But when she graduated from George Washington University in 1989, the downfall of the Soviet Union meant she had to pick a new career path.

“I realized the foreign service was not going to be in my future,” she says. Fortuitously, a job at a law firm led to her becoming a legislative assistant.

“Suddenly, I was chasing down bills and sitting outside hearing rooms, and really learning how Congress worked,” she says. “It was quite a revelation.”

Moorhead, who grew up in a small town in Ohio as the daughter of a dentist and travel agent, built a career in health policy. By 2000, she was leading the Alliance to Improve Medicare, advocating for passing a Medicare prescription drug benefit, which culminated in the Medicare Modernization Act of 2003. For eight years, she worked as the head of what was then called the Disease Management Association of America.

“The core work there was to develop a framework of how to assess individuals on the healthcare continuum,” she says. 

Last year, she was recruited and hired to become the president and CEO of the American Association of Post-Acute Care Nursing, along with its subsidiaries, the American Association of Nurse Assessment Coordination (AANAC) and the American Association of Directors of Nursing Services (AADNS).

“What I bring to the table is an effective ability to build partnerships, to assist and direct, and to develop strategic vision,” Moorhead says.

The board wanted someone who was ambitious and ready to take the organization “to the next level,” says AANAC Chairwoman Stephanie Kessler.

“She has a lot of the qualities that we were looking for,” Kessler notes. She added that combining the group’s conferences for a larger show in April is owed in part to Moorhead.

“She’s been wonderful in pulling the team together,” Kessler says. “She’s just a really good leader.”

Moorhead said a huge goal for 2019 is highlighting how the organization can help providers adjust to the Patient-Driven Payment Model, and looking to partner more with organizations such as the American Health Care Association and LeadingAge.

“Tracey is a successful association leader who has done a great job in creating start-up associations and in helping traditionally successful associations have a broader vision of themselves, and a more progressive business plan,” says retired LeadingAge CEO and President Larry Minnix. “Also, she is an outstanding advocate. She’s a winner whom we can follow into battle.”

While Moorhead visits the AAPACN office in Denver regularly, she has kept her home base in northern Virginia. She remarried last year and lives with her husband, Mark, and children: 15-year-old Ava, 13-year-old Jackson and 11-year-old Ruby. The family makes a point of eating together, with the added dimension of cooking meals together.

“That’s a really important activity, and family bonding time,” Moorhead says. A firm believer in healthy living and fresh, home-cooked food, the 52-year-old runs or exercises six days a week, usually hitting the gym before 5 a.m.

Even without the Foreign Service, foreign travel still is a priority. Moorhead notes how spending time during high school living in Switzerland  impacted her profoundly. She has made it a point to take her children to places such as Paris, London and Rome. 

Still, she’s never sorry to return to Washington, D.C.

“I love this city and its cultural aspects,” she said. “Early on, I considered it my home.”

Resume

1989 

Graduates from George Washington University with bachelor’s degree in international affairs

1995 

Completes master’s degree at GWU in legislative affairs and public policy

2000 

Starts as executive director at Alliance to Improve Medicare

2002

Represents healthcare policy as vice president, government relations, Healthcare Leadership Council

2005 

Serves as head of the Disease Management Association of America (DMAA), now known as the Population Health Alliance

2009 

Joins Patient Centered Primary Care Collaborative’s

Executive Committee

2011 

Ends three-year commitment as Advisory Board member for the Coalition to Transform Advanced Care

2013 

Moves to Visiting Nurse Associations of America as president & CEO

2018 

Named president and CEO of American Association of Post-Acute Care Nursing

 Both of Ruby Kate Chitsey’s parents work in long-term care and she’s been a frequent visitor to nursing homes during childhood.  Last May, she grabbed a notebook and started chatting with residents at the Harrison Rehabilitation and Health Care Center, in Harrison, AR. Ruby Kate asked everyone what three things they wanted most in the world.  

 Amanda Chitsey, a geriatric nurse practitioner, expected her daughter to unearth outlandish requests, but they were surprisingly all grounded and realistic.

 “The answers were stunning. It made me cry because I had had some of these residents for 18 years,” Chitsey said. “It really brought me to my knees because I had never noticed it.”

 Cathy Abatangle, the administrator at Harrison Rehab, says Ruby Kate has a magical effect on the facility’s residents.

 “She’s a very special little girl,” Abatangle told McKnight’s. “It just lights up their faces. They’re so happy to see her, and she connects with them in a different way than adults do.” 

The mother-daughter duo decided to spread the effort to five nursing homes, launching a  GoFundMe page to pay for the endeavor. In early February, it had raised more than $95,000 and was still rising.

A big one is the widely disproved notion that incontinence is an “old person’s disease.” Another one is that “incontinence cannot be cured.”

In a recent study, in fact, significant numbers of professional nurses and a vast majority of nurse assistants told Indiana University researchers they believed bladder disorders are a normal part of aging.

Time and again, researchers have refuted incontinence mythology. Along the way, their efforts all too often show how frail elderly individuals can quickly tumble down a path of declining health, endless indignities and painful bed sores. That is, if open minds and a thorough assessment had not prevailed before a resident’s head hit the pillow for the first time.

Taking the long view

The risks for improper, inadequate or missing assessments can be dire.

“The failure to fully understand the underlying reasons that are influencing incontinence can and does lead to depression and possibly life-threatening conditions such as urosepsis from a urinary tract infection,” says Martie Moore, RN, chief nursing officer of Medline.

The body’s most vulnerable organ is skin. That fact places huge importance on choosing the right products and methods.

“Resident dignity, comfort and quality of life — not to mention, skin health — can be quickly compromised if their incontinence is not managed appropriately,” says Michelle Christiansen, vice president of clinical sales and marketing at Medline. “If a resident is placed into a product that is not absorbent enough to manage their output or if the product does not fit right, the resident’s skin can become compromised.”

Medline’s Continence Management Program educates healthcare workers on moisture management, proper product selection and application, as well as dignity and management strategies for various types of incontinence.

Tony Forsberg, RN, national clinical director of Essity Health and Hygiene, is fond of quoting Albert Einstein, who famously said if he had one hour to solve a problem on which his life depended, he’d take 55 minutes to study the problem and five minutes to devise a solution.

“Fully understanding the problem is critical in determining the very best path forward,” Forsberg says. “If the assessment is not thorough, our solutions may not be the best possible option for this individual. Incontinence may worsen, self-esteem may be negatively impacted, participation in activities may be reduced, mobility may decrease and the risk of falls may increase. And, we may have missed an opportunity to have a positive impact on the individual.”

Improper or missing assessments also can set into motion a cascade of unforeseen problems, and damaged skin is only one of them.

To Megan Ramirez, director of marketing and public relations for the Wound, Ostomy and Continence Nurses Society™ [WOCN^®], the psychosocial implications are far reaching. 

Among the most problematic of them are: isolation, pressure injuries [with other factors], kidney disease, autonomic dysreflexia, financial burden, lawsuits, impactions, dilated colon, caregiver burnout, inability for placement in certain care facilities, distrust of care provider and lost revenue.

One slip, many ramifications

Missing that initial assessment opportunity can have severe consequences. This has always been true but takes on even more meaning Oct. 1 with the onset of the Patient-Driven Payment Model, which demands an excellent initial appraisal.

“Short-term, if a resident is not assessed properly, it can impact their immediate plan of care. Long-term, it can affect how they are managed and or treated for specific conditions,” observes Michele Mongillo, senior clinical director for First Quality Healthcare. 

In both scenarios, residents may miss an opportunity for a behavioral toileting program, be placed in a product that does not manage their specific type of incontinence, or miss a related skin condition such as associated dermatitis, she explained.

Missing the clues

One of caregivers’ greatest sins is conducting an assessment that overlooks a host of hints both subtle and overt.

All too often, those performing assessments fail to connect the dots and miss a critical clue that’s either a symptom or cause.

“Assessments related to continence status vary as widely as the non-specialist clinician,” says Ramirez. “There are influencing factors to episodes of incontinence. For example, a patient who has a slow or unsteady gait, vision issues or trouble getting up out of the chair may spend so much time getting to the toilet that they just do not get there before their bladder empties.”

Frequently, those performing initial assessments may know of a residents’ comorbidities but fail to associate how they relate to the loss of control over their bowel and bladder. Falls and UTIs are popular examples.

“Incontinence is a symptom of changes within the body systems,” says Moore. “It is not a disease within itself but really an outcome of whatever is influencing the performance of the bladder.” Diseases such as Parkinson’s, Alzheimer’s, diabetes and hypertension are just a few that will have urinary incontinence consequences as the disease progresses, Moore says.

It’s also easy to misjudge the severity, nature and timing of the resident’s incontinence when performing an initial assessment. Any one of them should generate a flurry of questions.

“Is it a few drops, a gush or a full bladder emptying that is quite saturating?” Ramirez says. Timing is a critical factor when assessing possible causes of bowel incontinence. “Is it related to eating? If so, which meal or time of day? Is any urge felt at all? Was their attempt at retention to be in a more private place? In this type of incontinence, anal sphincter function and integrity are very important.”

Best practices, products

The ravages incontinence incurs on skin underscore the weight that assessments have in choosing the right products that both repair and prevent damage.

In a study reported in the Journal of Aging Life Care, researchers called incontinence-associated skin disease (IASD) “a prevalent but under-recognized form of skin damage in the older person with urinary or fecal incontinence.” They recommended a structured skin care regimen as a form of prevention and treatment. That includes perineal cleansing with a cleanser that mimics the skin’s pH, and application of a moisturizing agent and skin protectant.

The industry has responded with a variety of high-quality incontinence briefs and cleaning and protection products.

Nursing home providers say product selection and formulary compliance are essential. Empowering staff to choose the best evidence-based products is another. At a late 2018 industry roundtable discussion sponsored by Essity, participants agreed that real promise could be found in products that can promote the strong natural barriers of skin itself.

Christiansen believes that assessments should be conducted soon after the resident is admitted to a facility, at any time there is a change in cognition, or if caregivers “find themselves really struggling to manage moisture and skin health.”

A great deal of current research is focusing on best practices around sourcing the right product for the right condition, as well as how best to gauge the effects on quality of life when determining treatment options.

In October 2017, WOCN hosted a consensus conference on absorbent products. 

“Given the significant lack of available evidence on the proper use of these products, the society convened a group of continence care experts to assess gaps in the evidence base and obtain consensus in needed areas,” Ramirez says. 

The goal of the conference was to develop evidence- and consensus-based statements. Those conclusions were published in the May/June 2018 issue of the Journal of Wound, Ostomy and Continence Nursing, and form the basis of “The Body Worn Absorbent Product Guide,” an evidence- and consensus-based clinical decision tool, she adds. The free online clinical tool is expected to debut this summer.

Product considerations vary by a number of factors, including a resident’s gender, the type of incontinence, timing and the levels of urine and feces expelled in each episode, Ramirez says.

Mongillo stresses the need for facilities to have options when it comes to undergarments.

“A resident’s quality of life and dignity may be affected if they are wearing a product that they don’t necessarily need,” she says. “Products should be selected based on the resident’s individual needs, including their level of incontinence and functional mobility. Staff may have only one or two types of products, which don’t often promote a resident-centered approach to incontinence.”

Moore and Christiansen both suggest recording voiding habits in a patient journal. 

“Utilizing a bladder diary can identify patterns of incontinence with appropriate intervention taken from timed voiding, bladder training and other interventions,” Moore says.

“A thorough, detailed voiding diary will provide the very best information needed to choose a product,” Christiansen says. “It is important to consider what the resident can manage. We want to look at issues such as mobility, cognition and medication. Sizing is also a crucial element to overall comfort. If a product is too big, it may sag and leak. If a product is too small, it can irritate the skin.”

Incontinence is irritating enough as it is, everyone agreed. There’s no sense in giving it another way to aggravate an already touchy issue

Equipped with small commercial Speed Queens, they are designed to mimic the feeling of a home laundry, right down to resident-selected detergents and easy controls.

Chief Operating Officer Matt Trimble chose side-by-side 30-pound washers for the Warwick, RI, homes when they were constructed in 2017. A pair of stacked, 45-pound capacity dryers completed each of the operations, which are designed to serve up to 12 residents per household.

“The beauty of it is, we have commercial machines, but they look and feel residential,” he says.

The majority of the laundry is still done by direct care staff because few residents are physically able to do it. But the choice is each resident’s to make, and smaller machines put family members at ease if they want to do a quick load of wash while visiting.

Saint Elizabeth runs four of the nearly 300 Green Houses operating in the U.S. today. As they and other alternative skilled nursing settings gain market share, providers are reconsidering laundry operations to improve back-of-the-house service.

Appropriately outfitting a laundry room with efficient equipment and strategies for safe garment handling is as much about cleanliness as it is about caregiving. Making the right selections depends on a variety of factors, ranging from resident characteristics and population size to capital and machine capacity.

“In some facilities, basic equipment may be the best fit,” says Bill Brooks, UniMac’s North American sales manager. “In others, leveraging a higher level of technology to measure and monitor the laundry can pay dividends. There is no one-size-fits-all methodology. The best advice I can offer is to work with an experienced laundry equipment distributor, someone knowledgeable about the long-term care industry.”

The book on LTC laundry

Trimble wanted hot wash capabilities, but he also wanted to combat long-term care’s notorious laundry issues: lost items and over-processed clothes that come back stained, shrunken or stretched beyond repair.

Pat Armstrong, Ph.D., a professor of sociology and women’s studies at York University in Toronto, literally wrote the book on laundry in long-term care.

“Wash, Wear, and Care: Clothing and Laundry in Long-Term Residential Care,” reflected her  10-year study of care homes in six nations based largely on in-depth site visits.

“The three things we heard about all the time were staffing levels, food, and clothes and laundry,” Armstrong says. “[Clothing] is the last piece of you that you bring into a long-term care home. It’s major in terms of keeping your identity. Laundry is so understudied, but it is so important.”

A high-quality setup can help residents keep track of their clothes, keep them in good shape and inspire confidence in family members. Even in otherwise clean and orderly buildings, lost and worn clothing is a major pet peeve.

Facilities large and small can improve laundry performance and streamline their processes by identifying the best technologies for their particular needs.

Start with how laundry is handled and how much needs to be done at one time.

“To obtain the best productivity and cleanliness, we typically use the rule of one pound of washing, per resident, at a max capacity,” says Michael Zaccaretti, operational excellence manager with Healthcare Services Group. 

Bigger not better?

Though a bigger machine might feel like a better value, it doesn’t always equate to efficient use.

Look for options such as customizable cycles that accommodate specific linen types and allow different fill levels to reduce water use; robust temperature controls and soaking and cool-down times for fabric care; and multiple hook-ups for cleaning agents.

Multiple smaller machines also can provide flexibility in on-premise long-term care. When laundry arrives in dribs and drabs, staff can start one load or designate times for linens versus personal items.

“This ensures all resources are maximized, including labor, as only full loads are processed and staff isn’t waiting around for enough pieces to fill a load in a larger machine,” Brooks says. 

Another way to avoid delays, Zaccaretti says, is choosing a machine with a spin cycle powerful enough to effectively rinse linens and cut down on extra drying time. It’s also important to use the machines as they were designed.

Katie Hurley, lead chemist for Ecolab, says setting an appropriate load goal for every cycle is a good starting point.

“If a machine is underloaded, foam and too much water can prevent sufficient mechanical action,” she says. “The linens won’t rub against each other to help loosen soil, plus water and energy are wasted. If a machine is overloaded, not every linen piece will be thoroughly wetted or exposed to cleaning chemistry.”

A proper load would have about 85% of its capacity in linens. For example, a 65-pound machine should be loaded with 55 pounds of linen, Hurley says.

Technology advances

The pressure is on for technology upgrades: Alliance has invested some $300 million in advances over the last five years.

“Our small and mid-size washer-extractors [45- and 65-pound capacity] cannot only be configured with our UniLinc Control for unparalleled flexibility and machine operation data … but when paired with our TotalVue system, managers gain the pinnacle of data collection and reporting,” Brooks says. “This level of information gives them the insights necessary to gauge the health of their laundry as well as identify areas for improvement.”

Some distributors with knowledge of skilled nursing standards also will perform laundry operating cost analysis that compares current setup and equipment upgrades — and potential investment versus efficiency or labor savings — in facility-specific numbers.

Built-in options like data tracking that report problems to select employees outside the laundry room can help improve practices inside it.

Even in large facilities with a large-scale laundry operation, managers can quickly respond to error codes or track longer-than-expected wash cycles. And the faster they get laundry treated, the more likely it is to get clean.

“You think about the amount of time for laundry staff to come up and take away laundry,” says Deborah Wiegand, director of operations for The Green House Project. “People are sometimes incontinent. And what is one thing that really offends people? Odor. There are so many advantages — perceptions, odors, infection control — that come from smart laundry handling.”

In Sweden, Armstrong encountered two homes with a small washer and dryer unit in each resident’s bathroom. When care workers helped residents dress in the morning, they could toss a basket of wash, separated by color, or on gentle, as needed.

When items aren’t commingled — and if they’re not soiled — there is no need to use harsh chemicals such as bleach.

Armstrong says the practice helped with infection control, and reduced demands on workers who otherwise would have to lift more. Linens, however, could still be taken to larger machines where boiling water and more powerful chemicals go to work.

She witnessed one “posh” facility in Texas that offered a similar split between commingled linens washed by dedicated laundry staff and personal items cleaned nearby by care staff.

While that approach is uncommon in the U.S., Green House models come close to it.

Divide and conquer

A former administrator at a 300-bed skilled nursing facility, Wiegand says she has seen Green House strategies starting to influence laundry practices at traditional facilities.

Sometimes, that just means adding an extra washer and dryer set somewhere on the main floor, rather than requiring every soiled item to head to the basement.

“We work with the regulations to create efficiencies,” Wiegand says. “We also do a lot of education and training, and as the model has grown, we’re sharing a list of appliances and strategies that work.”

Armstrong’s study didn’t examine technical capabilities of washers, instead examining social and labor-related impacts of the routine practices. But she encourages those shopping for long-term care to check out a building’s approach to laundry, its facilities and equipment before committing.

“Laundry tells you a lot about their approach to care,” she says. “The conditions of the worker are often the conditions of care. And we know laundry (is) essential to care.”

BY THE NUMBERS

When choosing a machine size for your operation, consider how many pounds of linen you expect to go through per day, how frequently the linen arrives in the laundry room, and whether linens from different residents can be combined. Consider the following scenarios:

Example 1: An operation needs to wash 350 pounds of linen each day with linen arriving every few hours, and 75 pounds of that is five residents’ personal items that are designated for isolated washes. With each resident’s personals only 15 pounds, this could most efficiently be run in a homestyle washer, so the operation might choose to have one or two. That leaves 275 pounds of linen throughout the day for commercial machines. Remembering that proper loading is 85% of capacity, it might be wise to use two machines with a 40-pound capacity each. That would allow for eight appropriately sized loads per day, either run in parallel or in series, depending on the rate of incoming soiled linen and the availability of labor.

Example 2: Consider an operation needs to run 700 pounds of linen per day, delivered in the morning, and does not launder personal items. This operation might choose two or three commercial machines at 165 pounds to achieve five appropriately sized loads that cover the increased demand quickly.

Seeking an antidote for the stresses of life and long-term care, I’ve been attending yoga lately, slipping out of the office at lunchtime in my sleek yoga garb to writhe and gasp on a rubber mat. I’ll pause a moment for you to dwell on that frightening mental image. 

Here’s what I’m learning, and perhaps why it’s such a refreshing respite from the world we work in. At yoga, you’re always doing it right. You just keep breathing and do your best. If you tried, that’s enough. No penalties. No judgment. You simply show up.

Remind you of anything? I didn’t think so. 

The longer I practice, the more fervently I wish survival in this profession could be more like yoga. Feeling the snapping, foamy jaws of the PDPM (Patient-Driven Panic Model) at your heels? Take some deep, cleansing breaths, and simply accept those fear sensations. No further action required. 

The possibilities for compliance and conflict resolution through yoga are endless. Family member yelling at you? Strike a child’s pose, and stay there until they go away. Payers choosing other providers? Don’t feel bad — you are perfect just as you are. Surveyors dwelling on your faults? They need to recognize the divine in you, and you should tell them so. 

Unfortunately, as reality intrudes, I’m forced to admit that yoga offers only a respite, not a workable model for our profession. We’re dealing with people’s lives, so it’s probably not enough to just show up and try. Certain expectations must be met and standards achieved. 

But maybe we can still make a little yoga-inspired time away from our well-deserved anxieties to mindfully stop, walk and breathe. On a particularly trying day, perhaps a little Shavasana time in a darkened supply closet would even be in order. 

Our long-term care challenges are real and frightening, but yoga could help us greet them as friends, hands to heart center, with a soft and genuine, “Namaste.”

Things I Think is written by Gary Tetz, a national Silver Medalist and regional Gold Medal winner in Humor Writing in the American Society of Business Publication Editors (ASBPE) awards program. 

For better or worse, the long-term care landscape is awash with PDPM experts and advisors. You can’t swing a therapy cat by the tail nowadays and not hit someone claiming divine knowledge.

The Patient-Driven Payment Model is entirely new and nobody, the feds included, knows how it will shake out until a few months after its Oct. 1 start date. 

But the feeding frenzy continues. As well it should. Among all the angst, it should be noted there are going to be some great opportunities. Call it the uprising of the non-therapy ancillaries, a category that you will hear mentioned a lot.

PDPM is designed to be budget-neutral. So for every loser, there should be at least one winner. Stock in nurse assessment coordinators undoubtedly has risen. With MDS information driving reimbursement, nurses — and assessment coordinators — will be treasured more than ever for revenue-finding skills. In other words, if your name is the American Association of Nurse Assessment Coordinators, you’re sitting pretty.

Other potential big winners? Pharmacists. With the emphasis changing from rehab to actual medical condition, pharmacists could be used more than ever to optimize planning and coding early in a resident’s stay. This is especially true, given the new importance of making spot-on initial assessments. 

“The wonderful thing about nursing services is, it’s not regressive payment,” pointed out recent McKnight’s webinar speaker Nancy Losben. “Once it’s set, that payment rate will remain the same.” There will be “great value” in taking more complex patients, she added, “because we’ll be compensated for it.”

IV medications will reap 25% greater payments, for example. And younger patients might mean better reimbursement. Federal regulators clearly want providers to accept higher-acuity patients.

“We must get over the fear of taking residents with HIV, or those who have a trache or need a ventilator,” Losben stressed. “We may even see the return of the respiratory therapist to our buildings.”

The importance of medical directors, pharmacists and others is about to rise considerably. With potentially huge drops in some rehab billings, that means money is going to pay for other aspects, including nursing, pharmacy and electronic records.

There’s a new age coming. The key to thriving is to look for solutions in new places.

How tough is the labor market? It’s come to this: More and more employees are simply vanishing.

The Federal Reserve Bank of Chicago put a name on this growing trend in its December’s Beige Book: “A number of [employers] said that they had been ‘ghosted,’ a situation in which a worker stops coming to work without notice and then is impossible to contact.” 

There are no national numbers on how often ghosting takes place. But there is a good chance this sector is well represented. Why? Because long-term care facilities often feature two characteristics likely to spur the practice: relatively low pay and poor treatment of employees. (I know, not at your facility. But both have been known to occur in this field.)

For this unfortunate turn of events, we can largely thank an increasingly tight labor market. We are seeing some of the lowest unemployment figures in nearly half a century. In other words, your prospects and employees now have the best job options they have ever had.

The result? Applicants are increasingly blowing off job interviews. More are getting hired and never reporting to work. Worst of all, more employees are simply leaving, sometimes heading to lunch and never coming back.

I spoke to one operator who now makes two offers for each available position, as there’s a good chance one or both hires won’t show up.

One easy answer is to offer more money and perks. Really. I realize that labor is already your biggest expense. But if you don’t want someone to leave for a job that pays $11 an hour, you probably shouldn’t be paying $10.

One proven strategy is  to build good relationships throughout the hiring process. Are prospects likely to feel like they are at a cattle call? Or are they more likely to feel they are being courted for something that’s a great opportunity?

Once your new hires show up, put them on a career growth track, mentor and treat them like the important team members they are. 

It also might be a good idea to ask your charges how they like their jobs, and how management might do things better. Just make sure those meetings aren’t scheduled for after lunch.

Besides its cosmetic value, LED (light-emitting diode) lighting provides a brighter tone while utilizing less energy than conventional bulbs, says Wartburg’s Greg Poole-Dayan. As company COO, he spearheaded the $190,000 upgrade of 5,000 fixtures. The 152-year-old eldercare community now includes approximately 11,000 new LED lamps.

The initiative to replace fluorescent and incandescent bulbs with LEDs, completed in the fall of 2018, is expected to save 736,000 kilowatts of energy a year, which Poole-Dayan says is the equivalent of 548 metric tons of greenhouse gas. These savings are also about the same as nearly 600,000 pounds of coal burned or nearly 62,000 gallons of gasoline consumed. Local contractor Lippolis Electric handled the installation.

“The savings also translate monetarily, and the project, assisted by rebates and incentives, will pay for itself in decreased energy costs after 18 months,” Poole-Dayan says.

Located on a 34-acre campus near Mount Vernon, NY, Wartburg serves residents across the continuum of long-term care, including skilled nursing, inpatient/outpatient rehabilitation, assisted living, home care and adult day care services.

Founded as an orphanage in 1863, the 405-bed community’s commitment to energy efficiency and green practices started with two new buildings — the Friedrichs Residence and Rehabilitation and Adult Day Services Center — that earned Leadership in Energy & Environmental Design (LEED) Gold Certification. LEED certification signifies that a building is “exemplary in conserving energy, lowering operating costs and improving health for occupants.”

“First of all, no matter what business you’re in, addressing energy efficiency and reducing waste makes good business sense,” says Dani
Glaser, program director of the Green Business Partnership, a Wartburg advisor on how to be more environmentally friendly. “If you’re more efficient, you’re saving money.”

Organizational investment in eco-friendly materials and practices does not have to be expensive, Glaser says, because much of it can be funded with available energy grants or by purchasing products they already use that meet environmental standards. A grant from Consolidated Edison subsidized 30% of Wartburg’s LED project and Poole-Dayan is pursuing another grant from the New York State Energy and Development Authority that can fund 75% of a part-time energy manager’s salary.

“There is a lot of low-hanging fruit that organizations can find,” Glaser says. “It starts with making sure lights are turned off when not in use, replacing disposables with reusables, increasing recycling and starting a composting program. When an appliance dies, get one that is energy efficient.”

Lessons learned

1. Replacing fluorescent and incandescent bulbs with LED lighting is a quick, inexpensive and environmentally friendly upgrade for any community.
2. Grants can be found for organizations that demonstrate a commitment to green energy practices.
3. Working with a community advocacy group can provide ideas on how to improve efficiency while reducing costs.

1. Understand the benefits.

Whether performed on an occasional basis, routinely or automatically, monitoring is recognized as an essential practice.

Regular monitoring provides critical information into residents’ overall well-being and impacts their quality of life and length of stay, notes Trisha Cole, COO of Medtelligent.

“Vitals such as blood pressure, weight, blood glucose level, temperature and pulse offer valuable insight into a resident’s anxiety level, acclimation to surroundings, eating and drinking habits, and physical responses to medications and medication changes,” she explains.

Regular monitoring also provides a foundation for treatment plans and can reveal early signs of disease, allowing for early intervention and prevention of rehospitalization, according to Kimberly Mulquin-Shumway, senior clinical content specialist for MatrixCare.

Experts advise establishing baselines around the metrics produced by monitoring to spot sudden or gradual changes.

“Without a baseline, clinicians responding to every little change also could cause problems with unnecessary treatments,” says Maria Arellano, clinical product manager at American Healthtech.

Baselines allow clinicians to set care thresholds, and take corrective measures to avoid a needless hospital visit, adds Nikki Bulis, a nurse consultant for CareSmart.

2. Be aware of conditions that warrant continuous monitoring.

Vital signs are always necessary and obvious to track. But many other instances call for vigilance.

Mary Gannon, BSN, chief nursing officer at Netsmart, says weakness, shortness of breath, excessive or abnormal sweating, dizziness, confusion, fever, chest pain and difficulty speaking are some of the more common conditions.

Mulquin-Shumway asserts that patient criteria should drive the decisions. For example, pulse and respiration are key indicators to track in patients on pain
medications.

Event-related monitoring also can lead to prophylactic interventions. Falls are a good example, adds Gannon.

3. Be mindful of complacency.

Respiration is a big one, says Arellano.

“Recent studies have indicated that respiratory rate is frequently minimized in importance and not well monitored by staff but can be a pivotal clue to changes in condition,” she says. As technology continues to improve and automate respiratory rate monitoring, Arellano believes facilities are likely to see an improvement in their recognition of subtle changes. 

Staff often are trying to cram in so much in a day they may miss trends in vital signs, Cole adds.

“If time is not set aside to intentionally and consciously review the information for irregularities, the potential usefulness of the data is lost.”

4. Experts quickly point to the importance of documenting monitoring results in the facility’s electronic health records.

“Using tools that funnel monitored information into an individual’s electronic health record can lead to better clinical decisions,” says Gannon. She stresses the need for providers to collect “these real-time data points along with additional data surrounding care delivery.”

Even more important is the need for high-quality data.

“The consistency of the information that flows to the caregiver is important, since every application may present the data in a different way, meaning time spent by the caregiver figuring what is important from the information provided,” notes Scott Moody, CEO of K4Connect. He advocates for a single system that integrates monitoring devices and provides consistent information to the care team.

5. The case for automation is significant.

Few dispute the value of devices that automatically perform continuous monitoring.

“Manual recording of vital signs is time-consuming and error-prone. Thresholds can be ignored, and routine monitoring is generally only once a shift,” says Mulquin-Shumway. “In a busy facility or on a busy unit, the accuracy and frequency of vital sign checks may be inadequate to distinguish deterioration, especially at night.”

In many ways, automatic monitoring provides a vital second set of eyes and ears for thinly staffed facilities, she adds.

There is, however, at least one negative, according to Tina Beskie, vice president, business development and marketing for Constant Care Technology. 

“While continuous monitoring of vitals has significant benefits in delivering real time information, the downside is the need for a separate, disparate software solution since the data required by continuous measurements is too large to be ingested by the electronic medical records systems,” she says. 

Plus, there’s consensus that tools and technology are no substitute for experienced staff with keen eyes.

“The belief that these tools replace clinical decision making is a big overlooked area,” says Matt Jante, product manager, healthcare equipment for Direct Supply.

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Mistakes to avoid

—Complacency. While conventional vital signs like pulse and heart rate are essential, it’s easy to overlook subtle changes in breathing, for example. 

—Neglecting the value of consistency. To be most meaningful, monitoring must be maintained at set, regular intervals.

—Overreliance on machines. While they’re ubiquitous and necessary, they’re no substitute for a caregiver’s watchful eyes and ears.

The 13th annual virtual trade show offers webinars conducted by leading national experts, continuing education credits, an exhibition hall with giveaways, contests, white papers and more. All for free.

The dates to circle are March 27 and 28. Attendees can stay wherever they want to be. All that is needed is an internet connection.

“Attendees [in the past] have been very gracious with their  praise,” noted McKnight’s Editorial Director John O’Connor. “They’re going to be in for a real treat again this year. Providers cannot operate without knowing about our first-session’s payment and regulatory updates, as well as the information found in the other webinars.”

Day 1

Annual favorite Leah Klusch kicks off the first educational session at 11 a.m. Eastern Time on March 27, one half hour after the exhibit hall initially opens. 

Throughout the two-day event, visitors may attend sessions, browse booths and “converse” with booth representatives in real time, or pop into the visitors’ lounge to make new friends or reconnect with old ones.

Klusch will present “Operational strategies for surviving the regulatory, payment and other changes ahead.” Topics will include preparing for shifts in the payment and documentation process.

The session also will delve into how data that a facility is transmitting will impact quality measures and performance metrics.

“We’ll discuss what data we can utilize now to identify facility services, demographics and the accuracy of a facility’s database,” Klusch added.

The Quality Track session will come next and start at 1 p.m. ET. Jill A. Schumann, president and CEO of LeadingAge Maryland, will deliver “Understanding the practical implications of trauma-informed care.” 

The Centers for Medicare & Medicaid Services is asking for policies that are “culturally competent and trauma-informed” by Nov. 28, 2019. Given all of the other requirements for Phase 3, there may be a tendency to view this information purely from a compliance perspective, Schumann warned.

“In addition to identifying mental health resources when needed, creating environments that are sensitive to, and respectful of, trauma-related issues goes a long way toward creating safety for staff and residents,” she said. “We don’t necessarily need to know much about the trauma to guess when people aren’t feeling safe.”

The final session of the day, “Mobile tech: Friend or foe in the LTC workplace,” will start at 3 p.m. Attorney Kimberly Gordy, an associate with BakerHostetler, will offer valuable updates, and accompanying warnings, about digital safety. 

“This session will educate about the ‘3 B’s’ of using mobile technology in long-term care: Basic Capabilities, Business Associates, and Bombshells,” Gordy said, adding that she’ll include a few helpful “words of warning.”

She’ll also give a candid assessment of how to handle apps and mobile-device safety that will apply to all listeners. “Because mobile apps are constantly evolving, this session will open with an overview on key terms to understand when evaluating an app, including the platform, the security, and the popular features in long-term care,” she explained.

“We will also identify key risk areas, or bombshells, that are associated with mobile technology use. From app providers masquerading as HIPAA compliant to the potential pitfalls of sharing information with families through an app, we will discuss how to protect your community in the mobile world.” 

Day 2

Webinars will resume at 11:30 a.m. ET on March 28 with a sensitive wound-care presentation by Kevin R. Emmons, DrNP, of the Rutgers School of Nursing-Camden,  clinical associate professor and WOCNEP Faculty Advanced Practice Nurse. The session, “Understanding wounds at end-of-life: We all have skin in the game,” is designed to appeal to clinicians and non-clinicians alike. Topics will include how each organ system impacts the skin, particularly at end-of-life, when a person may experience multiple organ dysfunction. 

“Often, healthcare providers, management, clients and families have differing ideas about the development of wounds, degeneration and realistic expectations,” Emmons noted. “We will identify ways to improve understanding between all members of the healthcare team, including clients and family members regarding wounds at end of life.”

The Expo’s final session will be led by Beth Burnham Mace, chief economist for the National Investment Center for Seniors Housing & Care, at 1 p.m. ET. She’ll highlight trends in seniors housing market fundamentals, supply and demand and rent growth. Mace also will discuss some challenges facing the sector such as tight labor markets and labor shortages. 

“Recent data shows that labor expenses, as measured by hourly wages, are growing at a faster pace than rents, suggesting [net operating income]  pressure for many operators in the year ahead,” Mace noted.

“In addition to labor market considerations and market fundamentals, four other significant factors are influencing the industry today.  These include healthcare payment and delivery disruption; demographics and the longevity revolution; technology; and the economy.”