Operators working overtime to deal with new labor realities

Labor costs typically eat up 50% to 75% of a facility's operating budget. So it's small wonder that wage issues are at the heart of so many management-labor battles.

Flashing the badge at conferences

One of the more mortifying moments of attending a recent conference was when I went up to a participant and asked to interview her. She nicely reminded me that I had interviewed her 10 minutes before.

Keeping workers healthy may harm your bottom line

Long-term care operators are in the business of solving problems. They make problems disappear for residents, families and the government. And let's not forget employees.

Group On: Why it's important for LTC to be joiners

Group memberships improve self-esteem, say Canadian Institute for Advanced Research fellows, who were specifically looking at school children, the homeless and the elderly. The caveat is that the groups have to contribute to the sense of who they were and their social identity.

Maybe we should start calling it short-term care?

We used to call them nursing homes. But that changed during the '80s and '90s. The term would eventually lose out to another moniker with less negative baggage: long-term care.

Has MedPAC been infiltrated?

Don't look now, but it appears that nursing home owners might have sneaked one of their own onto the Medicare Payment Advisory Commission.

The volunteer conundrum

While it's hard to have firm data on visitors to nursing home residents, it's estimated that at least half never have a visitor. This can be for a variety of reasons: A relocation away from a community, estrangement or busy families, or outliving most friends and relatives.

What's more frightening than the nursing shortage? What's driving it

To better appreciate this sector's alarming nurse-staffing nightmare, it's helpful to recall the warden's famous line in Cool Hand Luke: "What we've got here is failure to communicate.

Now here's how you celebrate 'The Voice' (the original one)

There's a reason you go back to your favorite restaurant, television show or shoe store. They're good, and you can count on them being good. That's how I feel about the public relations folks at Erickson Living Communities. They "get" it, and their newest project is a perfect example.

The ballad of the MDS coordinator

A NADONA presentation focused on preparing documentation and audits spent time diving into the way MDS managers are treated — and it doesn't look great.

Obtaining critical claims data may soon get easier

The government plans to make new claims data and other resident-care information available to providers and entrepreneurs as never before. Is it too good to be true?

Campaign to archive dementia love stories stumbles

Jane Youell appeared to have hit the jackpot with her timing, but now that's exactly what she still needs: a financial jackpot. The British researcher is attempting to build a first-ever love-and-dementia archive.

Catching payroll bandits

The big news last week wasn't that two women were charged with stealing $144,000 from a nursing home in Pennsylvania. It was that their alleged scam lasted for three years.

Many regulations are truly bad — but ...

Long-term care operators are rightfully concerned about the never-ending onslaught of new rules and regulations. But a deadly fire in China this week might frame things in a new way for them, if they give it a chance.

CVS purchase of Omnicare to bring severe teeth gnashing

It's an odd thing to see the king of the jungle become the hunted instead of the hunter. But now that the smoke has started to clear from last week's announcement that pharmacy giant CVS will be buying Omnicare, the future is coming into better focus.

Debate over engaging seniors' brains

New research indicates too much time playing video games may reduce our memory skills.

Where's your next lawsuit coming from?

If a recent survey of about 800 corporate attorneys is to be believed, there's no shortage of things to lose sleep over.

Having standards isn't enough

There's a country music song that popularly declares, "You've got to stand for something or you'll fall for anything." Well, I'm here to tell you, having standards isn't the answer.

Failure in discharge planning

There's a feel-good national story that debuted last week around how emergency responders helped an 81-year-old man. Wonderful people came to his aid. But why did it have to come to this?

Note to associations: Give General Powell a break

The first time I heard Gen. Colin Powell speak at a trade show was in the mid-1990s, and he gave one of the most spellbinding presentations I'd ever witnessed. That said, it's now probably time for senior living organizations to stop hiring him.

Answers about your top 5 technology challenges

I've learned after many years of covering long-term care that certain things are sure to arouse providers' anger — over regulation, under payment and reckless media accounts among them. What provokes fear is even easier to identify: technology.

Winning recognition for your facility

Here's how you know a program is successful: When people keep asking you when it's coming back.

Alzheimer's drug maker sends a different message in the courtroom

It's almost impossible to turn on the tube these days without seeing an ad from a drug company. The typical scenario goes something like this: Person with a disease or problem is all smiles, thanks to the benefits of the advertised drug. But there's a catch.

The engine behind ACOs is showing its muscle

The American West was largely settled by pioneers in covered wagons. It looks like a couple hundred years later, the American healthcare landscape is going to be infiltrated by covered Pioneers. And this wagon train is only picking up momentum.

Playing fast and loose with Medicaid termination

There are many benefits to communicating to your cohorts in neighboring states, and not the least of it may be knowing when a provider is kicked out of Medicaid.

Residents and sex: It's time to re-examine what's appropriate

It's so easy to think of older people as being done with sex. And truth be told, many are. But as anyone who has spent time in a skilled care setting can attest, that's hardly a one-size-fits-all notion.

Providers suffering Medicare appeals backlog — at their own hand?

If providers were charged a fee for challenging Recovery Audit Contractor findings, there wouldn't be the current overwhelming backlog of Medicare appeals, says the administration — and, surprise, the auditors themselves.

A good book's unintended lesson and tears for a great friend

One of the best signs of a good book is its unplanned lessons. While its title might profess how to fix this or do better at that, a high-quality book also will lead the reader to enlightenment for reasons a PR agent might not promote. Such is my personal experience with Atul Gawande's "Being Mortal."

Maybe it's time for ADAPT to adapt

What kind of cruel, heartless person could openly criticize disabled people in wheelchairs? I guess that cruel, heartless person would have to be me.

Salary matters in long-term care

The University of Pittsburgh's research involving certified nursing assistants and why they leave is among the most interesting I've seen recently in long-term care. Salary, it turns out, is not nearly as important as respect and flexibility in scheduling.

Who cleans up after the 'fix' is in?

It will be interesting to see what happens when the guitars are put away and the strains of "Kumbaya" die down after last week's ballyhooed passage of a new Medicare doctor payment rule.

Our government is a terrible thing — to hate (and a thank-you)

Providers are finding their personal and professional relationships with the government tested these days. But before we all grab our torches and pitchforks, let's take a deep breath.

Wristband holds hope for depressed patients

The verdict is still out on how practical or helpful some of new wristbands and other monitoring devices are among long-term care residents. But one new study indicates that a particular wristband may be able to track how depressed patients will respond to common drugs such as Prozac.

Mind games the way to recover from stroke

Do we need another reminder that a positive attitude or strong mind helps healing? We do. This time, it's with regard to stroke survivors who can't move body parts.

Operators could take a lesson from this program

Here's a win-win arrangement that really stands out. For providers wanting to inject a little extra youthful stimulation and outside perspective into their communities, it's worth a look

5 pieces of Facebook guidance for the uncool

As some of you know, none of the cool kids are using Facebook anymore. However, given its growth among those above age 65 (your residents) and its continued use among 30-somethings and up (your employees), it's worth being clear on some easily-avoidable professional and personal problems. Here are some examples.

We were all in on the scheme and didn't even know it

The recent past came rushing up other day, and it wound up whisking all of us onto the set of some fast-paced, financial mayhem-filled movie. Yes, you were there, too — though like me, you might not have realized it.

They told us everything we need to know about the future — except what to do

What should long-term care operators be doing to prepare for the future? Take your pick of these three things.

New editor stages coup

Greetings. Today seemed like the day to tell you that I, Elana, have taken over Elizabeth Newman's column. McKnight's made the decision after a detailed data analysis related to what drives pageviews. (Have you surfed the Internet lately?!)

Can we get that in writing? We better

If you asked long-term care providers what their main concern is, you would think it would be "patient care," right? It turns out, that's not reality. Most providers, it appears, are consumed by documentation.

An emerging union challenge: 'micro' management

The National Labor Relations Board's willingness to let smaller groups of people form "micro unions" has many operators on edge.

Genetic testing opens can of worms for Alzheimer's patients

Healthcare professionals tend to have a belief in facts, and as a corollary believe in conventional wisdom that knowledge is power. Of course, what people SAY they want to know and how they actually act is often miles apart.

Volunteer calls out nursing homes for not delivering

After five years, Gary Gamponia says he has had enough frustration. His message to nursing home administrators and activities directors would likely be, "I'm mad as hell and I'm not going to take it anymore" — if only he had enough leverage, that is.

The mess that is long-term care funding

In some ways, my parents did their children a great favor by dying early.

What long-term care can learn from Van Halen

David Lee Roth, best known for being the theatrical frontman of the rock band Van Halen, is a decision-making genius whom long-term care providers can learn a lot from.

Alarming headline about safety gives incomplete picture

Curse the headline writers, for they sometimes don't do stories justice. The nursing home profession knows this as well as anyone.

Are glowing acquisition reports a cause for optimism, or concern?

Taken collectively, two recent reports show that last year was a great time to sell a property in this field — and this year may be even better. That may be good news for the movers and shakers. But is it an encouraging sign for the sector overall?

The hidden gem of the Online Expo

Maybe you look like a supermodel, or maybe you are morbidly obese. You might be a CEO who looks like a college student, or in a scooter. Either way, when you attend any conference and visit the Expo Hall, you may wonder how vendors will take you. That's one of the often overlooked aspects of the virtues of the McKnight's Online Expo Hall.

Nursing homes receive an unexpected compliment

Would anyone recommend duplicating something if they didn't feel it was worthy or successful? Of course not. It's this reasoning that should give skilled nursing operators comfort and pride.

This Medicare shift may change the way you do business

When you ask providers to name the biggest Medicare change they've encountered, the answer is almost always the same: the advent of prospective payments. But we're not hearing much about a potentially bigger reimbursement shift that is quietly taking hold.

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.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan and Senior Editor Elizabeth Newman.

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