply availability and shortages. Stress your commitment to their safety as well as that of residents, visitors, and others.<br></p><p>Train staff about supplies that can be reused and how this can be done safely.<br></p><p>Engage suppliers and other partners early on. Discuss what future needs may be and possible payment arrangements to reduce avoidable strains on your budgets.<br></p><p>“Supply chain shortages aren’t new, but they were exacerbated during the pandemic, and we learned to be more resilient and creative. We can look for ways to get the supplies we need and save financially, while managing our expectations,” Watson said.​</p>2022-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/SeptOct/PublishingImages/supply.jpg" style="BORDER&#58;0px solid;" />CaregivingThe CDC has mandated enhanced barrier precautions in nursing homes to prevent the spread of multidrug-resistant organisms.
Celebrating Joyful Moments & the Future of Assisted Living<p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/LaShuanBethea.jpg" alt="LaShuan Bethea" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />This year during National Assisted Living Week<sup>®</sup> (September 11-17), we celebrate “Joyful Moments.” This special observance honors assisted living staff, communities, residents, and families that come together as a large extended family and create happy, special memories together. <br></p><p>After the challenges of the past two and a half years, this theme is especially meaningful. Assisted living providers stepped up during that time to ensure their residents felt safe and loved and still had access to the care they need. They continued to create “Joyful Moments”—even when it wasn’t the easiest. <br></p><p>As we begin to emerge from one of the most challenging times in recent history, assisted living providers should evaluate new ways to continue delivering the highest quality care for residents going forward. <br></p><p>One strategy that may be relatively new to many within assisted living is population health management (PHM). PHM is the process of improving the health and quality of life for residents.&#160;It focuses on wellness, prevention, and proactive care coordination/management. <br></p><p><strong>What does that mean for assisted living providers, and why is it so important? </strong><br>Although a new concept for assisted living providers, other provider types—especially acute and primary care—have been leading the way under a multitude of PHM models for many years. PHM models deliver value-based care that helps improve outcomes and delivers better services to consumers. They help achieve the triple aim—the right care, at the right time, in the right place. The good news for assisted living providers is that a strong understanding of PHM can help you improve quality outcomes for your residents, position yourself well in the market, and manage risk within communities. <br></p><p>Assisted living is a natural setting for PHM. You offer meals, wellness programs, social engagement opportunities, transportation, supportive care, and other services focused on a whole-person approach while maintaining a home-like environment. You are positively influencing social determinants of health factors, thus being in a strong position to enhance outcomes, improve care, and lower costs. This is important because your community partners and referral sources are being held accountable to outcomes that you influence and are tracking your performance on these metrics—whether you are aware of it or not.<br></p><p>In addition, there has been growth in supplemental benefits offerings under Medicare Advantage. Many plans offer benefits such as companion services, which are currently out-of-pocket expenses for assisted living residents. Some plans go even further, helping with groceries and other traditionally non-health care-related benefits. Although fairly new and small in scope, the number of plans offering these benefits will increase. This could impact the amount of private-pay services in assisted living communities and will necessitate better coordination with health plans for covered services, as well as expand the options for innovations by assisted living providers themselves.<br><br><strong>What can assisted living providers do now to prepare for the changes ahead, such as a move towards PHM? </strong><br>First and foremost, collect important data. The health care landscape continues to change and evolve, and assisted living providers should begin now to track key data, such as hospital readmissions, emergency department visits, etc. Health plans and payors are already tracking these data and know how different providers compare. It is important to know where you stand and how you can improve. This will allow you to be a better partner with health plans and other providers in the future. It will also help you understand what is happening in your community and improve resident satisfaction by developing systems to reduce unnecessary hospitalizations and emergency transfers. Long Term Care Trend Tracker<sup>sm</sup> (<a href="https&#58;//www.ahcancal.org/Data-and-Research/LTC-Trend-Tracker/Pages/default.aspx" target="_blank">https&#58;//www.ahcancal.org/Data-and-Research/LTC-Trend-Tracker/Pages/default.aspx</a>) is a free tool offered to National Center for Assisted Living (NCAL) members. It allows you to start tracking immediately and trend yourself next to other providers in your area and across the country.<br></p><p>Additionally, start learning about what is happening in the health care space. What changes are occurring? What opportunities exist in value-based care? How can you partner with or become involved in provider-owned plans? Understanding the changing landscape puts you in a strong position to be successful in the future. <br></p><p>You should also plan to attend this year’s AHCA/NCAL Population Health Management Summit December 7-8 at the Gaylord National Harbor in Maryland. There will be several sessions focused specifically on assisted living, and this will be an invaluable opportunity to learn more about how to be successful utilizing PHM strategies and models in your communities. For more information and to register, go to <a href="https&#58;//www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank">https&#58;//www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx</a>.<br></p><p>Success means being able to deliver quality care for assisted living residents. It also means continuing to nurture the relationships that make your communities feel like home and create so many more joyful moments that are worth celebrating. <br></p><p>Enjoy National Assisted Living Week<sup>®</sup> (NALW), and be sure to share your celebrations on social media using the hashtag #NALW. Visit <a href="http&#58;//www.nalw.org/" target="_blank">www.NALW.org</a> for more information on National Assisted Living Week<sup>®</sup> (September 11-17). <br></p><p>Visit <a href="http&#58;//www.ncal.org/" target="_blank">www.ncal.org</a> to learn more about the National Center for Assisted Living. <br></p><p>Visit <a href="http&#58;//www.ahcancal.org/Reimbursement" target="_blank">www.ahcancal.org/Reimbursement</a> for more information on AHCA/NCAL’s Population Health Management efforts. <br><br><em>LaShuan Bethea is the executive director of the National Center for Assisted Living (NCAL). ​</em></p>2022-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/SeptOct/PublishingImages/AL.jpg" style="BORDER&#58;0px solid;" />CaregivingLaShuan BetheaAs we begin to emerge from one of the most challenging times in recent history, assisted living providers should evaluate new ways to continue delivering the highest quality care for residents going forward.