At our recent Activities Strong Virtual Winter Gathering, Liza Behrens, PhD, RN, an assistant professor at Penn State University, examined “surplus safety” in eldercare, in which the goal is to reduce risks at all costs. 

“This is a byproduct of regulations and institutional practice designed to eliminate all risks, including the risk of positive and meaningful experiences that make life worth living,” Behrens said. 

To protect residents’ rights to enjoy a person-directed quality of life, Behrens asserted the need for a “just” culture of safety — one that identifies and addresses behaviors that create the potential for adverse events, calls for appropriate accountability that supports disciplinary actions against individuals or organizations who engage in reckless behavior, and avoids punishing individuals for adverse events over which they have no control. 

“We need a just culture where we can do our best to honor residents and their right to make choices,” she noted, adding, “Each of us can help this change. We can’t eliminate all risk in the name of patient safety, but we can’t allow surplus safety to continue.” 

It is important to talk about the dignity of risk-taking. “No matter what we do, we impact residents’ dignity,” Behrens said. “Dignity of risk in eldercare refers to empowering an individual’s ability to make choices and remain autonomous in decision-making, which may give rise to risk taking that subsequently enhances personal growth and quality of life.”

“If we can help people engage in risk-taking, we can improve their quality of life and wellbeing,” Behrens continued.

“If we want to create meaningful moments for our residents, we need to work backwards and start with individual preferences,” said Betsy Kemeny, PhD, CTRS, FDRT, associate professor at Slippery Rock University and president of the National Academy of Recreational Therapy. 

“Part of this involves moving away from pre-designed programs and fitting the residents into it and evolving to a live calendar that incorporates individual preferences,” with an emphasis on smaller groups with common needs such as affiliate groups or clubs that provide continuity and purpose.

Kemeny added: “We want to get away from preplanned calendars and really think out of the box. To do that, we need to go beyond Section F of the MDS [Preferences for Customary Routine and Activities].” 

In other words, we need to know our residents holistically and beyond just their medical and daily care needs.

A truly person-centered model of care that improves wellbeing must be built on a deep understanding of who the person is and what their current needs and preferences are. This is key to enabling dignity of risk and empowering residents with the ability to make choices and remain as autonomous as possible. 

When we truly get to know residents in a holistic way, we can gain an understanding of how they view risk and what risks they are willing to take to enjoy the quality of life they have defined for themselves. 

As Kemeny said, “We need to be aware of risks but not limit residents from living their own lives and do things like using typical tools like bread knives or scissors.” She added, “Don’t limit access to outcomes because of your own biases related to a resident’s age and ability to engage and risk taking.”

When we have residents’ life stories and get to know them holistically, it is easier to set expectations around the dignity of risk taking. We can all start today by being champions advocating for a stand operating procedure for decision-making related to health and safety risks for residents, especially for those who are living with dementia. 

Learn more about surplus safety, dignity of risk, and getting to know residents by watching the webinar here.

Charles de Vilmorin is the CEO and co-founder of Linked Senior, creators of the Life Story product.

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Your estimated arrival time is now going up, and you’re going nowhere! An element of this frustration is because you see no end in sight, and it’s just wasted time (and fuel) as you wait. Not to mention that relative who is also now circling the airport arrivals section, and promising to themselves never do this pickup favor for you again.

Well, this is the core of many healthcare providers’ frustration with the prior authorization system. It seems as if we are just circling and circling to accommodate insurer requests, but getting nowhere by doing so. Let’s back up a bit and give you the 30,000-foot view for a general big picture of the prior authorization process.

Prior authorizations were introduced in the 1960s. Originally, they were designed as a measure to ensure appropriate utilization of healthcare services, specifically to avoid unnecessary hospitalizations. However, with time these requirements have evolved into a complex process with far-reaching implications. While insurers maintain the primary purpose of PA is to safeguard patients from unnecessary and costly interventions, concerns have arisen regarding the potential misuse of PA as a cost containment tool. 

Quite often, providers see authorization issues leading to delays in patient care and unjust denial of medically necessary treatments.

Cue the appearance of third-party solutions: to address the challenges posed by PA requirements, various third-party solutions have emerged. One of them involves the implementation of software that enables insurers to create prediction models based on historical data and member acuities. 

These predictive models aim to identify cases where PA may be warranted, thereby streamlining the process for legitimate cases while reducing administrative burden by weeding out those deemed unwarranted.

Conversely, some provider-focused software has been developed to counteract this insurer pushback. Utilizing automation and, yes, even artificial intelligence. With this, providers can identify and address common reasons for PA denials, push for consideration when appropriate, bolstering the basis for appeals, and ultimately ensuring a more transparent and efficient PA process.

This is where the circling and dizziness feelings ensue. As each side continues to create solutions to counteract the other’s last attempt to circumvent it, we are just whirring in a circle of reactive solutions instead of really thinking of answers that will be amicable for both parties. A solution is needed that fosters collaboration between healthcare providers AND payers. After all, both parties share the common goal of delivering quality healthcare, but the misalignment in their objectives at this point is hindering the process.

Let’s be clear. Healthcare providers understand the necessity of PA screening, acknowledging its role in promoting evidence-based care and cost-effectiveness. On the flip side, insurers are also aware of the growing concern that some patients are being denied essential treatments recommended by reputable providers, due to rigid PA criteria.

So back to our airport analogy. I’d like to propose a “TSA PreCheck” style solution to this conflict. As we all know, TSA has extensive security measures in place. Line up, IDs out, shoes off and then pat downs if you look like you’re smuggling more than 3.4 ounces of liquid (gasp!). 

But then there are those who qualify as trusted travelers with TSA PreCheck.

Less scrutiny, shoes stay on, even laptops can stay put. The concept is that once they have been vetted and proven to be trusted, they are given more leeway. Of course, at any time they can be pulled over for a spot check; even lose this privilege if there is any reason for concern.

Imagine we introduced a similar collaborative technique for prior authorizations. Here is how it would fly:

Insurers introduce a tiered methodology to provider credentialing based on providers’ historical adherence to evidence-based practices, patient outcomes, and avoiding rehospitalizations. Providers with a proven track record of delivering high-quality care could be granted Tier 2 status. This allows for expedited PA approvals, and recognized standard procedures that do not require PA, thereby reducing administrative burdens.

By establishing this, a provider is motivated to maintain this status and, therefore, ensures their adherence to insurer rules and directives. Insurer relaxes the heavy scrutiny, but reserves the right to periodically check on provider observance of obligations and red flag or demote to Tier 1 as necessary. 

This can really be a win-win situation that can lead to more collaboration with the insurer, and the provider finally being on the same page once and for all.

Now nobody said this will be easy to implement. It will likely need to begin with conversation between leadership on both ends of what the criteria would be, and what effect this tier-based approach will have on the current PA process. So, at this point, please look at this as an idea. 

An idea with only the best interests of everyone in mind, to solve an industry problem that has been going on for too long. After all that’s how all good ideas “takeoff” — it all starts with an idea. Let’s just hope this one lands!

Steve Shain is Partner, EVP of Contracting at LTC Ally. His team negotiates managed care contracts and authorizations on behalf of healthcare providers. Contact him directly at steves@ltcally.com.

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As sobering as this finding is, COVID-19 is far from the only infection threat facing long-term care facility residents. For example, studies have also shown that C. difficile — identified by the Centers for Disease Control and Prevention (CDC) as a threat level “urgent” pathogen — affects one out of every 50 residents and leads to 29,000 deaths every single year. 

On a broader scale, the 2004 National Nursing Home Survey (2004 was the most recent year that the CDC conducted this survey) revealed that the approximately 1.5 million people who live in long-term care facilities experience, on average, about two million infections per year.

The data is clear: infections are one of the most pervasive threats facing nursing home residents. To help protect their vulnerable populations, facilities must prioritize implementing infection prevention and control (IPC) best practices. These tips are especially important as we enter the holiday season all while influenza, COVID-19, and RSV continue to circulate in our communities. 

One of the easiest and most effective ways to help protect your residents from infection is to educate every individual who walks into your building about the role they play in reducing the spread of communicable and infectious diseases. For example, this signage can describe when visitors should wear a mask or avoid visiting their loved ones (when they are ill). Placing this education where it can be easily seen when entering the facility can go a long way toward keeping your residents safe. 

To be the most effective, signage should also be accompanied by relevant personal protective equipment (PPE). In other words, if you post education advising individuals to wear a mask, ensure there are masks available right next to it. If your sign is about hand hygiene, make sure it’s near an alcohol-based hand sanitizer dispenser (and that the dispenser is fully stocked).

The CDC also has posters you can print out for free that can be hung outside of resident living quarters indicating what precautions people should take when entering and exiting a resident room. All visitors need to be made aware of what transmission-based signage means when it is posted on a resident’s door. 

This typically indicates that specific PPE needs to be worn before entering the resident’s room. It is important to have a restocking process in place so that there is always an adequate supply of PPE. If the bins are empty, individuals may go into the resident’s room without PPE which increases the transmission risk. Consider assigning this role to the environmental service employees as they enter each resident room every day. They can check the PPE bins before entering the rooms. In addition, you could consider assigning it to the other staff who may conduct frequent stocking of supplies. Consider avoiding assigning it to one individual such as the infection preventionist as they are not always in the facility.

This approach is far better than taking the stance that keeping PPE stocked is “everybody’s responsibility.” Too often, that leads to nobody checking PPE, because everyone assumes someone else will take care of it. Assigning people to handle this task is a simple way to avoid this problem.

Finally, one of the best ways that visitors can protect their loved ones during the holidays is to stay up to date on all recommended vaccinations. This can include COVID-19, influenza and Tdap vaccinations. It is important to remember that long-term care residents are a vulnerable population and that outbreaks spread rapidly within this congregate healthcare setting. Everyone who enters a facility has the potential to protect or infect this community. 

Taking measures like these will help reduce and prevent infections among your facility’s vulnerable population. Reminding everyone who comes into the facility of the importance of hand hygiene — which is demonstrably one of the most important elements of effective IPC — and giving them access to alcohol-based hand sanitizer, for example, can reduce rates of bacterial and viral infections. 

Placing informational signs, keeping relevant PPE within easy sight and access to visitors for at-risk or infected resident rooms, and staying current with all recommended vaccinations can similarly reduce the spread of pathogens and mitigate the risk of infection outbreaks among other residents and staff. 

Ultimately, these IPC best practices are highly effective and can be part of every facility’s IPC program. They don’t require a large investment or time and can be put into practice today. 

Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. She and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.

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The Fundamentals of Underwriting Senior Housing and Care Certificate Program is a comprehensive, 90-day program, which is offered online in a self-paced, asynchronous format to maximize convenience for learners. The program is available multiple times a year and not only saves you time but also money by bundling relevant courses together.

This certificate program stands out as the industry’s premier certification program designed to train investment and finance professionals. Upon completing the program’s six courses, graduates will earn a certificate in the Fundamentals of Underwriting Senior Housing & Care and the professional designation of “CSHIP” — Certified Senior Housing Investment Professional. 

In the senior housing and care industry, the significance of hiring is growing due to shifting demographics in the United States, evolving consumer preferences, the introduction of innovative technologies, and the increasing demand for novel housing solutions. Hiring and retaining skilled, well-trained employees will be imperative as the industry prepares for expansion.

Traditionally, the senior housing and care industry, known for its niche and unique nature, has relied on on-the-job training (OJT) methods to onboard new hires in real estate or investment-based roles within the sector. While OJT methods have their advantages, they also come with various challenges. For instance, many OJT training methods lack standardization of quality control, offer limited exposure, and often result in a loss of productivity among teams responsible for managing new hires. These challenges prompted the NIC Academy team to reconsider how best to prepare the next generation of industry professionals, ensuring they are equipped with all the tools for success.

NIC Academy’s Fundamentals of Underwriting Senior Housing and Care Certificate Program provides a viable solution by enhancing the training and onboarding process and acting as a strong supplement or replacement for OJT training methods.

I recently had the opportunity to speak with Zach Bowyer, MAI, Senior Managing Director at Cushman & Wakefield. As an executive in the senior housing and care industry, he effectively balances the demands of his executive role with the essential task of training new hires.

“Attracting top talent and equipping them with the necessary expertise as swiftly as possible has always been a top priority for us,” Bowyer explained. “I’m excited to learn about NIC Academy’s Fundamentals of Underwriting Senior Housing & Care Certificate Program, and I am confident it will be a game-changer in this regard.”

Properly training new hires is vital for the growth, success and long-term sustainability of any organization. It not only equips employees with the necessary skills and knowledge but also fosters a positive work environment and a professional culture, ultimately leading to improved business outcomes.

Promoting the pursuit of professional designations will help the senior housing and care industry grow by ensuring standardization, credibility, quality and ethical standards, and by facilitating career advancement and increased collaboration. Professional designations benefit professionals by fostering a culture of excellence and continuous improvement. 

The NIC Academy team is confident that the CSHIP designation will establish a new “gold standard” for the senior housing and care industry moving forward, becoming the foundational requirement for hiring and training new employees. This designation offers new industry entrants and career changers an equal opportunity to succeed in the ever-evolving senior housing and care industry.

Serena Lipton serves as Programming Curation Manager at the National Investment Center for Senior Housing & Care (NIC). In this role, Ms. Lipton collaborates with senior living industry leaders to develop educational platforms and content to service the industry. Before joining NIC, Ms. Lipton served as an Associate with Artemis Real Estate Partners’ healthcare business and was responsible for supporting asset management activities across the healthcare platform with a focus on seniors housing, in addition to prior years spent as an analyst for JLL and CBRE’s Senior Housing Valuation & Advisory Services.

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Early detection of C. auris, optimally pre-infection, is the key to setting up early defenses and preventing the spread – but common testing protocols are lagging. Molecular testing, which has been used in infectious disease detection for decades, allows for precise DNA fingerprinting of pathogens and is our best weapon in the fight against C. auris.

Antibiotic use in long-term care

The Agency for Healthcare Research and Quality (AHRQ) reports that antibiotics are among the most commonly prescribed medications in nursing homes. According to their research, about seven out of 10 residents in long-term care facilities receive an antibiotic every year, and up to 75% of those antibiotics are incorrectly prescribed for the respective infection. 

The large-scale, incorrect use of antibiotics is a known cause of developing antibiotic-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), and Clostridium difficile (C. difficile). As the danger of resistant bacteria becomes more well known, we hear the term “antibiotic stewardship” more often, particularly regarding urinary tract infections in nursing home patients. Antibiotic stewardship is an approach that focuses on improving antibiotic use by avoiding unnecessary or inappropriate antibiotics.

The rise of Candida auris

As concluded in the Annals of Internal Medicine, C. auris detection is often elusive due to limitations of outdated standard culture and sensitivity testing. Researchers warned that screening is not currently conducted uniformly across the United States, so the true burden of C. auris cases may be underestimated.

Lessons learned from other nosocomial infections, including C. diff and MRSA, are useful, like developing infection control and antibiotic stewardship practices that facilities can utilize for the rising fungal infection, but C. auris presents new challenges. C. auris can persist in nursing homes on various surfaces for up to 14 days, and poor detection often leads to an inability to employ general infection prevention and control practices.

Furthermore, C. auris is not usually identified with routine microbiology testing. C. auris requires a specific fungal culture that needs to be ordered specially and requires up to seven days to grow. MALDI-TOF Mass Spectrometry (Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) is a rapid and accurate technique used to identify Candida species. However, clinicians must order this test specifically looking for C. auris.

The future of UTI testing 

A trend to replace traditional urine culture testing for routine urinary tract infections (UTIs) with molecular Polymerase chain reaction (PCR) has demonstrated to be more specific, offer faster turn-around times, and produce information regarding antibiotic resistance genes in bacteria. Identification of resistance genes can help nursing home administrators identify trends in populations for emerging resistance. 

Another potential unforeseen benefit of PCR testing for UTIs may be the incidental detection of C. auris. As Alexander Flemming, the physician and microbiologist best known for discovering the world’s first broadly effective antibiotic substance, penicillin, ironically once said, “One sometimes finds what one is NOT looking for.”

This testing method provides a unique avenue to find patients harboring this pathogen — even without thinking to look for it. Early identification of these individuals will allow nursing homes to implement strict infection control measures to prevent transmission, including:

• hand hygiene
• proper use of personal protective equipment (PPE)
• isolation precautions for infected patients
• thorough cleaning and disinfecting of patient rooms and equipment

Everyone prescribing antibiotics should consider both their clinical and public health responsibilities. Our goal to “use the right drug at the right time and in the right duration” should extend beyond bacterial infections, as emerging drug-resistant fungal infections, such as C. auris, become a threat. Employing 21st-century molecular testing will prove to be an essential part of true antibiotic and antifungal stewardship.

Joel Diamond, MD, Co-Founder & Chief Medical Officer of Aranscia and Co-Founder of 2bPrecise, has extensive clinical and technology experience. He formerly served as CMIO and chairman of the Physician Advisory Board at the University of Pittsburgh Medical Center, St. Margaret Memorial Hospital, where he facilitated 100% adoption of CPOE in a community hospital. He is a diplomat of the American Board of Family Practice and a fellow in the American Academy of Family Physicians while continuing to care for patients at Handelsman Family Practice in Pittsburgh, PA.

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While AI’s applications in healthcare depend on an organization’s appetite for innovation, and the investments and approach from technology providers, we have barely scratched the surface in leveraging machine learning (ML) and AI in the healthcare space, particularly within the senior living and long-term care industries.

With the challenges faced by LTC facilities such as staffing shortages, increasing care needs and a shift to value-based care, it is essential for providers to explore innovative solutions for providing high-quality care. 

One proven avenue is leveraging artificial intelligence and the integration of remote monitoring technologies in skilled nursing facilities, as recognized by a survey conducted by the National Institutes of Health, where 79% of respondents believe AI and machine learning could enhance patient outcomes.

Monitoring changes in acuity and predicting risk of fall using AI

Falls present a significant concern among older adults, leading to a death every 20 minutes and an emergency department treatment every 13 seconds, according to the National Council on Aging. 

The financial implications are staggering, with data showing that across assisted living communities and skilled nursing facilities, the annual direct cost of all falls is as high as $380,000 and could be even higher at enterprise communities, with an average $712,000 per facility. These statistics emphasize the urgent need for intervention in skilled nursing. 

While several technologies exist to help identify a fall and speed-up response after a fall has occurred, providers should look for a solution that monitors change in acuity in near real-time and identifies residents that have a higher risk of falling, thereby allowing staff to take targeted and resident-specific preventive measures.

The AI/ML based remote monitoring and fall detection solutions have proven to improve clinical outcomes for residents in long-term care facilities. The near real-time and ongoing analysis of over 150 data points from the EHR allows us to continuously monitor a change in resident acuity and accurately assess their risk of a fall. 

When implementing AI-driven technologies, MatrixCare has observed an 8% reduction in falls among an initial cohort of 200+ LTC communities, resulting in an estimated $12.9 million in savings across the cohort, or about $96,000 per operator, from costs associated with treating major falls.

Leveraging AI to improve care delivery and resident well-being

Another critical aspect of care includes monitoring mood changes and helping efforts to prevent the onset of depression. By analyzing associated data points and utilizing AI-based models for indicators in mood changes, we can minimize reliance on antipsychotic medications and cater to resident’s mental health needs in a proactive and controlled manner. This approach can help reduce rehospitalizations and penalties while alleviating staff burden. Integration of advanced technologies in long-term care facilities enhances resident well-being, resulting in improved outcomes.

One notable highlight is the substantial improvement in therapy outcomes and adherence to Centers for Medicare & Medicaid Services’ recommendations. Our analysis of the clinical data showed a 20% reduction in the administration of antipsychotic medication to residents, along with a 7% decrease in the usage of antianxiety or hypnotic medications, when MatrixCare’s AI model was used to monitor changes in resident acuity.  

By embracing advanced technologies powered by AI/ML models that leverage EHR data, skilled nursing facilities can enhance therapy outcomes and help reduce reliance on medications, thus improving the quality of care and driving positive clinical outcomes for residents.

Embracing the future of long-term care

Artificial intelligence is evolving at an unprecedented rate and new applications are being developed every day. Long-term care providers must embrace this evolution and invest in technology that fosters secure, healthy and dignified living environments for our senior population. 

By integrating AI and remote monitoring technologies into their facilities, they can unlock new opportunities to improve the well-being of residents and enhance the efficiency of healthcare providers. These innovations enhance resident health tracking, mitigate safety hazards, and hold the key to alleviating the challenges faced by today’s care professionals.

Bharat Monteiro is the General Manager, Senior Living & Long-Term Care for MatrixCare.

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An estimated 85,000-plus dialysis patients are admitted to SNFs annually, a number that is projected to grow by 6% annually. Current dialysis solutions, which include outsourcing or transporting these patients out to clinics, can leave a SNF with limited control of the care continuum, present a heavy logistical burden for staff and patients, and result in poor patient experience. With recent advances in hemodialysis technology, however, it’s now easier for SNFs to create a wholly owned dialysis program on site whereby the patient care continuum, reimbursement, and quality are all controlled by the SNF network.  

Better care is possible

In off-site dialysis models, when a patient with end-stage renal disease is discharged to a SNF, staff must immediately coordinate with a local dialysis clinic for that patient’s treatments. After arrangements are made, challenges often arise related to transportation delays, care issues during transport, weather delays, and missed treatment time.  

After treatment, patients often return from the clinic feeling groggy and fatigued leading to a decrease or inability to participate in scheduled therapy sessions. In some instances, rehab directly conflicts with dialysis, disrupting care and increasing the risk of hospital readmission.

In-house service providers also create issues

To date, the most widely accepted alternative to this arrangement has been contracting the service to a third party to perform hemodialysis on site at the SNF. This enables a SNF to accept more dialysis patients, but still has significant drawbacks related to cost and control of how and when dialysis is performed. 

The SNF typically bears the cost of infrastructure, such as building out a dialysis den and water room and may be obligated to provide additional staff to serve the provider while the service provider retains control of treatment staffing and scheduling. In this model, the third-party service provider collects the Medicare B reimbursement for dialysis and may also charge the SNF a sitting fee for every treatment. 

In a wholly owned SNF program within its existing walls, operators receive the entire reimbursement for treatments performed at their facility and control all aspects of treatment administration while simplifying logistics. Now that dialysis technology is more streamlined, a wholly owned program allows SNF operators to more easily realize:

1. Census optimization. On site dialysis care enables a SNF to accept more kidney patients and eliminate caps.  
2. New revenue stream. Providing dialysis care ensures the SNF’s dialysis entity secures Medicare B reimbursement for the service.  
3. Reduced cost and risk. In-house dialysis eliminates expensive and potentially dangerous transportation.
4. Easier scheduling. Eliminating transportation time makes it easier to schedule rehab and dialysis without conflicts. 
5. Better continuity. Patients benefit tangibly from the continuity of care that a SNF-owned dialysis service offers. 
6. Fewer readmissions. Better, more integrated patient care means fewer returns to acute care and stronger relationships with acute care facilities. 

Technology drives innovation

New simplicity and usability of hemodialysis technology allow the wholly owned approach, a strategy already being widely adopted across the acute and post-acute space, to become a reality for all SNF operators. These devices are easier to learn and more intuitive to operate, minimizing training requirements, while allowing remote monitoring, EMR integration, and elimination of costly infrastructure.  Moreover, by providing high-quality in-house dialysis, the SNF becomes a preferred referral destination for hospitals discharging kidney patients.

With thousands of kidney patients diagnosed every day, a wholly owned SNF dialysis program offers the potential for significant bottom line impact, increased operational control and a better, more consistent, higher quality experience for patients.

Michael Aragon, MD, is chief medical officer at Outset Medical, a medical technology company pioneering a first-of-its-kind technology to reduce the cost and complexity of dialysis. Aragon is board-certified in internal medicine and nephrology, receiving his training at the University of Texas Health Sciences Center in Houston.

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The answer is, of course, everything. Assuring the delivery of purposeful, meaningful and engaging activities is vital to person-directed living, and activity professionals are essential to this aim. 

Among the many people who bring life to long-term care, activity professionals are the ones who foster environments that honor unique daily rhythms and routines of elders, and celebrate their purpose. 

The Center for Innovation (CFI) has made it a priority to promote the advancement of person-directed living for elders. As such, we recognize that activity professionals deserve the resources, training and tools to support their important role.

CFI and its two organizations, The Green House Project and Pioneer Network, are known for ensuring the advancement of person-directed, relationship-rich living among all aging services settings. In Green House homes and other settings committed to non-institutional models of care, contextualizing and normalizing activities as part of everyday life is key to operations. 

Elders deserve rich and purposeful lives no matter where they reside. However, putting this into action is challenging in a world of competing demands, clinical complexities and stretched workforce. Sadly, much of the natural daily rhythms are disrupted inside of traditional long-term and post-acute care settings, due to risk-averse rules and procedures. 

Risk isn’t something eldercare organizations are comfortable with. As a result, residents — particularly individuals with Alzheimer’s disease or other dementias — often are discouraged or even prevented from doing things they enjoy and living their lives the way they want. Positive risk-taking improves autonomy, social interactions, and elements of both physical and mental health. 

We believe there is a way to balance dignified risk-taking and safety for older adults — and activity professionals are essential to this.

While challenges are real, opportunities for engagement are ample. For example, CFI prioritizes and advances the normalization of pets as part of the fabric of everyday life in all eldercare settings. Dogs, cats and other animals bring joy to many of us throughout our lives, and they should not be prohibited simply because we have moved into a nursing home or assisted living community. 

Intergenerational relationships enrich our lives as well. Enjoying the laughter of children and the cooing of babies shouldn’t suddenly stop because someone has been placed in a new home that, ostensibly, is designed to help them live their lives to the fullest.

An important component to shifting away from risk aversion and into an environment where dignity of risk is recognized is education and training opportunities that are not one-and-done efforts. One underlying theme throughout the Green House model is knowing the elder, and that this is valued above what they have lost or what diagnoses they may have. 

By engaging in deep knowing of the residents, the Green House model empowers all staff, activity professionals in particular, to focus on meaningful engagement. Taking proactive roles in addressing loneliness, boredom and helplessness is the norm in such settings.

There is no quick fix to overcome the barriers to ensuring person-directed living for all elders. But if we continue to prioritize education and training, as well as empowerment opportunities, we can make progress. And when we empower and enable activity professionals to lead the way in meaningful and purposeful programming, we can give all our elders the lives they want as well as the care they need. 

Toward this end, Linked Senior is excited to have the CFI team present our next Activities Strong Virtual Winter Gathering on Dec. 5, from 12 p.m. to 4:00 p.m. ET as they address the importance of activities and its relationship to person-directed living. More details and registration can be found here.

Susan Ryan is the CEO of the Center for Innovation.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

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Against this backdrop, the recently proposed Centers for Medicare & Medicaid Services staffing mandate feels, to many industry leaders, like insult after injury. I interact daily with skilled nursing operators and the majority share the goal of improving staffing ratios – yet find themselves struggling to find, hire and retain the right personnel, particularly in rural geographies. 

One major concern is that aspects of the mandate, such as the requirements that a registered nurse be onsite 24/7, will simply lead to the closure of smaller sites. This is not a trivial problem. Shutting down facilities will widen gaps in care for those who can’t afford alternatives, and will place burden on hospitals and emergency room facilities by limiting discharge options.

Real and damaging impact could come from a poorly-structured mandate, so it is critical to engage to ensure that any final legislation be carefully amended. And yet, a broader point remains.

Mandate or no mandate, staffing is already a challenge with existential stakes for U.S. nursing homes. And mandate or no mandate, the imperative to innovate – now – remains the same.

The daily reality is that there are not enough nurses and CNAs in most geographic areas to meet demand for these roles. Meanwhile, competition for these roles has intensified – from hospitals and from venture-backed staffing marketplaces – both of which often pay more than skilled nursing facilities. 

The only real fix is to get creative with staffing – and fast. Business leaders do not have the luxury of waiting to see what happens with state and federal regulation over the coming years.

Fortunately, a clear playbook has emerged for staffing success – informed in part by other industries (hospitality, trucking, airlines) that have substantially evolved their staffing practices and technology over the past two decades. By learning from case examples, and capitalizing on new strategies, industry operators can set their organizations up for success and growth, no matter what policies come out of Washington.

Staffing is an existential problem, mandate or no mandate

There is no one-size-fits-all-solution, and staffing challenges will persist for at least the next 10 to 15 years for a number of reasons. 

Talent wars and worker shortages have been hallmarks of the healthcare labor market for decades. Almost half of all employees working at state and local public health agencies left their jobs between 2017 and 2021, according to an analysis published earlier this year. And a hefty portion of staff still report wanting to quit.

As a result, competition for talent remains fierce among nursing facilities – as well as with “substitute” care models like home-based care. With more and more adults preferring age in place, and with Medicaid now paying family members to care for their loved ones, finding sustainable models that provide more robust care support is genuinely a make-or-break challenge for many care facilities.

There is no guarantee that demand will persist for nursing homes that can’t clearly demonstrate their value proposition – and shoring up staffing ratios are becoming an increasingly non-optional aspect of operations, as well as sales and marketing efforts. 

What providers can do to fortify staffing

Nursing home and post-acute providers need to get creative. Simply put, the operational status quo won’t cut it. Fortunately, many providers also have low-hanging fruit innovations in front of them – operating changes that hold significant promise for shoring up staffing. 

I want to challenge providers to think differently, and here’s how:

• Identifying clear goals. As a starting point, individual facilities and broader operating companies will need to determine more precisely what they are optimizing for. Is your primary objective growth? Or cost containment? Or specific clinical outcomes and/or patient satisfaction metrics in the context of value-based contracts? Each of these objectives will imply differences in how an organization defines its optimal staffing strategy.  
• Consider staffing mix. Most facilities operate several implicit “pools” of workforce – even within a specific practitioner type (e.g., RNs). For example, just within RNs a single facility might have: 1) full-time on-staff employees, 2) employees on overtime, 3) employees subject to a wide range of union staffing rules, 4) per-diem workforce, 5) hourly workforce, 6) travel nurses, 7) other forms of contract workforce, 8) synchronous telemedicine engagement (i.e., video), 9) asynchronous telemedicine engagement (i.e., messaging), etc. Each of these pools implies different cost dynamics, and each implies different degrees of clinical efficacy. With a clear set of objectives in mind, an organization can take the critical step of defining a targeted “staffing mix” – i.e., targeted percentages against each of the pools outlined above, which may vary by region/facility, given local staffing dynamics. 
• Establishing flexible staffing operations. Having established a clear view on objectives and desired staffing mix, organizations must consider the interplay across and among individual facilities. Oftentimes, a parent organization will see wildly divergent staffing KPIs across different facilities and regions. Enabling flexible modes of sharing staff across and among geographically proximate facilities – and setting up float pools to flexibly support several facilities at once – can often mitigate staffing pain for the worst-off facilities, while simultaneously providing flexible working opportunities much appreciated by a stretched workforce. Such innovations are particularly helpful in scenarios where staffing demand is highly variable, and facilities need flexibility to operate efficiently during spikes and troughs alike.
• Getting in place the right tech. Finally, with the right goals and right staffing structures in place, operators require technology that enables schedulers to manage seamlessly and in real-time across different pools of the workforce. A human scheduler, tasked with filling a last-minute shift, cannot reasonably be expected to optimize in real-time across the many pools of workforce in the context of a business strategy. Technological evolution is required, and advanced technology will have a critical role to play. 

What staffing excellence enables

My strong belief is that providers who modernize their staffing strategies now will thrive, while those adopting a “wait and see” mentality will mostly be left behind. I encourage all facilities to start experimenting as soon as possible – taking first steps that can be expanded across a broader organization with time. 

While changing staffing operations can feel like a daunting task, the benefits are real. Better staffing operations enable lead generation by ensuring capacity and cementing a facility’s positive reputation among hospitals, ER units and other discharge entities. 

Additionally, strategic staffing models unlock opportunities to explore alternative reimbursement models such as value-based care. Oftentimes exciting new payment models only become possible with tighter control on staffing operations – which directly promote better clinical objectives, patient satisfaction, and practitioner satisfaction.

While the federal staffing mandate currently being debated poses a major challenge to long-term care providers, facilities can’t assume a reactive stance. The only real option is to  seize this opportunity as a catalyst for positive change.

Lee Hudson Teslik is the founder and CEO of Reverence. Lee launched Reverence after observing both the beauty and the challenges of long-term and end-of-life care models – and particularly the criticality of stable staffing models – directly within his own family.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Annual costs reaching a staggering $7.6 billion are attributed to adverse drug events (ADEs) within nursing facilities nationwide. This figure underscores the profound impact that medication-related issues can have on the financial well-being of nursing facilities. To address this challenge, the significance of establishing connections between pharmacies in post-acute care (PAC) settings cannot be emphasized enough. Clear communication and collaboration between healthcare facilities and pharmacies will revolutionize medication management, enhance patient safety and ultimately alleviate the financial strain on nursing facilities. 

One of the primary benefits of connecting pharmacies in post-acute care is improved medication management. A direct line of communication between healthcare facilities and pharmacies ensures that critical information such as medication orders, dosage changes and patient profiles can be instantly transmitted. This real-time connection streamlines the whole process, reducing delays and potential errors. Pharmacists can quickly review and verify prescriptions, cross-reference patient information and identify potential drug interactions or contraindications. This comprehensive oversight enhances medication safety, minimizing the risk of adverse events and promoting optimal patient outcomes.

Real-time information is essential. Pharmacists can actively engage in medication reviews and counseling sessions. They can assess the appropriateness and efficacy of prescribed medications, identify potential adverse effects or drug interactions, and collaborate with healthcare providers to make necessary adjustments. This collaborative approach ensures that patients receive personalized medication regimens, improving patient satisfaction, medication adherence, and overall health outcomes.

Connecting pharmacies in a post-acute care setting poses challenges for care facilities, including the lack of standardized communication protocols, interoperability issues between electronic health record (EHR) systems and pharmacy software, privacy and security concerns, and limited technological implementation and maintenance resources. Overcoming these challenges requires collaborative efforts, technological advancements and industry-wide standardization.

To overcome the challenges, post-acute care facilities can take proactive measures. Establishing partnerships and collaborations with pharmacies that prioritize technological integration can ensure standardized communication protocols and interoperability. 

This can be achieved by working closely with pharmacy software providers to integrate their systems with the facility’s EHR system. Secondly, implementing robust privacy and security measures, such as encryption and compliance with regulatory standards, can safeguard sensitive patient information during data transfer. 

Additionally, seeking financial assistance through grants, government programs or healthcare initiatives can alleviate the burden of limited resources for technological implementation and maintenance. Actively participating in industry-wide discussions and initiatives for standardization can help drive the development of consistent protocols that improve and ease the adoption of these efforts.

When integrated with pharmacy software, EHRs enable accurate and consistent information exchange and ensure pharmacies have up-to-date patient profiles. Additionally, e-prescribing platforms and pharmacy management systems provide the means to transmit prescriptions, facilitate medication synchronization, and automate refill processes. This can be accomplished through secure communication channels, such as health information exchanges (HIEs), which enable the transfer of sensitive patient data while adhering to strict privacy and security standards.

Collaboration between pharmacies in post-acute care is integral to providing optimal care and improving patient outcomes. Technology is pivotal in establishing this connection, lighting the way to transforming patient care. With enhanced medication management, efficient data transfer and innovative solutions, we continue to expand our integrations to benefit our residents, clients, and post-acute care system.

Claire Stephens, Vice President, American HealthTech.  AHT is a member of the CPSI family of companies, offers services and solutions created specifically for skilled nursing and senior living organizations.  As a leading EHR provider to post-acute care and senior living organizations of all sizes, the AHT solution delivers a seamless flow of information between care settings, resulting in better coordinated care and improved financial outcomes.  For more information, visit www.heathtech.net.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.