Having standards isn't enough

There's a country music song that popularly declares, "You've got to stand for something or you'll fall for anything." Well, I'm here to tell you, having standards isn't the answer.

Failure in discharge planning

There's a feel-good national story that debuted last week around how emergency responders helped an 81-year-old man. Wonderful people came to his aid. But why did it have to come to this?

Note to associations: Give General Powell a break

The first time I heard Gen. Colin Powell speak at a trade show was in the mid-1990s, and he gave one of the most spellbinding presentations I'd ever witnessed. That said, it's now probably time for senior living organizations to stop hiring him.

Answers about your top 5 technology challenges

I've learned after many years of covering long-term care that certain things are sure to arouse providers' anger — over regulation, under payment and reckless media accounts among them. What provokes fear is even easier to identify: technology.

Winning recognition for your facility

Here's how you know a program is successful: When people keep asking you when it's coming back.

Alzheimer's drug maker sends a different message in the courtroom

It's almost impossible to turn on the tube these days without seeing an ad from a drug company. The typical scenario goes something like this: Person with a disease or problem is all smiles, thanks to the benefits of the advertised drug. But there's a catch.

The engine behind ACOs is showing its muscle

The American West was largely settled by pioneers in covered wagons. It looks like a couple hundred years later, the American healthcare landscape is going to be infiltrated by covered Pioneers. And this wagon train is only picking up momentum.

Playing fast and loose with Medicaid termination

There are many benefits to communicating to your cohorts in neighboring states, and not the least of it may be knowing when a provider is kicked out of Medicaid.

Residents and sex: It's time to re-examine what's appropriate

It's so easy to think of older people as being done with sex. And truth be told, many are. But as anyone who has spent time in a skilled care setting can attest, that's hardly a one-size-fits-all notion.

Providers suffering Medicare appeals backlog — at their own hand?

If providers were charged a fee for challenging Recovery Audit Contractor findings, there wouldn't be the current overwhelming backlog of Medicare appeals, says the administration — and, surprise, the auditors themselves.

A good book's unintended lesson and tears for a great friend

One of the best signs of a good book is its unplanned lessons. While its title might profess how to fix this or do better at that, a high-quality book also will lead the reader to enlightenment for reasons a PR agent might not promote. Such is my personal experience with Atul Gawande's "Being Mortal."

Maybe it's time for ADAPT to adapt

What kind of cruel, heartless person could openly criticize disabled people in wheelchairs? I guess that cruel, heartless person would have to be me.

Salary matters in long-term care

The University of Pittsburgh's research involving certified nursing assistants and why they leave is among the most interesting I've seen recently in long-term care. Salary, it turns out, is not nearly as important as respect and flexibility in scheduling.

Who cleans up after the 'fix' is in?

It will be interesting to see what happens when the guitars are put away and the strains of "Kumbaya" die down after last week's ballyhooed passage of a new Medicare doctor payment rule.

Our government is a terrible thing — to hate (and a thank-you)

Providers are finding their personal and professional relationships with the government tested these days. But before we all grab our torches and pitchforks, let's take a deep breath.

Wristband holds hope for depressed patients

The verdict is still out on how practical or helpful some of new wristbands and other monitoring devices are among long-term care residents. But one new study indicates that a particular wristband may be able to track how depressed patients will respond to common drugs such as Prozac.

Mind games the way to recover from stroke

Do we need another reminder that a positive attitude or strong mind helps healing? We do. This time, it's with regard to stroke survivors who can't move body parts.

Operators could take a lesson from this program

Here's a win-win arrangement that really stands out. For providers wanting to inject a little extra youthful stimulation and outside perspective into their communities, it's worth a look

5 pieces of Facebook guidance for the uncool

As some of you know, none of the cool kids are using Facebook anymore. However, given its growth among those above age 65 (your residents) and its continued use among 30-somethings and up (your employees), it's worth being clear on some easily-avoidable professional and personal problems. Here are some examples.

We were all in on the scheme and didn't even know it

The recent past came rushing up other day, and it wound up whisking all of us onto the set of some fast-paced, financial mayhem-filled movie. Yes, you were there, too — though like me, you might not have realized it.

They told us everything we need to know about the future — except what to do

What should long-term care operators be doing to prepare for the future? Take your pick of these three things.

New editor stages coup

Greetings. Today seemed like the day to tell you that I, Elana, have taken over Elizabeth Newman's column. McKnight's made the decision after a detailed data analysis related to what drives pageviews. (Have you surfed the Internet lately?!)

Can we get that in writing? We better

If you asked long-term care providers what their main concern is, you would think it would be "patient care," right? It turns out, that's not reality. Most providers, it appears, are consumed by documentation.

An emerging union challenge: 'micro' management

The National Labor Relations Board's willingness to let smaller groups of people form "micro unions" has many operators on edge.

Genetic testing opens can of worms for Alzheimer's patients

Healthcare professionals tend to have a belief in facts, and as a corollary believe in conventional wisdom that knowledge is power. Of course, what people SAY they want to know and how they actually act is often miles apart.

Volunteer calls out nursing homes for not delivering

After five years, Gary Gamponia says he has had enough frustration. His message to nursing home administrators and activities directors would likely be, "I'm mad as hell and I'm not going to take it anymore" — if only he had enough leverage, that is.

The mess that is long-term care funding

In some ways, my parents did their children a great favor by dying early.

What long-term care can learn from Van Halen

David Lee Roth, best known for being the theatrical frontman of the rock band Van Halen, is a decision-making genius whom long-term care providers can learn a lot from.

Alarming headline about safety gives incomplete picture

Curse the headline writers, for they sometimes don't do stories justice. The nursing home profession knows this as well as anyone.

Are glowing acquisition reports a cause for optimism, or concern?

Taken collectively, two recent reports show that last year was a great time to sell a property in this field — and this year may be even better. That may be good news for the movers and shakers. But is it an encouraging sign for the sector overall?

The hidden gem of the Online Expo

Maybe you look like a supermodel, or maybe you are morbidly obese. You might be a CEO who looks like a college student, or in a scooter. Either way, when you attend any conference and visit the Expo Hall, you may wonder how vendors will take you. That's one of the often overlooked aspects of the virtues of the McKnight's Online Expo Hall.

Nursing homes receive an unexpected compliment

Would anyone recommend duplicating something if they didn't feel it was worthy or successful? Of course not. It's this reasoning that should give skilled nursing operators comfort and pride.

This Medicare shift may change the way you do business

When you ask providers to name the biggest Medicare change they've encountered, the answer is almost always the same: the advent of prospective payments. But we're not hearing much about a potentially bigger reimbursement shift that is quietly taking hold.

GAO has good points in how, why antipsychotics are given

The government recognizes the progress made in nursing homes with reduction of antipsychotics for residents with dementia, but also notes many who live in assisted living are receiving the drugs. It's part of a continuing narrative where the government is not super interested in paying for inappropriate medications that can harm seniors.

So how are you feeling? They thought so

It is no secret that long-term care providers are generally troubled by high turnover, workplace injury and absenteeism rates. That's why it might be a good time for LTC job seekers and managers to think about heading to Alaska. Or Hawaii. Or South Dakota.

Helping lawyers sue facilities? He's shocked, shocked you'd say that

Whatever you do, don't call Brian Lee a shill for trial lawyers. The former head of Florida's long-term-care ombudsman program is simply trying to improve nursing homes. That's his story and he's sticking to it.

Let your voice be heard

A new study reaches important conclusions about how important it is to — literally — speak up for yourself. Not to do so is a mistake, something I can identify with.

CMS's confusing kick in the teeth

One gets the feeling that federal regulators, no matter how proper the official talk went, took a bit of pleasure in sticking it to nursing home operators over rebasing their star ratings the past week and a half.

What if your residents stopped deteriorating?

Conventional wisdom holds that the sweet spot for long-term care residents is around age 85, give or take. But what if that figure were to suddenly rise by several decades?

Evaluating 'Still Alice'

Much like Amour a few years ago, it's not unrealistic for those who work or write about long-term care to feel as if the last thing they want to do is spend two hours watching a movie about illness, specifically Alzheimer's disease. But I'm glad I did Monday, when my mother and I had a chance to marvel at Julianne Moore's lead performance in "Still Alice."

As rating system changes, nursing homes should power on

As the countdown to Friday begins, and nursing homes ratchet up their anxiety over the public debut of the "new" Five Star rating system, I have a few words of wisdom to share.

Telemedicine too complicated for LTC? Don't tell this guy

Isn't it funny how something can't be done until someone comes along and does it?

The love story of Boris, Pumba and nursing home residents

It's hard to follow the love story around Rusty the dog, which we ran last Valentine's Day for our faithful readers. But I thought it was worth trying with the story of Boris and Pumba.

A time for providers to savor the good

It's true that there is danger in not stopping to smell the roses. Yet, in long-term care, it's understandable if you do just that, given how many hassles are tossed your way.

Don't want to be replaced by a robot? Then you'd better read this

We're hearing more about technology's growing role in the long-term care field. And to be sure, there are many positive things to be said about the shift. The bad news is that your job as a manager might be threatened.

Bingo, mean girls and being inclusive

Two incidents featured recently in the New York Times have provoked thought about inclusion in long-term care settings. Both are seriously depressing when we consider how much our industry promotes the concept of community.

The budget and a lack of friends

If there's one thing long-time political observers can tell you with certainty, it is this: You can make friends when you pass laws, but you rarely do when you propose a budget.

Operators need to start asking a fundamental question: How they gonna pay?

Conventional wisdom tells us that many existing options will not cut it as more discriminating customers arrive in long-term care. But maybe it's also time for operators to start giving more thought to a fundamental question: Will my future customers be able to pay?

A SNF-hospital marriage that appears likely to last

Partnerships linking skilled care operators and hospitals have been touted as all but inevitable. Yet good examples are few and far between. It turns out Dallas might be a pretty good place to look for a place to emulate.

Long-term care has better commenters

Part of the job for anyone who writes is the potential for receiving nasty comments. In some cases, this can lead to big problems.

Why providers aren't elated about new pay-for-quality goals

You can forgive long-term care providers if they weren't outwardly jumping for joy at Monday's announcement that Medicare is going to start paying for quality, and not quantity, of services.

Three strikes is good for baseball but bad for nursing homes

Even if you are not a baseball fan, you are probably familiar with the concept of three-strikes-and-you're-out. There's a certain elegance to the phrase, but it doesn't belong in the courtroom — or in judging nursing homes.

Dangerous work with low pay, and we wonder why they leave?

Researchers have concluded that workers are leaving the field in droves. The two main culprits: poor wages and dangerous work conditions.

Not time to pull the plug on hospital readmissions program ... yet

It's hard to sit on one's hands when caregiving issues are in play. Yet, that's exactly what I'd recommend with regard to at least one initiative aimed at lowering hospital readmissions.

'Ghost Boy': A terrifying story to inspire LTC caregivers

Anyone who doubts the enormous power wielded by frontline caregivers should listen to the premiere episode of "Invisibilia," a new radio show and podcast.

Your biggest expense is about to get worse

There are growing signs that labor costs will soon be creeping up. That may be good news for the frontline workers and other staff who literally do the heavy lifting. But it's not so great for those who have to make sure payroll is met.

Strength in unity is pharmacies' motto, and hope

Growing up, we had a saying when we wanted to cross a busy street but couldn't catch a break from drivers. "C'mon," one of us would gamely yell, while pulling the others onto the roadway, "there's safety in numbers!"

In praise of paradoxes

I have conflicting feelings about my long-term love for Miss America. There's love and then there's, well, not love. But not for the reasons you might imagine.

Corrupt judges star in nursing home cases

Plaintiffs and defendants in nursing home lawsuits might not agree on much, but recent developments suggest they might want to join voices and call for an end to elected judges.

Slighted workers may be killing you softly

It's a rare facility that doesn't promise job prospects stability, a chance to grow and a supportive work environment. But what happens when an employee feels such promises are merely lip service?

A workweek tweak that's worth the fight

The new Congress hadn't even officially started and already a major fight over stipulations for a new work-week threshold was heating up. Obamacare doesn't have the answer this time.

Taking a look at where we look for LTC talent

It would appear that long-term care executives are shooting themselves in the foot when it comes to hiring.

A winning score: 20 years of helping hands

An old parable says that if you're wondering whether acquiring a great new tool or developing a staff member is more important, try putting that tool in the hands of an incompetent worker.

An end to our bed bug nightmares?

Of all the scourges that hit nursing homes, there is one that always causes me to shudder. It's not pressure ulcers or norovirus, C. diff or MRSA. It's something less dangerous, but that I respond to viscerally because I have experienced it myself: bed bugs. That's why I am so excited by the news that 2015 could a turning point in the war against the pests.

Goodbye, Colbert . . . hello, flu

In honor of Stephen Colbert's recently ended run on Comedy Central, I'd like to address some "truthiness" I've recently spotted, which I believe could harm long-term care residents.

7 New Year's resolutions every long-term care operator should consider

Come next week, you'll be getting lots of advice on how to make good resolutions for 2015. In the spirit of beating the herd, here's my shameless list.

For Texas operators, a proposal that might not be as appealing as it sounds

At first blush, providers in other states might feel a bit envious about a proposal being floated in Texas. But they might want to reconsider.

Telehealth in three steps

From Jewish Home Lifecare winning a McKnight's Excellence in Technology Award for their project with Panasonic, to attending a session at LeadingAge on telehealth mental services, to moderating a Care Innovations telehealth webinar this week, it's clear more long-term care providers are trying to decipher this enigmatic issue. The big questions from providers, however, tend to be around reimbursement and the equipment.

Making the case: It's been a wild year

As the sands of the year race to their finish, there is one certainty about the long-term care news in 2014: It's been wild and trying.

Must-watch film shows 'simple' benefits of Green House care

A new long-term care documentary might eventually be called "the cattle prod" because it could be just the nudge needed to unify more communities to build a newer type of care home for the elderly.

RAC audit abuse answers vary

It has been more than 2,400 years since Plato demanded to know who will watch the watchmen. The question is suddenly taking on a modern flavor, as nursing homes, hospitals, doctors and other providers line up to decry the practices of Recovery Audit Contractors.

You call this a plan to reduce nursing homes?

It appears that a federal effort to downsize nursing homes might end up doing just the opposite.

Will residents 'stick it to the man' with their choice of provider?

In the dawning age of mega-providers, smaller long-term care chains and independent owners might be inspired by the story of The Coffee Bean & Tea Leaf.

Cut the hypocrisy when it comes to flu shots for health workers

Providers get enough pressure about vaccinating their employees. They don't need the hypocrisy dished out by surveyors too.

Inclement weather is here, and so is increased elopement danger

I was fortunate to be able to spend the past week visiting London, which was a good reminder that perception of weather is partially dependent on where you are from, where you live, and whether you have invested in flannel-lined jeans and sock liners. Similarly, the implications of elopement and wandering among long-term care residents have become more serious.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan and Senior Editor Elizabeth Newman.

    Contributors

    James M. Berklan
    Editor

    James M. Berklan

    Elizabeth Leis Newman
    Senior Editor

    Elizabeth Leis Newman

    John O'Connor
    Editorial Director

    John O'Connor

    ALL MCKNIGHT'S BLOGS