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Anthony Cirillo

Assisted Living


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The staff experience: employees have human needs too!

Wednesday April 16, 2014

Here is an excerpt from my recent Hospital Impact blog. In essence, healthcare must heal itself before it can heal others.

This month's blog post extends from both my January and February posts. In January, I shared how short-sighted financial decisions hurt patient experience. In February, I discussed my new role as primary caregiver to my mom, suggesting that instead of focusing on patient experience, we should look at the human experience.

One comment on the January post serves as a good segue for the rest of this piece.

"Health and wellness, just as death and dying, affect all of us. Clinicians and administrators share in the wins and defeats in healthcare. As nurses, we need to be in the mix, collaborating with various stakeholders, while holding the hand of another human being to ease their suffering."


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Quality Indicators No Good If Staff Does Not Understand Them

Monday April 14, 2014

A survey in the Journal of Research in Nursing shows that most nursing home staff do not fully understand the meaning and value of MDS 3.0.

A survey was used to measure clinical leadership's perceptions of staff understanding of the minimum data set (MDS) quality indicators (QIs) and ways to improve staff understanding of this system, as well as specific perceived training needs among Department of Veterans Affairs (VA) nursing home care unit (NHCU) clinical leadership.

An online survey using structured (quantitative) and open-ended (qualitative) items was conducted in 97 VA NHCUs nationwide. A total of 289 leadership staff including directors of nursing, medical directors, MDS coordinators participated.

Most respondents rated their frontline staff as having "good" to "fair" understanding of how the Quality Indicators are computed through MDS data. Lack of involvement with the MDS is the greatest barrier to greater understanding, the respondents indicated. Workers are often excluded from MDS processes, and there is a lack of training, the researchers found.

Respondents recommended education/training, involvement, reinforcement and other methods to increase understanding. Of specific training strategies/needs, the most frequently identified were using the MDS as a clinical assessment tool.

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22 Percent of Medicare Beneficiaries Experienced Adverse Events During SNF Stays

Friday April 11, 2014

More of this will happen if SNFs don't get their act together.

The Office of the Inspector General conducted a series of studies from 2008-2012 about hospital adverse events, defined as harm resulting from medical care. This work included a Congressionally mandated study to determine a national incidence rate for adverse events in hospitals. They continued that work by evaluating post-acute care provided in skilled nursing facilities (SNF). SNF care is second only to hospital care among inpatient costs to Medicare. What they found - almost one on four people experience an adverse effect during a SNF stay.

The study estimated the national incidence rate, preventability, and cost of adverse events in SNFs by using a two-stage medical record review to identify events for a sample of 653 Medicare beneficiaries discharged from hospitals to SNFs for post-acute care. Sample beneficiaries had SNF stays of 35 days or less.

An estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care. Over half of the residents who experienced harm returned to a hospital for treatment, with an estimated cost to Medicare of $208 million in August 2011. This equates to $2.8 billion spent on hospital treatment for harm caused in SNFs in FY 2011.

The OIG recommends that:

  • AHRQ and CMS raise awareness of nursing home safety and seek to reduce resident harm through methods used to promote hospital safety efforts.

  • There be collaboration to create and promote a list of potential nursing home events-including events not commonly associated with SNF care-to help nursing home staff better recognize harm.

  • CMS should also instruct State agency surveyors to review nursing home practices for identifying and reducing adverse events.

This report would indicate that nursing homes are failing as quality partners to hospitals in reducing readmissions. And that spells opportunity for assisted living and even skilled home health providers to fill the gap. After all, being in a nursing home is not much better than being in a hospital in terms of your likelihood to acquire an infection or other illness. A less acute setting coupled with the right care might be the right recipe in reducing readmissions.

McKnight's Long-Term News and Assisted Living editor staff writer Tim Mullaney has an interesting take on this too.

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Significant Gap in Healthcare Workers Predicted

Wednesday April 9, 2014

We need a lot more people getting interested in our elders.

The U.S. is unprepared to meet the current and future workforce needs for its older adult population, according to a set of state-specific issue briefs released by the Eldercare Workforce Alliance (EWA). The Alliance, a coalition of 30 national organizations committed to strengthen the workforce trained to care for older adults, cited data from the Health Resources and Services Administration and the Administration on Community Living showing the amount of federal funding going to each state to help develop a competent geriatrics workforce and support family caregivers.

Despite the growing need for eldercare, currently there are not enough healthcare professionals, including direct-care workers, trained to care for older adults. "We need a well-trained workforce and supports for family caregivers to meet the unique needs of older adults," said Alliance co-convener and American Geriatrics Society chief operating officer Nancy Lundebjerg. "Person- and family-centered interdisciplinary team care has been the hallmark of geriatrics and is the key to older adults receiving quality care and remaining independent for as long as possible."

"Nationwide we will require over a million new direct-care workers alone to provide critical care to people with long-term care needs," said Alliance public policy committee chair and PHI national policy director Steve Edelstein. Data from the Bureau of Labor Statistics cited in the issue brief finds that Personal Care Aides and Home Health Aides are among the fastest-growing occupations with demand expected to increase 49% by 2022.

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New Report Shows Other Side of Consistent Assignment - Isolated and Overburdened Staff

Monday April 7, 2014
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Chris Perna, CEO of Eden Alternative, respectfully disagrees!

Consistently assigning nursing home aides to particular residents could cause the aides to feel isolated and overburdened, suggests a study forthcoming in the Western Journal of Nursing Research. However, a prominent voice in the nursing home culture change movement says the study simply shows that providers must adhere to best practices to see the benefits of consistent assignment.

See the full post at McKnight's Long-Term Care News & Assisted Living.

Chris Perna

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Family Participation at Meal Time Has Benefits; Does Not > Food Intake

Friday April 4, 2014

While family participation in meal time has its benefits, apparently it does not help a loved one eat more.

Seventy-four nursing home residents from two Veterans Affairs (VA) and four community facilities in one geographic region were studied at mealtime periods in which family was present and compared with mealtime periods when family was not present for the same resident.

Results showed that family visitation was infrequent during mealtime; however, feeding assistance time was significantly higher when visitors were present. Despite the increase in assistance time, there was not a significant difference in intake.

Strategies that encourage the involvement of family in mealtime assistance may have additional benefits not directly associated with meal consumption, including providing family members with meaningful activity during a visit and enhancing residents' quality of life and well-being.

According to Alzheimer's Disease International and cited in an earlier post here, up to 30% of residents in long-term care are undernourished. In a report it recommended that:

  • Nutritional standards of care for people with dementia should be introduced throughout the health and social care sectors, and monitored for compliance.

  • All people with dementia should have their weight monitored and nutritional status assessed regularly.

  • All people with dementia, and their family carers, should receive dietary advice from a dietitian as a part of post-diagnostic care, updated, as appropriate, as their condition evolves, particularly with the onset of weight loss, aversive feeding behaviours, and need for feeding assistance.

  • Undernutrition, once established, is a serious health concern requiring medical attention and input from a dietitian and occupational therapy as appropriate. Those at risk of undernutrition require a detailed assessment of diet, feeding behaviors and need for feeding assistance. This should inform an immediate and intensive nutritional intervention to restore and maintain normal nutrition.

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CMS Pauses RAC

Wednesday April 2, 2014

CMS will takes it eyes off RAC for a bit!

In an update on its web site, CMS stated that it is in the procurement process for the next round of Recovery Audit Program contracts and it is important that it transition down the current contracts so that the Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts.

In addition, they state, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program.

It is is reviewing:

  • Additional Documentation Request (ADR) limits

  • Timeframes for review and communications between Recovery Auditors and providers

June 1 is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment.

CMS will continue to update its website with more information on the procurement and awards as information is available. Providers should contact RAC@cms.hhs.gov for additional questions.

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The Conversation Project Sparks End of Life Care Talk - April 16 is National Healthcare Decisions Day

Tuesday April 1, 2014
five wishes

The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. April 16 is National Healthcare Decisions Day - a time for families to consider discussing end-of-life care, especially before an illness strikes.

Too many people are dying in a way they wouldn't choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain. I can certainly attest to that with the sudden death of my sister and a general lack of knowledge our immediate family had about her wishes. Upon moving mom from FL to NC, we completed the FIVE WISHES document to assure we were all on the same page with her care. Ironic that when we switched her health plan, Blue Cross Blue Shield of NC included a Five Wishes document with her enrollment kit!

The Conversation Project believes it is time to transform our culture so we shift from not talking about dying to talking about it. It's time to share the way we want to live at the end of our lives. And it's time to communicate about the kind of care we want and don't want for ourselves.

Read more here at my Educated Aging blog.

Five Wishes

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Looking for Nursing Home and Assisted Living Activity Directors to Pilot New Music Program

Monday March 31, 2014

I am excited to announce a new, inexpensive way to broadcast live music over the Internet to residents in assisted living, skilled nursing and to elders in their home. It is called Stageit and it is an online venue that allows musicians to stream exclusive LIVE concerts.

I will stream live shows to you that your residents can watch, allowing you to bring live, interactive entertainment into your facility. You can use it as a group activity or a one on one activity with residents. It can also be used in adult day care centers and is perfect for home-bound elders.

You can interact with me live, talk to other activity directors and also call attention to special occasions, birthdays, etc. that are taking place at your organization that I can recognize on air. This interactivity is sure to delight residents.

Before I make a full-scale launch of this, I am looking for organizations and activity directors that would like to pilot this and engage with me in what is called a sound check. During this sound check, you will be able to see and hear the quality of the production.

There are some technical requirements and I can walk you through them.

You can "Follow Me" by going to http://www.stageit.com/Anthony_Cirillo. While there you can explore StageIt.

Want to have some fun? Contact me at anthonycirillojr@gmail.com and we can set up your sound check.

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U.S. News Releases Best Nursing Home List

Monday March 31, 2014
us news

U.S. News & World Report released its Best Nursing Homes 2014 at the end of last month, covering almost 16,000 nursing homes nationwide.

Best Nursing Homes provides data and information on care, safety, health inspections, staffing and more for nearly every nursing facility in the U.S. A searchable database lets users find highly rated nursing homes by distance as well as by location. Each facility's profile displays health and fire violations, performance in important clinical categories and how much time nursing staff spends with residents.

To create Best Nursing Homes 2014, U.S. News drew on data from Nursing Home Compare. U.S. News awarded the "Best Nursing Homes" designation to facilities that recently earned the agency's highest overall rating of five stars.

In the new ratings, the share of nursing homes with the top five-star rating has reached 25 percent, up sharply from about 19 percent last year. California has the most five-star-nursing homes, followed by Florida, Ohio, Texas and Pennsylvania.

As I tell clients and consumers alike, these ratings are merely a starting point. They can help narrow choices. The real test comes when you visit a care facility and start to pick up on the culture cues. I find at the end of the day, you go with your gut. I have had to a few times in the care of mom and have been pretty accurate in my assessments of places. That is a lesson for both consumers and people working in the industry. And again, doesn't it boil down to the experience of care!

US News and World Report

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