| NIC Says Senior Housing Occupancy Experiences Largest Decline on Record | <p>New data
from NIC MAP® Data Service (NIC MAP) provided
by the National Investment Center for Seniors Housing & Care (NIC) show
that senior housing occupancy declined 2.6 percentage points in the third
quarter of 2020, from 84.7 percent to 82.1 percent.</p><p>NIC said
the continued impact of the COVID-19 pandemic on occupancy is profound, and the
latest numbers mark the second quarter in a row where occupancy fell more than
2.5 percentage points, meaning the senior housing sector is now experiencing
its largest drop in occupancy on record.</p><p>Assisted
living and independent living facilities experienced their largest occupancy
drop to date, falling 2.9 percentage points to 79.1 percent and 2.4 percentage
points to 84.9 percent, respectively. Nursing care properties saw a steep
decline to 76 percent occupancy in the third quarter, NIC said.</p><p>NIC MAP’s
Intra-Quarterly data show that the occupancy rate for majority assisted living
facilities was down 6.1 percentage points for NIC MAP’s Primary Markets since
March 2020.</p><p>Independent
living facilities saw a considerable increase in inventory, posting the largest
gain since early 2009, NIC said.</p><p>“This reflects
the relatively robust lending and development environment of 18 to 24 months
ago that supported construction starts back then, and which now are completed
properties entering the market,” said Chuck Harry, chief operating officer of
NIC. </p><p>“Construction
starts activity in the third quarter continued to be relatively weak,
reflecting today’s more constrained capital markets.”</p><p>NIC said there
are large disparities between occupancy rates across metro areas and
properties. San Jose, Calif. (89.9 percent), San Francisco (87.0 percent), and
Portland (85.5 percent) had the highest occupancy rates of the 31 metropolitan
markets that encompass NIC MAP’s Primary Markets, while Houston (75.9 percent),
Atlanta (77.4 percent), and Phoenix (78.6 percent) recorded the lowest. </p><p>Of note, the
occupancy rate for senior housing in the Sacramento area fell 8.6 percentage
points since the beginning of the pandemic to 80.6 percent in the third
quarter, while the Washington, D.C., area saw a smaller 2.2 percentage point
drop to 84.7 percent.</p><p>“What
we’re seeing is a barbell effect, where 34 percent of senior housing properties
in the NIC MAP Primary Markets reported occupancies above 90 percent in the
third quarter, while 36 percent reported occupancies below 80 percent,” said
NIC’s chief economist, Beth Burnham Mace. </p><p>“The
operators with higher occupancy rates will be able to take on the stress of
COVID-19, while those with lower occupancy rates will be more challenged.”</p><p>Read the full report at <a href="https://www.nic.org/news-press/senior-housing-occupancy-reaches-record-low-in-third-quarter/" target="_blank">https://www.nic.org/news-press/senior-housing-occupancy-reaches-record-low-in-third-quarter/</a>.</p> | 2020-10-16T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/housing.jpg" style="BORDER:0px solid;" /> | Caregiving | Patrick Connole | New NIC data show that senior housing occupancy declined 2.6 percentage points in the third quarter of 2020, from 84.7 percent to 82.1 percent. |
| NAHCA, CNAs for Quality Care Announce CNA Staffing Summit Scheduled for Oct. 20 | <p>Amid the continuing strain from COVID-19 on certified nurse assistants (CNAs) and all providing care in the long term and post-acute care setting, the National Association of Health Care Assistants (NAHCA) and CNAs for Quality Care announced the first-ever CNA Staffing Summit to be held on Oct. 20 from 1 p.m. to 4 p.m. (ET).</p><p>The news comes on the heels of the release of the Coronavirus Commission for Safety and Quality in Nursing Homes report, which contains a number of recommendations that affect direct care staff, NAHCA said. In an effort to address what’s contained in the report, as well as other issues, the CNA Staffing Summit will convene nursing home operators, administrators, nursing staff, directors of nursing, HR professionals, recruiters, and more so that everyone can learn from CNAs—as well as from each other—with the objective of creating a more unified workforce.</p><p>A panel of nine career CNAs from nursing homes around the country will be moderated by NAHCA Chief Executive Officer Lori Porter. Harvard Professor David Grabowski, PhD, will examine the state of the research on COVID-19 and direct care staff. Medical Epidemiologist for Long-Term Care at the Centers for Disease Control and Prevention Nimalie Stone, MD, is invited to speak as well, NAHCA said.</p><p>In addition to education, CNAs and others will address what matters most to direct care staff: engagement, recognition, and recruitment. <br>“The purpose of this is to not only bring together the entire nursing home workforce ecosystem but also to dig into the unfettered truth about what CNAs and their team members need to be more effective, more engaged, and, frankly, more appreciated,” said Porter, who recently served on the Coronavirus Commission.</p><p>“I want to share with the long term care community what we can do to take steps to resolve the workforce crisis and create a unified nursing home team that offers better care to elders.” </p><p>For those interested in joining the summit, NAHCA noted that three CEUs are currently pending from the National Association of Long Term Care Administrator Boards.</p><p>The John A. Hartford Foundation, Sabra Health Care, and Fire and Life Safety are sponsors.</p><p>For more information and to register, go to <a href="https://www.nahcacna.org/cna-staffing-summit/">nahcacna.org/cna-staffing-summit/.</a></p> | 2020-10-14T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/senior_woman_nurse_3.jpg" style="BORDER:0px solid;" /> | Caregiving | Patrick Connole | The purpose of the Summit is to not only bring together the entire nursing home workforce ecosystem but to dig into the truth about what CNAs and their team members need to be more effective, more engaged, and more appreciated. |
| Therapy Shouldn’t Be DIY | <span style="background-color:initial;font-size:13.6px;"></span><p>Skilled nursing facility (SNF) providers are reeling after all the
changes with PDPM and COVID-19. While providers surface after a
challenging year, the truth is that skilled nursing has turned upside
down in many communities. Providers are seeking for answers that will
lead to a win for the residents and a win for their operations. </p><p>As
providers scratch their heads over the undeniable shortcomings of the
federal and state governments to support their needs during the
pandemic, they are left to search for ways to fund their unexpected
extra costs and balance their budgets. </p><p>In a recent presentation
by LeadingAge, Ruth Katz noted that a provider who only needed 6 gowns
per month prior to COVID-19 was now purchasing hundreds per month. She
equated this to the average person’s consumption of toilet paper, which
costs about $8/month for 8 rolls. The exponential costs and numbers of
personal protective equipment (PPE) required for providers is similar to
raising this cost to over $1,600/month per person in toilet paper.
These costs would be unsustainable for us as individuals, and they have
been disastrous for the senior living continuum as well. </p><p>Providers
have begun to consider therapy as an opportunity to recoup some of
their losses by bringing therapy in house, either with or without a
management agreement. Gravity Healthcare Consulting recently conducted
research on behalf of Reliant Rehabilitation, one of the largest
nationwide contract therapy providers. The goal of the research was to
uncover the actual provider operational costs and margins associated
with contract rehab versus management agreement models and in-house
therapy. </p><p>Life plan communities, in the same geographical area
with the same wage index, were compared. They were very closely matched
for census and case mix. The results were enlightening – in-house
therapy programs, either with or without a management agreement, yielded
lower reimbursement and higher provider costs than contract rehab. The
study spanned Q1 of 2020 and examined the data of multiple real sites.
Let’s break down the numbers: </p><ul><li>Minutes: Advocates all over the
senior care industry were campaigning to have accountability for therapy
minutes, since PDPM no longer tied reimbursement directly to the number
of minutes provided. The Centers for Medicare & Medicaid Services
listened, and they have stated that they will be watching closely to
make sure that providers continue to supply each resident with
individualized and medically indicated services. </li></ul><p></p><p>However,
this new risk has made some providers begin to consider bringing their
programs in-house, so they can internalize therapy oversight and ensure
that resident needs continue to be met within the framework of the new
payment system. The fear is that contract therapy companies will
inappropriately slash therapy minutes in an effort to increase margins.
</p><p>The study showed that overall the majority of therapy partners
have only made 10-20% cuts in the average delivery of therapy minutes.
Most residents receive around 450-550 minutes, a Rehab Very High (RV)
level of services. However, research conducted by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/" target="_blank">Hye-Young Jung about therapy dosing</a> showed that residents at the RV level achieved the same
outcomes as those who were elevated to a Rehab Ultra High, or RU level
of therapy at 720 minutes per week. </p><p></p><p>Additionally,
residents in the RV therapy range are 3.1% more likely to return to home
versus those who received less minutes. Managed Medicare companies have
been pushing this evidence-based range of therapy treatment for over 5
years. While there have been growing pains, this model has forced
therapists to reinvent their approach. It has proven therapists can do
more with less. Shorter lengths of stay with moderately reduced therapy
minutes yield the same functional outcomes and discharges to home when
governed by a clinically strong therapy team. </p><p></p><ul><li>Labor
costs: Contract therapy only cost $1,557 more than the staffing costs
for therapy under a management model (excluding the actual management
agreement fees) and was actually less than the salary costs for the
in-house programs. Therapist salaries are the largest for in-house
programs, at the 75th percentile and beyond. Departments overseen by a
management agreement see some cost control through salaries in the 60th
percentile. Contract rehab is able to manage their costs best on behalf
of the provider, and they generally pay around the median salary. </li></ul><p></p><p>While
it may appear that staffing for a contract rehab arrangement would be
more difficult with lower salaries, because of the plethora of
therapy-specific benefits and the opportunity to advance within the
company, contract therapy companies usually excel at fulfilling the
staffing needs. </p><p></p><p>Providers who partner with a proven
contract rehab vendor, such as Reliant, reap all the included benefits
that the therapy company offers for virtually no additional expense, or
even a cost savings! </p><p></p><ul><li>Margins: As may be expected,
contract therapy partners obtain and maintain the highest productivity
levels. And while there can be concerns with unrealistic productivity
expectations over 100% with the new model, generally speaking, contract
therapy targets a reasonable productivity expectation of between 80-90%.
Most jobs have some sort of productivity requirement, such as a certain
number of widgets, reports, or sales that are due each week. </li></ul><p></p><p>The
secret sauce, however, was not the focus on productivity. Rather,
contract rehab was armed with clinical expertise and research, and the
therapy champions from a contract rehab </p><p>management team empowered
the therapists to function at the top of their game. By focusing on the
clinical needs and medical necessity of each individual resident,
contract therapy showed an increased number of residents who were
evaluated and appropriately treated in long term care. Additionally, the
average therapy dose per day (number of minutes) for long term care
residents was actually higher with contract therapy than with management
agreement or in-house models. </p><p></p><p>This focus on productivity
and clinically appropriate service delivery yielded the largest
provider margins with contract rehab in the Gravity study. SNF margins
for in-house programs were on average 71% less than with contract rehab.
Management agreements didn’t fare much better, with an average SNF
margin of 61% less than contact rehab. This is both due to cost and
reduced revenue consistently seen with both the in-house and management
agreements. </p><p></p><ul><li>Compliance: The study showed significant
difference in compliance between the various therapy models. In-house
models scored 50% or less on therapy compliance audits. Management
agreement models fared a little better, averaging between 75-85%.
Contract rehab got the win with compliance audits usually at 95% or
greater. </li></ul><p></p><p>Stephanie Parks, MBA, MS, CCC-SLP, Chief
Development Officer with Reliant Rehabilitation, sums it up well,
saying, “Clinical and documentation quality assurance and performance
improvement are best achieved when the reviewers are reputationally and
financially accountable for potential claim losses and litigation risks
related to poor performance, as is the case with full-service therapy
partners.” </p><p></p><p>When collaborating with the right therapy
partner, the interests of both parties are closely aligned, and drive
compliance upward. While it may be tempting to bring therapy in house or
to a management agreement to reduce the provider’s liability, the
results show that compliance is best left up to the contract therapy
experts. </p><p>Many early projections for a transition to in-house or
management anticipate improved provider margins with the transition away
from contract rehab. However, the research shows that the actual costs
are greater, and revenue tends to decline. Some of these additional,
often unforeseen costs include the cost of a management agreement, the
cost of the therapy electronic medical record, the human resources costs
(which include some additional costs unique to therapy), and the
compliance and denials management costs. </p><p>The uncertain times
surrounding COVID-19 make the decision to insource therapy even more
risky. The Gravity study showed there are increased liabilities,
potential losses, and reduced outcomes for residents of in-house or
management agreement models. If you would like to have a complete,
unbiased third-party analysis of your current therapy program, please
contact us today. </p><p>Reliant Rehabilitation is a national provider
of rehabilitation services. The Company utilizes a proprietary care
model that emphasizes early intervention and assessment and properly
designed clinical care plans, as well as pathways to improve patients’
functional levels. Reliant differentiates itself by providing proven
program performance management, customer marketing support, and
industry-leading compliance systems. Our Mission is "Care
Matters.” We are completely committed to our employees, patients, and
the customers we serve. At Reliant, we strive for optimal patient
outcomes in the most efficient matter. <a href="http://www.reliant-rehab.com/" target="_blank">www.reliant-rehab.com</a>.</p><p>For more
information, please contact Stephanie Parks at <a href="mailto:sparks@reliant-rehab.com" target="_blank">sparks@reliant-rehab.com</a>.
</p><p></p><p>Melissa (Sabo) Brown, OTR/L, CSRS, CDP, is the Chief
Operating Officer of Gravity Healthcare Consulting. She is an
Occupational Therapist with over 15 years of experience in skilled
nursing, continuing care retirement communities, and home health. </p><p>Reference </p><p><em>1.
Jung, H.-Y., Trivedi, A. N., Grabowski, D. C., & Mor, V. (2016,
January). Does More Therapy in Skilled Nursing Facilities Lead to Better
Outcomes in Patients with Hip Fracture? Retrieved May 21, 2020, from
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/</a>. </em></p> | 2020-09-08T04:00:00Z | <img alt="" src="/Topics/Special-Features/PublishingImages/2020/MelissaBrown.jpg" style="BORDER:0px solid;" /> | COVID-19;Caregiving | Melissa Brown | SNF providers are reeling after all the changes with PDPM and COVID-19. While providers surface after a challenging year, the truth is that skilled nursing has turned upside down in many communities. |
| Pennsylvania Teen’s Nonprofit Connects With Seniors | <div>
Hita Gupta knew at an early age that she had a special connection with
the elderly. She and her 10-year-old brother, Divit, have always had a
close relationship with their grandparents. Their closeness is what
inspired her to find opportunities to connect with older generations.  </div><div> </div><div>“I knew that I could help, and I wanted to find a way to interact with seniors,” she says. </div><div></div><div><br></div><div></div><div><img src="/Monthly-Issue/2020/September/PublishingImages/feature1.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:287px;height:377px;" />Now,
at the age of 15, Gupta is running her own nonprofit that is bringing
encouragement and hope to residents in long term care facilities.
Brighten A Day has reached thousands of seniors in the United States
through cards, video messages, and care packages. Her goal is simple: to
lift the spirits of seniors and remind them that they are not alone. </div><h2 class="ms-rteElement-H2">
A Local Start</h2><div>It all began in middle school when Gupta started writing cards for
children in hospitals and residents in senior communities in her
hometown of Paoli, Pa., a suburb of Philadelphia. She soon got her
community involved through partnerships with her local school district
and public libraries. </div><div><br></div><div>During her freshman year of high school, Gupta started a club
called Brighten A Day. As her club grew, she made the decision to turn
it into a nonprofit. In 2019, Brighten A Day became an official
501(c)(3) and has grown into a national organization with thousands of
volunteers of all ages from locations across the country. </div><div><br></div><div>At the same time, she began volunteering weekly at a local assisted
living community. She spent most weekends at the facility talking to
residents and helping organize activities like trivia and Bingo. She
also worked with residents with dementia. The bonds they formed were
mutually beneficial. She loved spending time with the residents, and
they loved spending time with her. </div><h2 class="ms-rteElement-H2">Going National</h2><div>Then COVID-19 hit. Nursing facilities and assisted living
communities had to make the difficult decision to temporarily suspend
outside visitation in order to stop the spread of the virus. When Gupta
was told she could no longer visit, she thought about the residents and
the loneliness and isolation that would soon follow. She knew it was an
opportunity for Brighten A Day to step up.</div><div><br></div><div>Gupta immediately sprang into action and began sending care
packages to long term care facilities in and around her community. The
packages included large-print puzzles, adult coloring books, colored
pencils, and a handwritten note by her brother, Divit. She traveled all
over, personally delivering packages to the facilities. </div><div><br></div><div><span><div><span><img src="/Monthly-Issue/2020/September/PublishingImages/feature5.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:275px;height:206px;" /></span></div></span>In
addition to care packages, Gupta and Brighten A Day volunteers send
encouraging notes, cards, and video messages to long term care residents
nationwide. As virtual visits have taken the place of in-person visits,
she has so far been able to donate 20 tablets to facilities that need
them. </div><div><br></div><div>Hita and Divit Gupta search far and wide for senior communities
across the country to share their messages of encouragement. When they
find a community they want to help, they contact the facility and ask if
they’d be interested in working with Brighten A Day. The response has
been overwhelmingly positive. </div><div><br></div><div>“They’re all looking for ways to lift the spirits of seniors right
now,” Hita Gupta says. “There was one nursing home in Hawaii that told
us that they shared our cards and notes and our video messages. The
residents started to cry because they had been isolated for so long. It
touched them that someone was actually thinking about them right now.” </div><h2 class="ms-rteElement-H2">A Closer Connection</h2><div>Brandywine Living at Haverford Estates in Delaware County, Pa., is
one community that Brighten A Day has touched. Activities Director
Bonnie Edenfield first learned of Brighten A Day when Hita Gupta
delivered 50 care packages to her for each of her residents, whose ages
range from 70 to 103.<span><img src="/Monthly-Issue/2020/September/PublishingImages/feature2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:316px;height:221px;" /></span></div><div><br></div><div>Edenfield and Gupta began communicating via email and soon
coordinated video chats between volunteers and residents via Zoom, a
video conference software program. Gupta provided Edenfield with a
spreadsheet of volunteers and their interests. From there, Edenfield was
able to match the volunteers with her residents. Currently, three of
her residents have daily Zoom chats with three different<span></span> volunteers from Brighten A Day.  </div><div><br></div><div>“They look forward to that call every day,” she says. “It’s absolutely making a difference.”</div><div><span><br></span></div><div>Edenfield also shared a story about one resident who loves to play
Canasta but hasn’t been able to play since visitation was stopped. When
Gupta found out, she quickly sent the word out to her army of
volunteers. It wasn’t long before Edenfield was connected with four
volunteers who learned how to play the game on YouTube so they could
play with the resident online. </div><h2 class="ms-rteElement-H2">Getting the Word Out</h2><div>Through social media, word of mouth, and networking sites like
Volunteer Match, Brighten A Day has established a presence in all 50
states. Gupta’s GoFundMe page has enabled her to buy the supplies she
needs to put smiles on the faces of seniors nationwide. Since the
pandemic began, Brighten A Day has even gone international. Nursing
facilities in Scotland, Australia, Ireland, England, Germany, and Italy
have received encouraging cards and video messages from its volunteers. </div><div><br></div><div>Gupta is grateful to her parents for Brighten A Day’s success. “I
couldn’t have carried out this project without their support,” she says.
Whether it was helping her with the rigorous process of forming a
501(c)(3) or driving her to drop off care packages, her parents’ love
and encouragement have meant a lot to her.  </div><div><br></div><div>Brighten A Day has captured the attention of the media nationwide.
The work that she and her volunteers have done has made headlines on ABC
News, CNN, FOX News, and dozens of local television stations and
newspapers.</div><h2 class="ms-rteElement-H2">Seeking Personal Connections</h2><div>Gupta has been overwhelmed by the impact Brighten A Day has made, especially during the p<span><span><img src="/Monthly-Issue/2020/September/PublishingImages/feature3.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:208px;height:248px;" /></span></span>andemic.
While cards and video messages have been the mainstay of their COVID
outreach, she’s currently looking for nursing facilities that are
interested in video chats similar to the ones she helped set up at
Brandywine Living. Many of her volunteers are eager to have
conversations with long term care residents to give them the human
interaction they may be missing while they’re unable to see their loved
ones face to face.</div><div><br></div><div>As a junior at Conestoga High School, Gupta has a full workload
with her studies, but still finds time to dedicate to Brighten A Day.
While on summer break she has more free time, but during the school
year, she spends at least eight hours a day leading her organization. </div><div><br></div><div>“It’s literally like a full-time job,” she laughs.</div><div><br></div><div>When asked if she aspires to a career in long term care, Gupta
replies that she isn’t sure yet. “Right now, I’m just trying to make a
difference.”</div><div><br></div><div>There are many ways individuals can support Brighten A Day. To learn more about how to get involved, visit <a href="https://brightenaday.weebly.com/get-involved.html" target="_blank">https://brightenaday.weebly.com/get-involved.html</a>. </div><p></p> | 2020-09-01T04:00:00Z | <img alt="" height="430" src="/Monthly-Issue/2020/September/PublishingImages/feature5.jpg" width="568" style="BORDER:0px solid;" /> | Caregiving | | Hita Gupta and her 10-year-old brother, Divit, have always had a close relationship with their grandparents. Their closeness is what inspired her to find opportunities to connect with older generations. |