Returning from an early morning walk down to the harbor of this sleepy Cape Cod town, it's hard not to feel hopeful. My geriatric pups Melvin and Theodore couldn't get enough of the sea smells and feel of the sand under their little Shih Tzu paws.
With off-label antipsychotic use dangerously high in U.S. nursing homes as reported by Human Rights Watch, a question undoubtedly on the tip of everyone's tongue is "How do we fix this?" We all know the scenarios. We've seen them happen. How do we handle them?
Many of us working on reform since the advent of Medicare and Medicaid in the turbulent 1960s witnessed reform in the guise of reworking, re-engineering, redevising, recreating, redesigning and refashioning.
As healthcare workers, especially as healthcare workers in long-term care, we don't have jobs that most people can identify with.
Many industry experts believe skilled nursing's current marketshare challenges are temporary — that SNFs only have to hang on until demographic shifts kick in. But I worry about this strategy.
For many patients and their families, the notion of choosing to stop life-prolonging treatment is unthinkable. Disagreements over when to "give up" can tear families apart, precisely at a time they should be coming together. It doesn't have to be this way.
A new law in Georgia signed by Gov. Nathan Deal (R) on May 7 will provide additional safeguards against elder abuse at long-term care facilities.
It is regrettable that 17 state attorneys general are grandstanding by demanding that federal officials impose stricter nursing home regulation and sanctions. Their letter shows no real understanding of skilled nursing care or its challenges.
The Centers for Medicare & Medicaid Services has clearly stated a pathway for change including health literacy, true partnerships and moving the focus of care into a self-management model.
Everyone working in the aging services field knows: Action is needed now when it comes to building the eldercare workforce. And the legislative approach cannot be our only strategy.
Gaining network participation with a managed care organization can be difficult. In the ever-changing landscape of requirements to participate with an MCO, providers not only need to know what areas matter but also what matters in those areas.
Grandma sure liked her bingo. She excelled at bingo and most card games. Even in games that seemed to involve no skill at all, Grandma almost always emerged the winner.
Too often the senior care industry focuses on negative outcomes and the "clinical" part of the aging experience. Yet, there is much to be said about aging that is positive, and focusing on the benefits of growing old can increase the success of communities worldwide by making them more intergenerational and interdependent.
Nursing facility operators might be faced with this dilemma: Should I or shouldn't I provide an overpayment self-disclosure to the Department of Health and Human Services Office of Inspector General? This voluntary disclosure should be assessed with a cost benefits analysis lens while being mindful of the associated nuances.
Until the State Operations Manual becomes the quintessential tool for regulatory compliance, a 5-star rating will be out of reach for skilled nursing providers. It's as simple as that.
Last summer, along with my older sister and our children, we made a 900-mile trek across four states for no other reason than to sit across a picnic table from our paternal grandfather and listen to his stories.
I propose medical, nursing and other healthcare professionals consider the following guidelines in providing appropriate care of people who suffer from dementia
While the practice of turning away opioid addicts may appear heartless, this may be necessary given some of the administrative and regulatory hurdles that exist.
The shrinking workforce has created a "Bigfoot Phenomenon" in the recruitment process of top directors of nursing in the long-term care industry.
As a leader in the nursing home setting, I see the accountability game played out quite often. Mostly, it's a facility has failed to meet a certain standard of care and a state surveyor, during a detailed review of a glut of required documentation has unearthed that issue.
When my grandmother died, I didn't know anything about the medical field, nursing homes or taking care of people. What I did know, though, was that I could do better than the care she received.
Many times as leaders we feel that our actions are prescribed by entities beyond our immediate needs of those we serve.
Perhaps you think that the new therapy-payment bombshell (RCS-1) has turned out to be a dud. I hope to make the point that it was not.
With almost 15 years' experience in grassroots advocacy, working for causes from cancer to Alzheimer's prior to my current focus on aging services, has me convinced: Each and any one of us can have an impact without leaving our home turf.
To move from providing only the most basic of needs (shelter, safety and physiological support), providers need to understand how optimizing their engagement strategy can move their residents up on Maslow's pyramid.
In recent weeks, a study by the Human Rights Watch has shed light on a serious problem across many facilities where seniors live in America: the over-prescription of antipsychotics to unnecessarily medicate individuals with dementia.
There has been a lot of buzz generated by Julie Boggess' piece on leaving the profession from at least a bit of burnout. I am choosing something different. I am choosing to make a difference in the profession, teaching the leaders of the future and doing my best to implement this stuff in my building.
The Silver Spoon Dining Club — an innovative approach to address weight loss issues for residents with late-stage dementia — is not only realizing its goals of improving resident weight loss and reducing nutritional supplement intake. More importantly, it's also bringing socialization and a bounty of "feel good" benefits to residents, non-nursing volunteers and staff at Central Baptist Village.
Who better to tell Hollywood to "wise up" than the California Commission on Aging, the state's leading advocate for healthy, purposeful longevity?
At one time, I was a nursing home administrator who was "on fire" about the topic of culture change in long-term care. I believed that working to de-institutionalize the institution was the reason I was guided into the industry over 30 years ago. No more. I couldn't continue.
Easy to list negatives. Easy to become reclusive. No matter when you leave a home. Or retire. No matter the time or age or gender. Be positive in setting the goal, rejoice on reaching it: in a retirement home, in your long-time home, in a new marriage, in a new grandchild — all a new rhythm. Be positive. Reach! Try! Strive! Age allows it.
When instructor Chany Stolik comes into the classroom at The Palace Coral Gables, her students typically say a "gutn morgn" instead of "Good Morning."
We don't know when, and we don't know how, but when Payroll-Based Journal staffing data replaces the data currently being captured from CMS Form 671 for calculating Five-Star staffing, we are likely going to take several lumps.
Establishing processes to utilize root cause analysis for quality improvement is necessary, but it takes discipline. One of the first steps is to challenge your own beliefs about safety and quality failures.
There are many factors that determine what can or must be done to ensure a facility can survive and ultimately thrive. These 11 questions help to indicate the stability and sustainability of a facility and its market.
How can we provide our residents the compassion and care needed for their physical, emotional, social, and spiritual well-being at the end of life? Bring them, or surround them with, music.
We need to better understand our dementia residents and learn how to enter their world to make them comfortable, maintain their dignity and improve the quality of their lives.
There is a much more efficient solution to reducing Medicare spending than the proposed broad cuts to the program budget: Reduce the billions of dollars in incorrect payments each year.
With many whistleblower cases ending in multimillion-dollar settlements, providers could easily conclude that the deck was unfairly stacked against them in 2017. But the tide might have turned.
Each of these key terms can present significant risks if not negotiated or, at a minimum, understood when dealing with a Software as a Service (SaaS) agreement. All providers should be aware.
Every two seconds, someone in the United States needs blood, but this year a massive nationwide shortage is putting lives at risk. In response to this dire situation, the nation's long-term care facilities and support businesses have stepped in to help save lives.
As part of my early clinical training, I spent some time treating patients at a large psychiatric hospital that has long since closed.
All skilled nursing and rehabilitation centers are not identical, and when they are prepared or required to admit and retain challenging residents they need the support and consideration of residents, responsible parties, advocates and agencies in a fair application of requirements and the reimbursement commensurate with those needs.
Exceptional SNF utilized appropriate structure, process and outcome measures. Despite this, however, it might have better been called "Mediocre SNF."
Based on their assessments of the risks, different facilities may prioritize different types of hazards in the planning process.
Research indicates that every second of every day, an older adult around the world falls and sustains injury. In a care setting, a fall is even more so troublesome.
The issue of physician aid in dying is controversial at best and implicates the intersection of law, medicine and ethics. While the law allows for physician aid in dying in a handful of states, not all professional organizations have embraced or supported this growing movement.
Over just the past few years, the nation's three largest pharmacy benefit managers (PBMs) - CVS Caremark, Express Scripts and Optum Rx - have come to control more than 80% of prescriptions dispensed in America. For seniors living in the nation's long term care (LTC) facilities, and served by LTC pharmacies, this percentage jumps to more than 90%- a true oligopoly.
"Mrs. Jones" is in the middle of the dayroom, once again engaging in verbal abusiveness that disrupts the residents, families and staff on her unit.
The long-term care space is rapidly changing and evolving. Big data analytics will play a key role in helping to shape the future of this space.
Almost exactly 6 years from the date of our first training, we recently added our 50th home to the Eden Alternative Registry.
Nursing homes have an epidemic health problem these days, but it's not in their patient population, it's on their own balance sheet.
As someone who has close to 20 years of long-term care recruitment experience and who has personally worked as a nursing home administrator, I understand how important culture is when making the right hire. The first step in creating the right culture is matching the best candidates with your beliefs.
Legacy featured the works of 20 established and emerging senior artists from Long Beach, CA, and surrounding communities.
It's a loaded question: How good does your data need to be? If we're honest with ourselves, we must admit that we're not perfect. Nor are the systems we create to help minimize error perfect.
At the end of 2017, Congress recessed before a decision was made on the repeal of the Part B Therapy Cap that we've been living with, working around, and appealing since 1998.
With each new year, cancer patients find continued hope that a cure or treatment for their disease will lead to longer and fuller lives.
I was meeting with a new client recently at their skilled nursing and rehab facility for our in-service prior to launching their online digital marketing campaign.
While federal regulations state that nursing homes must provide "each resident with a nourishing, palatable, and well-balanced diet that meets dietary requirements and any special dietary needs" under the guidance of a registered dietician, facilities have a lot of flexibility on how this regulation is met.
What are long-term care providers to do post-Kindred? Should they expect that their agreements to arbitrate will be enforced or invalidated at the state level?
Over the last 20 years, there is a movement to assign elders to units that specifically address their need.
The design of the BPCI-Advanced program appears, at first glance, to offer little opportunity for SNFs looking to redesign their business models and take episodic healthcare risk alongside hospitals and payers. It effectively sunsets the original BPCI option that kicked off the risk-based episode at post-acute admission (called "Model 3"), leaving all bundled post-acute services to start with either an inpatient or outpatient service.
From Hurricanes Irma and Harvey to the California wildfires, there has been no shortage of extreme weather around the country.
I am frequently asked to consult about "inappropriate" behavior in skilled nursing facilities. The question is usually something like: "We have a resident who is doing 'X behavior'— what should we do?" (You can fill in the X with behaviors like wandering, yelling, hitting, hoarding, etc). My answer is always along these lines: "I have no idea what to do, but please let's talk about this particular resident."
Suddenly the plane dropped and items went flying, including people. We heard the strange noise again and realized that this was not normal turbulence.
I know you think you have unwrapped all of the presents under your company's Christmas tree-but wait. I know of a present that you haven't "unboxed" yet and it's the gift that keeps on giving year after year.
Think about SBAR. Situation, background, assessment, recommendation. Apply it to email. In other words, think bullet points, not novels.
Does your organizational safety program and committee focus solely on employee injuries and Workers' Compensation issues? If so, you are not alone.
Most of us have used or at least aware of the PHQ-9 (Patient Health Questionnaire) scale for depression. Through a series of questions that are directly related to the DSM-IV criteria, a patient or caregiver can determine whether they're depressed and how best to address their depression.
The post-Hurricane Irma disaster at a Florida nursing home, where multiple residents died from heat-related problems when the electricity went out, prompted a last-minute legislative add-on — allowing recording devices in residents' rooms — to a Florida bill requiring back-up generators for long-term care facilities.
National health expenditures will increase from $3.5 trillion in 2017 to $5.5 trillion in 2025, according to the Centers for Medicare & Medicaid Services. That's two trillion dollars in only eight years, and accounts for 19.9% of the GDP
The current implementation of Medicare's sliding scale ADR limit policy is preventing the recovery of improper payments and has afforded a significant portion of providers with immunity from billing accuracy review due to the low volume of claims they submit
The day after Thanksgiving, CMS further defined its intensions with the Five-Star Quality Rating System; more specifically how the new survey process and derivative data will be used in its calculation of the Health Inspection domain. Here's what that means — and doesn't mean.
Despite all of us having heard at least one story of good medicine gone wrong, coordinating care among skilled nursing facilities (SNF) and home- and community-based services (HCBS) can be a win-win situation.
Growing and arranging flowers and cultivating greens allows them to practice real tasks that are used in everyday life.
In recent years, the number of long-term and post-acute care providers who use electronic health records has grown rapidly in response to increased regulations, additional data requirements, and downstream pressure from acute care partners and accountable care organizations.
Most organizational employee recognition programs place a lot, if not all, of the responsibility for recognizing good work of their team members squarely on the shoulders of managers or supervisions. This is unfortunate and, actually, creates unwanted negative effects.
Experts in senior living know there is an impending leadership problem, if not a crisis. A wave of the industry's top executives are set to retire and it's uncertain from where the next generation will come.
I shared with the charge nurse my inner joy about filling all our staffing holes completely. She looked at the schedule and mumbled, "Great — you have scheduled nothing but Refrigerator Nurses."
As the population continues to age with an extended life expectancy, embracing innovative models ensures we all can experience both quality care and quality lives.
We all yearn for a time when value-based purchasing (and care) loses its originality. A time when motivations for providing excellent care and achieving excellent resident outcomes are aligned with reimbursement.
The political squabbles in Washington have many providers and support businesses on edge and wondering about the future of healthcare and our industry.
While arguably late to the telehealth game, long term care and post-acute care providers are now key players in telehealth as its benefits become more and more apparent for their patients and business models.
As senior housing professionals, we're well aware of the many opportunities that Life Plan Communities offer residents. The programs, amenities, services, and health care provided create an opportunity-rich environment that we believe supports wellness. It's a big part of the reason we do what we do.
Here I was standing at the funeral of Rabbi Israel T, one of the beloved residents of our nursing home and a man I came to love and admire in the too short period of time that I was privileged to know him.
Identifying ways to improve census is a common goal among long-term care providers. Despite a continually expanding elderly population, occupancy levels are at the lowest point in five years.
As McKnight's coverage of comments by The Centers for Medicare & Medicaid Services principal deputy administrator for operations at a recent hearing indicated, "several of the failings" that led to the nursing home resident deaths could be traced to inadequate training on the emergency preparedness plan, or following proper emergency protocol.
In the challenging environment of senior living facilities, owners and executive managers are increasingly realizing the incredibly high correlation between employee engagement and critical outcomes: Attracting and retaining great people, resident satisfaction, overall facility occupancy, and profitability.
Malnutrition is highly prevalent among cancer patients today, and is one of the leading causes of readmission for long-term care residents.
BPCI Advanced, or the next iteration of CMS's Bundled Payment for Care Improvement initiative, is coming. Despite the recent shake-ups at HHS, skilled nursing facilities (SNFs) that enroll in the program are poised to capture the rewards that stem from greater efficiencies and better patient outcomes during an episode of care.
Approximately 600,000 Americans live with ESRD, representing 1.1% of the Medicare population but 5.6% of Medicare costs.
I've seen it so often it becomes routine: Your coworkers complain about everything, they keep complaining, you start complaining just to join in, and soon you're involved in Complain-Fest 2017.
The key here is not only to understand outcomes of residents once they are discharged from the SNF, but also to leverage the information for talking points with hospitals when seeking preferred provider relationships or bundled payment arrangements.
We can learn a lot by examining Massachusetts, a state that has embraced healthcare reform and currently working to transform its Medicaid program.
If staff members are not aware of the proper guidelines on what information can and cannot be shared, there could easily be a breach of that resident's privacy.
With all the recent restrictions on psychotropic medications in skilled nursing facilities, many facilities find themselves struggling with a resurgence in unwanted resident behaviors that were previously well-managed by anti-psychotics, benzodiazepines and other drugs.
In my last article, I shared with you the latest research on employee and leader engagement. Let's now look at what leaders can do to improve engagement and help themselves become an engaged leader.
Cancer treatment can cause a multitude of side effects for patient resident who is suffering from the disease, many of which can affect nutritional status.
Watching the news these days, it's easy to feel like nursing homes and those of us working in them aren't doing anything right. I want to suggest otherwise.
The Department of Justice's largest-ever healthcare fraud enforcement action, announced in mid-July, sends a clear signal about the federal government's escalating efforts to eradicate and penalize fraud in healthcare: They're here to stay.