Daily Editors' Notes

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.

Sleeper measures could cut Medicare payments to skilled care operators

As far as skilled care is concerned, most recent reporting on a major Medicare bill has all but overlooked what's in the bill for the sector. And it's not trivial.

Reducing seniors' drug use, one iPod at a time

For reasons that are understandable yet hard to countenance, antipsychotic drugs are widely used in nursing homes. Too often over-used, according to government statistics. But it's beginning to look like new help may arrive — in the form of the iPod.

Overcoming the barriers to technology in long-term care

It's no secret that long-term care has been behind the curve when it comes to technology adoption. We keep telling people to invest, and providers respond that there is no money. But it's a little more complicated than that.

Nursing homes should get ready for another image battering

Long-term care providers are sitting anxiously on the sidelines as members of Congress tussle with what to do before the end of the month about certain healthcare payment formulas. What will actually be done — or not done — is a great unknown. But providers can be certain there will be at least one political arena where they're going to take a beating soon, and it's going to stretch out through the November elections.

In dementia's crosshairs, women speak out

Alzheimer's disease does not discriminate. Or so we've been repeatedly told — for example, when "Iron Lady" Margaret Thatcher died, almost exactly one year ago. But a report out last week suggests that Alzheimer's does discriminate, in a sense. It appears the disease picks on women.

Reversal of fortune revitalizes LTC funding source

For many long-term care operators, shrinking demand is not likely be a problem in the decades ahead. After all, about 10,000 baby boomers turn 65 every day, and the pace is just heating up. But there can be a big difference between prospects and paying customers.

Change the nursing home survey process

If LeadingAge's latest strategy works as hoped, it would mean high-performing nursing homes wouldn't have the fire of the Centers for Medicare & Medicaid Services dragon breathing down their necks every nine to 15 months.

It's not all bad news coming from MedPAC

A funny thing happened on the way to a semi-annual eye-rolling over a MedPAC report. It gave me reason to sit up with interest. Even more unlikely, it contained information that made some long-term care providers happy.

HBO documentary reveals a certified nursing assistant's struggle

President Lyndon Johnson highlighted impoverished families in Appalachia when he declared a "war on poverty." Fifty years later, as the nation takes stock of how successfully we've waged this war, the media is spotlighting certified nursing assistants in long-term care facilities as examples of the working poor.

Is this really the best way to get a raise?

I can say with a straight face that I'm not a complete stranger to the battle over decent living wages.

Do you really want to know when you'll get Alzheimer's?

Sometimes, ignorance truly is bliss. Or at least, it's better than what's waiting around the corner. Soon, researchers say, we might be able to learn if we're going to get Alzheimer's disease in the near future.

A Stritch in time

I have figured out who I want to be at 87, and it's Elaine Stritch. I realized this after seeing Stritch walk through New York wearing a leopard print coat, tights and big glasses during the new documentary, 'Elaine Stritch: Shoot Me.' It has multiple powerful messages about what it's like to grow older, especially when it seems your body is still ticking through sheer force of personality.

Provider denies it worked a nurse to death, but will court agree?

Long-term care workers, particularly nurses, might complain or even joke about it: I'm being worked to death. But now a dead nurse's family is testing such an assertion in court.

The 12 traits of great nursing home administrators ... and school principals

Social media often is credited with providing a stream of up-to-the-minute news, the latest developments breaking over Twitter or Facebook, and spreading virally in no time flat. But I've found that old stories also sometimes get a second life thanks to social media. Such is the case with a New York Times column from 2011that my friend Cory posted to Facebook this weekend. The column is about what makes a great school principal, but it could just as easily be talking about what makes a great long-term care administrator.

Federal regulators say they will back off nursing homes — at least for now

If you've been involved in the long-term care field for any length of time, you should be quite familiar with how the government typically deals with bad news about nursing home care.

The Greatest Generation? These days, they're more like the Forgotten Generation

It's all but impossible to read "The Greatest Generation" without being impressed by the people now residing in senior living settings. As Author Tom Brokaw points out, these folks dealt with many sacrifices caused by the Great Depression, fought in World War II and then helped revive a struggling national economy.

Budgeting for hand hygiene

One of my former colleagues, who had moved to the healthcare sector from television, shared with me the story of how she began her new job and was told, "Oh, yeah, you can figure out the budget, right?" Administrators with limited budgeting experience might hesitate to make big investments, but when it comes to hand hygiene, spending a little more today could lead to big savings down the line.

The power of the MDS, and the will to rein it in

The Minimum Data Set helps determine how resident care is classified and reimbursed. Because it drives providers' fate, virtually from start to finish, providers cling to any nugget they can glean about it. That's why newly released study findings prove so intriguing.

Adverse events and the culture of fear in long-term care

The government report on adverse events in post-acute care that was released yesterday shines a light on issues of real concern. However, as long-term care stakeholders and regulators consider the implications of the report and ways to reduce the number of adverse events, I'd suggest a companion report to be read alongside it: "Is Excessive Paperwork in Care Homes Undermining Care for Older People?"

Your residents might be safe, but what about your data?

Long-term care providers go to great lengths to keep residents out of harm's way. But it appears that the data many operators count on might be anything but safe.

Medicaid hypocrisy 2.0, or the art of not giving credit where it's due

Hypocrisy, thy name is Republican governor taking more Medicaid funding.

How to handle sexual assault allegations in long-term care

In the most comfortable of circumstances, it can be difficult to discuss sexual assault. Mention it as an issue in long-term care, and even seasoned administrators wince.

Speaking the right language when taking care of old people (oops!)

As someone who considers words so central to his existence, both personally and professionally, I suppose it's only natural I was sucked into this. Call me a willing victim.

Of Brookdale and branding: Thoughts for the small operator

Brookdale Senior Living's acquisition of Emeritus Corp. is part of an ambitious strategy to make Brookdale the first truly national U.S. eldercare brand. So is it ominous that the Feb. 20 merger announcement came three days after The New Yorker ran a piece arguing that the age of powerhouse brands is ending?

Brookdale expansion sends ominous message to many operators

Former House speaker Tip O'Neill famously said that all politics is local. Until last week, the same might have been said about senior living.

When states get a golden goose, they usually feed it to the lions

As my dear mother used to say, it's a rare cloud that doesn't offer some kind of silver lining.

When numbers are drawn out by healthcare auditors and red flags wave

The takeaway in a story last week about extrapolation and Medicare overpayments is, natch, how meticulous providers should be when filing claims — and to understand how individual claim problems can grow. And, boy, can they grow.

From hospital to nursing home: lapses in care exposed

For the long-term care operator who still thinks rehospitalizations are really just a worry for hospitals, it's time to think again. Researchers are narrowing in on why nursing homes don't always do what they're asked to by referring hospitals.

Forget Paris, give me the crossword: What makes residents happy?

Which would make you happier: walking onto your porch on a sunny morning or taking snapshots from the top of the Eiffel Tower? How about: having a long, fun conversation with your child or going to a Bob Dylan concert?

More talk about putting nursing homes out of business

Almost exactly two decades ago, we saw a huge push to move residents from nursing homes into home-based settings. But a funny thing happened once the number crunchers started doing the math. It soon became clear that such a shift would actually increase long-term care costs. Not surprisingly, the plan was given a quiet, decent burial

Nursing home residents find true love with Rusty the dog

Even if you are blessed to have a wonderful spouse, any animal lover will tell you: There's nothing like hugging a dog at the end of a long day or when you're feeling sad.

Professional education doesn't get better than this

What makes McKnight's 8th Online Expo such a good fit for providers is the way it goes about its business. Once again at the end of March, it will come in the form of five national experts, delivering five one-hour sessions on a diversity of topics important to your job. Attendees can earn free CEs. And it's all free.

Remembering Philip Seymour Hoffman, long-term care firebrand

When Philip Seymour Hoffman died on Feb. 2, the world lost one of its great actors — and one of the most persuasive voices to speak out about the pitfalls of the changing long-term care system in the United States.

Docs might get a raise, and long-term care might get a bill

Major League teams don't celebrate World Series victories midway through the season. But politicians do the equivalent all the time. Consider a revised Medicare payment plan that was joyously unveiled on Thursday.

Can you fire an employee for negative Facebook postings? It depends, apparently

Faceboook turned 10 this week and has essentially changed the way more than a billion people connect with each other via the Internet. But what's to be done when one of those people is an employee who is sharing harmful workplace information?

What long-term care can learn from CVS

Most journalists immediately ask "What's in it for them?" when finding out a big company is doing something that appears moral and draws wide praise. That was certainly true of CVS Caremark's announcement Wednesday that it would stop selling cigarettes and tobacco products on Oct. 1.

Pay cuts could wipe out labs, hurt nursing homes

When it comes to worries about how Medicare doctors will be paid, nursing home operators have thought they should stand at the front of a long and anxious line. Truth be told, they have some stiff competition for the "most nervous" title.

Nurse and therapist are two of the best jobs in the US — or are they?

Registered nurse, physical therapist and nurse practitioner are three of the top 10 jobs in the United States, according to new rankings from U.S. News and World Report. This might come as a big surprise to anyone who's been following the recent news in McKnight's.

Why nursing homes won't be catching many breaks this year

When you talk to experts in this field about the year ahead, an unsettling pattern soon emerges. Almost everyone seems fairly confident that regulators will be taking a much closer look at operators.

Feeling a bit run down? Blame the third shift

Long-term care professionals must be on hand to work the dreaded third shift, given the 24/7 nature of the job. For some caregivers, that means extra difficulties getting through an overnight shift. New research has your back if you're one of those struggling in the wee hours.

An easy way to reduce antibiotics

It is tempting to run to my internist and beg for an antibiotic to stem what could be a sinus infection, but is more likely, much like the polar vortex, a cold that won't go away. I was reminded of the need to hold back by a new study in JAMA Internal Medicine that reminds us that nearly half the antibiotic prescriptions given for respiratory infections are incorrect, as the majority of the diseases in question are viruses.

A 'Super' physician-pay fix in the making?

I suppose it's only fitting that during the week of the season's biggest football game, Washington healthcare wonks are discussing a potential huge punt of their own.

Provider networks: Too big to succeed?

At this point, you're well aware that the Affordable Care Act is putting pressure on post-acute providers to partner with hospitals and physician groups. A recent whistleblower case in California highlights just how important this systemic transformation is — but another legal battle making headlines underscores how difficult it might be to "right size" the U.S. healthcare system.

Time for long-term care to take a lesson from the NRA?

It's funny, most of the time, Congress gets along about as well as the Hatfields and the McCoys. But if there is one thought that seems to unify our elected officials, it's this: Nursing homes and other providers must be receiving too many tax dollars.

And now, some important reminders from a 94-year-old

Conventional wisdom can be a reassuring thing. Especially when it reinforces our suspicions. But it has a fatal flaw: Sometimes it can be flat-out wrong. Consider 94-year-old Olga Kotelko.

Who's buying your loyalty?

While the story of former Gov. McDonnell and his wife's alleged excess may make us shake our heads, it did remind me of the slippery slope many in business or politics can fall down when it comes to gifts.

Making the case for love at work

The main focus of any long-term care operation is usually the residents' wants and needs. Caregivers typically dole out huge helpings of personal emotional energy along the way. But they might be getting it wrong, researchers say.

Playing tennis, and the 'what if?' game

Watching the Australian Open tennis tournament, where temperatures have been hovering around 110 degrees, has helped my recovery from the recent polar vortex. It's also unexpectedly prompted me to reflect on the aging process and to imagine myself residing in a long-term care facility.

A better way to manage your most important assets?

What is it that truly sets your community apart?

Remember residents and farm life

Journalism, like long-term care, is a smaller world than one may think.

As cameras roll, providers raise hopes about hospital 'observation' stays

It's been said for a long time that a picture is worth a thousand words. Moving pictures? Start multiplying the worth. Add some sound or speaking to those moving pictures, well now we're talking really, really big impact. Long-term care providers are hoping so.

Little Sisters are behind the curve in a changing church

Challenging the Affordable Care Act's "contraception mandate" in court is a matter of conscience, according to The Little Sisters of the Poor. It's hard to fault people for following their moral compass. But I wonder if the Catholic long-term care provider has gotten the latest memos from Rome.

A field too often framed by innuendo and cheap shots

Ever hear the one about what nursing homes have in common with lawyers and policemen? All three are awful - until you need them.

LTC giant had one fatal flaw: bad timing

A bizarre thing happened when ESPN named its Athlete of the Century. The self-proclaimed world leader in sports apparently forgot that the 20th Century also included years predating 1990.

Holacracy: An idea for long-term care?

As a fan of titles, rules, and hierarchy (I would have made an excellent British subject), I greeted news of Zappo's new "holacracy," with a measure of fascination and horror.

Nursing home operators at 'all-time high'

Lost somewhere amid all the cookie baking, holiday parties and merry-making near the end of the year was nursing home operators' most optimistic story of 2013. The public has an all-time high opinion of you.

Former nursing home aide writes powerful poems

Janice N. Harrington worked as a nursing home aide in college, and she drew on that experience to write "The Hands of Strangers: Poems from the Nursing Home." This book-length collection of poems vividly describes the daily routines and grapples with the philosophical concerns of long-term care, including the complexities of aging, the burdens and rewards of caregiving, and the inevitably of death.

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.

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    James M. Berklan
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