“Linking the data collected from a smart watch to a family application can provide peace of mind with the ability to view vital signs, receive alerts and notifications, and send messages,” Webster explains. Strategically placed ADL activity tags can be used in conjunction with the devices to monitor for deviations in day-to-day activities, he adds.

For staff, the devices can be a big component of enhanced telehealth efforts and remote patient monitoring. Thanks to updates to the 2019 Physician Fee Schedule and Quality Payment Program, which included three new CPT codes for reimbursement of remote patient monitoring, “investments in technology to support RPM services can yield a significant [return on investment] for senior living operators.”

Elopement prevention is a major benefit. Severe dementia and Alzheimer’s residents in institutional memory care units typically benefit most from the use of RFID (radio frequency identification), while RF beacons and systems that leverage GPS, cellular triangulation and geo-fencing are geared more toward individuals with moderate and milder cognitive decline who are still living in the community, adds Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and executive director of the Center for Aging Services Technologies.

One of the devices’ most recognized benefits — automatic fall detection and emergency calling capability — are highly suitable for frail residents at high risk of falling, says Alwan, whose CAST staff evaluates and provides information on a wide array of senior living technologies.

2. Careful and thoughtful planning are needed to successfully implement the use of smart watches on a facility- or community-wide scale.

Alwan advises going forward with implementation as long as staff ensure devices are actually being worn and know how to locate the devices if they aren’t. Residents and staff also need to understand what various device alerts mean, and methods must be in place to stay vigilant on device battery charging. The watches also should integrate smoothly with existing systems like nurse call systems.

3. Adoption and compliance are critical for the success of any implementation.

Alwan encourages managers to ensure residents are convinced of the value of the smart watch. Good adoption tactics include group gamification exercises, complemented by staff training and education.

STANLEY’s Webster strongly urges engaging family when introducing smart watches. 

“National averages suggest that the amount of time residents interact with caregivers is less than three hours per day,” he says. “Stats like this should be used to educate residents and families about the value offered by smart watch capabilities when a caregiver is not present.”

Various tactics can be used to drive compliance, including on-wrist charging capabilities and choosing smart watches that are water- and sweat-proof.

4. Be mindful of major caveats behind smart watches, experts advise.

“We do not recommend that smart watches be used for life safety applications such as fall detection, wander prevention and emergency call,” says Brenda Gallenberger-Klumb, director of marketing and corporate communications at RF Technologies. “Our testing shows that fall detecting apps on these types of devices are unreliable, generating a high false alarm rate and missing some types of falls altogether.” 

She adds that emergency call capability is reliant on the quality of the cellular connection and availability of the cloud. 

Smart watches also can act like battery “vampires.” 

“Any life-safety application is dependent on the resident, or a staff member, remembering to keep the battery charged at all times,” says Gallenberger-Klumb, who bemoans that her own smart watch “goes dead on me two-to-three times a week.” 

She adds that Wi-Fi connections tend to drain watch batteries more slowly than cellular connections.

There are security concerns such as device theft and information privacy. Experts say voice-activated features on smart phones are currently not HIPAA compliant. 

“They should not be used to collect privileged health information,” says Gallenberger-Klumb. 

Finally, experts advise facilities to responsibly mine the data devices generate. 

“Simply collecting data will not improve the quality of care,” says Webster. “The true opportunity for smart senior living is the broader IoT platform that aggregates the data collected by a smart watch or other connected device to drive the insights that can help seniors live longer in a home environment and help caregivers improve care.”

The co-founder of Nightingale Healthcare’s first brush with tragedy came at age 12 when her mother died. Growing up in between two brothers, and the daughter of a physician, Leebron-Clay left Oklahoma to attend college. But after being hit by a car, she took a break. 

After recovering from her broken pelvis and working with indigenous people in Arizona, Leebron-Clay returned to school — until her father was diagnosed with cancer. She went home to take care of him. By age 30, she had lost both parents. 

She became a mother of four sons: Beck, Aaron, Jay and Pete. After a divorce, she relocated with her children to Idaho. She “had always sworn I wouldn’t work in a nursing home,” but moved to Spokane to start at her first skilled nursing facility.

Since Leebron-Clay’s background had been in acute rehab, she became a pioneer in an approach to patient care.

“We get people to where they want to go,” she says. “We approach patient care that way. It’s such a common-sense thing.”

She inherited a love of animals from her mother that manifested itself on her first date with eventual husband James Clay.

“He drove up in his BMW,” she recalls, “and the pygmy goats jumped up on top of his car. He was so sweet about it.”

She insisted her sons go out with Clay first to gain their approval. The fourth son, Pete Wolkin, is now the director of operations at Nightingale, the company Andrea and James Clay founded in 2014.

“She’s always been courageous,” Wolkin says. “Family has always come first.”

That was never more apparent than in 1999 when Jay, the third of her sons, died in an airplane crash. The family went to Mt. Kilimanjaro in tribute to the avid hiker.

Leebron-Clay, in addition to having weak knees, is “terrified of heights” but made it to the summit, six hours behind everyone else.

“It does speak to her determination,” Wolkin notes. 

Leebron-Clay didn’t stop there. The Clay International Secondary School was founded in 2004 in a rural Kenyan village.

His mother is “never willing to settle for ‘OK,’” Wolkin says. “It would have been easy to go over there and look at lions, but there she was in the little village educating women and girls about female reproduction and health.” 

The school is what Leebron-Clay calls her proudest achievement, while the death of her son will always be the hardest part of her life.

“You don’t get over it. It becomes bearable,” she says.

In addition to her three sons, the Clays are close to their grandchildren and great-grandchildren, and currently own five dogs and a cat. The Clays also use their home to host events for nonprofits, including Sustainable Connections, which is focused on helping local businesses become more sustainably focused.

“She’s one of the first people in the door to try something new,” says the group’s executive director Derek Long.

Leebron-Clay has pursued additional education, ranging from learning how to make documentaries to completing her Masters of Fine Arts in poetry in 2002. She even went to clown school. 

Now, at age 71, she still works as a nurse liaison at Nightingale.

“I’m such an idealist and have always believed that nursing homes don’t have to be considered the way that they are,” she says. “This is my chance to do it the way I wanted to all along.”

Each therapy “graduate” gets a send-off by employees and fellow residents, who gather to sing their original going away song “Show me the way to go home.” They also get a loaf of tea bread, a certificate of accomplishment and hugs goodbye.

Administrator Luanne Rogers wants to ensure a meaningful parting for each of the roughly six residents who leave monthly.

“We shouldn’t just escort the people who die,” Rogers said. “We want to make leaving here happy because we just like to have fun!”

When the time comes, some patients laugh, some are shocked and some cry.

One of Rogers’ most memorable send-offs was for a 93-year-old woman who had fallen at home. She was determined to return to her previous routine. On her way out the door, she raised her arms high above her head in triumph. 

“Wahoo! I’m going home,” the woman roared to applause.

The tea bread is a recent addition that is made in-house by kitchen staff. Rogers makes it a point to attend every send-off and encourages patients to enjoy it on their first morning home.

But how do Garden Spot and other long-term care facilities keep their linens, bedding, tablecloths and other non-clothing items clean? What laundry policies and practices work best at removing stains and odors? How do providers avoid audit red flags and ensure items are not prematurely disposed or over-dried?

Laundry experts have found answers to these questions, collecting tips for efficient and effective long-term care management. 

In-house or outsource?

The first step is determining the laundry system that will work best for a facility. Many large CCRCs and skilled nursing facilities choose to manage all laundry on their own. 

“Our residents bring a high expectation of caring, person-centered service, even when it comes to their laundry,” says Steve Muller, Garden Spot’s chief operating officer. “We don’t want to outsource this work because we would lose control of the process and the results.”

Keeping laundry services in-house, however, often requires partnering with a laundry design consultant to determine what equipment will adequately meet a facility’s needs, says Albert Vega, Garden Spot Village’s director of environmental services.

“Getting smaller washers and dryers for a large facility may initially have a more attractive price point, but it can wind up costing more,” he says. “In our facility, we have three 60-pound-capacity washers and one 40-pound-capacity washer, and we’re able to do three or four loads of laundry a day, compared to a less expensive smaller machine that would take eight loads a day.”

But vendors point to the cost savings outsourcing laundry can provide, as well as the additional space gained by removing in-house equipment.

“Labor availability is a significant concern in long-term care and reallocating workforce from laundry to other departments has proven to be a real benefit for many facilities,” adds David Potack, president of Unitex. 

Outsourced laundry partners generally have larger equipment. These can reach higher water temperatures to ensure better compliance with infection prevention standards than in-house equipment. They can provide more accurate data regarding linen usage and areas for efficiency in product use. An in-house model, rarely, if ever, tracks actual linen usage, he notes.

Stains and odors

No matter where the laundry is managed, one way to achieve great results when it comes to stain and odor removal is taking a tailored approach, according to Bill Brooks, North American sales manager for UniMac. 

“Sorting by item and soil level is the first step. From there, it’s all about leveraging washer programming that is designed to clean specific pieces and soils,” he says. Staff must be properly trained on the importance of sorting processes and selection of the proper wash program, he notes.

Ken Koepper, Director of Membership/Outreach for TRSA, a nonprofit trade association for the linen services industry, says that items such as linens, bedding, tablecloths and other non-clothing items require very specific wash chemistry formulas for efficient stain removal and overall cleanliness.

Keith Ware, vice president of sales for Lavatec Laundry Technology, notes water temperature must be 160 degrees for at least 25 minutes to kill bacteria. 

“Facilities must work closely with their chemical providers to ensure that they have the proper wash chemistry, temperature and time to keep stains to a minimum,” he says. “Sheets, for example, don’t require the same heavy wash formula as washcloths or underpads.”

The standard rule is a stain larger than a silver dollar should be discarded if it’s on a visible bed surface, Ware notes. Stains on terry linen should be smaller than a quarter and light in color, or the item should be discarded.

“Once an initial stain is spotted, it should be kept out of the general linen and run through a stain wash to attempt to remove the stain,” Ware says. “If the stain is not removed, a decision must be made as to whether the piece of linen is acceptable.”

In addition, if there are similar stains on linen, facilities work to determine the cause, be it a certain medicine, hand soap or other.

“Many hand cleansers used in nursing homes leave a light brown stain after the linen has come in contact with bleach,” he says. “Once this occurs, the stain is almost impossible to remove, and although the linen may be clean and sterile, the stain looks like dried blood or feces.”

Any linens that are ripped, torn or extremely thin should definitely be discarded or turned into rags, notes Michael Irrizarry, Director of Operational Excellence at Healthcare Services Group. 

“Ensuring linens are clean, in good condition and washed according to regulatory standards is essential to patient safety, and contributes to the residents feeling at home in the facility,” he says. 

Ware also recommends conducting routine bacteria testing on linens as a way to document that your facility is maintaining clean, sterile linen. 

“Just because something is white does not necessarily mean it’s sterile,” he says.

Many outsourced healthcare laundry service vendors are certified for cleanliness through TRSA’s Hygienically Clean Healthcare certification program. Developed to address growing concerns about existing accreditation (HLAC), this certification reflects a commitment to best management practices in laundering as verified by third-party inspection and ongoing microbial testing, Koepper says.

On the drying side, leveraging new technologies also can help extend the life of a facility’s linens, Brooks says. 

“Many operations will over-dry linens, which reduces their longevity,” he says. “Over-dry prevention technology will dry to a set moisture level and not further. This helps eliminate wasted labor time and utilities.”

Linens lifespan

When it comes to attracting attention from inspectors, clean and soiled linen handling errors are often more likely to cause issues than linen quality issues, Koepper says. 

“You don’t want a surveyor to see heavily soiled linen on a bed — it needs to be removed as soon as possible,” he says. 

Staff training is key, here, notes Daniel Gravatt, Business Operations Manager for ServiceMaster Clean. Housekeeping staff must be properly trained in how to handle, clean and return laundry.” Clean linen must never be stored near soiled linen, and it should be transported in covered carts back to residents’ rooms,” Gravatt says. “Facilities should also be sure to have a separate entry and exit for clean and dirty linens.”

Laundry teams should be routinely cleaning the outside of washers and obtaining ongoing titration reports on their wash formulas, Ware adds. 

Hands off!

Facilities also must train staff on how to protect themselves from coming into contact with soiled contaminants.

“Often in small facilities, we see the [sorting employee] working on soiled linen and then, without changing or cleaning up, walk over to the washer or dryer and empty a clean load of linen,” Ware says. “This greatly improves the chance for cross-contamination.”

Putting a routine linen assessment and replacement process into place also can help facilities maintain linen quality and keep large, unexpected expenses from occurring. 

At Inspired Living, a CCRC with locations in Florida, Georgia, Louisiana and Texas, all linens are replaced every quarter, says Christian Figueroa, vice president of operations.

“We also inspect our tablecloths and all linens every time they get cleaned and replace them if needed,” he says. Potack adds that when it comes to quality control, training helps the in-house linen team identify products that should be discarded. 

“If a facility chooses to own its own linen as opposed to renting them from an outsource provider, administrators should consider implementing a regularly scheduled linen injection program so that there is ample supply and a lower likelihood of hoarding on the resident units,” he says. 

Textiles’ lives also can be shortened when long-term care managers cut corners on budgeting for linen replacement, reducing par levels, so items are used and washed too often, Koepper says. But it’s also important to take efforts to avoid premature linen disposal, he believes. 

“TRSA estimates unnecessary linen loss in healthcare at $840 million per year,” he says. The cause may be poor equipment. 

“If laundry is done in-house, equipment is not as likely to be well-maintained, fostering snags on washing machine doors and rough spots in the washer cylinders,” he says.

The bottom line, Brooks says, is that administrators must stay on top of the latest best practices when it comes to handling linens.

With the right procedures, “laundry operations can not only extend linen life but also reduce inefficiencies,” he says. 

Therapists have long recognized their place and their value.

“Many of us garden, we play an instrument, we take care of our pets, we do brain puzzles, we love the smell of baking bread and cookies,” says Kathleen Weissberg, a doctor of occupational therapy and education director for Select Rehabilitation. “As these are incorporated into other facets of rehabilitation, they are done not as a different type of therapy or a different intervention, but instead a normal, functional activity that is engaging, meaningful, and fun for a patient. It is another activity that therapists can use to meet their goals.”

Physical and occupational therapists and speech-language pathologists today welcome the supplemental, and at times, pivotal role these non-conventional modalities offer. They include aroma, pet, horticulture and music therapy as well as art, dance, culinary, massage and aqua therapy.

Successfully navigating the sometimes thorny reimbursement rules surrounding them will help assure their role for years to come, experts say.

Conventional complements

Therapists are increasingly convinced these unconventional approaches help achieve better results.

“It’s no accident that we have strategically blended our respective disciplines, expertise and approaches into the content on iN2L systems,” says Christopher Krause, OT/L, director of rehabilitation for It’s Never 2 Late^®. “In my experience, the so-called ‘traditional therapies’ get better outcomes when such interest-based or ‘soft’ therapies are part of the rehab protocol.”

Krause says evidence suggests that people are generally more engaged and participate in activities for longer periods of time and report less pain and fatigue when participating in something they find meaningful and fun. 

“It stands to reason, and there is growing evidence to support the fact, that combining individualized, person-centered interests and activities with traditional rehabilitative approaches can facilitate improved outcomes in an efficient manner,” he observes.

“Soft” therapies often complement multiple conventional approaches, as Emily Rampmaier, vice president of clinical services for Reliant Rehabilitation, points out. Music therapy is one example. 

“Music can be used as a guide breath support and prosody for dysarthric speech patterns, as a prompt for task initiation or rhythm for mobility,” she says. “Music also may be integrated as a calming measure for individuals who experience pain or anxiety associated with traditional therapy tasks or settings.”

At Charles E. Smith Life Communities in Maryland, Music Enrichment Manager Lauren Latessa strives to provide musical opportunities that meet residents where they are. A classically trained cellist, Latessa leads small groups and individual music classes, runs drum circles, conducts choirs and lectures on music history  for residents.

“I feel fortunate that I can develop programs to enrich the experience of our patients, and I am often amazed by the impact of these musical interactions,” Latessa  says. “A few minutes of live music can change the someone’s entire day and bring brightness to their world.” 

Many times, the marriage of conventional and alternative therapies can yield unexpected yet delightful results, as Nettie Harper, MSRS, co-founder of Inspired Memory Care, has discovered.

It happened when Harper’s company was asked to consult on the transition of a continuing care retirement community resident to memory care. The woman feared losing her freedom, as well as the therapy dog she’d been assigned 13 years before, which had since become blind, incontinent and immobile. Yet, social workers were convinced keeping the dog, now as a pet, was essential for a successful transition.

“She agreed to a trial period in memory care, with her dog, and my promise that the team would support their partnership,” Harper says. “And they did! Physical and occupational therapy were able to use the dog to introduce a much needed rollator to Mrs. Smith, as well as a retractable leash to support safer walking.

“Recreation therapists gave the woman a new role greeting the other residents with her dog for pet therapy, which supported the development of friendships in her new environment,” she adds. 

Speech therapists even worked with the woman, a retired nurse, to introduce a medication administration record for the dog’s eye drops. At the end of her trial period, Mrs. Smith had developed strong friendships with her peers, therapists and aides. They cried with her when the dog passed away three months later from congestive heart failure.

In many respects, soft and conventional therapies have a symbiotic relationship that can often achieve unique results, says iN2L’s Krause.

While soft therapies focus on activities, life enrichment and recreation, conventional therapies focus on traditional training methods. When one combines the two intervention strategies, “magic can happen.”

“Team and approach methods are built to model best practices based on our experiences as former providers,” Krause adds. “Together, our recreational therapy, art therapy, music therapy, speech therapy, occupational therapy, physical therapy, nursing and administration professionals communicate regularly. The goal is to drive efficient outcomes. The approach is collaborative communication and goal setting. The method is to combine person centered interests with individualized clinical goals.”

Even end-of-life care is providing a place for the intersection of conventional and soft therapies.

Minneapolis-based Grace Home Health & Hospice uses massage, aroma, music and pet therapies as integral parts of its care plan to meet the physical, emotional and spiritual needs of the patients, says Executive Director Sarah Van Winkle, RN. Conventional therapists have often been enlisted to work with the soft therapists. 

For example, respiratory therapists worked side-by-side with aromatherapy and music therapy caregivers to ease anxiety and manage pain in a terminally ill resident. Van Winkle’s facility has devoted a great deal of effort employing similar non-pharmacological methods to treat residents and home-bound patients.

Other examples are plentiful. Inspired Memory Care is often called in to consult for residents who are refusing to eat. Harper and her co-founder/partner, Kelly Gilligan, often partner with on-site recreation therapy teams and an occupational therapist to set-up culinary clubs that engage residents to cook. 

“Research inspired us that there is more that we can do besides giving seniors who are declining their meals Ensure™,” says Harper. “Often, there are underlying reasons such as depression, lack of taste, wanting independence and control over their meals and/or wanting a choice of meals.”

Harper and Gilligan also integrate music therapy with physical, occupational and speech modalities to provide neurologic music therapy. They also have incorporated horticultural and art therapy modalities with occupational therapy to encourage stretching and strength training.

Tech’s role

Technology’s role in integrating soft therapies has been growing to a host of online person-centered content, Krause says.

Some companies are now experimenting with virtual reality to complement conventional approaches.

“In using these programs, patients are generally motivated and enjoy the engaging bio-feedback-based training games,” says Select Rehabilitation’s Weissberg. “It’s an alternative to traditional interventions that can be used to address the skilled needs of therapists related to balance, fall prevention and strengthening.” 

These programs complement traditional therapy as a treatment activity during the course of the therapy skilled intervention or for those with dementia, she adds.

Broader acceptance

For years, memory care has provided a perfect incubator to test soft therapies, many of which target the brain. Skilled nursing facilities and short-term rehab are now making greater use of it, according to Krause and others.

“The benefits of alternative therapy approaches can be seen throughout the aging services community,” Krause says. “The value of personal-interest-driven-intervention is now universally accepted.”

Weissberg was convinced of the value of soft therapy many years ago when her administrator returned from Christmas with a bread machine.

“Every morning, he used the machine to bake a loaf of bread that was served in the lobby to guests and residents alike,” she recalls. He began using the machine to bake cookies for residents and visitors each afternoon.

“Imagine how wonderful the community smelled when you walked through those doors!” she recalls. “Everyone — from nurses to housekeepers to the residents themselves — seemed happier. Those aromas brought memories, invoked certain feelings and impacted our interactions with one another.”

That might actually sound like good news, especially for those destined to be in our care. But here’s the dark side: Recent research suggests avoiding this dreaded disease might actually require personal responsibility and making better choices.

Darn it, I knew there was a catch. 

A recent study presented at the Alzheimer’s Association International Conference identified five lifestyle habits that combined could reduce the risk by 60%.

They’re just simple little things: eat a healthy diet, exercise regularly, don’t smoke, cut back on alcohol and get some daily cognitive stimulation. In other words, it’s impossible. 

I’m a pretty typical American. If I wanted my health to be dependent on personal choices, I’d have saved for retirement, thrown out the TV, bought long-term care insurance and quit tanning with baby oil. 

“As recent efforts to develop a cure … for dementia have proved disappointing, the fact that people can exert some control in preventing the disease through their own choices is encouraging news,” said one story on the study.

Encouraging to whom? Not to me. I prefer an instant, external solution. Something that solves the problem without effort and lets me keep doing what I want. 

Two of the five I could manage. I don’t smoke, and I avidly read McKnight’s to maintain mental alertness. But now they also want me to eat daily kale, visit the gym five times a week and reduce my wine consumption to a glass a day? Simultaneously? 

Famous Roman emperor Marcus Aurelius was big on self-control and discipline. “Where is Good? In our reasoned choices,” he wrote. “Where is Evil? In our reasoned choices.” He’s probably right, but he’s also dead. 

So find a real cure for Alzheimer’s. A pill. A magic potion. Anything. Just please don’t make this about me. 

That’s the sad but apropos message I have for hospice-operating friends.

Hospice operators recently were put on the hotseat. In a first-of-its kind (but surely not the last) national report, the Office of Inspector General skewered many hospice providers for falling short in their duties.

Clearly, not all are guilty of alleged shortcomings. But by bringing the sector into the negative spotlight, all members have been spattered, if only by association.

Sound familiar, nursing home operators?

Some might argue that seeing 87% of hospice operators tripping up at least once over a four-year span is a shrug-your-shoulders statistic. Who wouldn’t have glitches over a nearly 1,500-day span? It’s the 1 in 5 (about 20%), however, who had serious enough lapses to endanger patients that will raise significant eyebrows.

The implications for hospice operators are ominous. Once a watchdog sniffs you out, it tends to return often, like an overactive puppy.

This (watch)dog is clearly eager to “play” some more.

In skilled nursing, family members may saddle operators with wide-ranging, often unrealistic, expectations. But there are more modest presumptions from hospice clients and their families. Show up. Give support. Make it comfortable. Provide a good ending. (The fact there’s patient and family acknowledgement that an end is coming is a lift many skilled nursing operators wish they had.)

The relative simplicity of hospice goals can be a double-edged sword. Screw up these straightforward requests and needs, and families and government agencies will come down hard. That death is coming is bad enough: They expect you to get it right.

The Centers for Medicare & Medicaid Services currently doesn’t post all of the revealing information it might have about a hospice on its Hospice Compare website. Also, CMS also doesn’t have legal authority to assess fines.

It might not happen overnight, but expect both of those circumstances to change. With hospice use growing in popularity, expect the heat to intensify.

The dues are high in this club, and sometimes you’re a member whether you like it or not. Just ask the nursing home crowd. 

But when unemployment rates are at a 50-year low and the economy is roaring? That’s what’s known in the business as a game changer. And not in a good way.

To give you an idea of how serious hiring headaches have become, consider this: At least one major association is touting staffing sessions as a main reason to attend its fall show. The American Health Care Association has even set up a “Workforce Solutions” track.

At the facility level, we’re seeing perks and other hiring incentives as never before. The latest offerings include things like health insurance, partly- to fully-paid tuition, shopping discounts, wellness programs and more. Some operators are even going so far as to offer a living wage.

To be sure, many of these inducements seem a bit out of place. Especially for a sector that traditionally viewed the Burger Kings and Walmarts of the world as the competition. 

But will this shift actually help get the, er, job done?

Perhaps. But if a new report is to be believed, the key to fruitful hiring sounds a lot like the generally accepted keys to success in real estate: location, location and location.

A study by BlueCrew examined the top reasons why hourly job offers are turned down. And coming in at No. 1 … yep, location. More than one-in-three job offers (38%) were rejected because of a problematic venue.

The study suggests hourly workers will actually accept jobs that pay less in exchange for a shorter commute or better access to public transportation.

“Wages will, of course, always matter, but we see this more so when it comes to retaining workers — not hiring them,” said Adam Roston, CEO of BlueCrew. 

On the plus side, a less-than-stellar reputation and below-market wages may not be a deal killer.

However, if finding your building requires multiple bus rides and a 90-minute commute, lotsa luck.

So here’s the key hiring takeaway: Your firm’s address might matter more than what your firm addresses. 

However, the difference between what MassHealth, the state’s Medicaid program, pays nursing homes and what they spend on care is about $362 million, according to the Massachusetts Senior Care Association. 

Tara Gregorio, president of the MSCA, says the underfunding has been “a major driver of more than 30 nursing facility closures in the last 18 months.”