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.

Ebola shmebola! It's the real killers we should be worrying about

It's not hard to see why the Ebola outbreak has so many of us on edge. It's sort of like the proverbial monster under the bed. Except this time, the monster is no figment of our imagination. And now it appears ready to pounce on us.

Four-year nursing degree still a great choice

Good news for career nurses with bachelor's degrees: You're killing it compared to teachers, journalists and high school graduates.

Shedding light on the impact of hospice care

While there seems to be some disagreement over Malcolm Gladwell's posit that doing something for 10,000 hours will make you a master at it, the idea that practice leads at least to improvement has received another shot in the arm. (That would be hospice providers you hear cheering in the background.)

Critics agree: New book about long-term care is a must-read

Doctors have a lot to learn about long-term care."Duh," you say? Fair enough. But a newly published study and a just released book really drive the point home.

More long-term care operators feel pulled away from their day jobs

There is no denying that change is in the air. And I'm not just referring to yesterday's agreement that makes Kindred one of the nation's largest providers of post-acute and home care services.

The secret to success sits in dining services

By the end of the day Tuesday, after a week full of educational sessions, it took a lot to break through the clutter in my brain. That moment happened when Kyle Henderson made a slightly throw-away comment about some providers "investing in chefs, paying them $70-, $80-, $90,000. That's where we are seeing innovation in programming, because dining gives them a chance to impress three times a day."

Powell hits all the right notes

What do you call a 77-year-old who has worked with — indeed BEEN one of — the most powerful people in the world, traveled the globe extensively, served his country with honor for decades and then charms, compliments and entertains you for over an hour — without the help of a teleprompter? The perfect keynote speaker for your conference, that's what.

We serve the poor and aged (and love a great hotel)

Messages about how the long-term care sector exists to serve the neediest and most vulnerable can seem hollow here at the Gaylord National hotel, with its high-end steakhouse and a breathtaking glass atrium offering stunning Potomac River views.

For long-term operators, a growing list of 'frenemies'

Most of us are all too aware of our professional friends and enemies. But not so much when it comes to our "frenemies." Given the many changes taking place in healthcare today, the frenemy list for many long-term care operators is expanding as never before.

Where my ladies at?

If you went to the National Investment Center for Seniors Housing & Care conference for the first time three years ago, as I did, you'd be forgiven for recognizing its importance, but agreeing with the sentiment that it's a "WORM" (White Old Rich Men) crowd.

A show for all ages, a unique long-term care event

At the risk of sounding like a common shill, I cannot remember when I've more eagerly looked forward to an annual trade show than the upcoming LeadingAge gathering in Nashville. The main focus of my anticipation? The Oct. 19 world premier screening of "Glenn Campbell ... I'll be me," a powerful documentary about the music superstar who has Alzheimer's disease and now resides in a long-term care facility.

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.

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