| Vaccine Success Not Yet Helping Boost Senior Housing Occupancy | <p>Senior housing occupancy reached a record low of 78.8 percent in the first quarter of 2021, falling 1.8 percentage points from the last quarter of 2020 and 8.7 percentage points from a year ago, according to new NIC (National Investment Center for Seniors Housing & Care) MAP data, powered by NIC MAP Vision.</p><p>Despite the success of vaccination efforts in seniors housing, the latest numbers mark the sixth consecutive quarter occupancy has declined, and the fourth since the COVID-19 pandemic began.</p><p>“Senior housing residents have largely been vaccinated against COVID-19, which is dramatically reducing case counts and mortality rates, but this has not yet translated into a senior housing occupancy recovery,” said Chuck Harry, NIC’s chief operating officer. </p><p>“As move-in moratoriums continue to be lifted and operators get more inquiries from prospective residents, leads and property tours, occupancy may increase in the months ahead.”</p><p>The first quarter 2021 data show similar record low occupancy levels for assisted living and independent living properties. Assisted living occupancy fell a full two percentage points to 75.5 percent in the first quarter, and independent living occupancy dropped 1.6 percentage points to 81.8 percent. Since March 2020, assisted and independent living occupancy fell by 9.5 and 7.9 percentage points, respectively.</p><p>“It’s not surprising that a global pandemic and a specific virus that causes severe illness in older people is keeping senior housing occupancy at historic lows,” said NIC Chief Economist Beth Burnham Mace. </p><p>“It also is not surprising that occupancy improvement has not yet become evident since there is a natural lag between the time someone inquiries about moving into senior housing and the time that person actually moves into a property. Data from the next two quarters will signal whether consumers have moved beyond the pandemic and are again considering senior housing properties.”</p><p>Occupancy rates across metropolitan markets varied greatly. For example, San Francisco (84.2 percent), San Jose, Calif., (83.4 percent), and Seattle (82.9 percent) had the highest occupancy rates of the 31 metropolitan markets that encompass NIC MAP’s Primary Markets, while Houston (72.9 percent), Atlanta (73.5 percent), and Cleveland (74.2 percent) recorded the lowest.</p><p><a href="https://info.nic.org/nic-map-1q21-market-fundamentals">Click here </a>for the NIC Market Fundamentals report.<br></p> | 2021-04-09T04:00:00Z | <img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/1220_news1.jpg" style="BORDER:0px solid;" /> | COVID-19;Management | Patrick Connole | Reduced case counts haven’t yet translated into sector occupancy rebound. |
| How to Improve Administrator and DNS Relationships | <p><img src="/Monthly-Issue/2021/April/PublishingImages/AmyStewart.jpg" alt="Amy Stewart" class="ms-rtePosition-1" style="margin:5px;width:157px;height:200px;" />The relationship between the administrator and director of nursing services (DNS) has never been more important. Pandemic stress, coupled with increased regulatory scrutiny, has further strained what was already fraught; often, these stressors lead to turnover in one or both positions. <br></p><p>This critical relationship, often compared to a marriage, drives many aspects of care delivery. It affects facility culture because staff want to work on a cohesive team. It eases certification or complaint surveys by providing support. It generates financial benefits when these two collaborate on budget and census goals. And it improves the environment for residents and staff alike when communication between the two is transparent and truthful. <br></p><p>Achieving these results takes focus on the DNS-administrator relationship itself. When time and skill are invested in cultivating the relationship, it can withstand adversity, but if neglected, there can be far-reaching consequences. </p><h3>Improvement on Both Sides</h3><p>Consider this scenario: Joe, who recently started as the administrator, just told Nancy, the long-time DNS, she will need to cut her nursing budget this month. Nancy immediately became defensive, assuming he was saying she must make staffing changes. But, while Joe said she had to lower expenses, he hadn’t said to cut staff. In fact, Joe had wanted to review options with Nancy, but she jumped to conclusions. <br></p><p>Clearly, this does not create a cohesive team. If Nancy had listened carefully before responding, she would have known Joe wasn’t referring specifically to staffing. If Joe had built trust and established clear expectations, or communicated his wish to weigh options together, he could have avoided Nancy’s overreaction.<br></p><p>This scenario is far too common. When such conflicts occur frequently, they create irreparable damage. Below are five ways to improve the DNS-administrator relationship, regardless of tenure in each role.<br></p><h3 class="ms-rteElement-H3B">1. Teamwork Makes the Dream Work</h3><p>A solid foundation is necessary for a long-lasting, trusting relationship. Commit to working together as a team. Although each role has different responsibilities, the two must work together to meet patient outcomes and budgetary goals. <br></p><p>Yet teamwork goes both ways. Connect daily to discuss challenges, successes, and expectations. Start meetings by sharing what was done well before exploring what needs attention. Use reflective listening to understand what the other is saying before responding.<br></p><p>This takes practice. It is easy to let emotions take over, but reflection on the words used is more productive than reaction. Take time to learn each other’s strengths and weaknesses; use those strengths to improve care delivery and the work environment. A foundation of commitment and collaboration between the administrator and DNS will also reinforce teamwork within other departments and their staff. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>When Liz joined a small facility as the new DNS, tensions were high: The facility had recent survey issues, and census was low. Renee, the administrator, met with Liz daily. Renee discussed expectations and reviewed budget and census goals while Liz shared clinical improvements and concerns. By working to understand one another, Liz and Renee built trust and respected each others’ roles. </p><h3 class="ms-rteElement-H3B">2. Healthy Communication Every Time</h3><p>Learn each other’s preferred communication style and use it when possible. Some people prefer face-to-face communication, while others are perfectly happy with email. Whatever the style, remember that words are very powerful, so choose them wisely. Communicate frequently and honestly. Don’t hide issues to keep the conversations “nice and polite.”<br></p><p>Prioritizing communication requires a safe space to discuss tough situations that inevitably arise. Candid conversations are often necessary to improve care. Being truthful and having respect for each other avoids a negative work environment and supports the other’s efforts. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>When Mrs. Smith’s daughter arrived angry and demanded to speak to the administrator about care delivery concerns, Jen, the administrator, was already aware of the situation. She explained measures that had been initiated to improve care, and Mrs. Smith’s daughter felt reassured about how it was being handled. This confrontation could have gone differently if the DNS and administrator didn’t communicate regularly and transparently. </p><h3 class="ms-rteElement-H3B">3. Conflict Resolution that Works</h3><p>It is unrealistic to think that two people will always agree. Be prepared with a plan to overcome conflicts that will arise. It is best to disagree behind closed doors and work together toward resolution. Brainstorm options and discuss them until an agreement is reached. Sometimes, there isn’t a resolution; when that occurs, agree to disagree and move on.<br></p><p>Because the administrator and DNS are the two top leaders in a facility, staff watch the relationship closely. If staff observe disagreements, they may feel compelled to take sides. Don’t let conflict interfere with the facility’s mission and goals. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>Brenda, the administrator, and Amy, the DNS, discussed changing the uniform policy. Brenda wants nurses to wear one color uniform and nurse assistants another so patients know if the person entering the room is a nurse or assistant. Amy doesn’t agree.<br></p><p>Unhappy staff later question Amy about the change. Although Amy doesn’t like it, she explains the rationale fairly. Staff don’t need to know she disagreed, because it won’t change the policy, but could harm the work environment.</p><h3 class="ms-rteElement-H3B">4. Support Each Other</h3><p>There will be days when the stress level is so high that each person cannot be their normal self. Long term care has many stressful challenges, such as surveys, staffing, census, and regulatory change. When stakes are high, be a support system. Recognize when stressors are taking a toll.<br>Many of these challenges are unique to long term care, and no one can understand like the administrator or DNS. When things get tough, lean on each other. Occasionally, share a small token of gratitude to show you value one another. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>Already stressed about staffing, DNS Mike has just been told the survey team has arrived. Soon after, a surveyor asks Mike about an incident, and the conversation goes poorly. Administrator Tom recognizes that Mike’s stress level is increasing and checks on him, bringing a favorite coffee, moral support, and a sympathetic ear. This leaves Mike feeling heard, valued, and appreciated. </p><h3 class="ms-rteElement-H3B">5. Be Goal-Getters </h3><p>It’s easy to set goals, but the DNS and administrator must collaborate to achieve them. Being goal-getters requires a cohesive team. Offer to help one another with individual and mutual goals. When goals are not aligned, attainment becomes more difficult, and both parties become frustrated. However, when the two work together, goals are more easily achieved. And don’t forget to recognize and celebrate successes. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>Kathy, the DNS, proposes an annual goal of being deficiency-free with no complaint surveys. Bob, the administrator, recognizes that this is an ambitious goal and asks Kathy if she might want to consider a more realistic goal, such as fewer complaint surveys and two fewer deficiencies than last year. <br></p><p>Bob shares his census and budget goals and discusses how Kathy could help meet them. He asks her to include goals that increase the staff’s ability to care for medically complex patients, to help meet budget and census goals.<br></p><p>Cohesiveness in the administrator-DNS relationship has many benefits for a facility. Studies have shown that tenure of the two roles is associated with less staff turnover and lower survey deficiencies. It also enables better patient outcomes, as expectations, goals, and communication remain central to the working relationship. When both parties work together to provide the best care in a transparent manner, they can improve this critical relationship. <br><br><em>Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, is vice president of education and certification strategy at the American Association of Post-Acute Care Nursing (AAPACN). She can be reached at <a href="mailto:astewart@aapacn.org" target="_blank">astewart@aapacn.org</a> <br></em></p><p style="text-align:center;"><a href="http://www.aapacn.org/" target="_blank"><img src="/Monthly-Issue/2021/April/PublishingImages/AAPACN.jpg" class="ms-rtePosition-3" alt="" style="margin:5px;width:200px;height:58px;" /></a> </p><p><em></em></p> | 2021-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2021/April/PublishingImages/0421-mgmt.jpg" style="BORDER:0px solid;" /> | Management;Workforce | Amy Stewart, RN | The relationship between the administrator and director of nursing services has never been more important. |
| PharMerica’s PropacPayless Brings Local Focus Aligned With National Presence | <p>In David Welker’s world, the importance of a long term care pharmacy partner begins with the relationship, the ability of the provider to trust that medications will be on time and in the right supply, and that any problems can be rectified in quick fashion.<br></p><p><img src="/Topics/Special-Features/PublishingImages/2021/DavidWelker.jpg" alt="David Welker" class="ms-rtePosition-1" style="margin:5px;width:145px;height:186px;" />As chief executive officer of Brookfield Health and Rehabilitation of Cascadia in Battleground, Wash., he has entrusted his residents and staff with just that partner, the PharMerica company PropacPayless. <br></p><p>Welker says since PharMerica acquired the Pacific Northwest pharmacy PropacPayless, his skilled nursing facility has benefited greatly from not only the speed and efficiency of their customer service, but also the localized attention from pharmacists and nurse consultants that is complemented by PharMerica’s national scope and scale. <br></p><p>“This is the best relationship I have ever had with a pharmacy. The meds are on time, and we receive daily invoices showing really low costs,” Welker says. Still, beyond the bottom line there is the consistency of the PharMerica team that in normal times is visible in the facility, and now, during the pandemic, just a virtual visit away.<br></p><p>“It is so helpful to first and foremost know who the sales rep is and the nursing rep. Tons of things come up and usually late at night or after hours, and they respond immediately to emails and texts,” he says. “Other companies may get back to you the next day and it is too late. I really enjoy the response I get from our PharMerica team.”<br></p><p>As in most businesses, the continuity is vital as is the expertise. “We get emails from actual pharmacists. It is so nice to have them on our side; it feels like they have a significant role in our fight to provide top-quality resident care.”</p><h3 class="ms-rteElement-H3B">Oregon Provider Likes the ‘Personal’</h3><p>Nearby in the same Pacific Northwest region is where Andrew Becker, vice president of operations, Sapphire Health Services in Portland, Ore., tells his own story of how PharMerica’s PropacPayless has kept pace with his growing business.<br></p><p><img src="/Topics/Special-Features/PublishingImages/2021/AndrewBecker.jpg" alt="Andrew Becker" class="ms-rtePosition-2" style="margin:5px;width:145px;height:186px;" />A regional group that now has 20 facilities covering the full slate of senior care settings, Becker says the personal ties forged between the PharMerica consultants based in the same communities in which he operates have made all the difference. <br></p><p>Naming the consultants by first names, he says knowing who they are and for many years is a key part of the top-notch customer service that Sapphire’s nursing centers receive. <br></p><p>“We really have grown to appreciate the customer service and what they do for us. I mean you can pick up the phone and get an immediate response. It is the small things even, like when we had a pill crusher break. We asked if they could help, and they said they would be right out with a new one,” Becker says.<br></p><p>The nursing staff, he jokes, have become spoiled by the attention PharMerica’s nursing consultants pay the facility. Medication carts are checked and supported without fail.<br></p><p>“When PharMerica acquired PropacPayless, I was worried that some of the local touch would not be there anymore, and I have been more than pleasantly surprised to realize those things that I really loved have not changed. John [PharMerica rep] is still roaming the halls and checking out the carts, and Paul or Judy are there to help on pricing…”<br></p><p>And, when there is a tough client, the first step his team takes is to call the PharMerica consultant pharmacist and do a drug regime review to see if there is something missing that could help the resident. “Hopefully, we can get it resolved and at least move in the right direction to help our residents to get a better outcome.”</p><h3 class="ms-rteElement-H3B">National Scope </h3><p>The company, Becker says, truly has a national footprint with a local focus. An example is the way in which information on the COVID-19 pandemic has flowed nonstop from PharMerica, with national and state regulations and rule changes being communicated quickly and ahead of the curve.<br></p><p>And, the actual way in which PharMerica worked with the provider changed fast and seemingly without effort, he says. <br></p><p>“They jumped right in and adapted when the pandemic hit. This shows how their national presence helps. </p><p>There might be a lag in certain areas of the country with the rollout of a pandemic response, but a company like PharMerica with a national footprint can move some of those agendas quicker than others,” Becker says.<br></p><p>This was seen with the move from in-person to virtual visits and updates, which have proven to be very valuable in ways unforeseen before the pandemic.<br></p><p>“At times it was hard to have the time for a nurse to do a training in-person, but now with Zoom and other virtual methods, we can record a training and use it anytime,” he says.<br></p><p>Other PharMerica changes included using cardboard boxes for medication shipments as the regular totes could be an infection control issue as they were moved from facility to facility. “A lot of things had to change and had to be done quickly and seamlessly. The cardboard versus tote might not seem like a big deal, but it makes a big difference,” he says.</p><h3 class="ms-rteElement-H3B">It Is a Big Deal</h3><p>In the end, Cascadia’s Welker says there are many components in building a high-quality care operation to serve the needs of the elderly and those with disabilities who make up a nursing facility. It is with PharMerica, he says, that the pharmacy component of this quest is satisfied.<br></p><p>“It really plays to our ability to be a Five-Star facility. All cylinders have to fire to get to that level, you cannot be lacking in any one area, and PharMerica is one of the reasons why we are the highest-rated nursing home in Clark County,” he says.<br></p><p>“People are happy with the service they are getting, and if the pharmacy was failing, they would not be happy with their stay here. It is a really big piece of what we do,” Welker says. “We may not have the fact PharMerica is our pharmacy partner out on a banner out front, but it is a big deal.”</p><p><br></p><p style="text-align:center;"><img src="/Topics/Special-Features/PublishingImages/2021/PharMerica.jpg" alt="" style="margin:5px;width:190px;height:39px;" /><br></p> | 2021-04-01T04:00:00Z | <img alt="" src="/Topics/Special-Features/PublishingImages/2021/0421-PharMerica.jpg" style="BORDER:0px solid;" /> | Management | Patrick Connole | The importance of a long term care pharmacy partner begins with the relationship, the ability of the provider to trust that medications will be on time and in the right supply, and that any problems can be rectified in quick fashion. |
| ‘Start, Stop, Continue’ Lets You Listen, Learn, and Leap Forward | <p>The coronavirus pandemic has exposed gaps and problems but also innovations and opportunities for long term/post-acute care providers. The time is now to capture and nurture the great ideas and creative efforts, while doing away with outdated or unproductive processes or activities. This doesn’t have to be a time-draining, cumbersome endeavor. It can be as easy as start, stop, continue.  <br></p><p>The Start, Stop, Continue framework is a fairly easy technique where managers and their teams can assess what processes, systems, practices, ideas, and programs are working and where changes are needed.<br></p><p>By identifying which of these things the team thinks should be started, stopped, and continued, the manager can pinpoint ideas for team-based action, change, and innovation that can be implemented quickly.</p><h3>Clarify Means</h3><p>To get started, make sure that the team members understand what should go on each list:</p><h4><img src="/Monthly-Issue/2021/April/PublishingImages/start.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />START.</h4><p>These should be items that the team thinks would have a positive impact and contribute to better outcomes, teamwork, morale, engagement, and retention that aren’t already being used.</p><p>For example, staff may want to start more flexible schedules, make better use of technology, or a develop a better system to communicate or share information.</p><p><br></p><h4><img src="/Monthly-Issue/2021/April/PublishingImages/stop.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />STOP. </h4><p>These include activities or tasks that aren’t helping the team achieve their goals and actually may be impeding their efforts. For instance, staff want to stop having so many Zoom meetings.</p><p><br></p><h4><img src="/Monthly-Issue/2021/April/PublishingImages/continue.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />CONTINUE. </h4><p>These are things that have worked in the past and should continue to be part of the team’s workflow. “Continues” may include flexible scheduling, efforts to support staff during a crisis, or partnerships with local health departments and other stakeholders. </p><p>Ask everyone to submit one to two items for each category. Suggestions may be limited to each team’s work area (for example, clinical, administrative, operational) or open them up to recommendations about any aspect of the workplace.<br></p><p>Have an interdisciplinary, representative, and inclusive workgroup review the submissions, eliminate the duplicate ideas, and come up with a manageable list. The workgroup can develop specific action items in each area and send these back to the larger group to vote on the ones they think are most important and practical.<br></p><p>The workgroup then can involve the appropriate players to plan and implement each of the final stop, start, and continue actions.</p><h3>Extra Benefits</h3><p>While the pandemic and the fallout from it continue to place a burden on staff and leadership alike, this process can be done over a period of weeks, and the results can be powerful. Among the potential benefits:<br>● People will find that they have much in common and share some similar ideas. This can contribute to team building, engagement, and motivation.<br>● Staff are engaged and appreciate that their opinions are sought and valued.<br>● Problems, gaps, and other troublesome issues that are flying under the radar are brought to light and can be addressed early on.<br>● Ideas, thoughts, and concerns are captured while they are fresh in everyone’s minds. <br></p><p>Giving teams an opportunity to provide teamwork on a regular basis enables them to contribute and helps create a culture of trust, inclusion, and loyalty.  <br></p><p>For more information, go to <a href="http://www.forbes.com/sites/groupthink/2016/02/02/start-stop-continue-tutorial/?sh=6dc19e412798" target="_blank">www.forbes.com/sites/groupthink/2016/02/02/start-stop-continue-tutorial/?sh=6dc19e412798</a>. ■<br></p> | 2021-04-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2021/April/PublishingImages/0421-CS3.png" width="595" style="BORDER:0px solid;" /> | Management;Caregiving | Joanne Kaldy | New technique helps leaders and their teams easily assess their own programs for efficiency and success. |