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.

When Father's Day arrives in December

I have enjoyed a life largely free of the misfortune that time and circumstance can bring. All things considered, it's been a pretty good ride so far. But even the most fortunate among us does not get off scot-free

Another revenue stream threatened?

For just about every skilled nursing facility out there, this is probably a good time to break out the flop sweat. That is, unless the prospect of being culled from one of your most vital revenue streams is nothing to worry about.

New ACO proposals could leave long-term care providers smiling

If nothing else, federal health officials displayed Monday that they are intent on getting this accountable care organization (ACO) thing right. Or at least closer to "right" than it has been.

Aging in style: Film focuses on senior fashion, senior care

The new documentary "Advanced Style" provides inspiring examples of vibrant aging, sharing the stories of older women — some nearing 100 — who continue to push the boundaries of fashion. But I was surprised to find that it also offers a glimpse of a senior care landscape in which older adults increasingly encounter the healthcare system through rehabilitation and home- and community-based services.

Managed care project runs into trouble in CA

In case you were wondering how the largest pilot program for managing dual eligibles is going in California, the short answer is "Not great."

Illustrating how to double your flu vaccination rate

Take whichever side of the argument you want, but you can't disagree that New York state's new flu-vaccine mandate has had a profound effect. By declaring health workers have to wear a facemask during flu season if they aren't vaccinated, the state has compelled more to line up for their shots. Jewish Home Lifecare just might be the most creative. Or bold.

One tip to improve long-term care marketing

Feed your marketers, they're probably starving. Sorry, this won't be as easy as dialing Domino's ... I don't mean LTC marketing executives are starving for food, but that they are starving for connections with their peers and the chance to glean expert insights into what they do, and how they could do it even better.

3 reasons why LTC profits may soon be harder to come by

While nobody in the field is shouting it from the mountain tops, the long-term care sector has been enjoying more than its share of easy layups lately. That could be coming to an end in the not too distant future.

Life, death and other tough choices for nursing homes

As Mom used to say, where you stand usually depends on where you sit. That adage seems especially relevant for handling the wishes of residents diagnosed with terminal conditions.

Ability to read emotions is an undervalued skill in long-term care, elsewhere

According to a psychologist at the University of Bonn, recognizing people's emotions positively affects income, namely because these people in a business environment are able to care and deal with the emotions of their colleagues.

No joke: Nursing Home Compare, ratings earn praise

At first blush, the phrasing seemed like the punch line to a questionable long-term care-related gag. But upon further reflection, it began to sound more and more like an earnest compliment. The government's Nursing Home Compare website is better than others but still ripe for improvement? So true.

Feel-good stories that make nursing homes look bad

Being discharged from a nursing facility to a home- or community-based setting seems like a completely positive development — and the media certainly present it that way. These human interest stories tend to focus on improved health and regained independence. But in reality, these transitions are more complicated.

Replace the Five Star Quality Ratings system with points?

There's a need to fix what's broken with the Five Star nursing homes-ratings system, and the way to do it is obvious.

Providers likely to gain from immigration policy changes

President Obama will be unveiling a multi-pronged plan to overhaul the nation's immigration policy, possibly later today. Its most controversial component — a reprieve for the millions who face deportation — could also deliver a huge payoff to senior living operators.

Expanding telemedicine definitions

The quickest, and most dangerous, way to dismiss the concept of telemedicine in long-term care is to envision it as a physician or nurse sitting in front of a computer with an elderly resident on the other side. Wrong, just like the notion that telemedicine probably isn't for you.

Long-term care insurance: Time to yell 'Run!' yet?

There is a memorable scene in the movie "Forrest Gump" when Lt. Dan chews out the well-intentioned title soldier for saluting him while the enemy is likely watching. The implication is that if you want to strike a crushing blow to something, you take out its leader.

Were we sold snake oil at LeadingAge?

Did a crackpot give the keynote speech at last month's LeadingAge conference?

Contradictory promises from politicians

Following the most expensive and perhaps ugliest campaign season in our nation's history, we watched two leaders who can barely stand the sight of each other predict crimson and clover going forward.

Opportunity may be knocking, but many operators don't want to answer the door

If you are a long-term care operator, the latest report from the National Hospice and Palliative Care Organization should leave you with mixed feelings.

How to become an exceptional leader

If there's one critical tool to becoming an exceptional leader, it's not drive, smarts or even likeability. It's the ability to listen.

The center of the long-term care universe — and it's growing

From the president of the United States to healthcare regulators and providers of all stripe, the focus is increasingly on innovation and creating caregiving alliances. One place in the United States is taking it beyond all others.

Real names and toilet seats: Keys to resident happiness

Feel like you need to renovate your building to boost resident satisfaction? Here's a tip: Make sure your staff knows the names of all the residents first. And black toilets might not hurt, either.

Providers should pay special attention to what happens in the Senate tomorrow

Tomorrow's the big day. All across this nation, voters will go to the polls to decide thousands of races and issues. But providers should care the most about the various U.S. Senate race outcomes because they could potentially change the way many operators do business.

Falls can cost more than an arm and a leg

Long-term care operators have many good reasons to keep resident falls to an absolute minimum. Yet it's amazing how blasé we've become about the damage that falls inflict.

Magic wafers may keep residents healthy

Most people have some quirky food issue, whether it's gagging at the smell of fish or a hatred of condiments. I'll confess mine: I detest raw apples. Apple cider, applesauce, apple pie — they're all OK. But start slicing a regular apple in front of me or bite into one, and it's all I can do to not run out of the room. It's a texture issue, perhaps stemming from years in braces where I felt like I looked like Hannibal Lecter and developed a high level of nerve sensitivity in my teeth.

Provider's rebranding and restructuring catch national attention

My first thought was one of concern: What had gone so wrong that one of the most esteemed long-term care providers in New York had to change its name? If it ain't broke, don't fix it, right? What was broken?

3 tips for a strong SNF-hospice partnership

Easier said than done. That phrase often pops into my head when I read the latest long-term care research.

It can be hard to see straight when you're being robbed blind

Should we be shocked to hear that the business office manager of a nursing home in Michigan allegedly stole more than $460,000 from a resident? Probably not. And that's not a narrow comment on skilled nursing operators.

Guess who's asking whether to discontinue skilled care?

The audience member had a question that in previous years would have been found at the corner of Blasphemy and Crazytalk. She wanted to know whether it would be advisable to drop skilled care from her nonprofit organization's portfolio. Not too long ago, that might have been like Toyota asking if it should make cars without seats.

Managing time for staff to reflect after a resident's death

Singing "Amazing Grace" or playing a ukelele version of "Somewhere Over the Rainbow" may not immediately spring to mind as ways to help staff members grieve after a resident has died, but they were among the musical tributes healthcare professionals shared during a LeadingAge session Wednesday.

Glen Campbell Alzheimer's documentary brings out the stars — caregivers and celebrities alike

As readers of this blog may recall, my expectations for the special screening of the new documentary about music superstar Glen Campbell's journey with Alzheimer's disease were high. Sunday night's star-studded showing and concert were to be unlike anything long-term care professionals had experienced before. And they were.

Subliminal messages: A basic part of nursing home care?

"Will your app deliver subliminal messages to my residents?" I did not hear that question yesterday while I wandered the expo hall at the annual LeadingAge conference. But perhaps I will next year.

In long-term care, success can be bad for business

To get an idea of why different fiscal rules seem to apply to the long-term care sector, look no further than Netflix.

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