We hate it, fear it, fight it. But since it’s inevitable, I asked some of the world’s foremost experts on change — the seniors we serve — how they’ve coped.

They had no instruction book for what they faced, but came through it with resilience and positivity intact. 

So what was their secret?

For one thing, acceptance. “Change is going to happen,” said one, stating the obvious. “Accept and embrace it,” advised another. “It’s just another chapter in the book,” chimed in a third. “Circumstances arise, and you arise to them,” added a fourth.

“You can’t give up. You have to make the best of it,” said a soft-spoken gentleman who just happened to have survived the Auschwitz concentration camp in World War II.

Maintaining a positive attitude is everything. From the man who lost his wife: “I just accepted it, without complaining about it.” From the woman who endured a grueling rehab program: “I just hung on, and did what I had to do.” From another still battling back from a debilitating accident: “This day is mine and I will make the best of it I can.”

They not only accepted change, but seemed to crave it, saying things like: “Change is exciting.” “Where would we be without it?” “Every change makes you the person you are.”

Near the end of the day, that relentlessly positive rehab patient, her leg still in a cast, expressed an indomitable spirit that would have made Winston Churchill proud — and should inspire the rest of us.

“I am not saying ‘poor me.’ I don’t have time for it,” she said. “I want back what I had, and I’m going to get there.”

The deal will allow Optima to expand its post-acute care options for those operating outpatient therapy clinics, CEO Josh Pickus said. Vantage had developed “sophisticated billing processes.”

“By outsourcing their billing and marketing functions to Optima, SNFs and ALFs that operate with limited staff will be able to offload much of the administrative burden involved in these functions to dedicated experts who are focused on helping them drive referrals and maximize reimbursement and cash flow for their business,” he told McKnight’s. “RCM services cover every part of the billing lifecycle, including electronic claims submission, payment processing, patient and insurance collections and accounts receivable management. The digital marketing services range from websites to content marketing, social media, lead generation and more.”

Many senior care facilities are offering outpatient clinic services today in their therapy gyms, Pickus added. Plus, some providers are moving into freestanding clinics as they diversify their service offerings.

Optima is based in Palm City, FL, while Vantage has its headquarters in Bend, OR. Vantage’s 20 employees all will be joining Optima. Over time, the Vantage brand will transition to Optima.

“Optima is a recognized leader in the therapy market with a 25-year track record of technology innovation, regulatory expertise and customer satisfaction,” said Tannus Quatre, president of Vantage Clinical Solutions. “Our shared values and commitment to excellence will provide our customers with a truly differentiated solution and the resources needed to meet changing regulatory, clinical and business demands.” 

Optima is a portfolio company of Alpine Investors V and V SBIC LP.

The acquisition was a good fit for HydroWorx’s existing product line by offering customers an even more compact product solution, said CEO Tim McCarthy. While many senior care facilities undergoing remodeling or starting from scratch partner with HydroWorx, other providers struggle with space, McCarthy told McKnight’s. That’s also true for outpatient physical therapy areas with small clinics.

“Where we have not had product solutions is for pre-existing small clinics not going through renovation,” he said. “The benefits of Hydrotrack is that it’s an even smaller option. That’s really the principal target, but it would fit in a fitness center and certainly would fit into high school environments that are space-constrained.”

HydroWorx, which is based in Pennsylvania, acquired all existing inventory and the customer database for the Arizona-based HydroTrack company. McCarthy said a redesign of HydroTrack technology is expected to deploy by the end of 2019. While some consulting extensions will stem from the deal, HydroWorx underwent a strict asset purchase, McCarthy said.

HydroTrack was founded by Raymond, Rodney and Connie Crandell of Conray Incorporated in 1990. Its client base includes senior living, physical therapy, fitness and veterinarian clinics.

“As we explored our options to sell, HydroWorx was at the top of our list for many reasons,” said Raymond Crandell. “We knew their robust sales and marketing arm would protect our brand and deliver unprecedented and ongoing support to the existing customer base. Their ongoing commitment to delivering world class education, service, marketing and design assistance to clients is an important differentiator in this market.”

It is legal to not hire a prospective employee who fails a drug test administered by a qualified drug-testing company. It is important to screen prospective employees for drug usage based on important considerations.

Any organization serving seniors needs qualified employees making treatment or other important decisions concerning its residents. As an employer, you do not want your employees making these decisions and implementing treatment or other important decisions when the employee’s judgment may be impaired by drug usage.

Moreover, if you have a policy that you will not hire someone who fails a pre-employment drug test, under what grounds would you retest? Retesting based upon a prospective employee’s vociferous denial of drug use may make the policy unenforceable in the future.

The fact that you need “all the workers you can get” should not lead to non-enforcement of the pre-employment  drug screening policy. You need qualified and unimpaired workers.

Another consideration supporting the policy is the fact that there are significant amounts of drugs on the employer’s premises. The drugs must be safeguarded from theft or unauthorized use by employees.

In conclusion, presuming you have a qualified company performing the pre-employment testing, it will be difficult to enforce the pre-employment testing if you retest because a prospective employee denies drug use and claims the test results are wrong.

That’s because in mid-September the upper chamber unanimously approved a resolution near and dear to providers’ (and many others’) hearts. September 22 was officially designated “National Falls Prevention Awareness Day.”

Yes, it was, not coincidentally, also the first day of fall (autumn).

As a pun and wordplay enthusiast, I “get” the connection (which also has been noted and celebrated in previous years, it must be noted). But the long-term care stakeholder in me overrides the word nerd to almost find this concept in poor taste.

The first day of fall becomes THE day to focus on falls prevention? Pulleeeze.

Try that one out on any of your residents’ family members. Imagine the following telephone conversation: “Hi there! Glad your loved one has moved in with us. Next week, we’re going to really start keeping an eye out for potential falls hazards.”

The fact is, of course, that you need to be a paranoid fall-hawk virtually every moment. You need to stare down any potential falls hazards, make sure residents are properly nourished and hydrated, and stunt any aberrations that could lead to a fall-prone situation.

You are employed because falls prevention awareness is part of your job description. 24/7/365.

Still, we should not dismiss a well-intended measure authored by Sen. Susan Collins (R-ME), the chairwoman of the Senate Aging Committee, and cosponsored by Sen. Bob Casey (D-PA), the committee’s ranking member.

In 2016, about three million older adults were treated in emergency rooms after falling, according to federal figures. Earlier this year, my mother joined those ranks, again. Luckily, she didn’t break a bone or even become concussed. But it did lead to a three-week stint in a very fine rehab facility.  Tough rehab, huge bills.

As the Aging Committee notes, and I can heartily agree, the physical and emotional impact of falls is staggering. The annual cost to the healthcare system for older adults’ falls is $50 billion.

It bears repeating: Falling is NOT a normal part of aging. And, as we all know, just one day shouldn’t be considered THE day, symbolic or not, to be aware of falls-prevention efforts.

SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) are separate, but related, programs.

QRP is required by the IMPACT ACT to collect data from five domains using assessment data as well as assessing measures related to resource use and claims-based measures. If a facility does not submit the required data, it will receive a two percentage-point reduction to its annual payment update. This is the data that is contained in your review and correct reports.

Currently, data is being collected on: Cross-Setting Pressure Ulcer Measure: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury; An Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients; and many others.

On the flip side, VBP offers incentive payments to skilled nursing facilities based on the performance of readmissions. Two percent of payments have been withheld to fund the incentive payments, and 60% of the amount withheld will be returned to high-performing facilities.

There is a curve to determine who gets incentives, and how much. The bottom 40% of facilities will receive less payment than normal.

VBP incentives are based this year on the SNF 30-Day All Cause Readmission Measure.

CMS uses a computer program to assign an incentive multiplier. This multiplier can be anywhere from 0 to 3%, based on performance scores. This can be a double-whammy for those facilities that lost 2% for not meeting thresholds, and yet another 2% without achieving any of the incentive payments.

Research published in Wounds compared 3M’s new Cavilon Advanced Skin Protectant — in which acrylic polymers are combined with 2-octyl cyanoacrylate — with a liquid skin protectant, a no-sting skin prep and a skin protective barrier wand product.

The 3M formulation can adhere to both intact skin and denuded skin. For the study, 21 healthy individuals had carbon pigment and each of the four skin barrier products applied to their arms and monitored.

The product showed no significant wear of the underlying pigment after seven days, while the other products had less than 50% of the pigment left after a week.

“This product has the potential to greatly improve the care of patients with severe incontinence, including fecal incontinence such as observed with Clostridium difficile infections,” study authors wrote.

Though the research was controlled and randomized, it was open-label and funded by 3M.

A research team of gynecologists, gerontologists and palliative care specialists estimated that at least 3.2 million Americans living at home with suspected or diagnosed dementia are sexually active. Forty-one percent of those ages 80 to 91 were still sexually active. However, few men (17%) and almost no women (1%) with dementia had talked with a doctor about sex.

The study found the more cognitive impairment a participant had, the less likely he or she was to have had an intimate partner. In addition, 12% of women and 17% of men with dementia said they had sex out of obligation; 10% said they felt threatened or frightened by a partner.

“People with more severe cognitive impairment are at higher risk of sexual victimization, a concern that has driven restrictive policies and even legal action against spouses of people with dementia,” researchers wrote. They suggested better guidelines be created for elder abuse screening and standards of consent.

That’s according to a lawsuit filed in late September against the Glenridge on Palmer Ranch, an upscale retirement community in Sarasota, FL, that offers skilled nursing and other services. In the filing, the Equal Employment Opportunity Commission alleges that managers encouraged dining worker Michelle Fredericks to apply for a supervisor position in 2015.

But before she could apply, a manager texted Fredericks and asked when she planned to have her next child, writing, “With this position it doesn’t leave a lot of time off for long periods of time,” according to an EEOC filing. Glenridge never interviewed Fredericks for the position, and offered it to a female “that it did not believe would become pregnant,” the suit said.

The EEOC alleges that Glenridge is violating the Civil Rights Act and is seeking back-pay, discrimination damages, and injunctive relief to prevent any future pregnancy discrimination, after failing to resolve the matter outside of court.

Sunya Wilson, a human resources representative at the Glenridge, told McKnight’s that the organization does not tolerate discrimination and regrets how the incident transpired.

“At the Glenridge on Palmer Ranch, our philosophy in hiring practices is to be equal and inclusive, and it is not our policy to discriminate,” Wilson wrote.

“In this circumstance, we believe a text message exchange among co-workers and friends was taken out of context, and we regret that this unauthorized communication occurred. Ms. Fredericks did not formally apply for the open position and as a result, was not interviewed.”

The investigation is part of the second phase of the Indiana University Center for Aging Research’s ongoing OPTIMISTIC innovation model, which embeds clinicians in the nursing home to manage chronic conditions.

In the first phase, without financial incentives, readmissions plummeted by 33%

Researchers will be studying outcomes at 40 Indiana nursing homes to see if rehospitalizations can be cut even further, Indiana University announced in early October.

“Phase Two of OPTIMISTIC removes financial barriers to keeping people in nursing homes where they can be treated safely in place,” said the Regenstrief Institute’s Laura Holtz, senior research manager of the project.

She said that more than three times as many nursing homes as could be accommodated applied to be part of OPTIMISTIC’s second phase.

Nursing homes taking part will be reimbursed for onsite treatment of the six conditions most commonly linked to unnecessary rehospitalizations for nursing home residents: pneumonia, urinary tract infections, congestive heart failure, dehydration, skin ulcers and chronic obstructive pulmonary disease.

OPTIMISTIC stands for Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care.

It was first implemented in 2012 and will receive more than $30 million in CMS funding through the Initiative to Reduce Avoidable Rehospitalizations Among Nursing Facility Residents by 2020.