Tamar Abell

Attending the American Health Care Association’s (AHCA) 2021 Convention and Expo this year felt like reuniting with friends after spending two years on the frontline of a battlefield.  

The group was tired, suffering from PTSD, but happy to be amongst the survivors.  Most of the sessions focused on the “new norm in LTC” — and how to hit the reset button.  One thing I felt for sure — as an LTC professional, I was not alone but instead, part of a very special team.  

Here are the top “lessons learned” I’d like to highlight after attending the conference:

This is what we chose — this is who we are.”

At the end of the day, this is the common theme for long-term care professionals.  Being in this industry is a calling. We get beat up, but we dust ourselves off and move on. One recurring conversation was to not minimize the trauma we have endured as an industry.  

At every level, from the loss of life to the media bashing of LTC professionals, we’ve earned the badge of “healthcare heroes.”   Our staff need to be nurtured and provided support and mental health counseling. The PTSD is real.


Really, that’s all I need to say.  Unless you are a UNIQUE facility, this is the most serious issue plaguing our industry.  The AHCA Government Relations Update made it very clear that staffing is the number one challenge they are addressing on many different fronts.  Attendees expressed overall concern regarding mandatory staffing — not the concept itself, but the shortage of tools and resources to implement such requirements.  

Also discussed was “price gouging” by nursing staffing agencies when many facilities are not able to accept admissions due to the staffing shortage.  To their credit, AHCA is exploring some creative approaches to the staffing issue, including working with Afghan immigration agencies to source staff.   

But if you’re looking for help finding staffing shortage solutions from the Centers for Medicare & Medicaid Services, look again. In his talk, Evan Schulman from CMS acknowledged they (CMS) do not know all the challenges providers face in recruiting and retaining staff, but that providers need to do “as much as they can within their control… they aren’t helpless and can’t say there is nothing more to do… it’s not just about having bodies in place.” 

Mr. Schulman, this is where I beg to differ. I work with all kinds of providers — large urban to small rural, and the pain is real. While we all try to be creative, opening hearts and pocketbooks, the staffing situation is dire, and we look to CMS to share in the problem-solving. Posting turnover rates and making it part of the Five-Star Quality Rating System is not the answer to the staffing crisis — it’s time to get more creative.

The bottom line for staffing? Buckle up… this problem is not going away anytime soon.


While the predictions were that the PDPM would be budget neutral, it actually increased payment to SNFs in year one by $1.7 billion!  You can bet the government will do a recalibration of the system.  With recalibration will come increased scrutiny on resource utilization by the providers.  It is more critical than ever to continue regular monitoring and analysis of your PDPM data.  

If CMS is looking at the data, then we need to do so first!  We specifically want to assess MDS coding pattern changes — are there true changes in the population and improvements in assessments or is there “gaming” of the system?   It is critical that providers show outcomes as they relate to the PDPM coding changes to avoid potential compliance issues. Speaking about compliance….

Compliance is more important than ever

In this new COVID world, robust compliance is no longer optional.  The Compliance Officer must ask the hard questions and the role needs to become much broader than checking for exclusion checks and hotline calls.  We need to ensure that the facilities have a way to self-evaluate and correct — with access to data being a key component.

Last but not least, the CMS update

It’s always a treat to attend CMS updates… enough said.  This one deserves its very own article — but here is a high-level summary.  This episode is called “Don’t Shoot the Messenger- Part 352.”

Get. Vaccination. Rates. Up

Mr. Schulman was very clear — a major push from CMS is getting staff and residents vaccinated and getting the doors open again. Again — no surprise here. With the federal mandate to vaccinate staff or lose them, Mr. Shulman was preaching to the choir. Providers articulated that the staff shortage is so overwhelming that imposing another barrier is impossible. He further stressed that infection control guidelines must be carefully followed, and masking is not going anywhere. It’s all about managing risk.

Resident visitation

Schulman verified what providers already knew — separation of families has been as heartbreaking as the physical effects of the virus. CMS is working on policy to help increase visitation. One suggestion is to, as the holiday season is approaching, look to schedule visitations to avoid an influx of guests. FYI — you can ask about the vaccination status of visitors but you can’t restrict visitation based on status.

Getting back to basics

CMS is reporting a backslide in quality since the outbreak of COVID. With the lack of staff and the focus on COVID/infection control, this was to be expected. With surveys ramping up again, you can expect increased scrutiny on mobility, weight loss, pressure ulcers and the use of psychotropic medications. Additionally, there is a huge backlog of surveys and compliant surveys that need to be completed. When questioned how far back the surveys will look, the response from Mr. Schulman was “CMS will take a reasonable approach.”

And on the topic of 3 ROP rollout, Shulman stated, “a lot depends on how things go in the next few months and there is departmental sensitivity of what is asked of the LTC community.” He did stress that everyone should be focused on making sure they have an infection prevention program based on Phase 3 in place— don’t wait for enforcement.

So, dear readers, I end where I began — this is what we chose, this is who we are.  We need to continue to ride this wave and don’t let the tsunami hit you!

Tamar Abell is CEO of TBA Compliance, a consulting group that specializes in developing compliance programs that are relevant and operational for long-term care facilities. In addition, the team works with organizations in implementing quality of care corporate integrity agreements.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.