A huge fiscal cliff looms for skilled nursing

Our goal is to treat everyone like family and provide your loved ones with the highest level of quality care. But we are in an increasingly difficult situation.

Shattering my rose-colored glasses: From provider to family member

Over time and with specialization your work focus can become narrowed. You can even convince yourself that healthcare has progressed to the point of thinking we are doing a remarkable job. But being on the other side with my father has taught me how far we have to go.

QAPI spells success for SNFs

Outdated operating models - solely meeting the basic needs of patients - does not bode well for SNF operators to survive.

Operators are not 'blasé' about negative stories

Rather than putting the burden on skilled nursing providers, I challenge the news media, along with other institutions, to be fair and accurate, and report the good news, too.

CMS and You: Strategy and action finally together

The Centers for Medicaid & Medicare Services outlined its priorities and goals in its quality and strategy plan. Translating its goals into leadership actions, however, is another matter.

Do millennials want to be shown appreciation differently?

Adjusting to the characteristics and desires of younger employees has been the source of much research. The Gallup Group found that the majority of millennials (55%) are less engaged at work than all other generations and that earning more money is not the primary driving force for them.

Does an administrator affect the success of a director of nurses?

My company, Tobin & Associates, is currently conducting a training program for nurse leaders funded through the Civil Monetary Penalty Grants.

Examining the issues of granny cameras in SNFS

The news headlines are bringing a modern issue to the public regarding the operation of skilled nursing homes - and that issue is the pairing of social media and the use of video cameras, known in the industry as "granny cameras."

In nursing homes, a sense of loss can be a blessing in disguise

Reflection reveals that while loss is ubiquitous in our lives, in the prime of our adulthood we generally have options with which to mitigate loss.

Human-centered design on aging well ... Happening now in Louisville

He answered with confidence and insight. He had fought in one of the wars and knew his history on the others. I shamefully could only answer one or two questions.

What's happening at MedPAC - and why therapists should care

MedPAC's mandate is to analyze access to care, quality of care, and other issues affecting Medicare. The ultimate goal of implementing and tracking quality measures is to improve outcomes in healthcare.

'Love hurts' and sometimes so do averages

Averages can help or hinder your evaluation of performance. Adding a few additional pieces of data can really support your efforts to properly see opportunity and manage risk.

The development of C.diff testing

Clostridium difficile infection is one of the most common healthcare-associated infections in adults in the United States.

Connecting generations isn't an option — it's a must

As often is the case when I'm hunkered away behind my computer screen for work, my young child is basking in the glory of being our family's only grandson. With that status comes much pomp and circumstance; an overkill at times, but I love to witness it nonetheless.

SNFs can incorporate palliative care to reduce hospital readmissions

The American Health Care Association recently announced an update to its National Quality Initiative, a multi-year effort designed to further improve quality of care and the patient experience in America's long-term and post-acute care centers. Since the launch of the Initiative in 2012, members have been challenged to meet measurable targets in key areas such as hospitalizations.

Caring for those who care: Retaining your team through revolutionizing the workplace

Full employment — it's the term economists use to describe a market where virtually everyone who can and wants to work lives. For places like Denver where the current unemployment rate is an incredibly low 2.8%, "full employment" means both a booming economy and a particularly difficult market for retaining team members who care for older adults.

Strategic goals: Now comes the hard part.

In the first two articles of this series, the CMS Quality Strategy Goals were discussed. While those quality and strategic goals are audacious, the other half of the plan is the Mount Everest of Healthcare. Few will get there, but those who do will be on top of the world.

The truth behind long-term care insurance

For some, long-term care insurance has long been viewed, despite all evidence to the contrary, as a nostrum to fix what ails long-term care.

Keeping residents safe with disaster preparedness plans

Last year, the nation watched as Hurricane Harvey dumped torrential rainfall across the south, leaving homes and businesses in shambles.

How SNFs are cutting costs without cutting back on care

As if managing the health of patients wasn't difficult and time-consuming enough, skilled nursing facilities now have to do more to manage their increasingly complex businesses as well.

Attorneys general seek greater punishment for nursing homes: A counterproductive approach?

Amid dire economic reports, wasteful Medicare spending must stop

Given the significant financial pressures facing our federal government and with the health and economic security of nearly 48 million American seniors on the line, Congress must act now to authorize CMS to review Medicare claims before they are paid and finally put an end to the rampant wasteful spending within the program.

All the data points to ... you tell me

Returning from an early morning walk down to the harbor of this sleepy Cape Cod town, it's hard not to feel hopeful. My geriatric pups Melvin and Theodore couldn't get enough of the sea smells and feel of the sand under their little Shih Tzu paws.

GDRs, antipsychotics and PRNs, Oh My!

With off-label antipsychotic use dangerously high in U.S. nursing homes as reported by Human Rights Watch, a question undoubtedly on the tip of everyone's tongue is "How do we fix this?" We all know the scenarios. We've seen them happen. How do we handle them?

Digital practice in LTC: Impact of AI, AR and digital technologies

Many of us working on reform since the advent of Medicare and Medicaid in the turbulent 1960s witnessed reform in the guise of reworking, re-engineering, redevising, recreating, redesigning and refashioning.

Life or death

As healthcare workers, especially as healthcare workers in long-term care, we don't have jobs that most people can identify with.

The 21st Century SNF: two paths forward

Many industry experts believe skilled nursing's current marketshare challenges are temporary — that SNFs only have to hang on until demographic shifts kick in. But I worry about this strategy.

A lasting lesson from Barbara Bush

For many patients and their families, the notion of choosing to stop life-prolonging treatment is unthinkable. Disagreements over when to "give up" can tear families apart, precisely at a time they should be coming together. It doesn't have to be this way.

New law brings tougher eldercare background screening — for employees AND owners

A new law in Georgia signed by Gov. Nathan Deal (R) on May 7 will provide additional safeguards against elder abuse at long-term care facilities.

Political grandstanding hurting long-term care again

It is regrettable that 17 state attorneys general are grandstanding by demanding that federal officials impose stricter nursing home regulation and sanctions. Their letter shows no real understanding of skilled nursing care or its challenges.

Strategic goals: Do your goals align with the goals of CMS?

The Centers for Medicare & Medicaid Services has clearly stated a pathway for change including health literacy, true partnerships and moving the focus of care into a self-management model.

Progress occurring with eldercare workforce innovations, but more urgently needed

Everyone working in the aging services field knows: Action is needed now when it comes to building the eldercare workforce. And the legislative approach cannot be our only strategy.

Medicare Advantage contracts: Why can't I just have one?

Gaining network participation with a managed care organization can be difficult. In the ever-changing landscape of requirements to participate with an MCO, providers not only need to know what areas matter but also what matters in those areas.

Bingo: The road to ruins or the road to riches?

Grandma sure liked her bingo. She excelled at bingo and most card games. Even in games that seemed to involve no skill at all, Grandma almost always emerged the winner.

Ignite purpose with engagement

Too often the senior care industry focuses on negative outcomes and the "clinical" part of the aging experience. Yet, there is much to be said about aging that is positive, and focusing on the benefits of growing old can increase the success of communities worldwide by making them more intergenerational and interdependent.

Office of Inspector General voluntary disclosures — should I or shouldn't I?

Nursing facility operators might be faced with this dilemma: Should I or shouldn't I provide an overpayment self-disclosure to the Department of Health and Human Services Office of Inspector General? This voluntary disclosure should be assessed with a cost benefits analysis lens while being mindful of the associated nuances.

A former surveyor tells THE key to getting good star ratings

Until the State Operations Manual becomes the quintessential tool for regulatory compliance, a 5-star rating will be out of reach for skilled nursing providers. It's as simple as that.

To tell a story is to change a life forever

Last summer, along with my older sister and our children, we made a 900-mile trek across four states for no other reason than to sit across a picnic table from our paternal grandfather and listen to his stories.

A psychologist's view of best-practice dementia care

I propose medical, nursing and other healthcare professionals consider the following guidelines in providing appropriate care of people who suffer from dementia

Unfortunately, turning away opioid addicts might be necessary

While the practice of turning away opioid addicts may appear heartless, this may be necessary given some of the administrative and regulatory hurdles that exist.

What is your plan to catch Bigfoot?

The shrinking workforce has created a "Bigfoot Phenomenon" in the recruitment process of top directors of nursing in the long-term care industry.

The case for dialogue over swift sentencing

As a leader in the nursing home setting, I see the accountability game played out quite often. Mostly, it's a facility has failed to meet a certain standard of care and a state surveyor, during a detailed review of a glut of required documentation has unearthed that issue.

Why I chose to join the nursing home profession: A new administrator's story

When my grandmother died, I didn't know anything about the medical field, nursing homes or taking care of people. What I did know, though, was that I could do better than the care she received.

Strategic goals: Do your goals align with the goals of CMS?

Many times as leaders we feel that our actions are prescribed by entities beyond our immediate needs of those we serve.

Payment reform: Ready! Set! Don't go! No, I mean go!

Perhaps you think that the new therapy-payment bombshell (RCS-1) has turned out to be a dud. I hope to make the point that it was not.

Lessons from the Hill: Can one person make a difference? You bet.

With almost 15 years' experience in grassroots advocacy, working for causes from cancer to Alzheimer's prior to my current focus on aging services, has me convinced: Each and any one of us can have an impact without leaving our home turf.

Fulfilling needs to support purposeful living

To move from providing only the most basic of needs (shelter, safety and physiological support), providers need to understand how optimizing their engagement strategy can move their residents up on Maslow's pyramid.

Reducing the overuse of antipsychotic medication: A person-centered care approach

In recent weeks, a study by the Human Rights Watch has shed light on a serious problem across many facilities where seniors live in America: the over-prescription of antipsychotics to unnecessarily medicate individuals with dementia.

Why I stay in the game: A determined nursing home administrator

There has been a lot of buzz generated by Julie Boggess' piece on leaving the profession from at least a bit of burnout. I am choosing something different. I am choosing to make a difference in the profession, teaching the leaders of the future and doing my best to implement this stuff in my building.

Dining and dementia: CBV's Silver Spoon Club puts on the pounds, cultivates connections.

The Silver Spoon Dining Club — an innovative approach to address weight loss issues for residents with late-stage dementia — is not only realizing its goals of improving resident weight loss and reducing nutritional supplement intake. More importantly, it's also bringing socialization and a bounty of "feel good" benefits to residents, non-nursing volunteers and staff at Central Baptist Village.

Hollywood needs to 'wise up'

Who better to tell Hollywood to "wise up" than the California Commission on Aging, the state's leading advocate for healthy, purposeful longevity?

Why I chose to leave the nursing home profession: A fed-up executive's story

At one time, I was a nursing home administrator who was "on fire" about the topic of culture change in long-term care. I believed that working to de-institutionalize the institution was the reason I was guided into the industry over 30 years ago. No more. I couldn't continue.

Let the positives outnumber the negatives

Easy to list negatives. Easy to become reclusive. No matter when you leave a home. Or retire. No matter the time or age or gender. Be positive in setting the goal, rejoice on reaching it: in a retirement home, in your long-time home, in a new marriage, in a new grandchild — all a new rhythm. Be positive. Reach! Try! Strive! Age allows it.

Palace residents embrace Yiddish for anti-aging and keeping their heritage alive

When instructor Chany Stolik comes into the classroom at The Palace Coral Gables, her students typically say a "gutn morgn" instead of "Good Morning."

How will PBJ impact Five-Star staffing? Would you like one lump or two?

We don't know when, and we don't know how, but when Payroll-Based Journal staffing data replaces the data currently being captured from CMS Form 671 for calculating Five-Star staffing, we are likely going to take several lumps.

The power of biases

Establishing processes to utilize root cause analysis for quality improvement is necessary, but it takes discipline. One of the first steps is to challenge your own beliefs about safety and quality failures.

The top 11 questions all operators still have to answer in 2018

There are many factors that determine what can or must be done to ensure a facility can survive and ultimately thrive. These 11 questions help to indicate the stability and sustainability of a facility and its market.

'All We Have Is Today': Music therapy at the end of life

How can we provide our residents the compassion and care needed for their physical, emotional, social, and spiritual well-being at the end of life? Bring them, or surround them with, music.

Just the facts? No way. Managing agitation and behaviors in dementia

We need to better understand our dementia residents and learn how to enter their world to make them comfortable, maintain their dignity and improve the quality of their lives.

Congress should require more Medicare claim auditing — before and after payment

There is a much more efficient solution to reducing Medicare spending than the proposed broad cuts to the program budget: Reduce the billions of dollars in incorrect payments each year.

Salus decision offers a golden ticket to some long-term care facilities

With many whistleblower cases ending in multimillion-dollar settlements, providers could easily conclude that the deck was unfairly stacked against them in 2017. But the tide might have turned.

Coming to terms with Software as a Service agreements for long-term care

Each of these key terms can present significant risks if not negotiated or, at a minimum, understood when dealing with a Software as a Service (SaaS) agreement. All providers should be aware.

Long-term care heroes needed to help critical blood supply shortage

Every two seconds, someone in the United States needs blood, but this year a massive nationwide shortage is putting lives at risk. In response to this dire situation, the nation's long-term care facilities and support businesses have stepped in to help save lives.

Seven strategies for treating psychiatric patients in SNFs

As part of my early clinical training, I spent some time treating patients at a large psychiatric hospital that has long since closed.

Understanding Maryland's SNF landscape

All skilled nursing and rehabilitation centers are not identical, and when they are prepared or required to admit and retain challenging residents they need the support and consideration of residents, responsible parties, advocates and agencies in a fair application of requirements and the reimbursement commensurate with those needs.

Does cognitive impairment contribute to SNF-to-hospital transition?

Exceptional SNF utilized appropriate structure, process and outcome measures. Despite this, however, it might have better been called "Mediocre SNF."

Plans for preparing and responding to disasters a must for LTC

Based on their assessments of the risks, different facilities may prioritize different types of hazards in the planning process.

Fall prevention and protection from injury: A global challenge

Research indicates that every second of every day, an older adult around the world falls and sustains injury. In a care setting, a fall is even more so troublesome.

Death with dignity: dying to die

The issue of physician aid in dying is controversial at best and implicates the intersection of law, medicine and ethics. While the law allows for physician aid in dying in a handful of states, not all professional organizations have embraced or supported this growing movement.

To help elderly patients, CMS should prohibit PBM fees - not reform them

Over just the past few years, the nation's three largest pharmacy benefit managers (PBMs) - CVS Caremark, Express Scripts and Optum Rx - have come to control more than 80% of prescriptions dispensed in America. For seniors living in the nation's long term care (LTC) facilities, and served by LTC pharmacies, this percentage jumps to more than 90%- a true oligopoly.

Behavior management plans for challenging behaviors

"Mrs. Jones" is in the middle of the dayroom, once again engaging in verbal abusiveness that disrupts the residents, families and staff on her unit.

Data equals understanding and requires integration

The long-term care space is rapidly changing and evolving. Big data analytics will play a key role in helping to shape the future of this space.

10 lessons we learned on our culture change journey

Almost exactly 6 years from the date of our first training, we recently added our 50th home to the Eden Alternative Registry.

In addition to caring for patients, SNFs must take care of business

Nursing homes have an epidemic health problem these days, but it's not in their patient population, it's on their own balance sheet.

Beer and Wings or Wine and Cheese?

As someone who has close to 20 years of long-term care recruitment experience and who has personally worked as a nursing home administrator, I understand how important culture is when making the right hire. The first step in creating the right culture is matching the best candidates with your beliefs.

Creativity knows no age limit

Legacy featured the works of 20 established and emerging senior artists from Long Beach, CA, and surrounding communities.

How good does your data need to be?

It's a loaded question: How good does your data need to be? If we're honest with ourselves, we must admit that we're not perfect. Nor are the systems we create to help minimize error perfect.

The therapy cap reborn

At the end of 2017, Congress recessed before a decision was made on the repeal of the Part B Therapy Cap that we've been living with, working around, and appealing since 1998.

Is sub-acute care in a SNF the best option for cancer rehab patients?

With each new year, cancer patients find continued hope that a cure or treatment for their disease will lead to longer and fuller lives.

Your line staff of CNAs and nurses will make or break your facility's reputation

I was meeting with a new client recently at their skilled nursing and rehab facility for our in-service prior to launching their online digital marketing campaign.

The true cost of obesity to SNFs

While federal regulations state that nursing homes must provide "each resident with a nourishing, palatable, and well-balanced diet that meets dietary requirements and any special dietary needs" under the guidance of a registered dietician, facilities have a lot of flexibility on how this regulation is met.

Arbitration agreements: Is a signature enough?

What are long-term care providers to do post-Kindred? Should they expect that their agreements to arbitrate will be enforced or invalidated at the state level?

ACE (Acute Care For Elders): Integrating acute, post-acute and LTC

Over the last 20 years, there is a movement to assign elders to units that specifically address their need.

SNFs: Time to step up, not give up

The design of the BPCI-Advanced program appears, at first glance, to offer little opportunity for SNFs looking to redesign their business models and take episodic healthcare risk alongside hospitals and payers. It effectively sunsets the original BPCI option that kicked off the risk-based episode at post-acute admission (called "Model 3"), leaving all bundled post-acute services to start with either an inpatient or outpatient service.

4 considerations for building your emergency preparedness plan

From Hurricanes Irma and Harvey to the California wildfires, there has been no shortage of extreme weather around the country.

Understand the resident to understand the behavior: Part 2

I am frequently asked to consult about "inappropriate" behavior in skilled nursing facilities. The question is usually something like: "We have a resident who is doing 'X behavior'— what should we do?" (You can fill in the X with behaviors like wandering, yelling, hitting, hoarding, etc). My answer is always along these lines: "I have no idea what to do, but please let's talk about this particular resident."

Lessons Learned: What falling out of the sky taught me

Suddenly the plane dropped and items went flying, including people. We heard the strange noise again and realized that this was not normal turbulence.

#Unboxme in 2018

I know you think you have unwrapped all of the presents under your company's Christmas tree-but wait. I know of a present that you haven't "unboxed" yet and it's the gift that keeps on giving year after year.

Make a resolution to use email better

Think about SBAR. Situation, background, assessment, recommendation. Apply it to email. In other words, think bullet points, not novels.

Playing it safe: The need for a comprehensive safety program

Does your organizational safety program and committee focus solely on employee injuries and Workers' Compensation issues? If so, you are not alone.

Depression in dementia: How do you know?

Most of us have used or at least aware of the PHQ-9 (Patient Health Questionnaire) scale for depression. Through a series of questions that are directly related to the DSM-IV criteria, a patient or caregiver can determine whether they're depressed and how best to address their depression.

As demand increases for granny cams, what should LTC facilities do?

The post-Hurricane Irma disaster at a Florida nursing home, where multiple residents died from heat-related problems when the electricity went out, prompted a last-minute legislative add-on — allowing recording devices in residents' rooms — to a Florida bill requiring back-up generators for long-term care facilities.

Provider survival strategies in an at-risk environment

National health expenditures will increase from $3.5 trillion in 2017 to $5.5 trillion in 2025, according to the Centers for Medicare & Medicaid Services. That's two trillion dollars in only eight years, and accounts for 19.9% of the GDP

Loophole allows low volume Medicare providers exemption from auditing

The current implementation of Medicare's sliding scale ADR limit policy is preventing the recovery of improper payments and has afforded a significant portion of providers with immunity from billing accuracy review due to the low volume of claims they submit

Five-Star is anything but frozen

The day after Thanksgiving, CMS further defined its intensions with the Five-Star Quality Rating System; more specifically how the new survey process and derivative data will be used in its calculation of the Health Inspection domain. Here's what that means — and doesn't mean.

Coordinated care: Recommendations to improve quality

Despite all of us having heard at least one story of good medicine gone wrong, coordinating care among skilled nursing facilities (SNF) and home- and community-based services (HCBS) can be a win-win situation.

4 reasons to consider horticulture therapy as an alternative treatment

Growing and arranging flowers and cultivating greens allows them to practice real tasks that are used in everyday life.

Electronic Health Records: It's not you, it's me?

In recent years, the number of long-term and post-acute care providers who use electronic health records has grown rapidly in response to increased regulations, additional data requirements, and downstream pressure from acute care partners and accountable care organizations.