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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 &amp; 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&#58;//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&#58;0px solid;" />COVID-19;ManagementPatrick ConnoleReduced case counts haven’t yet translated into sector occupancy rebound.
CMS Proposes 1.3 Percent Increase to Medicare Rates for SNFs in 2022<p>The Centers for Medicare and Medicaid Services (CMS) on Thursday released the Skilled Nursing Facility Prospective Payment System (SNF PPS) FY 2022 draft rule in which the agency proposed a 1.3 percent increase in Medicare rates for nursing homes.</p><p>In response, Mark Parkinson, president and chief executive officer of the American Health Care Association (AHCA), said the 1.3 percent rate hike for SNFs in the next fiscal year would result in an increase of approximately $444 million in Medicare Part A payments. </p><p>“Nursing homes across the country continue to dedicate extensive resources to protect their residents and staff from COVID-19,” he said. </p><p>“This ongoing work makes government support and robust reimbursement rates more important than ever. With the skilled nursing profession grappling with an economic crisis and hundreds of facilities on the brink of closure due to the pandemic, it is critical that Medicare remain a reliable funding source and reflect the increasing costs providers are facing.”</p><p>Parkinson added that “we also recognize the importance of quality measures associated with COVID-19, including a proposed measure of the COVID-19 Vaccination Coverage among health care personnel. We thank [CMS] Acting Administrator [Liz] Richter and the [Biden] administration for their support through the pandemic.”</p><p>For further information, go to <a href="https&#58;//www.federalregister.gov/public-inspection/current">Federal Register &#58;&#58; Federal Register Documents Currently on Public Inspection. </a></p>2021-04-08T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/DC-at-night.jpg" style="BORDER&#58;0px solid;" />Reimbursement;PolicyPatrick ConnoleThe hike for SNFs in the next fiscal year would result in an increase of approximately $444 million in Medicare Part A payments.
Teamwork Carries the Day During Pandemic<p>​During the pandemic, it hasn’t been unusual to see a director of nursing (DON) in the kitchen, human resources staff making beds, maintenance staff picking up or dropping off employees, and administrators feeding patients. There’s an “e” in teamwork, and in the past year, that’s stood for “everyone helps everyone else.” <br></p><p><img src="/Monthly-Issue/2021/April/PublishingImages/Oguin.jpg" alt="Jennifer Oguin, RN, DON" class="ms-rteImage-3 ms-rtePosition-1" style="margin&#58;5px;width&#58;144px;height&#58;177px;" />As Jennifer Oguin, RN, DON, at Trinity Care Center in Round Rock, Texas, says, “My title went out the window. When it comes down to it, we are a team that pulls together without even asking. People just jump in and do what needs to be done. It’s embedded in our culture.”<br></p><p>Teamwork has taken on new meaning during the pandemic. Facilities have implemented new strategies for communication,&#160;collaboration, and innovation. Transparency, resilience, and empathy are not buzzwords but essential elements of daily work life.<br></p><p>Getting past the pandemic and the politics of 2021 calls for renewed efforts to focus on the residents and what it takes to keep everyone safe and engaged, as well as building and strengthening cultures that will weather any storm or crisis. </p><h2>Head of the Class&#58; Education Moves Up<br></h2><p>Team education has always been essential in post-acute and long term care. However, during the pandemic, it’s taken on a new level of urgency. It’s also been more challenging, as guidance, recommendations, and clinical evidence regarding COVID-19 have changed constantly. Keeping up with this has been challenging. <br></p><p>How challenging? Well, according to Ohio State University researchers, there have been more than 87,000 scientific papers alone on the coronavirus since the pandemic started. <br></p><p>“You have to communicate frequently and have one-on-one conversations,” says Oguin. “You have to discredit misinformation before it spreads and is embraced as fact.” At first, she says, people were often confused and frightened.<br></p><p>However, she says, “We have kept staff informed as new evidence and information arises. As they saw positive results from guidance and protocols, it lessened their fears and increased their confidence and trust.”<br></p><p>Keeping everyone on the same page when they are getting different information from several sources is “a constant battle,” Oguin says. “As the CDC [Centers for Disease Control and Prevention] put out new guidance, we were regularly updating protocols and recommendations.” <br></p><p><img src="/Monthly-Issue/2021/April/PublishingImages/JBB.jpg" alt="Jeffreys Barrett, RN" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;192px;" />When change is this constant, it is important to acknowledge that it’s frustrating and challenging, she says. “You need to say, ‘We’re doing this, too; we’re there with you. We know this is new and different, but it’s the right thing to do.’ You need to have a team that trusts you, and this helps build trust.”<br></p><p>Jeffreys Barrett, RN, MHA, NHA, executive director of Wellsprings of Gilbert in Arizona, says, “Early on, there were some people who didn’t believe COVID was a real virus, and others who were terrified of it. I would post emails once a week and constantly communicate information we received from the CDC and department of health.”<br></p><p>At some point, he suggests, “You can only educate people until they stop listening. But you can build a level of trust between yourself and others and deal with what is happening without being bombastic or threatening.”<br></p><p>As the pandemic wore on and the holidays approached, team leaders wanted to ensure that staff resisted the urge to attend large parties and family gatherings. “We provided a lot of staff education leading up to the holidays talking about ways to safely celebrate with family and friends,” Barrett says.<br></p><p>Buster Peter, administrator of Park Bend Health Center in Austin, Texas, says, “Then we gave staff take-home kits with PPE [personal protective equipment], hand sanitizer, and other items. We got the most positive response we’ve ever gotten for a staff gift. They appreciated getting something that they needed.”</p><h2>Hiring for Character</h2><p><img src="/Monthly-Issue/2021/April/PublishingImages/Buslovich.jpg" class="ms-rtePosition-1" alt=" Steven Buslovich, MD," style="margin&#58;5px;width&#58;145px;height&#58;186px;" />Hiring during the pandemic was challenging. It was difficult to vet job candidates to determine if they’d be a good fit for the organizational culture. Yet, it’s important to communicate that “if you are devoted to the residents and this patient population, you will do everything possible to protect the resident,” says Steven Buslovich, MD, CMD, MSHCPM, a New York-based geriatrician and chief executive officer of software producer Patient Pattern. “If you’re doing it solely for the paycheck, this isn’t likely the place for you.”<br></p><p>Staffing is always challenging. However, Oguin says, “It is important to have a back-up plan in advance for how you will maintain adequate staffing in a crisis.” Cross-training can help, she says. Training everyone on basic tasks such as feeding, monitoring the dining room, making beds, and basic infection control can make it easier to enable people to fill in when there are shortages on the front lines.</p><h2>Nurse Aide Adaptions<br></h2><p>In many communities, “People stepped up and helped others,” says Alice Bonner, PhD, RN, FAAN, senior advisor for aging, Institute for Healthcare Improvement. “Nursing homes worked with area agencies on aging, senior centers, etc. Administrators and others connected with high schools and community colleges to help fill job openings. Everyone came together, and that made a big difference.”<br></p><p>During the COVID-19 public health emergency, the Centers for Medicare &amp; Medicaid Services (CMS) waived the federal nurse aide training and competency evaluation requirements for newly hired nurse aides, with the exception of requirements that nurse aides be competent to provide needed services. CMS issued this waiver “to assist in potential staffing shortages seen with the COVID-19 pandemic.”<br></p><p>The American Health Care Association/National Center for Assisted Living stepped in to help by offering free eight- and 16-hour online courses for a temporary nurse aide (TNA) able to provide services and supports such as assistance with dining, ambulation, and other activities of daily living. After successfully completing the online training, TNAs then go through a competency evaluation by the provider before beginning work. <br></p><p>Currently, the program is permitted under special waivers, exceptions, or flexibilities for TNA roles in several states. To make the transition to become licensed/certified nurse aides/nurse aides included in state CNA/LNA/NA registries, TNAs need to complete additional certification requirements in accordance with federal and state regulations.<br></p><p>While this solution has filled a need during the pandemic, the National Association for Health Care Assistants (NAHCA) recommends that CMS reinstate the nurse aide training and competency evaluation standards as soon as possible, and no later than the end of March 2021.<br></p><p>NAHCA also suggests that the agency require that temporary nurse aides (those employed under the waiver) complete the training and competency evaluation set forth in federal regulations, since CMS has no authority to extend a waiver beyond a declared emergency period.<br></p><p>Elsewhere, callouts have been an issue. While these were problematic, Peter says, “We always put the safety of our residents and staff at the forefront. We recognize that short-term staffing strategies lead to long-term infection control success. We had nurses covering shifts as CNAs [certified nurse assistants], and we had people working double shifts. But we wouldn’t let people come to work when they didn’t feel good.”</p><h2>From Fear to Firefighters</h2><p>“Some people ran from the fire, but many were firefighters,” Buslovich says. “People with COVID often stop eating and drinking, and they need support and encouragement. We started systematic fluid hydration protocols, and anytime anyone went in the room, they would offer the patient a drink.” Everyone, including therapists, activity staff, administrators, and others helped hydrate and feed patients, he says.<br></p><p>“You might have one or two brave aides on a COVID unit with 20 residents. We don’t have the luxury of relying on them to adequately feed or hydrate everyone,” he says. “It takes a team to enable residents to recover from COVID and, whenever possible, stay out of the hospital.”<br></p><p>These types of efforts were significant, Buslovich says. “We have some of the frailest patients, yet our mortality rate has been remarkably low. Our teams have been a great commodity, and their efforts saved lives.”<br></p><p>Many team members made significant sacrifices to protect residents and co-workers. For instance, Buslovich says, “I moved out of my house and rented an apartment so staff could protect our families and be available 24/7 to the facility. We didn’t know enough about the virus early on, and you had to make a choice to fight the fire or stay back. This way, we could be present and available.”</p><h2>Small Fish, Big Pond</h2><p>One key to reducing turnover is to support staff when they get sick. “For staff who are out, it’s easy to feel like you don’t matter, like you’re a small fish in a big pond,” Peter says.<br></p><p>“When our people call in to staffing coordinators, they get a call from the administrator—not to find out when they’re coming back but to let them know we’re thinking about them and are genuinely concerned about their well-being. They appreciate that,” he says.<br></p><p>“The wheels would fall off without staff. We made sure we expressed appreciation for people’s efforts.”<br>Barrett agrees. “When people were out sick, we sent flowers and food from Door Dash. We made sure we covered people’s wages while they were out. We take caring for our people seriously. It’s not just lip service.”<br></p><p><img src="/Monthly-Issue/2021/April/PublishingImages/JJG.jpg" alt="Jefferson Gerodias, RN" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />Jefferson Gerodias, RN, BSN, director of clinical services at Wellsprings of Gilbert, says, “We took care of employees and their families. We sent them food. Other staff would go grocery shopping and leave them on the doorstep for families.” <br></p><p>Gerodias knows this from experience. He contracted COVID in January and was out sick for two weeks. “Every day I woke up to 50 text messages asking how I was doing. And my floor staff got together and brought me groceries.”<br></p><p>Bonner adds, “When people are out sick, managers can call and check on them. There should be a buddy system where colleagues check on each other. People who are out with COVID shouldn’t feel forgotten or unsupported.”<br></p><p>Moving forward, empathy is key. “You need to understand what everyone is feeling. Everyone has obstacles they are dealing with,” says Oguin. “While everyone is doing their best, you can’t expect them to always drop everything. Managers need to be flexible and understand that their employees are juggling lots of responsibilities and challenges.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.​</em></p>2021-04-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/April/PublishingImages/0421-CS1.jpg" style="BORDER&#58;0px solid;" />COVID-19;WorkforceJoanne KaldyTeamwork has taken on new meaning during the pandemic. Facilities have implemented new strategies for communication, collaboration, and innovation.
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&#58;5px;width&#58;157px;height&#58;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&#58; 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&#58; 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&#58;astewart@aapacn.org" target="_blank">astewart@aapacn.org</a> ​<br></em></p><p style="text-align&#58;center;"><a href="http&#58;//www.aapacn.org/" target="_blank"><img src="/Monthly-Issue/2021/April/PublishingImages/AAPACN.jpg" class="ms-rtePosition-3" alt="" style="margin&#58;5px;width&#58;200px;height&#58;58px;" /></a>&#160;</p><p><em></em></p>2021-04-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/April/PublishingImages/0421-mgmt.jpg" style="BORDER&#58;0px solid;" />Management;WorkforceAmy Stewart, RNThe relationship between the administrator and director of nursing services has never been more important.