Should we all want to die at 75?

Nursing homes would be put out of business if scientists discover how to stop the aging process, McKnight's Editorial Director John O'Connor wrote in his blog yesterday. But the reverse is also true: Nursing homes would find their beds empty if many seniors were to die earlier in life — because, say, they start refusing antibiotics for common infections, as Ezekiel Emanuel, M.D., Ph.D., plans to do once he turns 75.

If this guy succeeds, every nursing home might be put out of business

What if people could remain sound of body and mind into ages of, well, biblical proportions? That elusive goal has captured the imagination of windmill chasers and serious thinkers for time immemorial. The latest seeker of note is not your typical crackpot. Unless a hedge fund manager with a medical degree from Harvard might be considered a crackpot.

A fun book about death

For an industry that spends so much time dealing with death, we know surprisingly little.

Painting by numbers: the way to go to make the right business decisions

The reasons to pursue more robust data-crunching activities keep growing. Especially for long-term care providers, who could have a leg up on other providers and payers.

White House to providers: New antibiotic regs on the way

Long-term care providers should take pride in their antipsychotic reduction efforts, and certainly should work hard to meet the new goals announced Friday. But it should not escape their notice that just a day earlier, the White House released an ambitious national plan for addressing antibiotic resistant infections. The plan suggests that a facility's antibiotic stewardship is about to join its antipsychotics rate as a defining feature of quality in the eyes of the government.

Yet another report takes aim at nursing home staffing levels

Seems like it is was only a few weeks ago that the New York Times was blasting the nursing home industry for playing fast and loose with staffing numbers. Now comes a state-by-state report card that essentially says chronic understaffing is undermining care.

Maybe this sector's bankers need to start taking their own advice

First and foremost, the NIC conference is a conduit that links those with money to those who need it. The event also features informative educational sessions that delve into where the market is now, and what operators need to do in order to compete down the road.

ICD-10 is around the corner, for real this time

There's a looming massive report on all the hospital readmissions data in your area and the strategic plan your facility needs to pursue. It involves talking to lots of employees, gathering data, doing statistics and the actual writing, not to mention proofreading, and having your boss sign off on it. It's due Oct. 15.

The sweet irony of a nursing home report card

It's said that politics, among other things, makes for strange bedfellows. Add long-term care quality improvement efforts to the list.

Five-star ratings: What a racquet?

The provider community can sound downright oxymoronic when it comes to the five-star rating system for nursing homes.

Is it any mystery why so many beds remain empty?

Ask skilled care or senior living operators about their biggest operational challenge, and the answer is almost always the same: keeping the place full. A new investigation of the way many operators deal with prospects shows that there's a lot of room for improvement.

Playing hardball with recidivists or taking good nursing homes out of the game?

Even if you're not a baseball fan, you're probably familiar with the notion of three strikes and you're out. If a lawmaker has his way, it's an approach that might be soon get applied to troubled facilities — and perhaps to other nursing homes as well.

The upside of a long-term care journal

I thought writing in a journal to recap my day would be more trouble than it's worth. That was before I went on a two-week vacation halfway around the world. But you don't have to travel that far to make it worthwhile too.

Latest therapy-billing showdown could be ominous sign for long-term care providers

Don't let anyone tell you that long-term care operators don't know how to read between the lines. They might not have known to fear a McKnight's Monday news item before it broke, but it definitely has their attention — and apprehension — now.

Control issues: helping patients and staff members after a setback

If you're a leader at a long-term care facility, you're constantly trying to promote persistence in the face of obstacles. Maybe you're trying to motivate a patient to progress with therapy or a struggling nurse aide to improve on the job. I've got one magic word that could help in this effort: Control.

Finally, some coverage that puts 'nursing home' and 'great' in the same headline

By any standard, much of what's being reported about nursing homes these days could hardly be considered good news. I could point out many examples, but the point is clear: There's a lot of bad coverage out there. So I was pleasantly surprised to see some recent industry-related copy that goes against the usual grain.

Why the survey system may never be fixed

Given certain realities about skilled-nursing facility inspections, we should not be wondering why cheating has occurred. Rather, we should be amazed it hasn't been more rampant.

Minimum wage battle inches closer to long-term care

I remember with a sad chuckle the way my German friend Volker felt that American news coverage during one of his visits was too narrowly focused. Where, for example, were the stories about the Iraq-Iran war? he wondered.

Dedicated nurses are in it for the money

I'm here to suggest that providers start seeking out nurses who are not even motivated mainly by the desire to help other people.

The nursing home survey system is about to get a much closer look

You had to know this was coming. Earlier this week, the New York Times reported that many nursing homes are submitting massaged staffing and quality indicator data to the feds. The alleged reason? So facilities could pull better Five Star ratings.

Ice buckets, fund-raising and long-term care

Whoever dreamed up the ALS Ice Bucket Challenge should be given a medal — and immediately hired to speak at the next long-term care association conference. Such creativity and that kind of Midas touch don't come along often.

Benefiting from a selection tool for EHRs

There are many parts of attending annual big conferences that I love, from seeing old industry friends to attending good sessions. But I also, not so secretly, love the exhibit halls — for several reasons.

Is it any wonder this field has an identity crisis?

What's in a name? That's a fairly topical question, given the many differing views on how best to describe the business we're in. Not that this field's identity crisis is a recent development.

Some unsolicited advice to Genesis: Good luck with the new 'owners'

This week's blockbuster deal has private equity-backed Genesis HealthCare combining with Skilled Healthcare Group.In some ways, these sorts of marriages seem all but inevitable. After all, in the outcomes-based post-acute world that's emerging, size and scale are the flavors du jour.

AALNA falters in conference dates

Hey, did you hear the one about the long-term care conference that was scheduled on Christmas? Of course you didn't, because it would never happen.

Quality soars in long-term care

Much like a parent raising a child — a topic on my mind this week as I send my oldest son to college — dedicated advocates have long encouraged long-term care providers to do the best they can. This week, there's evidence that the effort has paid off, in seeing how many providers earned honors from the American Health Care Association/National Center for Assisted Living.

Good news for (yawn) shift workers and residents

Long-term care professionals around the country cheered wildly last week when the Food and Drug Administration approved Belsomra, a new sleep drug. Shift workers applauded the addition to their medicine cabinets, already well-stocked with sleep aids. "I've tried melatonin and Ambien, but I didn't feel great on either one of those dr—" said certified nursing assistant Susie Sleepless, interrupted by a yawn.

You won't believe where a great source for LTC insight is waiting

Leaders in this field seem to have an unquenchable thirst for new insights.

God help providers accused of religious discrimination

There was a time when reading Gary Larson's "The Far Side" was an essential part of my daily routine. Yes, the now-defunct strip was a bit quirky, but it was almost always good for a laugh.

Reducing emotion in long-term care

Long-term care may be a calling, but it's still a job, and it's an industry that would be served by a reduction of emotion. That's especially true when discussing the government, which is called out in histrionic terms fairly often.

Going viral: A day without complaints brings personal discoveries

Writers are expected to promote their work, especially blog posts like this, virtually any way they can. But I'll admit maybe this one isn't for you. After all, you're likely working in or around the long-term care profession and if that doesn't give reason to complain, I don't know what does.

A future without long-term care arbitration agreements

The White House has not banned arbitration agreements in long-term care. But if a recent executive order got providers thinking about life without these contract provisions, that might be a good thing.

Learning the ABCs of LTC

When I accepted a summer internship at McKnight's, I thought writing and editing skills were all it would take to fulfill this position. Spoiler alert: I was wrong.

Four reasons why states need to stop inspecting nursing facilities

What if every state had its own language, currency and traffic signals? Life could get a lot more complicated once you ventured into another jurisdiction.

Light for nurses, and residents, shows results

Much like one of my tabby cats, one of my favorite spots to lounge and read in my house is in front of a large horizontal window, in full sunlight. In my McKnight's office, I recently restructured furniture to try to maximize natural light, in case the cats stop by to visit.

Why be optimistic when anxiety is an option?

Depending on how you like to interpret the news, nursing home operators are either facing some of the worst of times, or they've been infused with new life.

Why jurors might overlook gruesome testimony against nursing homes

In reporting on lawsuits against long-term care providers, I've spoken to plaintiffs' lawyers who rival Stephen King in their descriptions of misery and gore. So I understand why nursing home operators worry about juries being swayed by a gruesome depiction of a bad pressure ulcer rather than the facts of a case. New research shows that these concerns are justified — but it also gives hope to long-term care operators facing unfair accusations.

Bed taxes and other troubling compromises

As my colleague Tim Mullaney reported last week, the Government Accountability Office has been taking a closer look at Medicaid bed taxes lately. And the investigative arm of Congress doesn't seem to care much for the view.

Want to know what 'secrets' you'll soon be sharing? Buy a car

As never before, data collection and analytics have become part and parcel of long-term care. Even midsize and smaller operators are sifting through amazingly granular information to document strengths, address weaknesses and unearth new opportunities. It's all fantastic stuff.

There's an app for that, but should there be?

Some apps - like those that are meant to track blood pressure or give medication reminders - are geared toward your future residents. And that's where the trouble can arise, according to a group of experts writing in the New England Journal of Medicine.

Could you make money if Mom's nursing home does a good job?

A man recently raised more than $51,000 ... to make potato salad. And in a similar type of online campaign, senior living investment company Mainstreet raised more than $1.6 million in four weeks through a crowdfunding website.

Finally, a Medicaid funding plan that actually makes sense

When politicians talk about Medicaid funding and nursing homes these days, an unsettling theme often emerges: the need to spend less of the former on the latter.

What are the scouts saying about your long-term care organization?

There is no draft in senior living, nor really a need for one. But what if its three most dominant players were to be sized up? How might the scouts rate skilled care, assisted living and home care, respectively? My guess is their reports might look something like this:

Butler County should take the addicts

It's not a secret most county nursing homes are hemorrhaging money. That's why I was intrigued by a Butler County (OH) proposal to allow heroin addicts to stay short-term in the county-owned nursing home. I believe it's a good idea.

Too late: Change is here for long-term care

If someone were to complain that long-term care has become a "same old, same old" scene, you might be inclined to agree. Staffing, reimbursement, over-regulation — they're all ongoing challenges — well, OK, outright problems. And they're not the only ones. But things clearly are not the same.

Think you're having a weird day? Take a lesson from the pros

There are plenty of developments that can force you to reconsider the way you do business. Whether it's merger/acquisition fallout, notable court rulings, additional regulatory guidance or legislation being introduced, new stuff is constantly hitting the proverbial fan.

Accepting what nurses cannot fix

Like perhaps many of you, I come from a long line of "fixers." Multiple people whose schedules are conflicting? We'll coordinate. Someone isn't able to find a job? We'll provide help on their resume and introduce them around. A friend needs a boyfriend? Let me show you my multi-step PowerPoint plan.

A disconnect all professionals need

Heading out on vacation soon? If not, well maybe you ought to. No, you know you ought to. One way or another, you should be getting away from the office sometime soon, but you're probably going to do a poor job of it.

Are assisted dying facilities about to go mainstream?

It's no secret that aging Americans increasingly are attracted to assisted living, but recent developments in this country and others suggest they also have a growing interest in assisted dying. Long-term care providers should take note.

Who to blame for the job-hopping epidemic in long-term care

Too many long-term care operators let potential "noble" payoffs get in the way of basic marketplace realities when it comes to pondering why staff turnover is so high.

Supreme Court's message to long-term care operators: You're not worthy

It has been said that we are the residue of our choices. If that's true, what should we make of the Supreme Court these days?

Religious freedom: Not just an issue for Hobby Lobby

It's tough for nursing homes to attract good certified nursing assistants or aides. It's even harder when rumors abound about the mistreatment of those on the lower end of the power and pay scale. It's practically impossible when there is a belief a nursing home miay punish those for sincerely held religious beliefs.

Latest great Alzheimer's hope comes with caution

At first blush, news that a new breakthrough Alzheimer's study had found an 87% success rate was, well, irritating. Why not closer to 100% or at least 90%? Although many media types splashed news of the hopeful British study, others collectively grumbled. "Get back to us when you have something truly solid to report," they seemed to say.

Four tips for relieving stress in long-term care

Stress is hurting the job performance of a huge number of people in this country — and long-term care workers are among those at greatest risk. At least, this was suggested by poll results released Monday. The findings indicate that facilities would be smart to proactively help staff manage their stress. Here are four strategies to consider.

Summer blockbusters, and some films you want no part of

With another huge movie weekend behind us, it's a good time for providers to exhale in relief. Or wonder anxiously if they have, in fact, been on camera themselves. Especially if Mike DeWine is the film's producer.

Celebrating new citizens, all around us

The Fourth of July is not a holiday that I tend to think much about. Fireworks are pretty, but when set off in the alley behind my house both terrify the cats and make us fear that our garage is going to get set on fire. Flags, "The Star-Spangled Banner" and barbeque are all fine, but nothing that sets my heart aflame.

Renew that 'Us Weekly' subscription: Nursing home residents are just like us!

If you understand the title's reference to Us Weekly's "Stars — They're Just Like Us!" segments, you'll probably be happy to hear this: Nursing home residents derive great benefits from keeping up with celebrity culture. That's according to a study done in Belgian nursing homes, which provides some ideas for how to improve residents' quality of life through their interest celebrity culture.

You'll never guess where the latest Medicaid relief is coming from

If you are a long-term care provider relying on Medicaid dollars to make ends meet, Illinois is probably one of the last places where you'd want to be doing business. But Illinois also might have a program worth emulating wherever you are.

The sick versus the 'not sick' in long-term care

Of the many intriguing philosophies offered up at the Long Term Post Acute Care Health IT Summit, one that stuck with me was from Andrey Ostrovsky, M.D., the founder of Care at Hand. (He's also a pediatric resident at Boston Children's Hospital, and my lunch table had a debate as to whether he ever gets to sleep).

As demand for frontline caregivers soars, Direct Care Alliance strains for a lifeline

Long-term care workers are, by nature, hearty souls. They have to be. That's probably why Monday's notice set off bells in numerous offices here. It's over. Operations are ceasing.

It's time to stop long-term care state rankings

Minnesota routinely is named best state for long-term care, as it was last week in AARP's 2014 scorecard. AARP held a panel discussion to unveil the rankings, and of course an official from Minnesota was on hand to share his state's secret sauce. But the panel also featured a speaker from Mississippi, one of the lowest-ranking states. I came away thinking that Minnesota actually might not have much to teach Mississippi — and questioning what these types of state rankings accomplish.

Three signs of the Apocalypse (for traditional senior living)

It's a rare day when we don't get a new press release touting the latest property merger or acquisition. Virtually all of them tend to memorialize participants who are trying to move up or move on.

Combatting UTIs with juice and good labs

Here's the good news: A juice may reduce the incidences of urinary tract infections in nursing home residents by up to 50%. That has huge implications for a problem that plagues seniors, not to mention clinical staff.

Details on special lights to improve dementia care: A fish tale

In the last week, quite a few McKnight's readers have asked me for more details about special lights that improve dementia symptoms, prompting me to dig deeper into this story. I've learned that PetSmart might be a better bet than Home Depot to get the right bulbs.

Putting a conference in the happiest place

Far and away, the most pleasant conference experience I have had was in Anaheim, CA, last week, where NADONA held its annual conference. That is because of the Disney experience, and the fact it brings both customer service and attending conferences into focus.

Where long-term care's money is spent when it's for 'technology'

Healthcare providers are considered relatively slow technology adopters, and long-term care operators as a sub-group are believed to be among the slowest. Whether or not that's true, at least you have a cool resource to gauge how you are spreading your tech dollars compared to your peers.

Tackling nurse bullying

In a session on bullying among nurses at NADONA's annual conference this week, audience members were invited to say how they felt when a supervisor yelled at them. I heard "embarrassed," "disparaged," and "incompetent." But one other word stuck with me: "scary."

Flood of bad CPR news raises quality concerns

McKnight's news stories can be a good source of ideas for quality improvement projects, long-term care attorney Janet K. Feldkamp recently told a webcast audience. Looking at our recent items, I'd say the time is ripe to review CPR policies: Three separate stories emerged last week about a variety of problems — and penalties — related to resuscitation.

Emerging state approach to long-term care gives 'criminal intent' a whole new meaning

States are beginning to consider a bizarre new long-term care strategy that has many providers rightfully concerned.

A commonsense way to free up funds for long-term care

They say politics makes for strange bedfellows. It makes for stranger politicians.

Avoiding norovirus like the plague

Norovirus is the scourge of nursing homes, not to mention frequent travelers. The release of Center for Disease Control and Prevention data this week confirms what many of us see firsthand, which is "the public health burden exacted by noroviruses is substantial." This report is near and dear to my heart: a strain of a norovirus recently found me.

Taking a cue from Big Brother: A hospital tool for long-term care providers

Relationships between hospitals and nursing homes can be funny things. Working together, they can do great things. But "cooperation" and "outreach" are not operative words frequently enough. Sibling rivalry always bubbles just under the surface.

'Derek' returns, focuses on nursing home privacy

When the Ricky Gervais show "Derek" hit Netflix last year, I sat down to check out an episode and ended up binge-watching the whole season, captivated by the storylines set in an English nursing home. With the second season — on Netflix now — I had the opposite experience. The first few episodes didn't appeal to me, but the last few made me glad that I had stuck with the series. I was left misty-eyed and thinking about some significant long-term care issues, particularly the privacy implications of a "homelike environment."

Food for thought: Maybe actual candy bars would be a better dining option

It was while my mother was struggling with small-cell lung cancer and trying to stay above the 100-pound mark (unsuccessfully), that she first encountered dietary supplements. It's fair to say they left a bad taste in her mouth in more ways than one.

Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.


    James M. Berklan

    James M. Berklan

    Elizabeth Leis Newman
    Senior Editor

    Elizabeth Leis Newman

    John O'Connor
    Editorial Director

    John O'Connor


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