Daily Editors' Notes

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.

These nurses are picking a fight they'll be hard-pressed to win

A nurses union's media campaign that claims to expose the increasingly ugly underbelly of "digitalized care" might be biting off more than it can chew.

Falling short in labeling seniors

I'm confident I'm not the only person who has worked in a hospital or long-term care who has heard this conversation about someone elderly who has recently died. "Well, she fell and broke her hip a few months ago," Person A says. Person B shakes her head and says, "Well, after that, it's all downhill."

'Special' times ahead for more nursing homes, and that's not good

As spring blends into summer, some nursing home operators are going to start feeling more heat — and it will have nothing to do with the weather. They will be given places on the proverbial hot seat. Well-earned seating arrangements, as it were.

Dreams or delirium? Why making the right call is important

As they approach death, people often are transported across time and space to be reunited with loved ones and relive meaningful moments. They do so in dreams and visions, which frequently are a source of great comfort, according to a recently published study. But nursing home and hospice caregivers might not be so comfortable with these dreams — which could lead to patients experiencing less peaceful deaths.

Saluting our veterans is nice gesture, but it's hardly enough

As a nation, we seem to have a conflicted relationship with those who served and continue to serve in the military. Any ounce of recognition we direct toward those in uniform is both welcome and overdue. But let's face it: These public displays of affection hardly mask the stink that permeates the lousy way we often treat those who have served.

Invite in infectious disease docs to LTC

If I'm predisposed to being fond of infectious disease physicians, it's because I believe they offer insight beyond that of a general practitioner. This is not to say that a long-term care facility's medical director can't handle a flu outbreak. But it is acknowledging that long-term care staff handles large caseloads with complex patients, and that more facilities should embrace partnerships with an ID physician.

When a provider gets caught in a web: The Cochran photo affair

The list of losers in this week's sensational story about photos secretly being shot of a U.S. Senator's Alzheimer's-afflicted wife, is large. A long-term care operator is just hoping the incident blows over — the sooner the better.

Fike 2.0: How national tragedy created a long-term care champion

Last week, President Obama dedicated the 9/11 Memorial Museum in New York City. The occasion got me thinking about how the searing experience instilled in some survivors a fierce sense of mission. Katy Fike is among those transformed by 9/11, to the benefit of seniors and long-term care providers.

Kindred bid shows that not all the fishing will be taking place upstream

Some might wonder why a skilled care giant like Kindred Healthcare would launch a $533 million hostile takeover bid of home-health provider Gentiva. The real question should be why such efforts haven't been happening more often.

Not keeping promises can lead to much more than a tarnished reputation

In the fierce daily battle to keep beds and units occupied, it can be tempting to fudge a wee bit about your ability to provide care. Here's my advice: Resist the temptation.

Kicking and screaming: The need to document verbal disputes

If I have a favorite quote from this year's LeadingAge Illinois conference, it's from Matthew Murer, an attorney at Polsinelli, who said it's OK for long-term care providers to turn away prospective residents who seem like a bad fit.

A better way for nursing homes to advance

Perhaps some of long-term care's brightest stars didn't want to be accused of getting worse. We'll soon find out.

For happy residents, don't go the extra mile

I have a welcome message to share with long-term care professionals: You should relax. Don't worry about going above and beyond for your residents and their families, because chances are, they're not really going to appreciate it. At least, this is what new research suggests.

Why are the 'keepers' constantly leaving? Thought you'd never ask

Whether you manage a caregiving team or run the company, you are probably dealing with three challenges more than you'd like to admit.

New wrinkles for population experts — and providers — to consider

It's hardly breaking news that we live in an aging nation. But a look inside the latest round of numbers might give providers more reason to feel optimistic about remaining solvent once the age wave hits.

Music that soothes the soul, enhanced by sorbet

It's likely most of us listen to the radio on our commute to work, with a mix of announcers blathering, the latest pop music, or public radio if we have the mental energy to focus on what smart people are saying.

A demand for nursing home laundry operations

It took a while, but the tentacles of a deadly fungal infection at a New Orleans children's hospital might wind up affecting the other end of healthcare's aging spectrum: nursing homes.

5 tips for abuse and incident response in long-term care

Allow me to share a little long-term care humor to brighten your day. Did you hear the one about the long-term care resident who kept unplugging her roommate's ventilator?

It's time to screw up that courage and take the plunge

I'll never forget my first encounter with the high diving board at Sherman Park pool.

An overtime fix that seemed to work for everyone - except the feds

It's a troubling staffing dynamic that regularly plays out at many long-term care facilities: Low-wage employees are practically begging for the opportunity to work extra hours. And the additional help is clearly needed. However, many facilities find themselves too cash-strapped to pay the time-and-a-half rate that overtime requires.

Instilling a love of nursing at an early age

One of the most rewarding parts of talking to employees currently working in healthcare is hearing how many of them come from families where the parents were administrators, physicians, nurses or aides. It's a testament to how excitement about working in healthcare can begin at home.

Early to bed, early to rise ... makes us better in ethicists' eyes

Ever since I used to wake up early as a young child and turn on the morning farm report on TV, my still-sleeping parents knew they had an early riser. An active morning person, if you will. They can be excused if they didn't know they were also likely rearing an honest, ethical person.

This American Life ... and death: Superb shows about hospice

A few months after Pattie Burnham started working as a hospice nurse, she forgot the name of the president of the United States. That's normal, her boss told her.

Plan of correction can be anything but, as this provider learns the hard way

Justice has an odd way of showing itself if you're a nursing facility that disagrees with a deficiency citation but decides to work with inspectors to clear your name. You're not going to believe this one.

Some nursing home operators may soon discover it's not so easy to hide

For years, some nursing home operators have relied on an unusual tactic for avoiding lawsuits and other trouble: a catch-me-if-you-can corporate structure. But the future is looking less bright for this dubious if effective business model.

Using the Internet to reduce depression

When I saw the headline "Internet use can help ward off depression among elderly," I figured it was an article written by the owners of It's Never 2 Late, Linked Senior or another vendor advocating for increased technology use in long-term care. But, no, it's real, actual science.

A jolt to long-term care best practices, amid the Ivy

This is going to sound terribly wrong on the face of it. There's no way around it. It appears that the nation's largest association of nursing home operators has just bought itself a whole lot of credibility.

Is 'person-centered care coordinator' the next must-have staff member?

Long-term care operators take note: You soon could fail residents, anger family members, increase survey deficiencies, drop Nursing Home Compare stars and lose money unless you hire a Coordinator of Coordinators.

Cost of doing business about to rise for many providers

It's not quite in the dirty-little-secret category, but here it is: The nation's recent economic downturn was good for the bottom line at many urban long-term care facilities. Change appears to be on the way.

When it comes to fixing long-term care, it's time to start thinking outside the tank

I was reminded of a cinema classic when I heard another think tank is being put together to consider improvements for our nation's long-term care system.

The potential break-up between hospitals and long-term care

The attempts of the hospital lobby and long-term care to move beyond casually dating to going steady hit a snag at the steps of a courthouse Monday.

A time for nursing homes to embrace the cheddar while they can

It can almost be classified as a case of no good deed going unpunished. However, even though this is about long-term care, let's not be quite so skeptical. Progress is progress.

What Chipotle can teach long-term care

I love Chipotle. What makes the burrito purveyor so great? The real secret might be how it grooms and retains its managers — it's an approach long-term care leaders might do well to study.

Additional nursing home inspection rules are not the answer

Many skilled care operators struggle to keep up with a seemingly never-ending array of survey and certification regulations. If two lawmakers get their way, providers can look forward to a large heaping of additional rules.

Premature obituaries about nursing homes unfair, off the mark

Attend an industry event these days and you're sure to hear doom-and-gloom forecasts for the skilled care sector. Simply put, LTC is not getting a lot of TLC.

Were the nursing home strippers really a bad idea?

If you typed the word "strippers" into the McKnight's archives Tuesday, the only story that came up was a blog about floor care. That changed Wednesday when we ran the news of a lawsuit in New York involving strippers allegedly being hired at a nursing home for resident entertainment.

Groups to find out if Obamacare is their golden ticket

Healthcare reform — Obamacare — has stuck a lot of providers and caregivers in tough positions. Whether proponents or opponent of the watershed law, most expect rocky times, at least temporarily, are ahead. But one key player sees nothing but opportunity.

Community connections and quarters: How one nursing home responded to a 45-day water crisis

In its forthcoming emergency preparedness guidelines for long-term care facilities, maybe the government should include this directive: The facility is to cultivate strong relationships with area businesses and keep a supply of quarters on hand. At least, this is one idea I took away from a conversation with Michael D. Gore, MBA, CNHA, FACHCA.

Paying for long-term care not unlike The Babysitter problem

It took decades to unravel, but I think I finally figured out why my parents had nine children.

What hostile work environment? The doctor only groped her once

In courtrooms, the prevailing notion is that everyone is supposed to get a fair shake. The facts of a case should determine its outcome; not whether one side happens to be more wealthy, powerful or connected. At least that's what's taught in civics classes.

End-of-life decisions may cause confusion, anger

When I lived in Baltimore, a stray, mangy cat adopted us. I am not trying to equate my cat with someone's parent, but I was reminded of Minou's last days when reading the dissertation of Mariette Klein on dementia caregivers. Specifically, how hard it can be to know what healthcare decisions to make for a loved one.

'The Best Days' — a best read

Where to start when discussing Jean Rene Champion's engrossing memoir is a difficult question, rivaled only by the struggle of where to stop. His self-published "The Best Days of My Life: Memories of a Hobo Soldier" deftly paints the adventures of an essentially parentless vagabond who makes the character Forest Gump look like a listless mope.

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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