1. Consider devices with tracking capability. 

Many utilize resident-assigned RFID or GPS location features that quickly point to their location using software. Before panicking, use common sense.

“Things to consider are: Was it accidentally placed in the laundry or trash? Did the resident remove it and place it in a drawer? Or is the resident out with family for the day and no one made a note in the system?” says Barbara Benner, technical trainer for STANLEYHealthcare.

Some larger devices, such as fall alert and pressure ulcer monitoring devices, and even specialty beds or chairs, now employ smartphone apps and Wi-Fi location services, notes Jared Pitney, vice president, senior living for RF Technologies., who also encourages physical “spot monitoring” checks to ensure big-ticket items don’t get misplaced.

Careful inventory and logging procedures can indicate lost device trends. Consider assigning a physical area for storage of all out-of-use devices, or delegating one person as the caretaker, so all items can be tracked appropriately, Pitney adds. 

Allie Roufus, senior customer marketing specialist for Direct Supply, recommends mandatory sign-in and -out logs.

“Some systems generate reports that can often be emailed on a scheduled basis for proper inventorying and device maintenance needs,” Roufus adds. Color-coded pagers make it easy for staff to return items to designated areas. 

“The process has helped many of our customers because it simplifies the technology-sharing process and provides accountability for the staff,” says Bob Venditti, product manager for Philips Home Monitoring.

2. Assess your facility’s monitoring needs before buying. 

“With so many technology capabilities available now, providers often purchase more technology functionality than they actually end up needing or using,” says Jeff Moore, vice president, long-term post acute care markets North America for Philips Home Monitoring. 

3. Involve staff and residents in your product evaluations.

They’ll likely take more “ownership” and care for the devices later on, says Pitney. If a device is not “user-friendly,” it likely will be neglected or abused, adds Patricia Howell, RN, a member of McKesson’s Clinical Resource Team.

Regular staff training also helps, adds Benner. For example, many devices now on the market have low-battery and locator alert features — both important for caregivers to know about.

4. Keep devices in top working condition. 

“Ensure that environment-of-care rounds are conducted regularly to reduce or eliminate broken equipment or equipment in poor repair,” advises Howell. “Incorporate routine inspection and preventive maintenance.” 

Establish priority responsibilities for maintenance — areas that affect residents first, but also high-risk related areas, inadequate equipment, physical plant issues and communication breakdowns.

5. Identify device loss vulnerabilities.

Pitney and Moore say the two most common times for a device’s loss are while it is out-of-use or a resident is transferring.

“Staff devices are more commonly lost or damaged than resident devices because staff members carry more technology around with them and leave the community much more often,” Moore adds.

Consider secure areas, or even bins, to protect valuable monitoring devices, advises Jen Mazzei, marketing specialist for Secure Care Products.

Mistakes to avoid

• Failing to involve staff and residents in product evaluations. Engage them early so they take “ownership” in guarding and caring for these devices.
• Neglecting to have an inventory and tracking system. Most devices today have built-in tracking capabilities.
• Ignoring key “device loss” vulnerabilities. Take extra precautions and use checklists during risky times like resident errands or transfers.

Skilled nursing occupancy rates hit their lowest level on record in the fourth quarter of 2016, according to the National Investment Center for Seniors Housing & Care.

The group’s Skilled Nursing Data Report for the fourth quarter showed the national occupancy rate fell from 82.6% to 81.8%, the lowest level since NIC began collecting data in 2011.

The occupancy drop came amid an “early and significant flu season,” which likely helped boost skilled mix but didn’t bump occupancy like it has in the past, according to Bill Kauffman, senior principal for NIC. 

A new website that will allow consumers to view quality ratings for skilled nursing facilities is slated for release in October 2018, Centers for Medicare & Medicaid Services officials said in late February.

The Skilled Nursing Facility Compare website was mandated by the IMPACT Act and will include data from the SNF Quality Reporting Program, CMS representatives said during an IMPACT Act status update call.

The agency is currently in an “exploratory phase” of how the new website will be integrated with the Nursing Home Compare site, they added.

The IMPACT Act call included updates on the Transfer of Health Information measures, which began the first phase of pilot testing in January. A second phase, which calls for data collection using mock assessment items, is expected to begin late this summer.

A national beta test of standardized patient assessment data elements also is slated to kick off later this year in 14 markets, officials said. Final reports on the elements are expected to be published in September 2018.

Long-term care leaders and other healthcare providers tore into a proposal from Republican House leaders that would cut funding from programs serving the elderly.

The measure would “fundamentally destroy the Medicaid program as we know it,” criticized LeadingAge President and CEO Katie Smith Sloan on March 8.

The American Health Care Act was scheduled by Speaker of the House Paul Ryan (R-WI) for tweaks at press time, and a full House vote just afterward.

Experts have estimated that the proposed per capita pay system could cut $110 billion in payments over five years while shifting decision-making back to the states.

In response to the outcry from providers and consumer groups, Ryan said four days before the planned House vote that his bill “should have even more assistance … for that person in their 50s and 60s because they experience higher healthcare costs.”

The leader of the second-largest nursing home association in America called on members in March to act passionately but politely when lobbying members of Congress.

“I hope you take the high moral ground during your Congressional visits,” urged LeadingAge President and CEO Katie Smith Sloan.

Her comments at the LeadingAge PEAK meeting reflected providers’ struggles over working with lawmakers while pushing back against Medicaid changes in the GOP’s healthcare bill.

Proposed cuts could devastate providers, officials warned.

“I’ve heard from many of you about concerns in this new political environment,” Sloan said.

Providers can’t ignore “the hyperpartisan environment we are in,” she added. 

If there is one sector that proves the adage about incentives driving behavior, it’s skilled care.

Operators in this field don’t need Deep Throat to tell them to follow the money: It’s practically baked into their DNA. 

Skilled care as we know it essentially came to be after President Johnson signed legislation in 1965 setting aside public dollars for care of the aged. As Medicaid was the easiest funding spigot to tap, it quickly became the industry’s preferred financier — an arrangement that has continued for more than five decades.

Which brings us to the unveiling of the Trump healthcare plan. The industry’s worst fears about what the legislation might contain have not just been met: They have been surpassed.

For starters, the American Health Care Act would cap Medicaid outlays. It also would start cutting federal Medicaid funds to the states, beginning in 2020. If this proposal is enacted, the clear result will be far fewer Medicaid dollars flowing into long-term care facilities.

But don’t take my word on this budding apocalypse. Take
LeadingAge President and CEO Katie Smith Sloan’s. She said the plan will “fundamentally destroy the Medicaid program as we know it.”

To be sure, this sector has always had a bit of a love/hate relationship with Medicaid. Its payments, quite frankly, have never been adequate.

Still, Medicaid has been, if nothing else, a reliable funding source. So what’s going to happen when that meager benefit is taken away?

Barring some as-yet detected silver lining, I think we will see two developments:

First, operators who can will do as much as possible, as fast as possible, to stay clear of the Medicaid program. 

As for the rest? They will have to do their best to get by on funding that is even more problematic.   

Our friends at the Centers for Medicare & Medicaid Services may think they have too many yo-yo facilities on their hands right now. To them, I say this: just wait.

For if you think healthcare is lousy now, just wait until the current batch of architects in Washington “improves” it.

Florida-based skilled nursing chain Consulate Health Care was hit with a $347 million judgment in early March after a jury found that it routinely inflated its Medicare and Medicaid claims.

Judge Steven D. Merryday, with the U.S. District Court for the Middle District of Florida, however, granted an emergency motion to stay the judgment in late March. He noted that the providers named in the suit don’t have the money to pay the judgment, which would potentially trigger a halt in operations and jeopardize 17,000 residents. 

The jury’s verdict, reached in mid-February, sided with whistleblower Angela Ruckh, who worked for the provider when it was known as La Vie Rehab. Ruckh was granted permission to use statistical sampling to show that Consulate spent years engaged in a “corporate scheme to bilk Medicare and Medicaid” by inflating therapy claims.

The jury’s verdict called for $115 million in Medicare and Medicaid damages. March’s judgment triples that amount under provisions of the False Claims Act, and it adds the minimum penalty of $5,500 for the 446 cited false claims.

Consulate is on the hook for $331 million of the total judgment, with the other $16 million to be paid by two other groups that owned facilities managed by Consulate. 

Consulate was not commenting on the judgment as of press time, a spokeswoman told McKnight’s. 

Terence J. Lynam, an attorney who represented Consulate in the case, told Bloomberg BNA in March that he was planning to file a motion to set aside the jury’s verdict.   

The providers had until March 29 to file a renewed motion for judgment, according to published reports. 

The U.S. Supreme Court may change course away from recent rulings that favored arbitration agreements in a case involving nursing home residents, according to one expert.  

Kindred Nursing Ctrs. LP v. Clark revolves around wrongful death lawsuits in which skilled nursing arbitration agreements were signed by someone with power of attorney for the resident.

The Supreme Court of Kentucky ruled in favor of the plaintiffs, finding that the agreements were not binding since the people granted power of attorney were not specifically given permission to sign such agreements. 

That decision received backlash from providers and groups including Kindred and the American Health Care Association, which filed briefs asking the U.S. Supreme Court to review the decision.

The Supreme Court has ruled in favor of arbitration agreements in two recent cases. But the arguments in the Kindred case, which were conducted in late February, may indicate a shift in the court’s thinking since people’s lives were involved, Imre Szalai, a professor at Loyola University New Orleans told Modern Healthcare. 

“[The justices] were more aggressively searching for a reason to favor the little guy,” Szalai said.

Justice Samuel Alito also noted the difference between nursing home arbitration cases and previous ones involving companies such as Direct TV during arguments in the case.

“This doesn’t involve an arbitration about the amount that you were charged for your cable bill or for your telephone bill,” Alito said. “This involves a situation where an elderly person needs care.”

Arguments in the case also touched upon how the Kentucky court’s decision could impact power-of-attorney issues outside of arbitration. Justice Elena Kagan also questioned whether the previous ruling — which was slammed as “erroneous” in AHCA’s brief — should be modified. 

“Usually, we don’t presume that State Courts are acting in ways that are not in accordance with law,” Kagan said. 

Is it legal to insert or attach pre-dispute mandatory and binding arbitration clauses in our resident contracts?

An Aon study showed that from 1995 to 2000, there was a dramatic increase in nursing home litigation. To spread the costs of the judgments and this litigation, insurance companies substantially increased premiums for providers, including for providers who had had no claims. 

Providers responded by creating self-insurance structures such as offshore insurance captives or risk retention groups. At the same time, providers increased use of arbitration agreements with their residents. 

After 1999, the average damage award against providers decreased 55%, from $226,000 to $146,000 in 2006. Arbitration can be a less expensive process than a jury trial in civil courts, and arbitrators generally award less in damages than juries do. In October 2016, HHS announced a “final rule” that prohibited arbitration agreements, effective November 28, 2016. 

In AHCA v. Burwell, a federal District Court enjoined enforcement of this, prohibiting arbitration agreements in all U.S. jurisdictions. On Jan. 5, the Obama administration filed an appeal in the 5th U.S. Circuit Court of Appeals trying to overturn the District Court decision. 

HHS has issued directions to its surveyors to not enforce the anti-arbitration rule in the survey process until court considerations have been completed. 

Until the Trump administration announces its position or until the 5th Circuit acts on the appeal, providers seem to still be able to use pre-dispute mandatory binding arbitration agreements — if they follow their state case law and if they carefully implement such agreements with residents.

A medication reconciliation program may help reduce hospital emergency room readmissions by as much as 6%, a recent study shows.

A British research team compared outcome measures between two groups of hospital patients: one that received medication reconciliation upon admission and discharge, and one group that received “usual care.”

The reconciliation group had a readmission rate of 17.9%, compared to 26.7% in the control group. That translates into a 6% reduction in three-month readmission rates, researchers said.

Results were published in March in the journal  Health Services Research.