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NIC Says Senior Housing Occupancy Experiences Largest Decline on Record<p>New data from NIC MAP®&#160;Data Service (NIC MAP) provided by the National Investment Center for Seniors Housing &amp; 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&#58;//www.nic.org/news-press/senior-housing-occupancy-reaches-record-low-in-third-quarter/" target="_blank">https&#58;//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&#58;0px solid;" />CaregivingPatrick 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&#58; 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&#58;//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&#58;0px solid;" />CaregivingPatrick ConnoleThe 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&#58;initial;font-size&#58;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&#58; </p><ul><li>Minutes&#58; 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 &amp; 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&#58;//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&#58; 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&#58; 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&#58; 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 &quot;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&#58;//www.reliant-rehab.com/" target="_blank">www.reliant-rehab.com</a>.</p><p>For more information, please contact Stephanie Parks at <a href="mailto&#58;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., &amp; 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&#58;//www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/" target="_blank">https&#58;//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&#58;0px solid;" />COVID-19;CaregivingMelissa BrownSNF 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.&#160; </div><div>&#160;</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&#58;5px;width&#58;287px;height&#58;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&#58; 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&#58;5px;width&#58;275px;height&#58;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&#58;5px;width&#58;316px;height&#58;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.&#160; </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.&#160; </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&#58;5px;width&#58;208px;height&#58;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&#58;//brightenaday.weebly.com/get-involved.html" target="_blank">https&#58;//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&#58;0px solid;" />CaregivingHita 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.