Short-handed or short-sighted?

Short-handed or short-sighted?

When we communicate that we are having staffing issues, whether or not that communication is correct, we are telling the residents and their families that we can't do our jobs.

Building championship teams during uncertain times for SNFs

Building championship teams during uncertain times for SNFs

As we face payment reform, delivery reform, the aging of America, the strength and challenge of an increasingly age and ethnically diverse workforce and the consumer demands of aging boomers, now more than ever before is the time to build championship teams.

Lower the risk and deter elopement

Lower the risk and deter elopement

The single most cited F-tag in a Centers for Medicare & Medicaid Services survey is F-323 in regards to resident safety and supervision.

Muse moments — engaging the hearts of those you lead

Muse moments — engaging the hearts of those you lead

The celebration of Valentine's Day is a celebration of love and connection. It also is statistically one of the highest dates for engagements to happen. When you translate that to the world of healthcare, how then do you engage the hearts of those you lead on a daily basis when our traditions seem to be a once-a-year event?

Avoid lawsuits and protect licenses

Avoid lawsuits and protect licenses

Document, document, document! Those words echo through the halls in a myriad of places − from the firing of an employee for cause, to substantiating or absolving an accusation of abuse or wrongful act.

Abe's Garden expands access to dementia care

Abe's Garden expands access to dementia care

At Abe's Garden, we know the alarming statistics about Alzheimer's and dementia. However, the focus of all who work and volunteer here are the unique adults we care for every day.

Practicing gratitude to heal the soul

Practicing gratitude to heal the soul

Wednesday is "gratitude journaling" day at Shuksan and for the next 30 minutes these residents will reflect upon their day and the past week, thinking back on whether there was anything that made them feel grateful. Anything at all.

What is your vision for PACE expansion and innovation?

What is your vision for PACE expansion and innovation?

In the final days of the Obama administration, the Center for Medicare & Medicaid Services provided a parting gift to the PACE community by issuing a Request for Information seeking stakeholder input on the design and implementation of a broad range of PACE pilots.

New accounting standard presents unique challenges for PAC providers

New accounting standard presents unique challenges for PAC providers

Healthcare companies, particularly post-acute care providers, may feel the pain more than others, and they - along with their investors - should prepare sooner rather than later.

What makes a Five-Star nursing home?

What makes a Five-Star nursing home?

The philosophy we've followed at Presbyterian Village at Hollidaysburg in order to achieve our Five-Star rating has always been to constantly evolve and strive for innovative and creative ways to provide the best care possible.

Maybe you don't want to be in that preferred network ...

Maybe you don't want to be in that preferred network ...

When it comes to contemplating joining caregiving networks, maybe you have more in common with the hospital than you think. Poor-performing hospitals tend to coexist in the same market as poor-performing skilled nursing facilities. Surprised?

Opportunity: Improve care for Americans who need it most

Opportunity: Improve care for Americans who need it most

For people with complex health and social needs, getting better isn't simply finding and receiving the best care they can access at their local hospital.

Caregivers and nurses: Knowing when to get involved in issues of elder intimacy

Caregivers and nurses: Knowing when to get involved in issues of elder intimacy

As caretakers of elderly people we focus on their health, comfort and emotions. We monitor their eating, bathroom routines, and even their socialization.

Understanding the risk of dialysis for LTC residents

Understanding the risk of dialysis for LTC residents

Researchers, doctors, nurses, patients and caregivers have already gone a long way in preventing catheter related bloodstream infections.

What to do when a POA agent doesn't pay

What to do when a POA agent doesn't pay

Long-term care facilities traditionally take steps to ensure that residents have a financial and a healthcare power of attorney in place upon admittance. But what happens when an agent named under a POA fails to make payments for the resident's stay at the facility?

A two-pronged approach to protecting SNF residents from influenza

A two-pronged approach to protecting SNF residents from influenza

Good news: More skilled nursing facility staff are getting their annual influenza vaccine than ever before. Last season, nearly 70% were vaccinated, up from 64% a year earlier. Bad news: SNF staff still have the lowest influenza vaccination coverage rates of healthcare professionals by work location.

Behavioral and psychiatric challenges in SNFS

Behavioral and psychiatric challenges in SNFS

"Bonnie" was admitted to the skilled nursing facility following surgery for a right hip fracture. Prior to her fall, she said she was living by herself, fully independent. Although she claimed she wanted to return to her apartment following rehabilitation, she was slow to make gains in her therapy, often complaining of great pain and isolating herself in bed.

Understanding 'Unbefriended'

Understanding 'Unbefriended'

We're wrapping up a time of year when many of us are heartened by seeing family and friends for the holidays. But what if residents don't have anyone?

Want to prevent lawsuits? Talk to us!

Want to prevent lawsuits? Talk to us!

I've heard a lot of talk lately about suing nursing homes - not only from family members distraught over an elderly loved one's injury or death in an SNF, but also from the growing chorus of lawyers trolling the local airwaves for potential plaintiffs.

Don't punish SNFs for training

Don't punish SNFs for training

The Centers for Medicare & Medicaid Services have made information technology and staff competency a priority for the past five years.

Bridging the gap: Millennials in LTC

Bridging the gap: Millennials in LTC

Millennials were raised to be confident individuals. This confidence can be off-putting to their more seasoned coworkers.

QAPI - Tips for the facility assessment

QAPI - Tips for the facility assessment

The long-awaited QAPI regulations are finally in effect. Facilities now have until November 28, 2017 to create their QAPI plan and present it to state surveyors.

Finding balance and lighting the way

Finding balance and lighting the way

Most of our patients over 80 have vestibular deficits, and that's why they fall.

Making moments count

Making moments count

As a professional caregiver, you see, hear and experience the story of the lives before you, and not just the shell of an aging body. Your actions do not make the evening news, but they should.

When technology fails us: 'We talk'

When technology fails us: 'We talk'

Driving my Grandma to one of her favorite restaurants to celebrate a significant birthday (she prefers that I don't specify which) offered me an important lesson in communication.

Transforming PAC through SNF, ED and hospitalist collaboration

Transforming PAC through SNF, ED and hospitalist collaboration

Patients in post-acute settings are among the most medically fragile, with multiple co-morbidities that often require intensive care

How to survive the likely shift to bundled payments

How to survive the likely shift to bundled payments

Shifting the focus from the volume of services provided to the patient outcomes achieved is remarkably beneficial to both parties.

Mandatory CJR program offers opportunities

Mandatory CJR program offers opportunities

The post-acute area is viewed by most as the leading opportunity to find cost savings and efficiencies.

HHS: RACs not the primary source of the Medicare appeals backlog

HHS: RACs not the primary source of the Medicare appeals backlog

The U.S. Department of Health and Human Services recently issued a brief to the federal D.C. District Court related to the American Hospital Association's case against the agency over the backlog of Medicare appeals.

Three stars will be the new one star

Three stars will be the new one star

Nursing home operators call it low occupancy. Medicare insiders call it a declining census. Economists call it excess capacity.

Easing the family's transition from home to care community

Easing the family's transition from home to care community

Even though I'd worked as an activities director and administrator in long-term care, placing my mother in assisted living and then in memory care was initially a wrenching and emotional experience.

Becoming the MVP of the post-acute sphere

Becoming the MVP of the post-acute sphere

Everyone is aware that the healthcare system for reimbursement is changing rapidly and reimbursement will now be the driver of how we get our business instead of the reward for filling the bed.

Managing through uncertainty

Managing through uncertainty

These are uncertain times. But workplaces are often uncertain places because of rapid changes in market, ownership, business plan, technology.

What is the grade of your referral sources?

What is the grade of your referral sources?

How does the performance of your referral sources impact your outcomes? Turns out ... a lot. If you want to gain a better understanding of a hospital's performance, The Leapfrog Group is a resource to consider checking out.

Addressing rehab 'outcome killers'

Addressing rehab 'outcome killers'

When a resident leaves a skilled nursing facility after a successful rehabilitation, it's a clear signal to the community the facility is doing its job.

Three Medicare changes SNFs can expect under the new administration

Three Medicare changes SNFs can expect under the new administration

Ever since the ACA became law in March 2010, HHS has set a breakneck pace for transforming traditional Medicare fee-for-service payments into a value-based system; with Obama's HHS Secretary projecting that nearly every fee-for-service payment the agency makes in 2018 would be tied, in some way, to value.

Agency staffing on the rise? Believe it — and plan for it

Agency staffing on the rise? Believe it — and plan for it

The use of contract agency staff to fill nurse aide and licensed nurse vacancies is escalating. This increase is seen across many states, not to mention across the nation as a whole. Yes, we have a well-documented nursing shortage. Who, if anyone, is concerned? Let's all take a number and get in line!

It's that time of year again ...

It's that time of year again ...

Currently, we should understand Medicare Part B through the lens of Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Cracking new PT and OT evaluation codes

Cracking new PT and OT evaluation codes

January 1 will put new evaluation codes for physical and occupational therapy into effect and we all better be paying close attention.

How family expectations change a healthcare organization

How family expectations change a healthcare organization

It has long been speculated that a patient's (or their family's) disappointment with the care they receive in the healthcare system is a key driver for complaints and sometimes even litigation.

Managing an unexpected emergency or natural disaster

Managing an unexpected emergency or natural disaster

"Information is King" when an unexpected emergency or natural disaster strikes. Not just for those tasked with responding to and managing the crisis but for everyone impacted.

How nursing homes are filling the gap in continuity of post-acute care

How nursing homes are filling the gap in continuity of post-acute care

Dispelling a myth, changing a perception and instigating a cultural transformation is a heavy lift and takes a lot of time. But all of those things are taking place in nursing homes across the country, even amidst challenges of a nursing shortage, low wages for long-term care employees and a burgeoning elderly population that is living longer and with more complex health conditions.

Three considerations when implementing a new model

Three considerations when implementing a new model

This past spring, we at Jewish Senior Life broke ground on a campus transformation project that will redefine home for our elders and revolutionize the way we deliver care.

5 ways to increase occupancy with LGBT and ally residents

5 ways to increase occupancy with LGBT and ally residents

Plus, we know that LGBT older adults are less likely to access care, and when they do, they feel they have to go back into the closet in order to minimize the risk of being mistreated.

CMS issues final rule on requirements of participation for nursing homes

CMS issues final rule on requirements of participation for nursing homes

At the end of September, CMS published the final rule revising the health and safety standards that long-term care facilities must meet to participate in the Medicare and Medicaid programs.

House calls coming back for seniors needing care

House calls coming back for seniors needing care

Baby boomers likely recall, in flickering black-and-white, kindly physicians making house calls on television and in the movies.

Congress, we must reform Medicare appeals

Congress, we must reform Medicare appeals

Ten years - that's how long the U.S. Department of Health and Human Services Office of Medicare Hearings and Appeals estimates the Medicare appeals backlog of 750,000 cases will take to clear.

Staring into the abyss when the abyss won't make eye contact

Staring into the abyss when the abyss won't make eye contact

In this world of RACs, ADRs, denials and incentivized payback demands, it behooves us as providers to stare back at The Abyss and defy the illogical and irrational edicts of "PLOF" as the determining factor for payment.

Defending nursing homes cited with F-Tag 314

Defending nursing homes cited with F-Tag 314

With these recent decisions, we have discovered that there is success in demonstrating to a jury or arbitration panel how a pressure injury can be unavoidable as defined under F-Tag 314.

Commit to reducing stroke

Commit to reducing stroke

The most common type of arrhythmia, AFib increases stroke risk by five-fold and disproportionately impacts older Americans, with close to half of all atrial fibrillation-associated strokes occurring in patients ages 75 and older.

Be careful about showing appreciation during unstable times

Be careful about showing appreciation during unstable times

Sometimes well-meaning supervisors (and sometimes leaders who don't want to do the hard work of dealing with problems) try to use appreciation as a "quick fix" for deeper issues that need to be addressed.

Section GG: Collaboration with rehab

Section GG: Collaboration with rehab

The new GG Section of the MDS has been in practice for almost a month — just enough time to see what questions about nursing and therapy departments cooperating still need answering.

Commitment to care coordination: Finishing what we've started

Commitment to care coordination: Finishing what we've started

When California launched Cal MediConnect, its landmark dual eligible demonstration project, its architects knew the challenge they were accepting.

Selling fear: Are you buying?

Selling fear: Are you buying?

Fearmongering has certainly played a major role in the 2016 presidential race, but you might not realize it's also become more and more common in our own industry as well.

Losing our landmarks

Losing our landmarks

To build a courageous pathway for their organizations, long-term care leaders need to have a clear vision of what they want the future to be — for themselves and those they want to lead. Then, they have to remove what appears to be "fabricated evidence" that tends to snap a person back into usual patterns or decisions.

It's time to bundle up

It's time to bundle up

As we are moving towards new payment systems, it is imperative that we are involved and offer comments when we are able to as this will greatly impact us as providers. We also need to stay informed so we can modify our policies and procedures to be reflective of the changes.

Senior Olympics tap into the spirit of winning

Senior Olympics tap into the spirit of winning

Each year we bring hundreds of elders together in many states to compete for top medals and trophies in a heartwarming competition.

Getting to gold

Getting to gold

APRC has always focused on quality improvement; it's part of our culture.

Future care: The caregiver gap epidemic

Future care: The caregiver gap epidemic

The future of healthcare and health insurance gets top billing from mass media as the primary crisis we need to contend with and resolve, especially in the U.S. But there is another epidemic looming that will affect the health and welfare of anyone in need of care in the next several decades.

Integrating technology into art therapy programs

Integrating technology into art therapy programs

Our art therapists will continue to identify new ways to integrate technology into our existing creative practices so that in-the-moment meaning can be preserved, revisited and shared.

The evolution of nursing homes

The evolution of nursing homes

Most new developments with beds for acute care are being built by non-profits that are working to achieve CCRC status, and they are merely setting aside space for the required percentage of skilled nursing beds in relation to independent living and assisted living residences

4 tips for boosting resident satisfaction

4 tips for boosting resident satisfaction

Your residents and potential consumers are paying more attention than ever to the care they receive, and long-term care providers are taking note.

A compelling case study in senior health

A compelling case study in senior health

Healthcare for seniors these days all too often focuses on the ill and the infirm, bedridden and beholden to physicians and nurses.

Leveraging patient call data to improve your value proposition

Leveraging patient call data to improve your value proposition

Thanks to new technology we have averted multiple re-hospitalizations, weeded out poor home healthcare providers, provided enhanced education to our patients and ensured that our commitment to our patients extends beyond their stay in our facilities.

Impaired practice: The reality of a taboo topic

Impaired practice: The reality of a taboo topic

My first experience dealing with impaired practice in the healthcare setting came when I was a young nurse. I just passed my boards and was still a novice nurse in my practice. The situation was layered in complexity and safety issues.

Cracking the code to seven years of Five-Star ratings success

Cracking the code to seven years of Five-Star ratings success

Since the inception of the Five-Star Quality Rating program in December 2008, there have been 113 Skilled Nursing Facilities (SNFs) that have earned and maintained an overall 5-star score. Who are these exceedingly high performers and how do they do it?

Who are you wearing: A director responds

Who are you wearing: A director responds

Patients and families, whether new to long-term care or veterans, get a first impression by our manner, our speech, and our clothes. Make the first impression the best one.

Preparing for baby boomers at the ASCP conference

Preparing for baby boomers at the ASCP conference

At the conference, not only will you have exposure to exceptional educational and networking opportunities, you will also be able to join us as we ready ourselves for the boom ahead

Hardwiring the invisible: Culture is a choice

Hardwiring the invisible: Culture is a choice

At Signature we have been on a long term project helping leaders to learn to recognize actions that support and/or conflict the Sacred Six.

Developing artistic leadership

Developing artistic leadership

Over time there have been numerous books, projects, articles and discussions on the art of leadership. The term "art of leadership" could be defined as the application of the skills of leadership.

Do you live to eat or eat to live?

Do you live to eat or eat to live?

Residents are people first and foremost, and they retain all the same rights as other people, including one so basic as choosing what to eat.

HHS issues final rule on the ACA's anti-discrimination provisions

HHS issues final rule on the ACA's anti-discrimination provisions

The rule requires that each covered healthcare program provide notice of its compliance with the rule's various policies and requirements, as well as how to file grievances and a complaint with OCR.

When your inpatient is an outpatient

When your inpatient is an outpatient

Working in the SNF environment as long as I have (don't ask) I have encountered lots of myths, rumors, fables and tales about how therapy should operate in our very limited community.

Finding the value in value-based care

Finding the value in value-based care

When I think of the ongoing shift away from fee-for-service, I am reminded of its value. Whether anyone likes it or not, the era of value-based care is emerging.

Evaluating legal risks in photos of nursing home residents on social media

Evaluating legal risks in photos of nursing home residents on social media

Taking, posting, and sharing unauthorized images of residents via social media (e.g., Facebook, LinkedIn, Snapchat, Instagram, etc.) can constitute abuse in violation of the Federal Conditions of Participation (COPs) for nursing homes.

'Patient' is a virtue

'Patient' is a virtue

Maybe I'm getting old, or the world is more complex, but lately I find my thoughts drifting to simpler times and moments that shaped me into the person I am today. Take, for example, by experience with Helen when I was 18 and she was 90.

What do we do when the antipsychotics are gone?

What do we do when the antipsychotics are gone?

In an era of outcome-based care, it is imperative that facilities successfully integrate evidence-based behavioral health services.

What OSHA's new ruling means for you

What OSHA's new ruling means for you

While we have worked hard to create safer workplaces, we still have work to do. A new federal rule on injury reporting and recording could help get us there.

Clinical nurse specialists are APRNs and must be classified as such

Clinical nurse specialists are APRNs and must be classified as such

For more than half a century clinical nurse specialists have been playing a central and unique role.

Understanding AEDs in the workplace

Understanding AEDs in the workplace

Waiting for the arrival of emergency medical system personnel can result in a lower survival rate.

Post-acute facilities must start acting like businesses

Post-acute facilities must start acting like businesses

Fading fast are the days of post-acute healthcare providers viewing patients as their primary customers.

Learning from design regrets

Learning from design regrets

Last week, McKnight's published a guest editorial by Michael Hass, "Five design decisions you'll later regret."

Proposed cardiac bundles open new opportunities

Proposed cardiac bundles open new opportunities

The recently proposed mandatory bundled payment program for heart attacks and bypass surgeries is the latest push by CMS to extend the "at risk" period from a 30-day to 90-day period.

Driving out loneliness through intergenerational relationships

Driving out loneliness through intergenerational relationships

Growing up, I had the blessing to spend large amounts of time with my grandmother.

You'll later regret these 5 design decisions

You'll later regret these 5 design decisions

For your benefit, here are five skilled nursing design decisions I've seen people regret once they actually move residents in.

5 approaches to make advance care planning useful

5 approaches to make advance care planning useful

Most of us want to have control over events when our health worsens or life seems short.

Ethical standards should go beyond end-of-life care

Ethical standards should go beyond end-of-life care

How people are viewed by those around them can have a big influence on how they think about themselves, especially when they become ill and rely on others for care

Looking back on 46 years as an administrator

Looking back on 46 years as an administrator

Forty-six years is a long time to do anything, but forty-six years as a nursing home administrator explains why I have no hair and tend to murmur acronyms in my sleep.

Dramatic results show how collaboration helps older adults

Dramatic results show how collaboration helps older adults

In recent years, healthcare providers have sought to prevent rehospitalizations for older adults, so they don't wind up riding a roller coaster of health crises. The statistics have not been encouraging.

Dual sensory impairment can impair ADLs

Dual sensory impairment can impair ADLs

One in six Americans over age 70 has impaired vision and one in four has impaired hearing. The prevalence of combined visual and hearing impairment more than doubles among those over age 80 when compared to those between the ages of 70 and 79.

Collaborations create model for memory care

Collaborations create model for memory care

Good design, when it's done well, becomes invisible. It's only when it's done poorly that we notice it.

The Aedes mosquito and human hands — are they related?

The Aedes mosquito and human hands — are they related?

Imagine you are on a train and the conversation around you is about the seven deadly summer diseases. You eavesdrop because you're a bit scared you might be exposed to one of them.

The heightened requirement for data-driven discharge planning

The heightened requirement for data-driven discharge planning

It's fascinating to observe the evolution of business processes regarding transitions of care.

Shaking up the world of restorative nursing

Shaking up the world of restorative nursing

In the world of skilled nursing care, many are left pursuing antiquated programming options.

My life as a rehab director

My life as a rehab director

This is story of a young physical therapy assistant with big dreams, good morals, strong ethics and not much of a clue as to where the world of skilled rehab was headed. Some things can only be taught in the real world.

Identifying hidden symptoms: Constipation & Parkinson's Disease

Identifying hidden symptoms: Constipation & Parkinson's Disease

Constipation is a common problem in Parkinson's disease, occurring in up to 60% of patients, and may occur even before motor symptoms appear.

Navigating the Five-Star conflict for the mentally ill

Navigating the Five-Star conflict for the mentally ill

Skilled nursing facilities across the country are seeing an increasing number of patients who suffer from mental health conditions.

Answers to lingering questions about PBJ

Answers to lingering questions about PBJ

Even though the Payroll-Based Journal kick-off was last Friday, it's understandable that questions still cloud this new process. It behooves providers to get up to speed and become better informed as soon as possible.

Can your building prevent falls?

Can your building prevent falls?

As a development, design, and construction professional, I have a generous and healthy respect for the fact that the buildings we build are entirely secondary to the care provided inside them.

Tale of the tape

Tale of the tape

The Summer Olympics are upon us. We will be seeing swimmers, volleyball players and pole vaulters striped in colorful tape again

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