Since its founding in 2019, the McKnight’s Women of Distinction Awards program has become the premier recognition program for women long-term care professionals of all experience levels

Eligible for recognition are women working as direct care providers, managers, executives, corporate executives and owners in independent living, assisted living, memory care and life plan communities. That’s in addition to those working in those capacities in skilled nursing facilities and in home care, home health, hospice and palliative care. 

Women who serve the fields indirectly — for instance as association staff members, academicians or thought leaders — also are eligible for recognition. Individuals working for vendor companies serving the industry are not eligible.

The early nomination deadline hits Jan. 5, 2024. Entries thereafter will be charged a late fee during a short window.

Since the program began in 2019, some 252 women leaders in the fields of skilled nursing, senior living and home care have been honored across multiple award categories.

The nomination categories are:

• Hall of Honor: Candidates should be senior-level professionals in the C-suite or at a level equivalent to vice president or higher and should have made a significant impact on their organization or the industry.
• Veteran VIP: Candidates should have more than 15 years of experience making an impact in long-term care and should be at a level lower than vice president or its equivalent.
• Rising Star: Candidates must be 40 or younger or have fewer than 15 years of experience in the profession.
• Spirit Award: This award recognizes inspiring caregiving and service provision efforts. Nominations in this category are free. Eligibility is open to women who have demonstrated acts of bravery, courage, perseverance, dedication, determination — or have made other noble gestures.

A Lifetime Achievement Award winner also will be named.

Nominations for the Rising Star, Veteran VIP and Hall of Honor categories (described below) that are submitted by Jan. 5 will have an $89 entry fee. Nominations in the week after that will cost $20 more.

The program, now in its sixth year, is coordinated by McKnight’s Long-Term Care News, McKnight’s Senior Living and McKnight’s Home Care.

All honorees, past and present, will be honored at an in-person event Tuesday, May 14, in Chicago. Information about the event, which includes a companion summit with educational sessions, is available now at mcknightswomenofdistinction.com.

For more information about the awards, or to submit a nomination for a deserving leader, visit mcknightswomenofdistinction.com.

Questions should be directed to Amanda Hassler, director of events for Haymarket Media, the parent company of McKnight’s, at amanda.hassler@haymarketmedia.com.

Read about previous award winners here. See lists of previous classes of honorees here and here.

Sponsors of the 2024 awards program include Curana Health, DirecTV for Business, Healthcare Services Group, PharMerica and Priority Life Care.

Long-term care providers were intent on dismissing undesirable memories of the COVID-19 pandemic as much as possible in 2023, but the year’s top stories revealed there were still remnants of it to deal with — and plenty of other issues to fill the gaps.

From unprecedented, increased regulatory pressures to newly introduced legislation, ongoing workforce challenges, image problems and more, there was a lot to digest.

Here are the top stories that grabbed our readers’ attention in 2023, the top handful of them inevitably related to the staffing mandate and the sector’s ongoing workforce challenges.

Federal minimum staffing proposal dominates

By the time the Centers for Medicare & Medicaid Services finally issued its first-ever rule to set nursing home minimum staffing levels, the sector had experienced a roller-coaster of tense emotions. The Sept. 1 announcement put providers and their advocacy counterparts in labor and consumer groups in an uproar.

Operators called the proposal an impossible, unfunded mandate, if not because of the estimated $4 billion or greater price tag, then because there simply aren’t currently enough registered nurses to satisfy the tripling of current mandated levels.

‘Accidental’ early study release, Biden unloads on providers

President Biden added fuel to the fire when he unloaded on nursing operators just days after the staffing mandate was proposed.

The administration, however, was undercut a few days before the proposed rule’s release, when a “draft” of it was briefly posted online before being pulled down. That gave outsiders an early look at study findings saying it’s impossible to settle on a specific staffing level(s) that would serve the White House’s desired goal. Despite officials calling it a “draft” study report, it was nonetheless included in the same form when the proposal was released later that week.

The intrigue persists: Was it truly an accidental early posting, or was it the purposeful act of an insider sympathetic to providers’ year-long criticism that an unprecedented staffing mandate would be a bad idea?

Staffing mandate’s costs greatly underestimated: report

Three weeks after the staffing mandate was officially proposed, a respected third-party analyst hired by providers found that its cost would be nearly 60% higher than the $4 billion annual cost estimated by the Centers for Medicare & Medicaid Services.

Nursing homes would need to spend more than $6.8 billion annually and hire more than 102,000 new workers under its proposed form, said an updated analysis issued by accounting and consulting firm CliftonLarsonAllen.

Bills would block federal staffing mandate

Within five weeks of the staffing rule’s proposal, Republican House members proposed legislation to block it. A similar Senate bill, this one bipartisan, was proposed in December. 

The legislative efforts are being led by lawmakers in rural states, which figure to be most severely hurt by any new staffing standard.

CMS delivers 4% Medicare pay raise

Nursing homes received a higher-than-expected 4.0% increase to their Medicare Part A payments for fiscal 2024. The July 31 final rule from CMS added 0.3% — or $200 million — to the agency’s original April proposal. Inflationary costs were deemed responsible for the largest annual increase in recent memory.

In addition, most of the recommended vast changes to CMS’ quality reporting and value-based purchasing programs were retained in the final rule.

Biden plan would tie pay rates to staff turnover rates

In mid-April, President Biden signed a massive executive order that included several measures intended to improve access to long-term care and bolster job protections for skilled nursing workers. Among them were calls to expand on the then-undisclosed staffing mandate and to tie Medicare payments to staff retention.

The White House called the 50-plus elements the “most comprehensive set of executive actions any President has ever taken to improve care for hard-working families while supporting care workers and family caregivers.”

Nursing home ownership transparency pushed

Federal authorities made good on their promise to increase transparency from anyone owning a stake in nursing homes, or doing top business with them, with a rule finalized Nov. 15.

The rule imposes many of the ownership transparency measures outlined in a February proposal and defines both private equity and real estate investment trust owners. A coalition of 18 attorneys general fueled aspects of the rule with a plea for more ownership information.

Feds lift COVID-19 vaccine mandate that Supreme Court upheld

Regulators made big news in late spring when they announced they were acting to COVID-19 vaccination requirements for healthcare workers. The mandate had been upheld by the Supreme Court in a historic court decision in January of 2022.

Other vaccine requirements also were lifted with the end of the public health emergency on May 11. Booster shot rates have plummeted since.

Among the other big story lines

As the referring examples in this sentence indicate, the skilled nursing sector saw a growing number of providers shedding or closing facilities, or filing for bankruptcy as access worries mounted.

Meanwhile, as Medicare Advantage plans passed the 50% market share level for the first time, regulators made moves to impose more standards on them, with providers appealing for even more.

On Oct. 1, the largest overhaul to the Minimum Data Set in years became effective, capping a hectic year of planning and worrying.

Also on the federal regulatory front, authorities quietly put into place new, stricter measures regarding infection control and general vaccine immunization matters. They also continued to increase scrutiny of the use of antipsychotics and schizophrenia medications.

In other pandemic-related matters, a federal jury found that the nursing home that was the site of the first major COVID-19 outbreak in the US was not liable for the deaths of two residents. It signified one of a number of heartening court victories for providers accused of wrongdoing in the early days of the public health emergency.

The tool uses existing evidence to form recommendations for staffing ratios in long-term care, acute and ambulatory care settings. All of the recommendations are based on key risk factors.

“We are excited to provide this tool to the infection prevention field,” Patricia Jackson, RN, president of APIC, said in a statement. “APIC members have been asking for a resource to help quantify staffing needs for years, and now we can begin to deliver on that promise. With member input, we will be able to provide a robust, accurate staffing tool that will help IP leaders make the case for adequate staff and resources to protect patients.”

The introductory version of the staffing calculator is an “exploratory approach,” APIC says. That is, it’s intended to provide a basic calculation of staffing needs and will collect data that can be used for creating a more rigorous algorithm in the future. 

Data gathered from healthcare facilities that use the tool will be utilized to update it so the tool improves over time. In the next year, an updated version will be released to reflect the accumulated data. In addition to updating the tool as it rolls out, APIC said that it will produce annual reports summarizing data to drive deeper insights into its effectiveness.

The news comes as more organizations are hiring chief infection prevention officers (CIPOs). An article published Dec. 7 in Infection Control Today shared details on this executive role that supports operational positions through the lens of preventing infection.

Home-delivered meals promote food security, socialization and independence in older adults who are homebound. The researchers wanted to know if it was feasible to enroll people with self-reported dementia for Meals on Wheels, and if doing so would delay nursing home placement. The findings appeared in JAMA Network Open Wednesday.

The program evaluated older adults with self-reported dementia who were on waiting lists for different Meals on Wheels programs in Florida and Texas between April and October 2021. Researchers compared daily delivery and frozen meals that were mailed every two weeks. 

The scientists randomized 325 participants into two groups. The first group included 128 people who received meals from a driver on a daily basis, and the second group was made up of 115 people who got frozen meals mailed to their homes every other week. Participants received the meals for up to six months. Of the people, the mean age was 81, 62.6% were women, and 49% of them lived alone.

At six months into the trial, 10.1% of participants were admitted to nursing homes. Participants who received daily-delivered meals had a lower, although nonsignificant, likelihood of being placed in a nursing home compared to those who received frozen meals. 

Six months after the program started, 65.8% were still getting meals; 68.8% of people who received meals daily finished the program, and 62.6% of people getting frozen meals finished the program. One factor that could be an obstacle for people who got frozen meals was that they needed to be heated up and didn’t come ready-to-eat like the ones delivered daily.

“This pilot study demonstrated the feasibility of implementing a pragmatic randomized clinical trial among participants with self- or proxy-reported dementia on waiting lists at Meals on Wheels programs,” the authors wrote. “We also showed the ability to link participants with their CMS data, monitor fidelity, and measure the time to nursing home placement.”

The goal of the 16-week program was to train staff to deliver personalized care to residents. 

Teams from the University of Exeter and King’s College London implemented the  Improving the Wellbeing and Health for People Living with Dementia (iWHELD) program, which included a one-month orientation phase followed by a four-month off-site training phase. The program allocated one day per month for person-centered care (PCC) classroom-based sessions led by an iWHELD trainer that incorporated didactic learning, experiential activities and implementation planning. The other four months required regular on-site consultation sessions with each care home to support the program as it launched. Live coaching was delivered during the COVID-19 pandemic. 

Researchers delivered the program to staff supporting 739 residents in 149 residential homes in the UK. The team compared those who used iWHELD to usual care. In addition to reducing use of sedatives, markers of quality of life were better in the intervention group.

“Urgent action is needed to ensure care homes have access to dementia care training and support that is both high quality and shown to be effective. Every person deserves thoughtful and compassionate care and not everyone is receiving it,” Joanne McDermid, creator of the iWHELD platform and lead author of the paper, said in a statement.

McDermid went on to say that iWHELD is the first program to provide an effective, evidence based, affordable and scalable solution that can address the care needs and improve the lives of the people with dementia.

“As part of the training around personalized care, we’ve realized we need to change our approaches and even our demeanors to communicate effectively with residents … so if someone is quite reserved, being very bubbly is less effective and relatable to that person,” Katie Ives, manager of  a care home that participated in the iWHELD training, said in a statement. “We’ve always tailored our approach to residents, but now we offer a wider variety of activities and clubs to suit people’s interests in their lives, and we’re seeing some residents spend more time in communal areas and less time in their rooms as a result.”

The cut included in the 2024 Physician pay rule, which was finalized by the Centers for Medicare & Medicaid Services in November, affects doctors working in nursing homes and other long-term care settings, as well as pay for therapists and other ancillary services. 

In the last few years, Congress has moved to offset similar reductions, which don’t necessarily reflect true costs of physician services but are required if CMS decides to put a greater share of its funding toward other types of care.

The ongoing regular reductions to reimbursement are “an existential threat” to the long-term care sector’s therapists and other providers who bill Medicare Part B, said Cynthia Morton, executive vice president of advocacy group ADVION, earlier this year.

Congress included a 3% offset to conversion factor cuts for 2023 and planned another 1.25% offset for 2024 in the 2023 Consolidated Appropriations Act. But bills that would help make that 2024 change more significant have not moved forward yet this session. 

Morton told McKnight’s Long-Term Care News that the next best opportunity for a fix is  ahead of the government funding expiration on Jan. 19.

“Whatever funding vehicle will be advanced to continue that, we want to have our Physician Fee Schedule patch attached to that,” Morton said. “It’s important that Congress deal with this patient issue in January because the reductions will have already gone into place on Jan. 1.” 

Looking for silver linings

A rate correction could be made retroactive, as has happened in the past.

While ADVION and other provider groups are still advocating for a full 3.7% patch to address the cut, the Senate Finance Committee has so far passed a 1.5% patch and the House Committee on Energy and Commerce passed a 1.25% patch.

Bills that could be a vehicle for the patch are: the Preserving Seniors’ Access to Physicians Act of 2023 (H.R. 6683), which would eliminate the 3.37% conversion factor reduction; and the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would add a permanent payment update to the Medicare PFS that is tied to inflation, as measured by the Medicare Economic Index.  

There also was a bipartisan letter of almost 200 House members sent to House and Senate leadership asking them to end the 3.37% reduction, Morton noted.

Meanwhile, the American Medical Association, which represents physicians and physician practices, has warned that Congress’ inaction so far could force some providers to cut office hours or forgo treating Medicare patients.

On Monday, the AMA recommended that lawmakers transfer about $1.8 billion from the FY 2024 National Defense Authorization bill to cover the cut. It includes $2.2 billion in money shifted from the Medicare Trust Fund to a Medicare Improvement Fund, which would be more than enough to stop the cuts.

“Facing a nearly 10% reduction in Medicare payments over the past four years and rising practice costs on top of the burdens and burnout of three years of COVID-19, for many physicians, continuing down this road is unsustainable,” said AMA President Jesse M. Ehrenfeld, MD, MPH. 

“These cuts will be felt first and hardest in rural and underserved areas that continue to face significant healthcare access challenges. Medicare physicians do not receive inflationary payment updates, which is why eliminating these cuts is so crucial.”

A series of struggles around assessment began in fall, with the most extensive updates in years to the Minimum Data Set, which captures patients’ clinical needs and also serves as the basis for much of a provider’s state and federal reimbursement.

“It’s not news to anybody that this rollout was not smooth,” said Alicia Cantinieri, senior vice president of Clinical Policy and Education for Zimmet Healthcare Services Group. “There were a lot of technical issues with coding, with skip patterns, with Section GG, with HIPPS code calculation being incorrect.”

Despite the Centers for Medicare & Medicaid Service issuing corrections and technical clarifications in the weeks after the Oct. 1 launch of the updated MDS, some providers still may face long-term consequences of coding errors or delays forced on them by incomplete early guidance from regulators. That was just one of the cautions shared by Cantinieri and two of her Zimmet colleagues during a webinar titled, “Fasten Your Seatbelts: It Might be a Bumpy Ride.”

Cantinieri said the lasting implications of some software and coding issues in the first week of the launch were going to especially affect providers in states that used the Patient Driven Payment Mode to determine a Medicaid case-mix before the changeover.

In the case of providers who needed to code patients receiving respiratory therapy, for example, many found the section blocked out and were unable to capture payment for related services. Some went back and modified submission; others waited to submit until they had clarification on how to correct the problem.

“Facilities have been left with questions about when to modify, when to resubmit,” she added. “And we haven’t heard any guidance from CMS that they would waive or forgive the submission timing requirement, so there’s the potential that facility could be cited.”

Chief Innovation Officer Steven Littlehale said that regardless of the complication or system error, it is critical that providers keep related records for a few years “so that ultimately you’re not left holding the bag for this sort of failed launch.”

Duplication of efforts

The removal of Section G to measure a patient’s functional status also continues to wreak havoc on payment, especially at the state level. Many states used G to determine payments, and without it, complications have continued to crop up, said Melanie Tribe-Scott, vice president of Quality and Regulatory Compliance.

For providers in many states not using the PDPM yet, the workload has increased significantly, with many requiring that MDS coordinators record information in the replacement Section GG and capture details for all patients on an optional state assessment, too.

The advent of MDS also has led to frozen pay in some states, while upcoming quality measure changes will lead to freezing quality measures as well, the speakers noted. That may discourage providers from being diligent in some areas, thinking they are temporarily less important.

But that couldn’t be farther from the truth for payment, Tribe-Scott added. She said some states would undoubtedly be using codes captured in the frozen period to see how provider behavior and patient needs would shape spending under a system more aligned with PDPM.

And those frozen metrics, which lock in April to give regulators more time to collect full data before publishing new calculations, also could come back to haunt if not given enough attention. Most are connected to new quality measures, which will be used later to inform quality measure ratings on the Care Compare website.

“Eventually, it will be thawed and you’ll see those new measures,” Littlehale said. “It’s important to not turn your back, for quality improvement reasons, on those very outcomes. You need to get a little old school with how you’ve tracking performance in those areas.”

Stay ahead of problems, and no blanking out

Another critical change is coming Jan. 1: Providers will need to submit a higher percentage of MDS data than in years past to remain eligible for a value-based purchasing payment bump. It’s critical they not leave boxes blank, especially new ones, simply because staff don’t understand how or when to complete them, Cantinieri said.

Providers can stay ahead of some of the challenges by taking a few steps as 2024 gets underway, the presenters said.

Cantinieri recommended auditing MDS forms to make sure information is being collected and submitted correctly; a standard size nursing home could make it a quality improvement goal to review 10 charts per month and include charts from a variety of patients involving a range of interdisciplinary staff. An external audit also could benefit providers who want to ensure they’re capturing everything possible in line with the Oct. 1 changes.

The team also suggested reaching out to any MDS-involved software vendors to ensure updates have been made and that any incorrect data caused by early adoption kinks has been retroactively corrected, if appropriate.

Multiple factors make it likely that the trend of rising labor activity in long-term care will continue in 2024, experts say.

In 2023, care workers and others across the US — from writers and actors, to auto workers — launched high-profile strikes, often successfully bargaining for higher pay and improved working conditions. 

These strikes capitalized on shifting workforce conditions and public opinion, Adam Dean, PhD, associate professor of political science at The George Washington University, told McKnight’s Long-Term Care News. 

Only 16% of nursing homes currently have workers that are represented by a union, but that number is likely to increase if today’s trends hold, he added.

“There’s enormous potential for the growth of unions in that sector and I think that the big labor wins that people have been following in the news … set the stage nationally for what’s possible when workers unionize,” he said. “I think that will set the stage for 2024. I expect to see more organizing and more strikes to come.”

Striking a good balance?

Dean was optimistic that such labor activity would benefit both workers and the long-term care industry as a whole.

“I expect that it will improve the quality of healthcare that residents or patients receive,” Dean noted, citing a study he coauthored that found unionized nursing homes were 78% more likely to comply with illness and injury reporting regulations. 

In skilled nursing, pressure from organized labor has been mounting since the early days of 2020, when workers threatened to strike over pandemic working conditions and the availability of safety equipment.

October 2023 saw the largest strike ever recorded in the healthcare sector as 75,000 Kaiser Permanente workers walked off the job for three days. That strike culminated in a 6% pay increase and promises of additional action to address staffing shortages.

Going into 2024, pay and staffing continue to top the list of labor issues that could become the spark for organized action

“The SEIU and other labor unions that represent healthcare workers have been pushing for higher nurse-to-patient ratios,” Dean noted.. “I expect those kinds of fights to continue.”

One key factor in the current labor upswing is the low rate of unemployment. 

Broad forces in play

“We have a low unemployment rate currently in the United States, which gives workers greater bargaining power with their employers,” Dean noted.

That rate sits at only 3.7%, giving workers the confidence to make demands of their employers since they are likely to be able to change jobs quickly if necessary. 

“It gets [workers] into a position of relative security,” Jason Resnikoff, PhD, assistant professor of contemporary history at the University of Groningen told NBC Washington. “It makes it much easier for them to go on strike.”

During 2023’s increase in strikes, public opinion shifted in favor of unions, especially among young Americans, some feel. 

“There’s a growing public support for unions and strikes,” Dean said, citing a study from the American Federation of Labor and Congress of Industrial Organizations. “88% of Americans 30 and younger have a favorable view of labor unions.”

The AFL-CIO study found that 71% of Americans supported unions overall. 

Since the program began in 2019, some 252 women in the fields of skilled nursing, senior living and home care have been honored across multiple award categories.

Eligible for recognition are women working as direct care providers, managers, executives, corporate executives and owners in independent living, assisted living, memory care and life plan communities. That’s in addition to those working in those capacities in skilled nursing facilities and in home care, home health, hospice and palliative care. 

Women who serve the fields indirectly — for instance as association staff members, academicians or thought leaders — also are eligible for recognition. Individuals working for vendor companies serving the industry are not eligible.

The nomination categories:

• Hall of Honor: Candidates should be senior-level professionals in the C-suite or at a level equivalent to vice president or higher and should have made a significant impact on their organization or the industry.
• Veteran VIP: Candidates should have more than 15 years of experience making an impact in long-term care and should be at a level lower than vice president or its equivalent. Whether as a community/facility administrator or executive director; or as a director of nursing, health/wellness or activities; or through some other position, they must have demonstrated an exceptional commitment to the senior living and care industry through their accomplishments.
• Rising Star: Candidates must be 40 or younger or have fewer than 15 years of experience in the profession. Also, they must have demonstrated an exceptional commitment to the senior living and care industry. Those achievements/accomplishments may include, for example, managing a project, developing a campaign or contributing to the field via research or thought leadership.
• Spirit Award: This award recognizes inspiring caregiving and service provision efforts. Eligibility is open to women who have demonstrated acts of bravery, courage, perseverance, dedication, determination — or other noble gestures.

Nominators for the Rising Star, Veteran VIP and Hall of Honor categories should be prepared to share detailed qualitative and quantitative information about nominees’ work histories, exceptional achievements and contributions or service, and anything else the judging panel should consider.

Nominators for the Spirit Award should be prepared to detail the actions that qualify the potential honoree for the recognition. Nominations for the Spirit Award will be accepted at no charge.

A Lifetime Achievement Award winner also will be named.

Nominations for the Rising Star, Veteran VIP and Hall of Honor categories (described below) that are submitted by Jan. 5 will have an $89 entry fee. Nominations submitted between Jan. 6 and 12 will cost $20 more.

The program, now in its sixth year, is coordinated by McKnight’s Long-Term Care News, McKnight’s Senior Living and McKnight’s Home Care.

All honorees will be celebrated at an in-person event on Tuesday, May 14, in Chicago that also will recognize inductees from previous years. Some information about the event, which also will include educational sessions, is available now at mcknightswomenofdistinction.com. Additional details will be announced at a later date.

For more information about the awards, or to submit a nomination for them, visit mcknightswomenofdistinction.com.

Questions should be directed to Amanda Hassler, director of events for Haymarket Media, the parent company of McKnight’s, at amanda.hassler@haymarketmedia.com.

Read about previous award winners here. See lists of previous classes of honorees here and here.

Sponsors of the 2024 awards program include Curana Health, DirecTV for Business, Healthcare Services Group, PharMerica and Priority Life Care.