Behavior management plans for challenging behaviors

Behavior management plans for challenging behaviors

"Mrs. Jones" is in the middle of the dayroom, once again engaging in verbal abusiveness that disrupts the residents, families and staff on her unit.

Data equals understanding and requires integration

Data equals understanding and requires integration

The long-term care space is rapidly changing and evolving. Big data analytics will play a key role in helping to shape the future of this space.

10 lessons we learned on our culture change journey

10 lessons we learned on our culture change journey

Almost exactly 6 years from the date of our first training, we recently added our 50th home to the Eden Alternative Registry.

In addition to caring for patients, SNFs must take care of business

In addition to caring for patients, SNFs must take care of business

Nursing homes have an epidemic health problem these days, but it's not in their patient population, it's on their own balance sheet.

Beer and Wings or Wine and Cheese?

Beer and Wings or Wine and Cheese?

As someone who has close to 20 years of long-term care recruitment experience and who has personally worked as a nursing home administrator, I understand how important culture is when making the right hire. The first step in creating the right culture is matching the best candidates with your beliefs.

Creativity knows no age limit

Creativity knows no age limit

Legacy featured the works of 20 established and emerging senior artists from Long Beach, CA, and surrounding communities.

How good does your data need to be?

How good does your data need to be?

It's a loaded question: How good does your data need to be? If we're honest with ourselves, we must admit that we're not perfect. Nor are the systems we create to help minimize error perfect.

The therapy cap reborn

The therapy cap reborn

At the end of 2017, Congress recessed before a decision was made on the repeal of the Part B Therapy Cap that we've been living with, working around, and appealing since 1998.

Is sub-acute care in a SNF the best option for cancer rehab patients?

Is sub-acute care in a SNF the best option for cancer rehab patients?

With each new year, cancer patients find continued hope that a cure or treatment for their disease will lead to longer and fuller lives.

Your line staff of CNAs and nurses will make or break your facility's reputation

Your line staff of CNAs and nurses will make or break your facility's reputation

I was meeting with a new client recently at their skilled nursing and rehab facility for our in-service prior to launching their online digital marketing campaign.

The true cost of obesity to SNFs

The true cost of obesity to SNFs

While federal regulations state that nursing homes must provide "each resident with a nourishing, palatable, and well-balanced diet that meets dietary requirements and any special dietary needs" under the guidance of a registered dietician, facilities have a lot of flexibility on how this regulation is met.

Arbitration agreements: Is a signature enough?

Arbitration agreements: Is a signature enough?

What are long-term care providers to do post-Kindred? Should they expect that their agreements to arbitrate will be enforced or invalidated at the state level?

ACE (Acute Care For Elders): Integrating acute, post-acute and LTC

ACE (Acute Care For Elders): Integrating acute, post-acute and LTC

Over the last 20 years, there is a movement to assign elders to units that specifically address their need.

SNFs: Time to step up, not give up

SNFs: Time to step up, not give up

The design of the BPCI-Advanced program appears, at first glance, to offer little opportunity for SNFs looking to redesign their business models and take episodic healthcare risk alongside hospitals and payers. It effectively sunsets the original BPCI option that kicked off the risk-based episode at post-acute admission (called "Model 3"), leaving all bundled post-acute services to start with either an inpatient or outpatient service.

4 considerations for building your emergency preparedness plan

4 considerations for building your emergency preparedness plan

From Hurricanes Irma and Harvey to the California wildfires, there has been no shortage of extreme weather around the country.

Understand the resident to understand the behavior: Part 2

Understand the resident to understand the behavior: Part 2

I am frequently asked to consult about "inappropriate" behavior in skilled nursing facilities. The question is usually something like: "We have a resident who is doing 'X behavior'— what should we do?" (You can fill in the X with behaviors like wandering, yelling, hitting, hoarding, etc). My answer is always along these lines: "I have no idea what to do, but please let's talk about this particular resident."

Lessons Learned: What falling out of the sky taught me

Lessons Learned: What falling out of the sky taught me

Suddenly the plane dropped and items went flying, including people. We heard the strange noise again and realized that this was not normal turbulence.

#Unboxme in 2018

#Unboxme in 2018

I know you think you have unwrapped all of the presents under your company's Christmas tree-but wait. I know of a present that you haven't "unboxed" yet and it's the gift that keeps on giving year after year.

Make a resolution to use email better

Make a resolution to use email better

Think about SBAR. Situation, background, assessment, recommendation. Apply it to email. In other words, think bullet points, not novels.

Playing it safe: The need for a comprehensive safety program

Playing it safe: The need for a comprehensive safety program

Does your organizational safety program and committee focus solely on employee injuries and Workers' Compensation issues? If so, you are not alone.

Depression in dementia: How do you know?

Depression in dementia: How do you know?

Most of us have used or at least aware of the PHQ-9 (Patient Health Questionnaire) scale for depression. Through a series of questions that are directly related to the DSM-IV criteria, a patient or caregiver can determine whether they're depressed and how best to address their depression.

As demand increases for granny cams, what should LTC facilities do?

As demand increases for granny cams, what should LTC facilities do?

The post-Hurricane Irma disaster at a Florida nursing home, where multiple residents died from heat-related problems when the electricity went out, prompted a last-minute legislative add-on — allowing recording devices in residents' rooms — to a Florida bill requiring back-up generators for long-term care facilities.

Provider survival strategies in an at-risk environment

Provider survival strategies in an at-risk environment

National health expenditures will increase from $3.5 trillion in 2017 to $5.5 trillion in 2025, according to the Centers for Medicare & Medicaid Services. That's two trillion dollars in only eight years, and accounts for 19.9% of the GDP

Loophole allows low volume Medicare providers exemption from auditing

Loophole allows low volume Medicare providers exemption from auditing

The current implementation of Medicare's sliding scale ADR limit policy is preventing the recovery of improper payments and has afforded a significant portion of providers with immunity from billing accuracy review due to the low volume of claims they submit

Five-Star is anything but frozen

Five-Star is anything but frozen

The day after Thanksgiving, CMS further defined its intensions with the Five-Star Quality Rating System; more specifically how the new survey process and derivative data will be used in its calculation of the Health Inspection domain. Here's what that means — and doesn't mean.

Coordinated care: Recommendations to improve quality

Coordinated care: Recommendations to improve quality

Despite all of us having heard at least one story of good medicine gone wrong, coordinating care among skilled nursing facilities (SNF) and home- and community-based services (HCBS) can be a win-win situation.

4 reasons to consider horticulture therapy as an alternative treatment

4 reasons to consider horticulture therapy as an alternative treatment

Growing and arranging flowers and cultivating greens allows them to practice real tasks that are used in everyday life.

Electronic Health Records: It's not you, it's me?

Electronic Health Records: It's not you, it's me?

In recent years, the number of long-term and post-acute care providers who use electronic health records has grown rapidly in response to increased regulations, additional data requirements, and downstream pressure from acute care partners and accountable care organizations.

Want an unstoppable team? Try using manager and peer recognition

Want an unstoppable team? Try using manager and peer recognition

Most organizational employee recognition programs place a lot, if not all, of the responsibility for recognizing good work of their team members squarely on the shoulders of managers or supervisions. This is unfortunate and, actually, creates unwanted negative effects.

Senior living organizations plan for a 'C-change'

Senior living organizations plan for a 'C-change'

Experts in senior living know there is an impending leadership problem, if not a crisis. A wave of the industry's top executives are set to retire and it's uncertain from where the next generation will come.

Employee engagement: Bringing head and heart to every action, every day

Employee engagement: Bringing head and heart to every action, every day

I shared with the charge nurse my inner joy about filling all our staffing holes completely. She looked at the schedule and mumbled, "Great — you have scheduled nothing but Refrigerator Nurses."

Developing a qualified nurse assistant workforce using technology

Developing a qualified nurse assistant workforce using technology

As the population continues to age with an extended life expectancy, embracing innovative models ensures we all can experience both quality care and quality lives.

Sometimes a carrot is really a stick ... but sometimes it's 24-karat gold!

Sometimes a carrot is really a stick ... but sometimes it's 24-karat gold!

We all yearn for a time when value-based purchasing (and care) loses its originality. A time when motivations for providing excellent care and achieving excellent resident outcomes are aligned with reimbursement.

Future leaders give the "Silent Generation" a voice in Washington

Future leaders give the "Silent Generation" a voice in Washington

The political squabbles in Washington have many providers and support businesses on edge and wondering about the future of healthcare and our industry.

Changes to Medicare telehealth coverage may benefit LTC

Changes to Medicare telehealth coverage may benefit LTC

While arguably late to the telehealth game, long term care and post-acute care providers are now key players in telehealth as its benefits become more and more apparent for their patients and business models.

Do life plan communities really help people age well?

Do life plan communities really help people age well?

As senior housing professionals, we're well aware of the many opportunities that Life Plan Communities offer residents. The programs, amenities, services, and health care provided create an opportunity-rich environment that we believe supports wellness. It's a big part of the reason we do what we do.

Give your residents the most precious gift

Give your residents the most precious gift

Here I was standing at the funeral of Rabbi Israel T, one of the beloved residents of our nursing home and a man I came to love and admire in the too short period of time that I was privileged to know him.

Consider transitional care to expand referral relationships

Consider transitional care to expand referral relationships

Identifying ways to improve census is a common goal among long-term care providers. Despite a continually expanding elderly population, occupancy levels are at the lowest point in five years.

Is your emergency communications plan ready?

Is your emergency communications plan ready?

As McKnight's coverage of comments by The Centers for Medicare & Medicaid Services principal deputy administrator for operations at a recent hearing indicated, "several of the failings" that led to the nursing home resident deaths could be traced to inadequate training on the emergency preparedness plan, or following proper emergency protocol.

The secret to outstanding employee engagement

The secret to outstanding employee engagement

In the challenging environment of senior living facilities, owners and executive managers are increasingly realizing the incredibly high correlation between employee engagement and critical outcomes: Attracting and retaining great people, resident satisfaction, overall facility occupancy, and profitability.

Why personalized nutrition is the key to reducing hospital readmission rates

Why personalized nutrition is the key to reducing hospital readmission rates

Malnutrition is highly prevalent among cancer patients today, and is one of the leading causes of readmission for long-term care residents.

Three reasons your SNF should sign up for CMS's BPCI Advanced Program

Three reasons your SNF should sign up for CMS's BPCI Advanced Program

BPCI Advanced, or the next iteration of CMS's Bundled Payment for Care Improvement initiative, is coming. Despite the recent shake-ups at HHS, skilled nursing facilities (SNFs) that enroll in the program are poised to capture the rewards that stem from greater efficiencies and better patient outcomes during an episode of care.

Value of palliative care for those with End-Stage Renal Disease

Value of palliative care for those with End-Stage Renal Disease

Approximately 600,000 Americans live with ESRD, representing 1.1% of the Medicare population but 5.6% of Medicare costs.

Trickle-down negativity

Trickle-down negativity

I've seen it so often it becomes routine: Your coworkers complain about everything, they keep complaining, you start complaining just to join in, and soon you're involved in Complain-Fest 2017.

The importance of home health data to SNF administrators

The importance of home health data to SNF administrators

The key here is not only to understand outcomes of residents once they are discharged from the SNF, but also to leverage the information for talking points with hospitals when seeking preferred provider relationships or bundled payment arrangements.

Looking at Massachusetts in LTSS reform

Looking at Massachusetts in LTSS reform

We can learn a lot by examining Massachusetts, a state that has embraced healthcare reform and currently working to transform its Medicaid program.

Communicating with families while respecting resident privacy

Communicating with families while respecting resident privacy

If staff members are not aware of the proper guidelines on what information can and cannot be shared, there could easily be a breach of that resident's privacy.

Essentials of managing behavior in LTC

Essentials of managing behavior in LTC

With all the recent restrictions on psychotropic medications in skilled nursing facilities, many facilities find themselves struggling with a resurgence in unwanted resident behaviors that were previously well-managed by anti-psychotics, benzodiazepines and other drugs.

Don't be a Humpty Dumpty leader: How to engage your inner creative self

Don't be a Humpty Dumpty leader: How to engage your inner creative self

In my last article, I shared with you the latest research on employee and leader engagement. Let's now look at what leaders can do to improve engagement and help themselves become an engaged leader.

How to help residents manage the nutritional side effects of cancer

How to help residents manage the nutritional side effects of cancer

Cancer treatment can cause a multitude of side effects for patient resident who is suffering from the disease, many of which can affect nutritional status.

Come fly with us!

Come fly with us!

Watching the news these days, it's easy to feel like nursing homes and those of us working in them aren't doing anything right. I want to suggest otherwise.

Why ASC 606 elevates risk for LTC providers

Why ASC 606 elevates risk for LTC providers

The Department of Justice's largest-ever healthcare fraud enforcement action, announced in mid-July, sends a clear signal about the federal government's escalating efforts to eradicate and penalize fraud in healthcare: They're here to stay.

CMS requirement for Legionnaires' disease control in LTC

CMS requirement for Legionnaires' disease control in LTC

Nineteen percent of all Legionnaires' disease (LD) outbreaks are LTC related.

Antibiotic Stewardship: At the heart of what we do

Antibiotic Stewardship: At the heart of what we do

It's not news that our planet has a serious antibiotic resistance problem on its hands, or that better antibiotic stewardship across the health care spectrum is essential to solving it.

Advice from a daughter to caregivers

Advice from a daughter to caregivers

Some tips from a daughter's perspective.

RCS-1 says goodbye to rehab? Yes & No

RCS-1 says goodbye to rehab? Yes & No

The more minutes of therapy, the higher the payment. Are there unintended consequences from the current model? Of course.

I rinse out my plastic bags

I rinse out my plastic bags

I rinse out my used plastic bags. Maybe not all the time, but often ... I do love our Mother Earth, but that wasn't driving my behavior.

Sharing secrets to success in ventilator weaning

Sharing secrets to success in ventilator weaning

Post-acute care facilities must excel at weaning patients off ventilators. After all, what hospital wants to transfer a patient to a facility with mediocre weaning success rates, after its staff has worked very hard to help its patient recover throughout a lengthy ICU stay?

Managing RCS-1

Managing RCS-1

The new Resident Classification System, which may be implemented Oct 1, 2018, is changing the game. I say "may be implemented" because there's reason to believe that it may be delayed a year.

A lesson in disaster preparedness for LTC facilities

A lesson in disaster preparedness for LTC facilities

As healthcare entities throughout Texas and Florida work tirelessly to put back the pieces following hurricanes Harvey and Irma, reflection is likely top of mind.

Psychotherapy creates meaningful identity for the LTC resident

Psychotherapy creates meaningful identity for the LTC resident

Yet many long-term care residents know, deep down, there is "something more" out there; and that "something more" is often something unfinished - a hope or aspiration that never came to full fruition in their lives

Sexual orientation dispute takes new turn

Sexual orientation dispute takes new turn

The ongoing court dispute over whether Title VII of the Civil Rights Act of 1964 outlaws discrimination on the grounds of sexual orientation — as opposed to gender — has taken a new turn with the filing of a brief by the Department of Justice arguing that it does not.

Employee engagement: What story does the data tell leadership?

Employee engagement: What story does the data tell leadership?

The first time I used the words "resilience" and "engagement" was with my leadership team at the time. I asked, "What can we do to advance engagement and help people to be more resilient?" Suddenly, everyone around the table had important emails to read on their phone.

Caregiving and curbing sibling discord

Caregiving and curbing sibling discord

Serving as a caregiver for an ailing parent or parents can be extremely challenging. It can be physically, mentally and emotionally draining.

Why your business needs hired and non-owned auto liability coverage

Why your business needs hired and non-owned auto liability coverage

Is there ever a time when your employees might use their private vehicles to perform company business?

Understanding the Braden Scale with pressure ulcer management

Understanding the Braden Scale with pressure ulcer management

Multiple studies have demonstrated the validity and reliability of the Braden Scale. However the accuracy of the risk assessment is dependent upon an understanding of the multiple risk factors contributing to the development of pressure ulcers, particularly for residents with risk for lower extremity wounds.

Exercise is more important than you thought

Exercise is more important than you thought

For those of us approaching the age where some of our peers are starting to show decline in their cognition, it's certainly worth doing everything we can and exploring all options to preserve the physical and mental health of our clients.

The cheese has moved ... will Sniff find it?

The cheese has moved ... will Sniff find it?

Imagine my surprise when several people came bearing the shocking news that "the MDS will not matter anymore" and that RCS-1 is "the end of the MDS." Wait, what? Not on your life!

Technology and the senior ethical terrain

Technology and the senior ethical terrain

One of the tasks of gerontology schools, nursing facilities, senior living facilities in an increasing geriatric society must seek ways of linking high-tech inanimate objects with value rituals of seniors.

Understanding and dealing with negativity in the workplace

Understanding and dealing with negativity in the workplace

Negativity is one of the most common, and deeply ingrained, obstacles to a healthy work environment.

Is the Trump administration signaling no employment protection based on sexual orientation?

Is the Trump administration signaling no employment protection based on sexual orientation?

Would you be surprised to learn that a conflict exists within the Trump administration? I didn't think so.

Effective rehabilitation influences success of care

Effective rehabilitation influences success of care

When it comes to rehabilitation and skilled nursing care, the majority of seniors and their families are looking for an effective and comprehensive process which will get them back home with a decreased chance of re-admission to the hospital.

Physiatrists: Optimizing and expediting PAC

Physiatrists: Optimizing and expediting PAC

With Medicare essentially stamping "declined" on more and more attempts to discharge post-acute patients to inpatient rehab facility care, skilled nursing facilities have become the preferred setting.

Improving end-of-life care begins with honoring patient preferences

Improving end-of-life care begins with honoring patient preferences

While hospitalizations and aggressive disease treatment are common in serious illness, hospice and palliative care specialists support patients through the entire trajectory of disease to include educating and empowering patients about the benefits and burdens of various interventions.

4 steps to creating an interactive music therapy program

4 steps to creating an interactive music therapy program

Music therapy is in the news a lot lately, and there's a reason for that: it works.

Emergency preparedness: More than an act of paperwork

Emergency preparedness: More than an act of paperwork

My phone rang and the voice said, "We are activating our incident command center." I asked, "Is this a drill?" The voice in a solid tone replied, "This is not a drill."

Monitoring quality of care for contracted services

Monitoring quality of care for contracted services

Regulatory and accrediting agencies such as Centers for Medicare & Medicaid Services and The Joint Commission expect healthcare organizations to monitor the activities of their external contractors to ensure the quality of care, treatment and services they provide.

And he did it 'his way' — will you and yours?

And he did it 'his way' — will you and yours?

Packing for New Jersey to help Bernie (my father-in-law, whom I was honored to call "Dad") navigate his transition from hospitalization to SNF, something told me to pack a suit.

Sector-specific LTC pharmacy data warehouse now a reality

Sector-specific LTC pharmacy data warehouse now a reality

Ensuring the provision of quality post-acute care in skilled nursing and assisted living facilities requires the need to direct and perform an increasingly complex array of medication management regimes and clinical functions.

Embracing tai chi in long-term care

Embracing tai chi in long-term care

When residents take initiative to create programs that flow from their passions, the result is greater engagement.

Facility assessment, emergency preparedness and QAPI — a service delivery exercise

Facility assessment, emergency preparedness and QAPI — a service delivery exercise

Your post-acute/long-term care organization should be well on its way to developing its Facility Assessment, Emergency Preparedness Plan and written QAPI plan for compliance by November 2017. The best way to address these three new RoPs/CoPs is by transitioning your healthcare organization into one focused on service delivery.

Learn how to advocate in D.C.

Learn how to advocate in D.C.

I've had the pleasure and honor of participating in advocacy in a variety ways in the last 10 years .

Nurse morale and its impact on LTC

Nurse morale and its impact on LTC

Nursing is a demanding occupation - a career as a nursing professional is often associated with long hours and high stress. Especially in long-term care facilities, where patients receive both physical and cognitive assistance around the clock, the emotionally taxing atmosphere can increase the likelihood of low employee morale.

Being a leader who leads as if there were no tomorrow

Being a leader who leads as if there were no tomorrow

What would our leadership look like if we thought that tomorrow would not come? If we ask ourselves that question, we immediately will reason there is a tomorrow. That is our challenge: We always give ourselves time. Time, in this case, is not our friend.

Don't mess with my Uber rating!

Don't mess with my Uber rating!

My most recent trip to Washington, D.C., was wrapping up like most others. I was heading to Reagan Airport by way of Uber, but what happened next was not typical — and drove me to write this piece.

Leadership lessons from cleaning ladies

Leadership lessons from cleaning ladies

Effective leaders leave powerful clues.

Understanding chiropractic care in LTC

Understanding chiropractic care in LTC

LTC health professionals know all too well that musculoskeletal pain is a common patient complaint.

Discerning between confidence and competence

Discerning between confidence and competence

The Harvard Business Review spoke to an issue a few years ago that has concerned many of us in and out of healthcare for some time: "Why do so many incompetent men become leaders?"

The call you do not want to make

The call you do not want to make

I can still remember it clearly when the phone rang and a serious voice on the other end of the line told me what happened. My loved one fell and, luckily, didn't break any bones.

Payment accuracy is a calling

Payment accuracy is a calling

Careers in the healthcare field span such a wide variety of applications - with some passionately drawn to provide care for vulnerable patients like children or the elderly, while others are attracted to fast-paced, hospital settings.

Residents with cognitive impairment don't feel pain

Residents with cognitive impairment don't feel pain

Please, someone tell me why we are still challenged with identifying and treating pain in the elderly, particularly those with dementia.

Acute care and PAC: A friendship long overdue

Acute care and PAC: A friendship long overdue

Hospitals and health systems are increasingly shifting their focus to managing an episode of care.

The ACA repeal and its impact on nursing homes

The ACA repeal and its impact on nursing homes

The public dialogue surrounding repeal of the Patient Protection and Affordable Care Act, also known as Obamacare, has made little mention of the nuts and bolts of the legislation that would be lost when it is gone.

The X-Attackman of LTC

The X-Attackman of LTC

While watching my son's lacrosse game this weekend, I realized those of us practicing in long term care could learn from the offensive team member positioned behind the goal—the X-attackman.

GAO gets it right with need for more IT

GAO gets it right with need for more IT

It's good to have a "big dog" recognize that the long-term and post-acute care sectors should be given more help with information technology and exchange.

A path to success for LTC antibiotic stewardship

A path to success for LTC antibiotic stewardship

There are two dates fast approaching that will have a major impact on long-term care operations and revenue.

How a 15-year-old inventor flew across the world to help pressure injuries

How a 15-year-old inventor flew across the world to help pressure injuries

The adage "you are never too young to teach and never too old to learn" took a new meaning at the National Pressure Ulcer Advisory Panel (NPUAP) Biennial conference held in New Orleans..

Navigating the discharge process

Navigating the discharge process

Not long ago, my mother broke her hip and spent time in the hospital. Upon discharge, the social worker gave us a list of post-acute care facilities.

Making the leap to person-directed care

Making the leap to person-directed care

How do we shape a new reality for long term care? With the aging sector in general under attack and ageism on the rise in today's society we have a larger obligation than ever to reach for something more. Transformation in its literal definition means to go beyond. The question then becomes how do we go beyond what we see?