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COVID Highlights Importance of Leadership<p></p>The COVID-19 pandemic seems to be settling down at the time of writing this article, but no one knows what the future may hold as far as variants, future surges, duration of vaccine immunity, and many other unknowns go. What is known is that COVID-19 has been absolutely devastating in post-acute and long term care centers, first and foremost to residents and their families, but also to staff.<br><div><br></div><div>Providers have also learned some lessons from the pandemic about leadership (and lack thereof) on many levels, about infection prevention and control, and about the courage and dedication their frontline workers have demonstrated.</div><br>It is impossible to express how grateful providers are to their nurse assistants, nurses, and all of the other heroes who have placed themselves and their families at personal risk day after day. <br><div><br></div><div>Probably every reader can appreciate the magnitude of the pandemic’s swath through long term care settings in the United States and worldwide. Even as health care professionals edge back toward normalcy, there will be profound and enduring changes to the way they do things. The full gravity of this pandemic will not be understood and appreciated for years to come. </div><h2>What the Pandemic Revealed</h2>The pandemic has clearly shed light on some of the shortcomings of the current paradigms in long term care. Providers have learned the vital importance of emergency preparedness, robust infection prevention and control measures, and the need for ample personal protective equipment (PPE).<br><div><br></div><div>There have been many calls for an overhaul of the long term care industry and increasing scrutiny on issues of equity, staffing, workforce, and infection prevention and control. </div><br>One lesson some nursing centers and corporations have learned is that medical leadership from the facility medical director can be of immense value. While there has been a federal mandate since 1975 for every nursing center to have a medical director, and while the duties of the medical director have been defined since the Omnibus Budget Reconciliation Act of 1987 (implementation of resident care policies and coordination of medical care in the facility—a tall order), there is huge variability in the extent to which medical directors actually fulfill their duties. <br><h2>The Plus Side</h2>Some nursing centers employ medical directors who demonstrate clear dedication, engagement, knowledge of geriatric medicine and infectious disease principles, and awareness of the complex regulatory framework in which they operate. <br><div><br></div><div>These medical directors for the most part have stepped up throughout the pandemic, helping residents, families, staff, and the administration navigate the difficult, confusing, often frankly contradictory guidance on PPE, cohorting, testing, vaccination, and visitation from a variety of agencies and public health authorities. </div><br>These leaders have helped create and roll out mitigation plans and other policies and procedures to protect their residents and staff and have helped ensure that goal-concordant medical treatments have been provided whenever possible—including attention to comfort and dignity with appropriate advance care planning.<br><h2>Different Approaches, Results</h2>Many medical directors have been in direct contact with survey teams and representatives of local and state public health departments. Many of these dedicated medical directors have also devoted their time and passion to helping educate staff about vaccination, and these efforts have been evidenced in an increased vaccine uptake among staff. <br><div><br></div><div>Conversely, there are medical directors who appear to have little interest in performing their federally mandated duties of implementing resident care policies and coordinating the medical care in their nursing centers. <br></div><div><br></div><div>There have been many tragic consequences of lapses on the part of these medical directors, perhaps none as infamous as what occurred at one nursing center in the northeast, where staff were directed to let symptomatic presumed COVID-positive residents eat in a common dining room with asymptomatic, COVID-negative residents.</div><div><br></div><div>But a common thread in facilities where strike teams from Doctors Without Borders had to come in and assist was that the medical directors of these facilities were largely missing in action.</div><h2>Tightening Ship</h2>Historically, some nursing centers and corporations have sought to retain medical directors who can drive census, such as doctors affiliated with hospitalist groups, Accountable Care Organizations, or other entities. There’s nothing wrong with having a medical director who will refer patients to a nursing center, but that medical director needs to also have some basic competencies, and many do not.<br><div><br></div><div>Other nursing centers have chosen to retain medical directors who have little knowledge or interest in geriatrics or long term care (sometimes retired surgeons or pediatricians) and who will essentially not “make waves” and just sign whatever paperwork they are handed. </div><div><br></div><div>This is no longer going to be acceptable, and this would be a good time to plan ahead to avoid future problems.</div><div><br></div><div>The sheer devastation related to COVID-19 in nursing centers has brought attention to the role of the medical director, and federal authorities are among those taking notice. It is reasonable to expect now that routine surveys are getting underway that there may be more of a focus on the role of the medical director in the Infection Prevention and Control Program and Quality Assurance/Performance Improvement (QAPI), and nursing centers should prepare for this.</div><h2>Value of Certification</h2>So, how does a nursing center find a qualified, competent medical director? One simple strategy is to make certification (available through the <a href="http&#58;//www.abplm.org/" target="_blank" title="www.abplm.org">American Board of Post-Acute and Long term Care Medicine</a>,) a requirement for the position, either as a condition of initial hire or as an expectation within a set time frame.<br><div><br></div><div>The Certified Medical Director (CMD) certification requires about 40 hours of continuing medical education specific to the nursing care setting, including more than 20 core areas that encompass clinical, regulatory, bioethical, and other topics.</div><div><br></div><div>California has legislation pending (AB 749) that will require all licensed skilled nursing facilities to engage a medical director who has a CMD certificate within five years, and a handful of other states have similar requirements for minimal credentialing or knowledge.</div><div><br></div><div>Short of the actual certification, nursing centers can also contractually require their medical directors to be members of medical societies like AMDA – The Society for Post-Acute and Long Term Care Medicine and maintain a minimum number of annual educational hours from such organizations that focus on geriatrics and long term care.</div><div><br></div><div>Some facilities also engage an associate medical director (or director of post-acute or a variety of other titles) to assist with quality initiatives, and this can be helpful.</div><div><br></div><div>Considering the high acuity of the case mix these days in most nursing centers, and especially in light of hard lessons learned from the pandemic, this would be an excellent time for all nursing centers to assess their current medical director’s level of dedication, engagement, knowledge base, and accessibility—and if lacking, strongly consider remediation or replacement. </div><div><br></div><div>Nursing centers pay reasonable stipends for these duties and deserve to have qualified, competent medical directors. Their residents, families, and staff deserve nothing less. </div><br><strong>Karl Steinberg, MD, CMD, HMDC, </strong><em>is president of AMDA – The Society for Post-Acute and Long Term Care Medicine. He has been a nursing home and hospice medical director in the San Diego area since 1995 and is chief medical officer for Mariner Health Central and Beecan Health. </em><br>2021-06-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/June/PublishingImages/0621_meddirector.jpg" style="BORDER&#58;0px solid;" />Management Karl Steinberg, MD, CMDThe COVID-19 pandemic seems to be settling down at the time of writing this article, but no one knows what the future may hold as far as variants, future surges, duration of vaccine immunity, and many other unknowns go.
Top 30 AL Providers Track National Trends Amid Pandemic, Occupancy Pressures<p>​After a year like no other, assisted living (AL) providers and the vendors that serve them are keeping a close eye on what most expect to be a gradual recovery in census amid the COVID-19 pandemic and subsequent decline in occupancy.<br></p><p>As this slow rebirth starts, <em>Provider</em> is publishing its Top 30 list of the largest assisted living companies by facility count, reinventing the annual measurement, which will be followed in July by a Top 30 list for largest nursing home companies. <br></p><p>The list contains many of the traditional large operators in the AL space, covering a wide swath of geography. Leading the way this year is Brookdale Senior Living. Based in Tennessee, the provider counts 35,126 units in 563 facilities across 43 states. Behind Brookdale in second place by a sizable margin is Sunrise Senior Living based in Virginia, which counts 14,550 units in 30 states and 274 communities. <br></p><p>Third rank goes to Five Star Senior Living of Massachusetts, which has 12,112 units in 31 states and 252 facilities. In fourth is Illinois-based Enlivant with 9,798 units in 210 communities across 26 states. And, rounding out the top five, is Atria Senior Living. The Kentucky-based provider has 9,673 units in 21 states and 141 communities.</p><h2>Charting the Recovery </h2><p>The number of beds and size and scope of these providers’ businesses—and all AL communities amid the pandemic— are of keen interest to vendors serving long term and post-acute care. One of those is MatrixCare,&#160;which provides post-acute electronic health record (EHR) software to more than 13,000 facility-based care settings and 2,500 home care/home health and hospice organizations.<br></p><p>Gary Pederson, executive vice president of MatrixCare, spoke to Provider on the trends in the AL sector, and overall care continuum for seniors, which his company covers from home health to hospice and nursing homes and independent living, among other care settings. <br></p><p>He said MatrixCare was tracking the impact that the COVID outbreak started to have on senior living even before most national media paid attention, and what they noted off the bat was that skilled nursing was taking a much heavier burden than AL, which led to more severe census declines.<br></p><p>“Skilled got hit hardest, and despite a slight uptick in September, the occupancy numbers have been bottoming out,” he says. “But recent indicators give hope that slowly and surely we are crawling out of the census hole, notably in skilled nursing with things like elective surgeries coming back.”</p><h2>AL Takes COVID Hit, Too</h2><p>For AL communities, Pederson says, MatrixCare didn’t see as much of a dip in occupancy as was seen on the nursing home side of its business, and from the data the company learned how the more technologically advanced of its customers fared better than others.<br></p><p>“If there is anything interesting in the trending data, it would be that the more modern the infrastructure of the facility and the provider’s ability to utilize engagement tools already in place, the more likely they were able to manage the intense need during the pandemic for handling the challenge of resident isolation,” Pederson says.<br></p><p>These tools include reliable Wi-Fi and the use of existing EHR to tap into engagement platforms for residents and families.<br></p><p>Pederson says because of the pandemic and the new need for even more up-to-date technology, the older-style AL buildings must decide on how to proceed.<br></p><p>“There are tough decisions coming up on investments in technical infrastructure to make sure their Wi-Fi is ubiquitous, as an example,” he says.</p><h2>EHR Takes New Turn</h2><p>MatrixCare also looked at its own services and systems during the pandemic and realized that it, too, would have to change. One thing Pederson says changed during the height of the pandemic was that many customers did not have the time to invest in new EHR upgrades. <br></p><p>So, MatrixCare spent time explaining to its customers how their existing platforms had many possibly untapped features that could be put to use, including in the areas of engagement. <br></p><p>“As our caregiver engagement tools were being widely utilized during COVID, we placed additional emphasis on family engagement, which is and was a huge need for our customer base during the lockdowns,” Pederson says. <br></p><p>“We also had all of this innovation available to our customers who may not have been using it to its full capability. They did not have time to buy new software during the COVID response, so it was an opportunity for us to show them how to make better use of their MatrixCare investment as we took on a more consultative approach to make use of this software.”<br></p><p style="text-align&#58;left;">Whatever the need, and no matter the size of the AL community, he says the EHR was put to use for meeting new regulatory requirements brought to bear by COVID and to make contact among and between family, residents, and staff that much easier.</p><p style="text-align&#58;center;"><strong><a href="/Topics/Special-Features/Pages/Top30Collect.aspx">Click</a>​ to access the Report&#58;</strong></p><p style="text-align&#58;center;">&#160;<span class="ms-rteThemeForeColor-5-4"><strong><a href="/Topics/Special-Features/Pages/Top30Collect.aspx" target="_blank" title="Top 30 AL"><img src="/Topics/Special-Features/PublishingImages/2021/Prv0621_Top30AL.jpg" alt="Click to access the Report!" style="margin&#58;5px;width&#58;170px;height&#58;170px;" /></a><br></strong></span></p><p style="text-align&#58;right;"><span class="ms-rteThemeForeColor-5-4"><strong><br></strong></span></p><p style="text-align&#58;center;"><span class="ms-rteThemeForeColor-5-4"><strong>Sponsored by&#58;</strong></span><a href="https&#58;//www.matrixcare.com/" target="_blank"><img src="/Topics/Special-Features/PublishingImages/Pages/Top-30-AL-Providers-Track-National-Trends-Amid-Pandemic,-Occupancy-Pressures/MatrixCare%20Logo_RGB_300%20DPI.png" alt="MatrixCare" style="margin&#58;5px;width&#58;185px;height&#58;65px;" /></a><br></p>2021-06-01T04:00:00Z<img alt="Top 30 Assisted Living" src="/Topics/Special-Features/PublishingImages/2021/Prv0621_Top30AL.jpg" style="BORDER&#58;0px solid;" />Caregiving;ManagementPatrick Connole​Assisted living communities with more advanced technology were better able to adjust to the demands for improved engagement with families amid the COVID-19 lockdowns.
AHCA Expands Board, Adds Leaders From Michigan, District of Columbia<p>The American Health Care Association (AHCA) has expanded the size of its Board of Governors and elected two new members to at-large positions&#58; Reginald (Reggie) Hartsfield of Michigan and Tina Sandri of Washington, D.C. </p><p>Hartsfield is president and owner of Advantage Living Centers, and Sandri is chief executive officer (CEO) of Forest Hills of D.C. </p><p>“We are fortunate to have Tina and Reggie joining our board. They are both extraordinary leaders in long term care, and their knowledge and passion will be crucial for our sector during this extremely challenging time,” said AHCA President and CEO Mark Parkinson. </p><p>“The long term care profession is facing unprecedented challenges on multiple fronts, and it is critical that our board include new voices to help us navigate these difficult times and usher in a stronger, more inclusive future.”</p><p>Hartsfield has been in the long term care sector for more than 20 years and is experienced as a licensed nursing home administrator, owner, and operator. His company Advantage Living Centers includes 10 skilled nursing facilities and two assisted living communities. </p><p>AHCA said Hartsfield is a proponent of high-quality care, enhanced communication, and diverse viewpoints and inclusiveness. Prior to being appointed to the AHCA Board, Hartsfield served as board chairman for the Health Care Association of Michigan and on AHCA’s Independent Owner Council and Future Leaders program. </p><p>With more than 20 years of operations experience in health care, AHCA said Sandri is committed to improving conditions for frontline caregivers and the public perception of careers in long term care. Sandri has diverse experience serving as a leader within hospitals, retirement communities, skilled nursing centers, assisted living communities, and hospice care in for-profit, nonprofit, chain, and freestanding communities. </p><p>Sandri also has extensive experience serving her community in civic, school, and church organizations that focus on developing youth through immersive, hands-on experiential learning and community service. </p>2021-05-25T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News2.jpg" style="BORDER&#58;0px solid;" />ManagementLeader says it’s critical to include “new voices” to usher in a “stronger, more inclusive future.”
Nursing Homes See Occupancy Bump Higher in Latest NIC Data<p>Nursing home occupancy levels increased to 71.2 percent in February 2021 compared to 70.7 percent from the previous month, according to NIC MAP® data prepared and released by NIC MAP Vision, which are both products of the National Investment Center for Seniors Housing and Care (NIC).</p><p>This brought the occupancy rate back to its December 2020 level. Despite the February improvement, occupancy remains 13.7 percentage points below its pre-pandemic level, NIC said.</p><p>The February NIC MAP occupancy data are starting to reinforce trends from other data sources. COVID-19 case counts at skilled nursing facilities are down 98 percent since December 2020 and the launch of the long term care vaccination program, <a href="https&#58;//blog.nic.org/cases-among-skilled-nursing-facility-residents-falling-despite-rising-rates-among-the-general-population">according to NIC. </a></p><p>Additionally, more than four in five operators in senior housing and skilled nursing are reporting an increase in lead volume since the beginning of the year, according to NIC’s latest <a href="https&#58;//blog.nic.org/executive-survey-insights-wave-26">Executive Survey Insights.</a></p><p>“February’s NIC MAP data underscore what some skilled nursing facility operators have been saying the past few months&#58; They are starting to see occupancy stabilization,” said Beth Burnham Mace, NIC’s chief economist. “Data from the next few months will be extremely important, as it will signal whether this is the start of a longer trend toward recovery.”</p><p>NIC MAP data powered by NIC MAP Vision show traditional Medicare revenue per patient day was steady at $555, but the share of Medicare revenue declined to 23.4 percent from 25.1 percent in January. The share of Medicare Advantage revenue increased to 11.1 percent, up from its pandemic low of 8.3 percent in May of 2020.</p><p>“Hospitals resuming elective surgeries and discharging patients to skilled nursing facilities may be responsible for greater share of Medicare Advantage revenue, thereby boosting occupancy,” said Bill Kauffman, senior principal at NIC. “Occupancy is still near historic lows, and many facilities will need to see substantial increases in occupancy in order to stabilize the balance sheet.”</p><p>NIC said as nursing homes begin to move beyond the pandemic, occupancy is an important indicator of recovery. Older adults continue to need an array of options for long term care, given personal preferences and health and mobility status. These include institutional settings for people with acute or multiple chronic conditions or mobility challenges and home- and community-based options, NIC said.<br></p><p>Click here to access the latest<a href="https&#58;//info.nic.org/nic-map-skilled-nursing-data-monthly-report"> NIC MAP skilled nursing data.</a><br></p>2021-05-10T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News1.jpg" style="BORDER&#58;0px solid;" />Management;COVID-19Patrick ConnoleMore than 80 percent of senior housing, skilled nursing operators report increase in lead volume.