The Nursing Home Podcast: Recent Episodes

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Timestamps

(00:00:02) Introduction

(00:01:01) Healthcare Risk Management Experience

(00:02:18) Fair Housing Act Explanation

(00:08:15) Prohibition of Disability Discrimination

(00:15:57) Understanding Essential Requirements

(00:23:15) Rules Around Common Accommodations

(00:29:42) Risks & Fair Housing Marketing

(00:34:55) Legalities for Assisted Living Services

(00:40:17) FSA & Housing Education

(00:43:22) Rules Disregard in Senior Living

(00:47:41) Risk Tolerance Discussion

(00:49:06) Risk Management in Senior Living

So as you mentioned, I did medical malpractice defense for a number of years in New York,

and then I moved to Pennsylvania because I was getting married and my husband was from

out of state.

And when I moved, I decided to switch hats, and I decided to do healthcare risk management.

So I was tasked with starting up a risk management program for FSA.

At the time, we started with 12 organizations, nonprofit, faith-based communities, generally

in the Philadelphia area.

Since then, we've expanded quite a bit, and we now have 37 sites in six states.

And so I give guidance and consultation on risk management issues.

So today, we are going to talk about marketing risks, but I'm going to talk about it from

my perspective, you know, from a risk management perspective and a fair housing perspective.

Okay.

So thanks for that background.

So let's get right into it.

What is the worst-case scenario if someone says, you know, I'm going to market however

I want to market?

I'm going to say what I want to say, do what I want to do.

What have you seen as like a worst-case scenario of someone has done this and this horrible

outcome has happened?

Great question.

Nothing like the fear factor right from the beginning.

So what I'm going to preface that question with is an explanation of why there are risks

in this venue, in this area.

And so in 1968, Congress enacted the Fair Housing Act, which was what I like to call

the third leg of the stool for civil rights litigation, legislation rather.

And so we had the Civil Rights Act, then the Voting Rights Act.

And then in 1968, they passed the Fair Housing Act.

And that precluded discrimination in housing choices and lending based upon what we call

the protected class status.

So started out with race, religion, national origin, color, gender, which now includes

gender identity and sexual orientation, and national origin.

In 1988, Congress amended the act to include two additional protected class categories.

Familial status, meaning that you are not supposed to be able to discriminate against

families with children.

And of course, there is a carve-out for our senior living settings.

And the one for purposes of our discussion today, which will be very pivotal, is it says

handicapped, but it's what we would refer to as disability.

So you have now protections under the Fair Housing Act, and we just call it FHA for both

the Amendments Act and the original act for all those protected classes, which act

essentially as a floor, not a ceiling.

So state and local jurisdictions can also add an additional protected class categories,

like, for example, maybe marital status, saying that, you know, you can't discriminate

against somebody because they're unmarried or, you know, because they cohabitate

together, for example, or source of income is another one that's fairly common.

So I think for a lot of senior living communities, they don't necessarily recognize

that they are covered by this act as a housing provider, because I think for a lot of

communities, they say justifiably, well, we're not a housing provider because we do so

much more than that. And you do.

However, in the eyes of the government, you are a housing provider and you are subject to

the Fair Housing Act.

And so there are lots of risks that come along with that.

Now, if you choose as an organization just to decide that you're going to market any way

you want to and you're not going to pay attention to various marketing risks, including

fair housing risks, what's the worst case scenario?

The worst case scenario is that you end up being in litigation, sued by potentially a

federal government. So it's now the United States of America versus, you know, senior

living community, A.B.

State. You are in litigation with the government.

You are being sued for housing discrimination.

Almost always that ends very badly for the community.

Almost always winds up in a monetary settlement.

Many times there is also a settlement compensation fund where the community has to

advertise in multiple places for people that have been subject to what they've just been

found by the government to be illegally doing.

Let's just say discriminating against those with scooters, for example.

And so they would have to advertise for anyone that's been impacted by that to give them

money. In addition, there's almost always what we call a consent decree that comes with

that. It's sort of, if you're familiar with the world of compliance, it's similar to

a CIA or a corporate integrity agreement whereby the government puts you into this

consent decree.

And the consent decree not only sets out the exact amount of money that you're going to

have to pay and how you would advertise to those who have been subject to your

discriminatory practices to give them money.

But there's also usually quite onerous burdens that are placed on the community,

including things like they get to and the government will review your actions for a

period of time. Usually it's about five years.

And so they will oversee and have to approve the policies, put policies in place for

whatever the particular topic is, change contracts, sometimes hire a fair housing

officer to perform acts to training and education for the staff on an ongoing basis.

And again, being overseen by the government for a period of time.

In addition, I would also say that you don't want to be the poster child for that.

So again, I happen to mention scooters.

And one of the pivotal cases in the world of, you know, communities that have been sued

for improper restrictions on scooters is a community called Twining Village.

And I don't like to use them, you know, but that that case is out there and everybody

knows about it. So you don't want to end up having the reputational damage in our world

of, you know, senior living where it's like, oh, that's the Twining Village case.

And so, you know, everybody knows based on that case, you know, some of the policies

that you have to have in place and the no-nos, the things that you shouldn't be doing.

You don't want to become the poster child for that, which can very easily happen.

Well, so a couple of questions.

Thank you for that. I mean, that's quite an overview.

So it were someone to actually go ahead and let me just back up.

So you're saying that there's the fair housing law, which puts nursing homes together in

that category. So therefore, they have these discrimination laws like you've outlined.

So is this, first of all, is this specific to marketing?

Are we talking about someone denies a patient because we don't take we don't want patients

with scooters because patients with scooters are dumb or whatever.

Yeah. So I'm speaking broadly about senior living communities.

Right. So it's anywhere that a person lives.

Okay. So if you are running a short term rehab only, then potentially you are excluded from

the Fair Housing Act because that's not someone's home.

The intention is to treat them for a brief period of time with the intention to discharge

them. However, it does apply clearly.

All the case law is very clear on this.

It does apply to settings like CCRC, independent living, assisted living, personal care,

long term care. So all of those things, you know, adult foster care, it does apply to all

those settings. It is questionable whether it would apply in the context of a short term

rehab strictly.

Okay. So let's back up.

If I don't have if I have a regular store and I sell chocolate and desserts and flowers and

what else? I can discriminate all I want?

No. There are other laws.

There are other laws that prohibit you from from doing that, that we're not necessarily

speaking about today. But again, when it comes to housing, we are under the auspices of

multifamily housing specifically, which means four or more people in a unit or, you know,

four or more units, I should say, not four more people.

Then you are subject to the Fair Housing Act.

So. Okay.

So the Civil Rights Act says that you can't discriminate.

Right. Suggested.

I understand that. So my point is that you have extra laws when it comes to if you're

managing or you own a home that has multiple families, say for like you said, four units

or more. So then you have you have extra focus.

So now let's assume someone has an assisted living facility, a long term care facility,

really can be an apartment building, too.

But we're saying even senior living facilities and they're going to and then they

discriminate against someone.

So does that mean that they refuse admission to someone?

Okay. So that's a great question.

So discrimination can take multiple forms.

It can be just as you said, refusal of admission or refusal to someone, an applicant to

be denied admission.

That can be a form of discrimination.

It can also be a form of discrimination, which is very common.

Probably the most common form of discrimination is the refusal to grant what we call a

reasonable accommodation for disability.

And that's where the scooters would come in, for example.

So if I was disabled and I had a mobility impairment and I required a scooter to enable

me to get around and to meet what we call the essential requirements of tenancy.

And you, as the provider, refuse to allow me to have that scooter or, for example, that

service animal, like you have a no pet policy and I wanted to come in with a service

animal. Well, that's not a pet, that's a service animal.

That's for my disability. That's a reasonable accommodation.

So you can refuse and then you could again potentially be sued for that.

But in addition to also refusing to admit somebody, which is a form of discrimination,

there are a multitude of other forms of discrimination under the act.

And it can be I come in and I'm able bodied when I come in.

And after I'm a resident at your community for some period of time, I now become

disabled. And again, I've asked for reasonable accommodation, whatever that may be.

And you now refuse to give me that reasonable accommodation or you are discriminating

against me and saying, because let's say I had a let's say I had a fall.

I lived in independent living and I had a fall.

And you say, well, now you're not independent anymore.

And so you need to move to assisted living because you had a fall.

You can't from a legal standpoint, from a fair housing standpoint, they'd have to be way

more to it than just forcing me to move up through the continuum for something like what

I just described. And then additionally, I would also say that, you know, there are

again, just treating that it's essentially under the Fair Housing Act, we don't want to

treat anyone worse, which is the more common thing to do.

We also can't treat anyone better because of their protected class status.

So if so, again, we serve primarily faith based communities.

So if I had a community that was, for example, a Quaker community and they said, because

we are a Quaker community, we want to give preferential treatment in admission to Quakers.

You don't have to meet the same kinds of financial requirements as we require from everybody

else. You can't do that either.

Right. So, again, it's admission, but it's also discriminating against somebody once

they're there.

OK, so there's also what's the line?

And I guess this is where the gray area comes in between providing reasonable

accommodations in this type of living setting versus we have a no

scooter policy, let's say, because of a certain maybe safety concern that we have due to

our building. Or maybe we don't allow service animals, even though it's not a pet, because

we have residents with advanced dementia and they view service animals as monsters.

They're going to eat them up or any other sort of reason, assuming that it's true

or even if it's not true.

I mean, you get a good attorney to make something up, but the reasonable accommodations

versus actual practical reasons why that it's not discrimination, but there's an

actual ramification of being, you know, let's see your example.

Someone was in an independent living and suffered from a fall and now can no longer

ambulate safely in that setting.

And they want to say, OK, now you have to move on.

You know, CCRCs, you have to move on to the assisted living.

Like, I don't want to go to the assisted living.

Well, over here, you can't take a shower.

You can't, you know, prepare your food.

You physically can't do any more.

We're not discriminating because we don't like people who fall, people who are old or

people who are weak.

We're just saying that we feel that this is not appropriate.

So is that where, and obviously the other side is that, no, I'm fine.

It's just because I fell.

Don't tell me I need to move on.

Let me get some therapy.

Let me go to the doctor.

Let me let this thing heal and I want to stay where I am.

So is that where, is that why people like you have jobs?

Right.

So, yeah, perhaps that's why people like me have jobs.

But what I would say to you is, you know, there are parameters around certain things.

So let's talk a little bit about that.

So, again, when we talk about disability, we, there is a requirement under the law that

says that in order to live someplace, whether that's just in the community at large, you

know, an apartment building or in a senior living setting, the tenant or the resident

has to meet what we call the essential requirements of tenancy, no matter what.

Disability, no disability, you still have to meet the essential requirements of tenancy.

So what are those?

First and foremost is paying your rent and fees on time.

Number two is keeping your unit in a safe, clean and sanitary condition.

Now, you know, I think that reasonable people may differ as to what's safe, clean and

sanitary. Right.

Also obeying the reasonable community rules.

Okay. Unless, of course, there has to be an exception made because of the reasonable

accommodation because of somebody's disability.

But again, generally speaking, you should have a set of reasonable community rules because

people have to obey those rules.

You also cannot have excessive damage to the unit.

Okay. Normal wear and tear is okay.

If I scrape the walls because of my scooter, that's okay.

But if I decide to, you know, take a hammer and make holes in the walls, that's not normal

wear and tear. Also not unduly disturbing the peace and tranquility of others.

Okay. And the last one, which is very important, is not being a direct threat to the

health and safety of others.

Now, in my opinion, and this is not in the law, this is not in the essential requirements

of tenancy. When you are in a senior living community, I feel that it is reasonable to

say you cannot be a direct threat, a direct threat.

That's very important language.

Not speculative, a real direct threat to your own health and safety.

Okay. So, but that's not been tested in the courts yet.

That's Christina's theory.

But I think it's a good one.

And so.

Hold on, let me talk about that for a second.

If someone's, and they're a threat to themselves, and certainly if they're a threat to

themselves, even if they're not, if they're trying to physically harm themselves, they're

trying to slit their wrists, they're trying to jump out a window, they're trying to, I

don't know, whatever, anything else that's unsafe.

And the facility has done everything that they can to prevent, stop, intervene, assist.

So there's a question, there are those who say that, no, you cannot, let's say, Section

12, you cannot send them out to the hospital because that would be discrimination.

Is that even a possibility?

Well, no, under the scenario that you just described, you're not evicting them.

You're not getting them out permanently.

You're just sending them out.

So I would say, no, that's reasonable.

But there have been situations, I like the examples that you use because they are extreme

examples. And I would argue, if I was a provider, that there is no reasonable accommodation

that will diminish that threat.

But that's always going to be a question because tying in with meeting the essential

requirements of tenancy, which everyone has to do no matter what, that's where the

reasonable accommodations come in.

So if I have a disability and I ask for a reasonable accommodation or you become aware

that I need a reasonable accommodation, then it should be granted because the reasonable

accommodation is generally what's going to help me meet those essential requirements of

tenancy. Now, going back just to the example that you used.

Someone who's suicidal or homicidal, even.

The, you know, I could say I can't handle, I don't have, I'm not equipped to handle

psychiatric issues and I certainly can't, you know, protect my other residents from this

homicidal individual or I can't protect them from themselves because there's so many

ways that they could attempt suicide.

And so they are not meeting the essential requirements of tenancy because they are a

direct threat. There have been occasions and there have been some cases.

Where in circumstances like that, the courts have said, well, and it's not specific to

senior living, it's just general housing.

Well, you should try a reasonable accommodation first.

So, for example, if you send that person out, you know, to be involuntarily, you know,

incapacitated in a psych facility for a period of time.

And let's say that they have been given medication that would, you know, presumably

control their behaviors.

Then the resident or the tenant in this case would be able to say, well, my reasonable

accommodation and I should be allowed to stay because I can remain on this medication

regimen and then my behaviors are controlled.

But I know of a case from a number of years ago, multifamily housing out in Connecticut,

and an individual had psychiatric issues and actually went after the landlord with a big

butcher knife and threw him down to the ground and started to stab him.

That gentleman was arrested and then the landlord sent notice, you know, you're hereby

evicted. You know, after he got out of jail, after he spent some time in jail and came

back, he realized that he couldn't come back to the apartment because he had been

evicted and he sued and he said, you're discriminating against me.

And the court in that case actually said, well, you have to try.

Let him have his reasonable accommodation.

And, you know, but I think that's not, in my view, that wouldn't be a reasonable

accommodation. It's not reasonable to allow someone who has, you know, extreme

behaviors like that, you know, again, that's a direct threat that we can't keep other

people safe or that even that resident, we can't keep them safe.

So that's the extreme example.

But, you know, most cases are not as extreme and most cases you're going to have to try

the reasonable accommodation and sometimes multiple reasonable accommodations before

you would say you're violating the terms of the resident contract or the lease or the

agreement, whatever it is that we have.

And now you're going to have to leave or move up to a higher level of care.

You're going to have to try a few different reasonable accommodations to be safe before

you can generally do that or you'll risk potentially a fair housing claim.

Well, that's very messed up, just to realize that for everybody, because to see that

someone who physically attempted to murder their landlord was jailed for it and now

evicted, reasonable accommodation, that sounds crazy.

But I agree with you on that.

I wholeheartedly agree.

I think that's fair.

But I just felt like I, you know, I had to, you know, kind of raise that to say it's not

necessarily a slam dunk.

But generally speaking, yeah, when somebody is a direct threat and it's not speculative,

it's not fear that something might happen, it's something did happen.

Right. So I want to be clear about something.

When it comes to reasonable accommodations, as a provider, you can and should have

rules. You don't have to make it willy-nilly, but you are allowed to have reasonable rules

surrounding common accommodations, reasonable accommodations.

So, for example, let's use the scooters again.

It would be probably very high risk if you just said we don't allow scooters.

But it's OK if you said we allow scooters, but we have these rules.

A rule, I always encourage my communities to have reasonable rules.

A rule might be that you have to sit with therapy and review the rules of the community

to use a scooter first.

You know, get educated on it and then sign off that you're agreeing, you understand all

your questions have been answered and you agree to abide by the rules.

And those rules might be things like you can only drive your scooter as fast as a

non-disabled person can walk.

You don't have the right to drive your scooter around like Speed Racer.

Right. It may say you have to have a horn and lights if you're going to drive outside.

You have to obey the rules of the road on campus.

You have to have a flag.

You can't park and block fire exits.

You can't block mailboxes.

If you're going to drive into the dining room, you have to have room.

And I want to touch on something that you mentioned a few moments ago, saying my

community is older and it's not equipped for these big SUV scooters that people have

now. Under the ADA, which also sometimes can tie in with the Fair Housing Act, there

are also construction requirements.

So the ADA went into effect in March of 1991.

So did those construction requirements.

So if you have construction that occurred after March of 1991 or if your building is

older than that, but you've done any kind of a renovation on your building and the term

renovation is pretty flimsy and loose.

It could be even like redecorating can be considered a renovation.

You then have to comply with the dictates of the ADA in terms of the physical

requirements. Like so, for example, it talks about thresholds.

You can't have, you know, a big where someone can't come up on the scooter, you know,

because of the thresholds or, you know, with their walker, that's an issue.

Thresholds, grab bars, lowering cabinets in handicap accessible units.

A certain number of your units should be made handicap accessible.

That depends on how many units you have.

It's a percentage.

And simple things like aisles wide enough for people to use their scooters.

And arguably in our setting, you know, knowing that many, many people do have mobility

impairments, it's even more important, you know, to make sure that your community has

abided by the rules and the Department of Justice, you know, and lots of fair housing

groups. And HUD also has put in a tremendous amount of money to talk about people's

fair housing rights and to make sure that providers and architects and contractors are

aware of what the physical requirements are for spacing and things like that and

thresholds. And they've spent a tremendous amount of money talking about that and

making sure that people are aware.

So it becomes very challenging in these days.

Every month a case will come out at least once a month on, you know, again, the owner

of multi-family housing, the owner of senior housing, a municipality, you know, many

different types for failing to construct their buildings in accordance with the

requirements of the ADA.

So you have to be careful about that.

But there are reasonable rules.

So have them about service animals.

You know, you can have about scooters, you know, any other kinds of reasonable

accommodations. You should have, you know, rules around the private duty aides.

They're another reasonable accommodation that you should have rules about.

Got it. Sometimes we see this, the application of these rules, you know, don't seem so

reasonable. I know a particular construction project that was not required to have an

elevator, but was required to have handicapped accessible bathrooms on the second

floor. Go figure.

Right. Right.

I don't know how, you know, somebody who's disabled, you know, then they would have to

have the right amount of housing on the first floor, you know, handicapped accessible.

It wasn't a housing project per se.

But, you know, we do see things like that sometimes, but that doesn't negate the rules.

But if we can focus the conversation from a marketing standpoint.

OK.

We want to, you know, we titled this the do's and don'ts of nursing home marketing.

So I know that there are things that we cannot say.

For example, the nursing homes can't say that they're dementia units because there are

laws. This has nothing to do with Fair Housing, but this is the Department of Public

Health. They haven't clearly defined a lot of regulations for what's qualified as a

dementia unit. And there's a whole process to go through.

So you can call it memory here.

You can call it a lot of other things.

They can't call it by that name.

I've actually walked in one of the nursing homes I was managing, at least in Massachusetts.

I worked with the gentleman whose name is Dr.

Paul Rea, and he's the one who wrote the regulations for what's called a dementia unit.

And we were thinking of maybe turning one of our units, our memory, our unit though

anyway was a dementia unit, to just make it an official one.

And the cost and just the work that it would take, not just money, but also the

inconvenience and the downtime that it would take to get it in compliance just didn't

make sense. And we changed the wording in our marketing materials and we had the same

result. So instead, we just decided, you know, it was a company decision, you know,

should we do it, should we not do it, so how extensive it was didn't make sense.

So question for you is what is the absolute, give me a great example of someone that did

something horrific in their marketing or something that someone can do like really bad

in their marketing. And like, I guess I'm a worst case scenario person.

And what happened as a result or what could happen as a result?

So let me give you some examples of things that are risks in marketing when it comes to

fair housing. And I've jotted a few of these down so that, you know, I cover everything.

So the first one that I would talk about is models, models or people in your marketing

materials, photographs of individuals, right?

That can be problematic because, for example, we talked about the protected class of race,

right? So if you only have photographs, they want to see, the government wants to see

diversity. So if you have, you know, all Caucasian individuals, that could be a risk for

you because where are the people of color?

You're not allowed to discriminate based on someone's color.

What if everybody in your marketing materials is running, jogging, biking, doing yoga?

Where are all the people that are on scooters, in wheelchairs, with walkers?

So models can be potentially problematic.

Another issue would be problematic language in your materials.

Another one could be potentially, I know a lot of times marketing, especially in the CCRC

setting, will do what's called a targeting marketing campaign, right?

So they want it, they're targeting to a particular income level.

All right. And they're sending the materials out to that, to the people in a particular

geographic area that meet those income requirements.

Well, there have been cases where that's been considered to be a discriminatory practice.

Why? Because you're only sending all your marketing material specifically to potentially

just white people.

Okay. And you're excluding and you may not have any discriminatory intent with that, but

that's the way it comes out.

And in the Supreme Court has decided that in fair housing, there is something called

disparate impact.

It doesn't have to be that you purposely discriminate against somebody, but there is an

actual disparate impact.

So that's an area that you want to be careful about.

Lack of an improper, lack of the fair housing logo, it's the little house, or having the

logo, but it's minuscule.

You can't see it. If you have the logo and you should have the logo, the fair housing

logo, it's put out by the government.

If you have one for leading age and you have one for, you know, whatever local societies

you belong to and they're all of a certain font and your fair housing is teeny tiny in

the bottom, that's problematic.

There is no requirement, by the way, on font, which makes it a little bit more complicated.

But you want to make sure that it's the same size as everything else.

Exclusionary practices for admission.

Again, we don't let people in with scooters or we don't let people in with service

animals. Problematic applications, asking lots of, again, this is for independent living,

not for nursing or, you know, assisted living or personal care.

Asking medical questions, if you're not a type A community, that can be potentially

problematic. Asking intrusive questions, asking them to undergo a physical exam.

If you don't have, you know, a guarantee of moving through the continuum of care, that

can be highly problematic.

Improper. Oh, I mentioned the improper request of physical exams.

Steering, which is a term of art in the fair housing world.

Steering means that I come in and I either and government, by the way, and so do fair

housing groups, send testers in to ask these questions and try if they think there's

discrimination going on, they will send somebody in who pretends to be an applicant or

is looking for housing for their loved one and ask the questions to see what the answers

are. Steering means that I come in and I say, hey, you know, my mom is looking for

independent living.

She uses a scooter.

She needs some help with her medication management.

You know, she sometimes gets a little bit confused.

And, you know, if you were to say to me, well, you know, she might feel a lot more

comfortable if she goes over into assisted living.

That might be a better place for her.

We don't really like those kinds of people in independent living.

We don't want to look like a nursing home.

That's steering. And that is illegal under the Fair Housing Act.

Discriminatory denial of reasonable accommodations.

And again, being aware of the state and local laws that expand upon the protected classes

and making sure that you are not, again, discriminating against additional protected

classes that your local jurisdiction or state may have in place.

So those are a whole series of marketing risks that I would tell you you have to be

careful of. Got it.

So let's say I have an assisted living and I am targeting a certain group because this is

the group that actually needs the service, can afford the service, will maybe want the

service. Is there no legal way to target that group?

If I'm going to put people, let's say, let's see an example of models or even, you know,

language. If I'm going to put words on there or pictures or other things that don't

resonate with them, then they're obviously much less likely to, you know, to respond.

It doesn't mean that these are the only people that are marketing to.

I may have a separate brochure and a separate marketing plan for, you know, for a

different ethnic group or a different protected class.

But right now I want to focus on these people.

You know, an open invitation is no invitation.

Come over to my house any night you want for a barbecue.

That means you're not invited. I'm not even telling you my address.

But if I say Tuesdays at 4 p.m.

having a barbecue, you know, please bring over, bring over your family.

Here's my address. Then you're invited.

Right. So the point is, people will resonate to marketing material if they will act on it

resonates with them. So if it's, you know, if it's tailored to them, then it'll work.

Can I? Is there no legal way to do that?

There, you know, well, first of all, I want to be clear.

I'm not giving legal advice here.

I'm giving you advice from a risk management standpoint.

And so, you know, listen, everything that we do is associated with a risk benefit analysis.

Right. So I want to be clear about that.

So a community can make a determination.

What is their risk tolerance?

If they really want to market and target towards a particular, you know, group because of

their income. And it turns out that that they feel like we could be accused of

discriminatory behavior because it's going to go to, you know, all white people.

That is a question.

If you still want to market to that group, I'm not here to say you can't do it or you

shouldn't do it. I'm just saying, be aware that that's a risk.

Right. So anything that you market on could be a risk.

But if you think that the benefit of targeting a particular group of people is going to,

you know, bring in the people that you want or that you think would benefit from your

services, then that would be your assessment of and that would be a risk tolerance to

your community. Right.

Got it. Who are the discrimination police that are going to bring this case in front of,

you know, they're going to get, you know, secret people coming in undercover and asking

for service.

So the DOJ has testers that work for them in the Civil Rights Division.

Now, who brings it to their attention so that someone would want to come down?

Yeah. So I'm going to tell you, there are a lot of fair housing advocacy groups out

there. There are a lot of law school clinics that also have fair housing, you know,

clinic that are staffed by law students.

The government gives money.

They're like quasi-public, private, public government entities.

They get money from the government in recognition of their work and they get money from

the government to do that.

So they are there to enforce fair housing rights.

Usually the way it would work is if I am an individual, many times this is how it

happens. I'm an individual.

I go, I apply for residency at a particular community.

I feel that I've been discriminated against for whatever reason that, you know, my

disability, my religion, the color of my skin, whatever it is.

I go to a fair housing group and I make a complaint.

If they, they will then investigate my complaint.

If they feel that there is some validity to that, they will do their own research.

They will start their own investigation.

They will have testers.

They will go out. They then turn it over usually to HUD.

With their findings, if they feel that there is what we call a pattern or a practice of

discrimination, they will send it to HUD.

If HUD, the Housing and Urban Development Office of the government, feels that it rises

to a certain level and they think that there is a discriminatory pattern and practice going

on, then that gets referred over to the Department of Justice.

So the lawsuit can either be me, Wildrick versus ABC Senior Living.

If I feel that I've been discriminated against individually, I can sue you in

state court or federal court.

If it's a fair housing group, then a lot of times, you know, that fair housing group

will bring it on my behalf.

So it would be Wildrick and the Fair Housing Alliance versus if it goes to HUD, it

would be, you know, HUD, Housing and Urban Development v.

the housing community.

And again, in the worst case scenario, it rises up to the level of the DOJ, the

Department of Justice, and they will bring the claim and it will then be the United

States of America. It will be in federal court and it will be brought against you.

So there are they are essentially what you're referring to as the police.

They are the enforcers.

They are bringing them. But private claims can be brought by individuals or by private

housing groups. And there are loads of them out there or the government can do it.

Well, so now on a professional standpoint, where do you come in the business that

you're involved in? Which piece of this?

Are you the police? Are you the defendants?

Are you just educating people to stay away from the cops?

Right. So my job as the risk manager for FSA, for the communities that we work with, we

bring we do lots of education.

We do lots of fair housing education, both for marketing and admission staff, as well as

staff within the community that is responsible to move people through that continuum of

care. So we do loads of education for them.

We also come in many times and we do education for the residents themselves.

We have meetings with residents.

Sometimes residents, for example, may say, you know, things that we feel are

inappropriate, like why is so and so in the dining room?

She's in a wheelchair and and she's totally out of it.

And I don't want to look at that when I'm eating and, you know, or asking questions.

Why is this person living in independent living?

This person doesn't belong here.

She's not like the rest of us.

She should go into assisted living.

You know, we have a problem with it.

We're here to educate the residents on their rights as residents, as well as, you know,

what the Fair Housing Act says and why we're not going to share any details and

information with them about other residents and what we're doing with them and for

them as far as reasonable accommodations or any any other way that we're working with

them. So we like to educate the residents.

We also work specifically with marketing teams.

We help them with, again, do's and don'ts in their marketing materials, language that

they should have on all of their websites, on their brochures, on anything that they're

doing. We help them with information on, you know, things to share and not share during

tours. So, you know, we're here and we develop all kinds of templates for policies

and procedures and things of that nature.

We also work with the risk management committees to review all of the marketing

materials and the website before they actually go live and before anything's printed to

make sure that everything is, you know, on the up and up, both from a fair housing

standpoint and a general risk management standpoint.

We don't want people over promising that, you know, it's all about for us setting

realistic expectations.

So we're here at FSA to help our communities understand what it is, understand the

risks, and also develop policies, procedures, rules, guidance.

So we talk about rules and we have templates for rules for service animals, rules for

scooters, rules for private duty aid, hold homeless agreements, indemnification

agreements when somebody does want to hire a private aide to make sure that they

understand that we're not responsible for, you know, what they do or what they do

incorrectly or what they fail to do.

So those are all things that we do at FSA in our risk management program to assist the

organizations that we work with.

Fascinating.

We've gone a little bit later because you're sharing, you're dropping all the jewels

there. But the question for, is there anything, it may not be necessarily fair housing

related, but if there are residents in a senior living setting that completely

disregards all discriminatory laws and regulations, to have some people that just

don't care anymore and they'll say things to the staff about their religion, about

the color of their skin, about the country that they come from, about their accent, and

they'll, they have nothing to lose.

Is there any recourse, and you can educate them, but they don't care.

Is there any recourse that providers can do to help really prevent their staff, not

protect their staff, or the residents from each other, when you have residents that

completely ignore all the rules that we're discussing?

Well, that would be a topic for an entire other podcast.

But what I will say is what you're describing for your employees is a hostile work

environment. And even if you cannot stop the resident from saying, you know, the

bigoted, you know, racist kinds of things that you're describing, you cannot, as a

provider, throw your hands up and say, oops, sorry.

You know, in one particular case that was, it's a fairly recent case that was brought

for a hostile work environment.

The CNA was being, you know, spoken to in that manner that you just said, and also

sexually harassed, groped, touched, you know.

And the administrator in that case, the language that she used was, put your big girl

panties on and deal with it.

OK. And they got hit with a massive verdict.

So you don't want to do that.

But so, again, there are things that you should and can do to mitigate the harm that

comes to employees. So, you know, for example, you might want to switch staffing

patterns around. You might, if it's somebody that is, you know, touching inappropriately,

then you might want to use, you know, a male caregiver or you might send that person in

with a second caregiver at all times.

Or you might, again, like in the case of the CNA that I was just talking about, she has

to be moved to a different wing away from that resident.

And that's when the administrator said that to her.

So, again, you want to look, there's all different things that you can do.

But what you shouldn't do is to basically throw your hands up and say, there's nothing

that I can do about that.

No, of course not. No, the question is not about the staff, but the question is, is there

anything that can be done to, I guess, to encourage or force the people who live in

that setting not to engage in those practices?

Well, other than what you just described, you know, like the education, and obviously

it's going to depend on the, you know, on the competency of that individual.

If that individual has intellectual disabilities and or dementia, right, right.

But if they don't have those things, then, you know, and they're not abiding by the

rules, then there may have to be, you know, after you've spoken to them, and

documentation is key, you have to be documenting everything you're doing, every

effort you're making, every conversation that you've had.

And if that resident is refusing, then there may have to be a discharge in that case

because you're not able to care for them anymore.

Got it. Got it.

Fascinating.

If people want to learn more about the topics that we're discussing or learn more

about you and your company, where's a good resource, where's a good place to send them

to?

Our website, FSAinfo.org, is a good place, and it has, you know, a number of the

resources that we have on there.

We, you know, we provide a lot of different services in addition to risk management.

Awesome.

Okay.

FSA, what is it, FSAinfo?

Yeah, FSAinfo.org.

Okay.

We'll include that in the show notes.

I'm going to take a little peek.

All right.

Any final thoughts before we let you go for today?

Again, I think it's really important that you recognize and discuss, you know, what

your risk tolerance is because the message that I want you to take is, yeah, there are

a lot of fair housing rules and the advocacy groups really, you know, they take a very

strong position pro-tenant, pro-resident.

You know, myself, you know, representing providers and on the, you know, trying to

keep providers out of trouble, I might take a more restrictive view of it, but it's

really be aware of what the risks are and then make informed decisions about your risk

benefit analysis and what your risk tolerance is.

Sometimes it might be better to decline admission to somebody, you know, and risk a

fair housing claim than to take somebody in that, you know, is not appropriate and

it's going to struggle in a particular level of care, you know, and it's going to, you

know, be really a massive burden to you.

You might choose to take the risk of potentially a discrimination fair housing claim

than to take somebody in that, you know, is going to be incredibly problematic and

potentially present you with a negligence action.

Got it.

Got it.

Okay.

I'm just going to, wait, you just want to unmute.

I know you didn't, I'm sorry.

I'm looking at the wrong place here.

That's my bad.

But there's just one comment here from Hannah.

It says, thank you, Christina, for sharing your expertise as a marketing professional.

Christina living in organizations is very interested in to think through the risks,

which is definitely true.

And there's something that you brought to us.

Thank you very much, Christina, for joining us today and for sharing everything that you

shared over here on the show.

It definitely has been very informative just about, like you said, knowing the risks, when

to take them, when not to take them.

Right.

Okay.

You're welcome.

Thank you for having me.

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Sara Well spent 12 years as a critical care trauma nurse on the acute side. She watched again and again as her facility’s money was put into much less pressing issues than staffing and saw how it impacted not just care and quality outcomes but overall revenue.

She saw how archaic many of the systems in place for staffing were, and with her tech background realized that this comprehensive issue was a scalable solution with a huge addressable market.

Nurses are often perceived as a cost rather than a revenue driver. They have been historically under-appreciated despite how much their presence and work directly impacts the length of stay which is not always covered by insurance.

The flaws already present in the healthcare conveyor belt were exacerbated by the arrival of the pandemic. An estimated 500,000 nurses were lost to COVID fatigue, switching to other less taxing professions.

At the same time many new travel nursing and outsource labor companies began to pop up, luring staff away from their traditional in-house positions with the promise of higher pay. These companies then sold the nurses back to the same types of facilities they came from at a much higher cost.

Though facilities were able to get staff quickly and easily, it was not cheap and cost them the integrity of their in-house teams.

Dropstat seeks to re-empower healthcare organizations, working with them to update and automate safe staffing processes, and give total transparent insight into their labor costs.

They see the most important relationship as the triad between patient, provider, and the organization that brings them together.

Dropstat uses machine learning and AI to predict a facility's staffing needs 60 days in advance. are able trace increased costs of standard labor and premium labor costs whether its agency or overtime bonuses. With this data they create patterns and recommendations and feed them back to the client.

When asked about the problem of staff leaving for a $2-3 raise Sara had some powerful insight to share.

She states that just like those serving in the military, healthcare workers see death and loss on a sometimes daily basis. But while the military has instigated an entire culture of comradery and airtight family dynamics within groups, the same is often not present in healthcare.

Sara concludes that if a facility is able to culture hack and ensure with authenticity that nurses feel loved, valued, connected, appreciated, that they are the key to aiding the aging population, they won't have to worry about losing staff because of pay.

FOLLOW SARA AND DROPSTAT

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After returning from military service, Eric Alvarez got his start in academia before moving to healthcare and delving into startups. It was this time working with students that led him to the idea of Grapefruit Health.

By the year 2026 healthcare will be short by 3.2 million healthcare workers. Eric states that many of the current solutions for this problem greatly reduce performance and output while driving up costs.

The year 2030 was always slated to be the year that our clinical aging workforce would max out, with baby boomers retiring at a much higher ratio than newcomers entering the profession. Many clinicians have either transitioned to part time or moved on to a gig economy platform.

We have heard from various perspectives on the healthcare staffing shortage on this podcast and Grapefruit Health brings a new solution to address this monumental problem. They have created the world's first and only healthcare workforce composed solely of clinical students.

Healthcare facilities often run programs to employ students, but this calls for a training preceptor and ultimately leads to an unproductive workflow. Grapefruit Health employees on the other hand provide assistance with remote, low acuity, high volume, repetitive telephonic tasks.

These include medication adherence, senior isolation and loneliness outreach calls, and post discharge follow up calls. All of these tasks are clinical in nature but do not require licensure.

About 10% of these telephonic tasks need a pharmacist interaction, in which case the employee will do a warm transfer to a pharmacist. This cuts down time greatly for short staffed pharmacy teams who would otherwise have to make all these repetitive calls themselves.

Grapefruit Health offers their services at $5 per interaction and doesn’t charge for unsuccessful interactions such as when a call goes through to voicemail or a patient hangs up.

Typically their client organizations have a program that's failing and are looking to supplement it or outsource it. After understanding the situation and what tasks and roles need to be filled, Grapefruit Health can build scripts and employ students and train them for the job in just six weeks.

Eric states that students are eager to learn with their clinical education fresh in their mind. Grapefruit Health leaves their employees with great skills and experience and even full time opportunities with the client organizations they worked with once they graduate.

FOLLOW ERIC AND GRAPEFRUIT HEALTH

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• Ep. 89: Take Full Ownership of Your Recruitment
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Erica has had 30 years of experience as a nursing home administrator and specializes in regulatory compliance.

Her nonprofit senior living campus is so excellent at staffing retention that they have managed successfully to never bring in outside agencies.

In today's senior care facilities, where administrators constantly struggle to keep staff from leaving, this is an incredible achievement. Erica outlines some of the means by which she and her leadership team have made it happen.

Firstly, they have made sure to be visible in the local community. They are involved with two chambers of commerce, hold lots of events, and have great working relationships with the local high-schools.

High-school seniors who have completed one year as nursing assistants and want to stay on, will receive 75% tuition reimbursement towards starting a nursing degree at community college.

They also hold raffles for those applying and bonuses to current employees for referring someone.

For current employees, there is a career ladder in place throughout all departments and excellent tenure. Staff can work to advance themselves and see results for their hard work rather than feeling stuck in a static position.

There are also many amenities provided including an excellent break room, and regular socials that help to create a great work atmosphere.

Above all, Erica holds that having a work family, all pulling together towards the same mission statement, is essential.

Right from the interview she assigns new hires a mentor in their department. By being present at the interview, that person will also be able to decide on behalf of their department whether they want to move forward with hiring.

She maintains a strong philosophy of servant leadership and strives to let all her staff know that she cares for and appreciates them.

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• Ep. 77: CNAs: Make Them Want To Stay
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Sam Gopinathan only got started in his field after the 2008 recession when he was forced to leave his job as a mechanical engineer. But Sam didn’t get into his current field by chance.

After a life-changing experience of helping to provide relief to a community devastated by a natural disaster, he learned that establishing a connection is a fundamental foundation of caring for others.

He decided to work in home health care because it aligned with his professional goals and personal values. Every day he goes to work he is helping someone with their life.

Sam states that long-term care insurance is the only product that will definitively cover the costs of care when one needs it.

Medicare will only pay for the medical side of things. It covers high acuity events, but not the nursing home stays that many people will need afterward. Unless someone has less than $2,000 in assets, they won't qualify for Medicaid coverage and will instead pay for the latter privately.

So how much care is provided by home healthcare? Sam explains that New Wave Home Care offers a minimum of 4 hours of care and a maximum of 24 hours. They help out with basic necessities like showering, meal preparation, and any other tasks that someone might not be able to complete physically.

Having the right amount of care early on can save expenses down the line, such as those that will occur if someone is injured.

In regards to payment, Sam states that 80-85% of clients pay via private funds, with 15% of clients using long-term care insurance. Depending on what policy someone has, they can get almost 100% off care expenses.

Lastly, Sam examines the benefits of a professional long-term caregiver over a private caregiver such as a family member, friend, or trusted employee. By seeking out help privately, someone can be risking a lot.

If you are employing someone privately, you are their employer on all records which can lead to a lot of trouble with lawsuits. It is also difficult to do background checks on a potential caregiver.

In theory, a family member or spouse would be the best solution. Still, the emotional burdens often become a problem made even more complicated if the caregiver is a similar age. With their assurance of expertise and knowledge, and ability to do complex background checks, agencies are the best option.

FOLLOW SAM AND NEW WAVE HOME CARE

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Lindsay Mclaughlin is an expert multitasker! Managing to juggle running a successful full-time venture, teaching others to do the same, and being a working mom, she wears many hats.

Her high-poweredness can be seen in the fact that she recorded this episode with us only a few days after the birth of her new baby!

Despite going into nursing school, Lindsay knew for a long time that she wanted to be self employed before her thirties.

Developing and running residential assisted living homes allows her to combine her background and skill-set with her long-time ambitions of entrepreneurship.

But what are residential assisted living homes and how do they differ from traditional, larger assisted living facilities?

Lindsay states that even though she prefers to build most of her homes from the ground up, the buildings themselves look and feel like cozy residential homes.

Instead of hundreds of residents, most residential assisted living homes usually only have 8-10 beds, and no more than two-dozen.

Rather than a host of amenities, clubs, and excursions to fill residents’ schedules, the homes offer a cozy, close environment where residents can gather in the common area, get to know each other, and feel like they are living in a real house with a found family.

Though they can’t provide care to higher acuity patients, such as those who need feeding tubes, residential assisted living homes can take on most patients and provide them with more focused and hands-on care.

Lindsay says that the set up of these homes is also very encouraging to the families who may be nervous and reluctant to send their loved one to a large, traditional facility.

The smaller setup allows for a more direct line of communication that families can use to receive more personal news and updates. They are also more inclined to feel better about sending their loved one to somewhere that feels like a home.

To sum it all up, Lindsay states that anyone looking to get into this sector of the senior care industry has to know what they want realistically before entering the business.

The job can be hands-on and emotionally taxing, but it also allows an owner to build a space from the ground up, set their own culture, and run their own show, even if they do not have a large budget going into it.

For those interested in this growing field, Lindsay is holding a 2023 flagship event where she gives attendees hands-on experience in running a residential assisted living home.

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• Ep. 79: Buying Your First Nursing Home
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Nebras Hayek’s incredible career in marketing throughout multiple industries is the result of her high-powered mindset and can-do attitude.

Though she has worked in a number of interesting places, Nebras got into healthcare marketing partly through the connections she made while hosting events for various healthcare related groups.

In addition to her intensive day job, she is also an active military combat engineer in North Carolina, a position which on top of everything else demonstrates her love for challenges.

Nebras started out at Gentell as a regional manager covering only a few states but rapidly ascended to assistant vice president of the company, covering all 49 states.

Her significant experience in senior care has shown that progress is best made through building authentic connections and establishing dependability and trust with others in the industry.

Senior care faces a lot of current challenges. While the largest issue may be staffing, census is still a very high priority problem for many facilities.

So what can a nursing home do to fix its census?

Nebras advises that before judging that a nursing home is struggling, you need to go in, find out what’s actually going on, and only target that specific issue rather than making a lot of large irreversible changes.

She states that some major points to be examined and evaluated are the facility’s current Medical Director and the actions of its Admission Directors.

Medical Directors are supposed to be representatives and advocates for their facility. They should be ready to fix the problems they encounter or delegate the process of fixing.

It is important to check in regularly with Admission Directors and find out what they are doing. Ask what challenges they are facing, who they are marketing to, and what's happening with referrals.

Lastly, when asked about the relevance of social media for both facility and vendors in senior care, Nebras states that, for both of these parties, the more recognition and familiarity the better. This is best done through authentic video content which is more informative than pictures.

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Having served as assistant administrator at a small facility with extensive experience in the senior care industry, Avi Richman understands the extreme challenges facilities face these days in staffing

There is a constant fight over employees and many states cap admissions when a facility is only operating at very low levels of staff.

Many facilities attempt to address the problem of staffing through working on their public appearance to prospective employees.

Avi states that this method often won’t work because it's almost impossible for most facilities to scale the idea of what they want their vibe and company culture to feel like.

The only situation in which this would work would be if the facility concerned was small, and standalone.

Avi gives an example of such a facility that deepened their company culture by creating an employee counsel that served as a legitimate decision making body.

But is there a sole strategy that will contribute with certainty to the success of staffing endeavors?

Avi asserts that facilities need to focus their time and energy on making sure the processes they plan are executed smoothly and to completion from start to finish.

It is easy to say that this will happen but very difficult in reality, the only way it will work is if the process is monitored and nurtured 24/7.

FOLLOW AVI AND VITA HEALTHCARE GROUP

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During her research into health disparities at John Hopkins, Athena witnessed the difficulties that aspiring healthcare workers who were underprivileged and financially insecure had in starting their career.

Single parents who were already working paycheck to paycheck could not afford to put themself through a CNA training program.

There is also the issue of overcomplication and outdatedness present in CNA training school sign-ups. Websites are hard to reach or do not even exist. Application documents are difficult to fill out and obtain.

Many of the people coming up against these problems are truly passionate about helping others and often already have experience and understanding of what they will face.

On the other side of the equation, facilities search high and low for CNAs to hire on.

In the post pandemic world, many CNAs have turned to other careers and it is often a struggle to find qualified CNAs who will stay on for more than a few weeks.

Athena’s company Dreambound addresses both of these problems simultaneously.

Dreambound works with 150 schools and training programs in multiple states. If there’s a school that’s currently not on the platform all they have to do is sign up on the website and start getting students.

Instead of a complicated application process, prospective students have only to fill out one universal application which will be directed to any of the schools on the platform.

For facilities, Dreambound provides a system by which they can choose students to sponsor who will come and work for them afterwards.

Athena also states that many schools are looking for clinical sites for their training. By taking this position, a facility will attract a lot more graduating CNAs who will have already trained there and decide to stay on out of the closeness and convenience.

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As a clinical psychologist with over twelve years of experience in the senior living space, Dr. Jennifer Stelter has a lot of experience with dementia.

Dr. Jennifer is critical of the idea that pharmacological methods are the only way to address mental health conditions and she strives to provide knowledge of non-pharmacological tools and coping skills that can be used firstly.

Together with her business partner Jessica Ryan, biologist, and aromatherapy educator, she created the dementia connection model which employs these types of tools for addressing dementia onset.

Dr. Jennifer states that while dementia training should be part of any clinical psychology studies, it is instead left all down to nursing homes.

Since most dementia training is just regulatory compliance, it will often be carried out without much real thought or planning and will not be effective.

When there is a lack of education in this area staff will not know how to empathize and interact with residents with dementia which leaves them more inclined to become overwhelmed and quit.

In order for a dementia training to be effective, it must be engaging and ideally use sensory based exercises to put employees and caregivers in the position of those with dementia.

Exercises that push people to think on their feet are also very important because this is an essential skill when caring for people with dementia.

In a post pandemic world, these trainings should be up to date, after all there is evidence that COVID-19 can be a factor of dementia onset.

Dr. Jennifer and Jessica will be opening their Dementia Connection Institute which provides in-person and virtual CE seminars and presentations, and staff trainings in all the tools and strategies of their model to staff and caregivers.

FOLLOW DR. JENNIFER, AND JESSICA, & THEIR PRESENT AND UPCOMING DEVELOPMENTS

• Dr. Jennifer's LinkedIn
• Jessica's LinkedIn
• The Dementia Connection Institute

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Having worked on the front lines with hundreds of nursing homes to develop effective infection control strategies, Dr. Buffy got a firsthand look at the way in which these facilities were targeted during the height of the pandemic.

She was moved by the stories she heard and problems she observed, to write her best selling novel Broken which highlights the difficulties faced by nursing homes in implementing infection control.

Most of these difficulties stem predictably from staffing and budget challenges. All nursing homes are required to have at least a part time infection preventionist on staff, but many take on the role while also holding other positions and with little training or hands on experience.

Dr. Buffy’s company, IPCWell, helps in these common situations by working with facilities to teach and support their infection preventionist in developing efficient and effective methods that will function inside a facility’s means and budget.

However, a considerable amount of difficulty is also brought about by the barrage of continuously changing rules and regulations.

Responsible regulations are always needed for the functioning of any industry. However, Dr. Buffy states that their sheer volume is crippling for senior care and makes it nearly impossible for facilities to operate inside.

This came to a head in 2020 when, instead of helping nursing homes suffering from no PPE and with overworked staff who were risking their lives, the government invested $80,000,000 in targeted infection control surveys.

In an effort to show that this money was being put to use, even the smallest action not following regulations word for word was cited.

Dr. Buffy states that instead of punishing nursing homes, this funding and attention should be put towards helping them and advocating for them.

The last chapter of Broken explains how anyone who has a relative in a nursing home can advocate for their facility.

FOLLOW DR. BUFFY

• To purchase Broken
• To follow her on LinkedIn
• To visit the IPCWell website

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• Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes
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• Ep. 33: Infection Control - Out of the Binder

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1. It's time for a mindset shift. Recruitment needs to be as important as census and marketing. You can even use some of the same resources and people to promote your recruitment activities.
2. Go out to your local supermarket and stop anyone with scrubs and offer them an interview. Find out where else they're hanging out and develop a presence there on or offline.
3. Improve the interview process. Treat them like royalty and make them feel like they arrived home.
4. Have a user-friendly application process, and please, go easy on the paper. Nobody loves filling out tens of pages of the same information over and over again.
5. Ensure your rates are competitive.

Need some help? Reach out to Quality Recruit and see how we can help you with this --> shmuel@qualityrecruit.com

Related Episodes:

• Ep. 76 - Employee Liabilities
• Ep. 73 - Make Your Staff Want to Stay!
• Ep. 71 - Combating Staff Turnover & Burnout In Nursing Homes

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Jennifer has been a practicing physiotherapist for 14 years, and shares about her experiences and what she has learned in this space, as a podcaster, author, and speaker.

She served as her dad’s caregiver for many years while he was housebound and through this experience can empathize and understand the struggles of residents and their families.

Most times, going into long term care is no one’s choice and therefore its essential for residents to feel independent and at-home.

Jennifer approaches every interaction with residents with the understanding that she is in their home and in their space as opposed to them being in her space because she is the therapist.

As a physiotherapist her job is to assess patients mobility, balance, and strength and she strives to enable and empower their independence while also minimizing their fall risk.

She advises physicians to try and tailor their sessions and treatments to the resident and their goals rather than rushing through and only thinking about the problem, not the person.

In order for an at-home environment to be established, residents must feel trust and rapport with their physicians and caregivers.

This rapport can only be gained if caregivers and physicians stay present with residents and remember that their role is to guide and inform, not to be authoritative and make decisions against the resident’s desires.

Jennifer states that compassion and empathy only takes moments and even small gestures can go a long way towards making residents feel comfortable in their surroundings.

FOLLOW JENNIFER

• Read Her Book - Communication is Care: 9 Empowering Strategies to Guide Patient Healing
• Her Podcast - The Healthcare Provider Happy Hour
• Her LinkedIn

RELATED EPISODES

• Ep. 72: Are We Treating Our Seniors Worse Than Horses?
• Ep. 56: Phone Calls Help Alleviate Loneliness in Nursing Homes
• Ep. 54: What is the Greenhouse Model?

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After the loss of his grandparent, who received terrible treatment in rehab after surgery, Ryan resolved to address some of the issues in post-acute care by buying a software company already active in that space and using his expertise to build it up.

VoiceFriend addresses the problem of inefficient communication faced in facilities where the many different stakeholders, including residents, families, and employees make for a quagmire of related issues.

With varying levels of technological proficiency among these stakeholders, there have to be many different methods in place for communicating and conveying information.

This type of chaotic system means that information and things said often slip through the cracks or can only be found again after a lengthy search which wastes time and effort.

While there are other tools designed to improve this problem, they often only cover a section of facility communication or don’t work well with software already in place.

Ryan explains that VoiceFriend is not a tool but a system designed to serve as the core communication platform of facilities by which all other means of communication already in place pass through.

The software can convey messages over a wide variety of platforms including text, phone, and even Amazon Alexa.

Recipients can set their own preferences to reflect how they would like to receive communications.

VoiceFriend’s simplicity and ease of use are great strengths and by integrating it, a facility can dramatically streamline its communication and enhance processes already in place.

FOLLOW RYAN AND VOICEFRIEND

• Website
• LinkedIn

RELATED EPISODES

• Ep. 81: Nursing Home Communication
• Ep. 67: Can Nursing Homes Be Less Chaotic?
• Ep. 37: What Should I post on Linkedin?

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Jana has represented many healthcare clients and serves as the outside general counsel for a large healthcare entity.

The False Claims Act was created to address fraud being perpetrated against the government. To free up government time and resources, private individuals referred to as relators were permitted to bring those suits.

Relators have to be an original source with inside information. In healthcare-related cases, they are often disgruntled, former employees or family members.

Jana has handled many false claims cases and asserts that the most important first step in making sure that a facility is aware and compliant with the regulations under the False Claims Act is to install a Comprehensive Corporate Compliance Program.

This type of program can be drawn up by a lawyer and details all the regulations that a particular facility will need to follow and what they can do to follow them to avoid causing claims to be made against them.

Common claims in a healthcare setting often involve billing for services that weren’t provided or are insufficient.

If an operator or administrator catches wind of this, they should investigate immediately and if a violation is found make a voluntary disclosure to the government and pay any difference that might be owed.

In a worse scenario, the government will find out about the violation first and send a Civil Investigative Demand requesting the production of certain documents or an inner view of an employee.

In this situation, the facility should act fast to hire experienced counsel and contact the government to negotiate a settlement rather than being taken to court.

Fox Rothchild has offices all over the country and can provide all sorts of services to healthcare facilities in the areas of corporate employment, real estate, compliance services for if a facility is involved in litigation or receives a subpoena or Civil Investigative Demand.

LEARN MORE ABOUT JANA AND FOX ROTHCHILD LLP

• Website
• LinkedIn

RELATED EPISODES

• Ep. 81 - Nursing Home Communication
• Ep. 76 - Employee Liabilities
• Ep. 38 - Administrator Vs The Surveyor

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Fast and efficient communication is vital in senior care, and may often be the difference between life or death.

Even disregarding such dire medical circumstances, a typical facility must constantly interface with numerous parties including residents, their families, employees, and external vendors at all times.

Needless to say, without adequate methods in place to streamline all these fractured lines of interaction, accidents are bound to happen.

Unfortunately, most senior care facilities still use antiquated means of communication.

Terry has spent his whole career modernizing antiquated processes. With Carefeed, he created an all-in-one system that can bring the communication methods of any facility up to speed.

The platform provides the most up-to-date technologies for every type of interaction that typically occurs in a facility.

Carefeed identifies and addresses all of the outdated, redundant, and faulty communication methods currently in use by a facility, automating and digitizing them.

Because of its all-inclusive approach, Carefeed is known as the central place for seamless communication and engagement with residents, family, and staff.

FOLLOW TERRY AND CAREFEED

• Website
• LinkedIn

RELATED EPISODES

• Ep. 69: Should Nursing Homes Be On TikTok?
• Ep. 66: We Only Notice When IT Stops Working
• Ep. 30: Don't You Love All That Admission Paperwork?!

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As an occupational therapist with an MBA who has, at one point, been responsible for 120 facilities at one time, Jean is an expert in both the care and business sides of senior care.

With his groundbreaking new designs and programs conceived to influence the lives, thought processes and social engagement of residents, he has become recognized as an incredible innovator in the space.

Jean’s buildings are structured to engage all five senses.

Through natural lighting or LED-controlled “Sky Ceilings,” they allow those with memory-related conditions to tell the time.

With a design based on the nineteen twenties, thirties, or forties, residents experiencing Retrogenesis and mentally reverting back to their youth can feel at-home in their surroundings.

Jean is passionate about the vision of his buildings from a clinical perspective and also understands that this cannot be accomplished without adequate financial backing.

He tells investors the true story, that by creating these spaces he is reducing clients’ pain and helping them to live longer and healthier lives and that this in-turn makes for significant cash flow.

With his penchant for innovation, Jean has been planning and developing various new programs and ideas.

Currently he is evolving his informational senior care, Alzheimer's, and dementia focused video platform Okrah.

Jean first had the idea for this concept after producing his own documentary on one woman’s experience of Alzheimer's and realizing how little media existed around that important topic.

FOLLOW JEAN, THE LANTERN GROUP, AND OKRAH

• LinkedIn
• The Lantern Group
• Okrah

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• Ep. 75: Flooring; The Biggest Difference
• Ep. 72: Are We Treating Our Seniors Worse Than Horses?
• Ep. 70: Memory: It's All In Your Head

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Adam Lewis is the CEO of Apploi, a hiring software company centered around healthcare.

With a background in HR, he has spent lots of time working with healthcare companies to identify and remove roadblocks in their job application processes.

Two of the largest problems often encountered in healthcare recruiting are: how to attract more candidates into the application funnel and how to successfully move them through said funnel.

To start with the latter of these issues, Adam states that out of all industries, healthcare takes the longest amount of time to recruit personnel with the average span being 40 days.

This is often the result of an application being too lengthy and complicated.

In order to make this process more frictionless, the application should feature fewer questions upfront and be mobile optimized so as to be accessible to nurses, CNAs, and LPNs who will likely be filling it out on their phones.

The job postings themselves should also be created with the needs of current healthcare workers in mind.

Rather than going by the old method of copying and pasting the needs of a position, employers must be more creative to grab the attention of job seekers in this modern competitive market.

Job postings should narrate the experience of company culture, the perks that employees will receive, and the value that they will be regarded with.

FOLLOW ADAM AND APPLOI!

• Website
• LinkedIn

RELATED EPISODES

• Ep. 77: CNAs: Make Them Want To Stay
• Ep. 73: Make Your Staff WANT To Stay!
• Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes

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Jeffrey is the founder and CEO of Cambridge Realty Capital, a real estate company centered around the nursing and senior care market that has made over 500 transactions in that space.

From his own experience, he states that those looking to make their first nursing home real estate deal and become an operator often possess experience in the industry but lack the funds.

For this reason, it is essential for first-time deal-makers to find a good investing partner to make the purchase with them.

Firstly though, they must be sure to make an economical deal with the seller that is written down in the form of a tangible document.

This will allow them to show the deal to different parties without being worried about people going behind their back. Maintaining this control is the most important part of making a deal.

Next is the question of loans and finding a good lender to work with.

HUD Loans, supplied by the Department of Housing and Urban Development, are an excellent resource but require the assistance of a HUD Lender who can interface with the department.

Lastly Jeffrey states the market is very lucrative and for those experienced in the administrative side of senior care, it's always a good time to break into the business.

FOLLOW JEFFREY AND CAMBRIDGE REALTY CAPITAL

• Website
• LinkedIn

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• Ep. 52: Investors Focusing on the Senior Care Space - LinkedIn Best Practices
• Ep. 40: Did The Coronavirus Make Nursing Homes Rich?
• Ep. 39: Administrators Speak Up; Time For a Change!

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Quanisah Bernard is a talented and experienced CNA and, with more than fourteen years of the profession under her belt, has a deep knowledge of the ins and outs of CNA culture.

After graduating from high-school in 2006 she started working at a nursing home in the dietary department. Soon after, she took a month-long CNA class which kicked off her journey as a CNA.

Since Quanisah had entered her first facility right after high-school she felt as though it was a second family.

Rather than treating her as a cog in the machine the administrators noticed her talent and proceeded to foster her skills and give her some chances to shine and be recognized.

It was only when the management changed and became less focused on providing this important acknowledgement and care to their employees that Quanisah decided to leave.

Though she had begun to think about the lack of a good salary, she states that it was this particular shift in company culture that forced her hand.

Though at this time, when senior care facilities are under intense pressure, it is difficult for them to pay employees a higher salary, it is important that they follow through with all financially related promises.

Quanisah states that even though the assurance of a raise or bonus may reflect well on a facility, not following through will cause CNAs to leave and let their colleagues know not to work there either.

Lastly, she explains that getting involved with colleges would be a great way to find and attract potential future CNAs who will be looking to apply for internships and positions at facilities.

RELATED EPISODES

• Ep. 77: CNAs: Make Them Want To Stay
• Ep. 73: Make Your Staff WANT To Stay!
• Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes

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Together with running her own CNA education program and separate home-care company, Aishling has a lot of experience with the types of people who become CNAs and the career paths they hope to lead.

The difficulty of the tasks that the average CNA faces everyday cannot be minimized and many take on this job without even realizing how grueling it really is physically and emotionally.

Aishling states that in order to weed out candidates that are prepared from those who might be a better fit at the nearby Target, employers must be upfront and transparent about the reality of what will be expected as well as required workload.

The new expectations of staff used to a more modern, gig-economy influenced style of scheduling must also be taken into account.

Communication should be established to determine what times staff will be able to work and put together a schedule that they will realistically be able to work with.

Finally, employers should seek to mentor and foster the capabilities of CNAs. Work with them to establish a career path then support them on their way towards their ultimate goal.

LEARN MORE ABOUT AISHLING!

• Aishling Care Academy Website
• Aishling Home Care Website

RELATED EPISODES

• Episode 73: Make Your Staff WANT To Stay!
• Episode 71: Combating Staff Turnover & Burnout In Nursing Homes
• Epsiode 42: Healthcare Workers Need Self-Care During Covid-19

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As a long-term care employment litigator, Richard has represented nursing homes and senior care facilities across the country.

Litigations can come in a plethora of different forms, yet they all share the same effect of draining resources and time as well as disrupting workflow.

Richard states that in order to decrease the likelihood of litigations or at least maintain more control over the process once they play out, employers need to put in place several key protections and strategies.

Firstly, good systems of documenting incidents need to be implemented. Since nursing homes often do not possess robust HR offices, documentation responsibilities must be shared between a number of inter-culturally aware, qualified personnel.

These systems must be as up-to-date, easy to access, and user-friendly as possible to ensure that important information, such as signed employee arbitration agreements and incident reports, are easy to find and access.

Training that clearly outlines policies around expected behavior and what is considered harassment must also take place regularly and be presented in an engaging way.

Lastly, to maintain more control in court, eliminate the threat of a jury, and minimize the chance of a class or collective action, employers should seek out an arbitration program.

Contact Richard

• LinkedIn
• Rscharlat@foxrothchild.com

Related Episodes

• Solving the Staffing Challenge in Nursing Homes
• Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark Kaszirer

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Originally in construction, Motty shifted his focus completely to flooring after realizing the room for innovation, and how little was known about the trade even by flooring professionals.

Many operators don’t even realize that their floors do not meet the requirements of statewide health regulations.

Motty explains that under the requirements of OSHPD, which sets the building standards for senior care in California, facilities may only use carpet or VCT (vinyl) for flooring.

Carpet is not very stable and often a hazard in nursing homes. This leaves VCT which requires a lot of care and cleaning as it becomes worn very easily.

Having built facilities from scratch Motty knows that flooring is always the biggest issue and makes the biggest difference in every project. He states that floors have a dramatic effect on a space and a nice clean floor can bring a building to life.

This is why it is essential to fit a facility with a durable, long-lasting floor rather than one that is less expensive and will need to be continuously redone and replaced.

After years of researching and tweaking other products, Motty engineered his own type of vinyl that is more durable than regular VCT and will remain unblemished by bleach and disinfectant.

Motty states that when looking to remodel facility floors, operators should do a lot of research, know the difference between commercial and residential flooring, and understand that price is not necessarily the best indicator of quality.

FOLLOW MOTTY AND HIS COMPANY RITZ FLOORING, INC.

• Website
• LinkedIn

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• Ep. 61: Real Time Fall Prevention
• Ep. 23: Keep the House and Still Get the Care You Deserve
• Ep. 11: Follow the Scent

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With his company Comprehensive A/R Solutions, Israel has seen all the ways that inattention to a billing team can wreak havoc on a facility.

In a difficult industry, nursing home operators must maximize every penny they receive. Despite this necessity, facilities typically have a lot of bad debt left on the table, often totaling to hundreds of dollars of uncollected receivables.

Rather than spending time and effort searching for ways to receive reimbursement for this bad debt, operators should instead focus on decreasing it as much as possible.

Due to typical billing cycles and the fact that operators do not have time to manage A/R, billing is often only done reactively and problems encountered only after the window where they could have been resolved.

In order to ensure that there is no money left on the table, operators need to conduct A/R proactively rather than reactively.

This can be accomplished firstly by making sure one’s billing team isn’t understaffed. With all the nitty gritty work that it involves, A/R is certainly not something that can be done by a receptionist between shifts.

It is also essential that the team center around an expert experienced in A/R and the ever changing trends of insurance and medicaid. This person should work proactively by planning and implementing processes to identify and mitigate these changes.

They should also be assigned to watch every patient’s payer source from the point of admission to discharge to detect any changes or inconsistencies before they become a real problem.

FOLLOW ISRAEL

• Website
• Email: israelr@comphcs.com
• Toll Free Phone Number: (877) 942-4558

RELATED EPISODES

• Ep. 30: Don't You Love All That Admission Paperwork?!
• Ep. 26: Consistent Leadership in Nursing Homes
• Ep. 8: Megadata in Nursing Homes with Shalom Reinman

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Izzy has explored these discoveries with his company GBC Facility Services, which provides full janitorial services for healthcare and other facilities.

With mass burnout and not much money, nursing home staff are rapidly leaving their professions for better paying, less stressful opportunities.

In order to keep staff, senior care employers need to shift their mindset from one of hierarchy and chain of command to one of servant leadership, where everyone feels valued and cared for.

To implement servant leadership in their company employers should follow a plan similar to the one detailed below:

First, a connection meeting should be held around 2-3 months after a new employee is hired to discuss how they would like to be treated. Next, a weekly one-on-one should happen once a week to recap their work and give them recognition.

The plan should also contain coaching during the game to create an ongoing dialog, discussing a personal development strategy with the employee to find out and acknowledge their career goals, and lastly performance reviews to discuss how they can improve.

Even if this sort of plan for conducting servant leadership may be too time-consuming for busy senior care facilities, just a five-minute weekly conversation with nursing staff will make a huge difference.

FOLLOW IZZY AND GBC FACILITY SERVICES

• Website
• LinkedIn

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• Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes
• Ep. 51: Solving the Staffing Challenge in Nursing Homes
• Ep. 35: Support Your Nursing Home Staff During Coronavirus Outbreaks

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Nancy’s podcast Glowing Older examines the intersection of wellness and senior care. With 25 years in the hospitality, health, and wellness industries, she has deep knowledge of the mental and physical benefits wellness can provide.

Wellness not only signifies keeping people healthy but also providing them with a good standard of living.

While senior care possesses the goal of keeping patients alive and healthy, it is also a very institutionalized setting, often reducing patients to numbers and diagnoses.

This inevitable dehumanization is due in large part to our society’s stigma of its elderly population. Many commonly held assumptions about seniors are flawed and overlook their innate intelligence and valuable life experience.

This ageism must be addressed and some fundamental shifts made in the way we perceive seniors in order for action to be taken to introduce more wellness into senior living.

LEARN MORE ABOUT NANCY AND GLOWING OLDER!

• Glowing Older Podcast
• LinkedIn

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• Ep. 56: Phone Calls Help Alleviate Loneliness in Nursing Homes
• Ep. 54: What Is The Green House Model?
• Ep. 11: Follow the Scent with Tuli Kraus

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Before becoming a serial entrepreneur, Pritma served as a registered nurse for 18 years. This first-hand experience allows her to understand what nurses want and need from employers.

As a nurse, Pritma would sometimes work double shifts that added up to 20 hours a day because of shortages.

In this time of COVID-19, facilities are often understaffed. Nurses are high in-demand and are constantly receiving competing offers of larger salaries and bigger paychecks.

As a result, nurses have become less concerned with money and more with how well they will be cared for by potential employers.

Facilities who want to attract and retain nurses must put more effort into supporting their staff, helping them develop career pathways and supporting their career progression.

Pritma states that this support doesn’t have to cost a lot of money and can be as simple as sitting down to get to know staff and learn where they want to end up on their career journey.

Another idea is the mental health toolkit provided by the American Nurses Association, which is designed to help nurses regulate and monitor their mental health during this stressful time.

In order to recruit nursing staff at all though, it is first necessary to possess an efficient employment method.

Apploi is a unique software which assists with all areas of the employment process and separates truly perfect candidates from the rest of the crowd.

LEARN MORE ABOUT PRITMA AND APPLOI!

• Website
• LinkedIn

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• Ep. 39: Administrators Speak Up; Time For a Change!
• Ep. 17: Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark Kaszirer

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As a geriatric social worker and memory coach who's been in the field for twenty years, Rena, knows a lot about memory and particularly how it declines.

She provides a distinction between normal memory loss and abnormal memory loss which impedes daily functioning and is associated with conditions such as dementia and Alzheimer's.

While genetics are often assumed to be the largest predictor of abnormal memory loss, they are in fact, only about one-third of the problem.

Lifestyle, including exercise, diet, sleep, focus, and cognitive stimulation, is a much larger factor in determining whether these types of conditions will develop.

Physical exercise prompts Neurogenesis. This is the process by which new brain cells are created. Sugar and other junk food impede this process, therefore it is essential to maintain a healthy diet and drink lots of water.

Sleep is also another huge factor, as is our ability to focus, which we should strive to maintain by refraining from multitasking.

Lastly, cognitive stimulation, including new learning and social stimulation ensures that new brain cells will continue to develop.

Just like any skill, memory can be trained through exercises, techniques, and practice. This is Rena’s area of expertise, and the first step to remembering anything is believing that you can.

LEARN MORE ABOUT RENA!

• Website
• Remembership
• LinkedIn

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• Ep. 59: Advanced Planning and Detailed Conversations
• Ep. 55: Fighting Loneliness With Laughter Yoga
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Despite starting off as a nurse and clinical liaison, Steve’s side gig of marketing and content creation soon grew into a full-service agency, Craft Media, of which he remains president.

Though senior care facilities serve an older clientele, they are really marketing to younger relatives, decision-makers and placement workers in hospitals, and potential employees.

Steve explains that all of these groups will likely be present on social media and will be influenced by the quality of a nursing home’s social media presence.

In addition, the content will be published online about nursing homes whether they like it or not.

Failing to maintain their brand through a digital presence will ensure that it is not created by them but by consumers, whose spiteful comments may do great damage to their reputation.

So where does TikTok fit into all of this?

Steve states that, at present, TikTok echoes Instagram’s early days, full of young experimenters and rapidly expanding to eventually become a solid segment of the social media landscape.

By maintaining a consistent presence on this platform while it is still early days, nursing homes will have a huge advantage in the long run.

FOLLOW STEVE AND CRAFT MEDIA!

• Website
• LinkedIn

RELATED EPISODES

• Ep. 65: Content Marketing In Senior Care
• Ep. 62: Social Media Marketing for Nursing Homes
• Ep. 12: LinkedIn Content Marketing with Shaneé Moret

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As the founder of MNT Associates and an experienced long-term care dietitian, Esther Gutman hires, trains, and provides dietitians to long-term care facilities.

Dietary is often disregarded as glorified catering when, in fact, it is one of the most prominent facets of a facility.

It is the one area of service that every resident and every family member can understand and look forward to. For this reason, Esther always tries to bring excellent standards to the kitchen.

In order to fully comprehend the reality of what staff must deal with, dietitians should spend time in the kitchen. This will allow them to make informed orders that staff will be able to carry out.

Esther states that personality and attitude are 75% of a dietitian's success and they should seek to be team players and establish rapport with staff, especially CNAs.

Obtaining weights may be one of the biggest problems that dietitians face. Rather than dealing with it on their own, they should hold team meetings around weights so everyone can understand the complex issue.

LEARN MORE ABOUT ESTHER AND MEDICAL NUTRITION THERAPY ASSOCIATES!

• LinkedIn
• Website

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• EP. 2: Recruitment and Staffing in Long Term Care with Alvin Kahn

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Tzvi Schwartz, certified EOS Implementer, explains that if a leader must motivate employees it means that they don’t have a clear vision, their employees don’t share their core values, or their employees aren’t in the right seat.

The concept of a vision refers to who a company is and where exactly it is going every day.

This doesn’t have to be a grand, altruistic plan. In fact, it will be obvious if a company’s vision is contrived or insincere and they will inevitably attract employees who do not align with their true mission or culture.

Despite how good people look on paper, they will not be a good fit, if their core values are not congruent with those of their workplace.

If employees remain uninspired despite a clear communication of company vision, it means that they are not the right people.

Finally, Tzvi states that if people aren’t placed in the right position, or seat, at their company they will do poorly.

Simply moving an employee to a different position may increase their productivity significantly.

FOLLOW TZVI!

• LinkedIn
• Email
• Phone: (917) 538-8676
• Read Traction!

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• Ep. 17: Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark Kaszirer
• Ep. 16: Selling Your Nursing Home in Today's Complex Marketing Climate with Joe Goldberg

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Nathan Berger, Chief Technology Officer of DigaCore, explains that most outsiders to the trade, such as nursing home operators, are often confused about what “IT” actually does and doesn't do.

IT covers the internet and computer infrastructures.

Without the help of an IT company, nursing home technology systems will likely be designed poorly and operators will lose lots of valuable time supervising repairs.

Unlike many other IT companies, DigaCore offers its services at a flat-rate model which means that there is no extra, by-the-hour cost for repairs.

Their whole business model centers around installing things right the first time or at least fixing them as quickly, efficiently, and permanently as possible.

DigaCore also understands that Nursing Homes usually do not have large budgets to work with and focuses on bringing cost-effective technology to clients.

LEARN MORE ABOUT NATHAN AND DIGACORE!

• Digacore.com
• LinkedIn
• Basic Buying Guide

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• Ep. 65: Content Marketing In Senior Care
• Ep. 39: Administrators Speak Up; Time For a Change!
• Ep. 16: Selling Your Nursing Home in Today's Complex Marketing Climate with Joe Goldberg

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Yitz Rubin, Director of Business Development at Renewal Rehab, is relatively new to the healthcare industry. Having been in sales for ten years he has done his fair share of outbound marketing.

These traditional sales techniques such as cold calling and mail and email blasts work by the principal that if something is done persistently enough you will begin to see results.

This method differs wildly from content marketing which involves creating valuable content that will establish a relationship with a desired audience and retain their attention on its own.

Chicago’s healthcare market is unique from many others in its practices of relationship building and maintaining which are built upon a foundation of mutual trust.

This means that the ancillary companies in the field often don’t hire any sales or marketing departments.

While this dynamic is extremely beneficial and has allowed such companies to breach the hundred million range, it only extends as far as the Chicago area.

It is Yitz’s hope with his Spotlight series to reach beyond this geographical barrier and break into the billion range.

LEARN MORE ABOUT YITZ, THE SNF SPOTLIGHT SERIES, AND RENEWAL REHAB!

• RenewalRehab.com
• SNFspotlight.com
• LinkedIn
• Call Yitz: 312-838-0077

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• Ep. 62: Social Media Marketing for Nursing Homes
• Ep. 52: Investors Focusing On The Senior Care Space - LinkedIn Best Practices
• Ep. 45: Make the Phone Ring With Google Ads

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Shmuel: What about the fact that this vaccine was developed so quickly? Shouldn't we be concerned that it was developed too quickly?

Katherine: No.

This is a different type of vaccine. It's an mRNA vaccine which can be developed efficiently in a much shorter time frame.

Shmuel: When they started working on a vaccine, did they know it would take this quickly?

Katherine: It's not earth shattering news. In the research community at least this was already known.

Shmuel: Should we be concerned about long term side effects?

Katherine: There's always a risk of a long term side effect and that's something can develop later on. But based on the research that was done, we're not expecting serious side effects.

Shmuel: Can someone get vaccine even once vaccinated?

Katherine: You can't get Covid from the vaccine and it's really unlikely that you'll get it once fully vaccinate but it's still possible.

Shmuel: Have you seen seniors in the nursing homes suffer from social isolation?

Katherine: It's really hard for the seniors and the staff are doing all sorts of innovative things to keep the residents connected to the world.

FaceTime. Outdoor visits. Window visits.

But at the end of the day it's not the same as pre-Covid.

You Can Help

If you have any extra tablets at home, bring them to your local nursing home. Call them up and ask what you can bring them.

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• Ep. 57 Should I Get the Covid Vaccine?
• Ep. 56 Phone Calls Help Alleviate Loneliness in Nursing Homes
• Ep. 55 Fighting Loneliness With Laughter Yoga

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Why did I start this podcast? 

It's actually pretty simple. 

I started the podcast to find the answers to basic questions that weren't showing up in the Google results. 

I was only finding flowery and jargon-filled content but nothing that spoke to me in a practical way telling me what to do.

The Nursing Home Podcast was created to fill this void.

I've received so many beautiful messages from owners, administrators, and those working in nursing homes telling me how they listen to the show on their commute to work or share pieces with their coworkers.

This makes it all worth it :)

Google is apparently noticing this as well as we are rating really well organically as well! ( Just Google nursing home podcasts and you'll see...)

Shameless Plug

If you service this industry and would like to be featured or sponsor an episode - reach out to me.

• Shmuel@snfmarketing.com
• Message me LinkedIn

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So let's say it as it is.

Social media marketing is not magic.

You don't just press a few buttons, get some engagement and your business soars through the roof.

It's not that simple.

A good content strategy does give you a fantastic way to provide value and engage with your target audience. It will encourage them to take the next step you'd like them to take.

This can mean applying for a job, coming for a tour, writing a nice review, or whatever you're focusing on at the time.

Know The Turf

Facebook

Facebook is great to potential residents, their adult children/decision-makers and even some of your staff in more rural areas. But Facebook is pay to play and without boosting (paying) your content you will likely see little traction.

Facebook is great for posting jobs - especially for nurses and CNAs. Generally, they're on Facebook and will notice those posts.

Facebook is for residents and their adult decisions maker children. Staff of rural communities will be there as well.

Instagram

Instagram is great for displaying company culture.

Some facilities have 0ne employee who takes over the account for the day to give a glimpse into what it's like to be a part of the team to attract new staff to the team.

Twitter

Twitter? Not really.

Maybe for the CEO or for a large brand to influence government policy and regulations. But for hiring purposes as well as census building it probably won't do too much.

Final Words

Don't focus on the shiny things. Stay focused on what's working and double down on it.

Follow Wendy!

• LinkedIn
• SparkrMarketing.com

Never Miss an Episode!

Join our email list here and be notified when we release new content.

RELATED EPISODES

• 47 - Senior Care is Waking Up! with Brian Wallace
• 37 - What Should I post on Linkedin? with Moe Rabi
• 12 - LinkedIn Content Marketing with Shaneé Moret

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Caleb York is the Channel Development Manager for VirtueSense and joined the company as a result of witnessing the ineffectiveness of other fall-prevention technologies during his time working at the University of Michigan Health System.

While other industries have successfully become more automated and as technologically advanced, healthcare continues to lag behind.

Most senior care facilities find it extremely difficult to purchase vital technologies with the potential to save lives because they are already struggling just to stay afloat.

Though fall prevention technologies such as pressure pads and bed alarms are used in many senior care facilities, these are often loud, disrupting, and have been known to give just as many false as they do legitimate alarms.

While more advanced fall-prevention technology systems such as camera-based monitoring do exist, these are only designed to be used as a means to determine how falls typically occur.

VirtueSense utilizes an infrared depth sensor piloted by an AI and is trained with over 1.5 million hours of patient data. It's able to recognize bodily mechanical errors that typically result in falls and prevent them on the spot.

Once the AI observes that a patient is likely to fall, it sends an alert, via an app, containing their room number to a nurse who can then catch the patient before it is too late.

Rather than only helping to clean up falls, this advanced system predicts and prevents such adverse accidents before they can happen.

LEARN MORE ABOUT CALEB AND VIRTUESENSE!

LinkedIn: https://www.linkedin.com/in/caleb-york-524584155/

Website: https://virtusense.ai/

RELATED EPISODES

• 52 - Investors Focusing on the Senior Care Space - LinkedIn Best Practices
• 51 - Solving the Staffing Challenge in Nursing Homes
• 49 - Better Care Coordination; Real Patient Choice
• 34 - Detect Coronavirus 2 Weeks Before Fevers Surface!

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Remember the good old days with the town doctor came to your house when you weren't feeling right?

Didn't think so.

But there was a time when that was the norm. The advances of medicine have moved that experience to the doctors practice we're all his tools are available to him.

Well what if you could get the best of both worlds? The top quality physicians providing excellent care in the home setting.

Now with Heal, this has become a reality.

Heal doctors serve as clients’ primary care physicians while also remaining much more available and accessible than regular PCPs.

Heal doctors also provide quality over quantity, with average initial appointments ranging 90 minutes in length.

Heal doctors are able to physically observe the actual environments and living spaces of their patients, they are able to provide much more realistic and accurate diagnoses and treatment plans.

LEARN MORE ABOUT HEAL AND NICK!

Website: https://heal.com/about/

LinkedIn: https://www.linkedin.com/in/nickdesaiheal/

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As a certified Alzheimer's disease specialist and expert in contested files with a masters in social work, Stephanie has had significant experience in the types of situations that can occur when people haven’t prepared for getting old.

These situations might include everything from self-serving relatives attempting to wheedle funds by invoking healthcare proxy and power of attorney documents to family disagreements regarding who should care of an older relative.

Stephanie states that people don’t usually start planning for aging until they have had children.

Even then, these plans are often limited to nonspecific, generalized legal documents that designate only the most basic physical care preferences and fail to take into account the individual’s identity at large.

Her guide outlines the correct stages that should be taken to approach aging including questions that should be initiated in families and documents that should be created such as a living will.

The latter can serve as a place to specify how the senior’s money should be distributed for their care and to whom.

Finally, In order to recognize a resident or patient by their unique identity rather than their diagnosis, senior care facilities can personalize that person’s surroundings by introducing sensory components such as music, scents, or pictures that possess meaning and familiarity for them.

FOLLOW STEPHANIE!

Book: https://stephanieerickson.ca/book/

Website: https://stephanieerickson.ca/

YouTube: https://www.youtube.com/channel/UC6zKUK52FgZ3G7Lrm4Mg7WQ

LinkedIn: https://www.linkedin.com/in/stephanie-erickson-1722229/

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Having worked in biotechnology and pharmaceutical manufacturing for the last decade, Andrew is no stranger to the type of studies that have been employed to test the recent surge of COVID-19 vaccines.

After deciding to volunteer in one of these studies, Andrew filled out a survey expressing his interest and was contacted a few months later by a representative from AstraZeneca.

On the day of his appointment at the pharmaceutical company, Andrew received a regular medical exam before being given the first shot of the study.

The injection was either the active vaccine or a placebo and this knowledge will be withheld from Andrew until the completion of the study two years from now, or if he decides at any time to opt-out.

The placebo is included in the study to discourage participants from altering their day to day behavior as they might if they knew for sure it was the actual vaccine they were receiving.

Andrew states that he has not experienced any side effects other than the regular muscle ache usually present after a flu shot. Furthermore, the AstraZeneca vaccine was approved in the U.K. just this week and the first doses are set to be administered on Monday.

RELATED EPISODE

EPISODE 57 - Should I get the Covid Vaccine?

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Learn more about Doctor G at AskDoctorG.com

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Research shows that talking is crucial to brain development, mental health, and well-being.

Talking has been shown to feed and enhance the working, short term memory, which is the first type to decline in Seniors. Improvement of the working memory will, in turn, feed the long-term memory and overall health.

Phone buddies are trained, empathic, passionate volunteers of all ages who are connected to a senior to call once or twice a week for at least half an hour.

It has also been shown that listening helps build empathy and talking helps to improve our mood so the benefits are reciprocal to both parties.

Friendly Voices also provides prepaid phones with unlimited minutes to all phone buddies who request them.

LEARN MORE ABOUT LAURA AND FRIENDLY VOICES!

• FriendlyVoices.org
• Linkedin

RELATED EPISODES

• Episode 55 - Fighting Loneliness With Laughter Yoga
• Episode 48 - The Loneliness Pandemic
• Episode 13 - Bringing the Caring Back to Healthcare with Dovid Weiss

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Alok Mahadevia, who goes by Loki, discovered laughter yoga in 2012 after feeling extremely lonely upon moving to the United States from India. His subsequent experience led him to discover how beneficial this practice was for seniors, those coping with chronic problems or terminal illness, and anyone else simply feeling isolated.

Founded in the late 90’s by Madan Kataria, laughter yoga incorporates voluntary, group-based laughter, and ancient Pranayama breathing techniques. Studies have shown that laughter, both real and forced, has numerous physiological and psychological benefits including acting as a natural painkiller, boosting endorphin and serotonin levels, and decreasing cortisone (stress) levels.

Though one must laugh for an average of 10-15 minutes a day in order to feel these helpful effects, most adults hardly even brush that number.

Loki has led laughter workshops in a number of places including the corporate sector and senior care facilities but when COVID-19 struck he had to think up a new method for his practice. He launched Laugh With Loki through Zoom and his virtual laugh yoga sessions have been attended by more than 700 people from over 16 countries.

Loki hopes to start collaborating with nursing homes to bring his virtual workshops to residents who, with the difficulties of COVID-19, are more than in need of a good laugh.

FOLLOW LAUGH WITH LOKI!

Instagram: https://www.instagram.com/laughwithloki/

Facebook: https://www.facebook.com/harshlokilaughs/

RELATED EPISODES:

• EPISODE 48: The Loneliness Pandamic
• EPISODE 24: Adult Care; Where Does it Fit Into the Continuum?

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Susan Ryan, senior director of the Green House project, delves into the negative stigma that faces seniors.

With 40+ years of experience in the senior care field, Ryan has witnessed first hand the problems of both nursing homes and home care.

With decreased independence, institutional living environments, coupled with a culture of ageist beliefs, elderly residents often feel disempowered and diminished. Those who partake in homecare may also become extremely isolated and lonely.

The Green House Model designs nursing facilities to look and feel like real homes. These pods or units contain around 10-12 rooms each equipped with a private bathroom.

A kitchen and courtyard provide residents with independence as they will be able to cook and venture outside should they choose to. Staff are dynamic and serve a variety of functions, thereby developing stronger relationships with residents.

Susan explains that in order to make their innovative project work, the Green House team has to:

• Keep development costs down
• Consider the best routes to fund and finance
• Develop a balanced payer mix of Medicaid, Medicare, and private pay residents
• Combine staffing of the various departments.

These homes are flourishing amidst the crisis of COVID-19 as a result of their small size and restricted admission.

LEARN MORE ABOUT THE GREENHOUSE PROJECT!

• The Elevate Eldercare Podcast
• www.TheGreenHouseProject.org

RELATED EPISODES

• EPISODE 13: Bringing the Caring Back to Healthcare
• EPISODE 1: Here's Why I Started The Nursing Home Podcast
• EPISODE 28: First - Put Your Own Mask On

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Freda Mowad is the CEO of Quality Rehab Management, QRM, and as a speech and language pathologist who has worked in the rehab industry for 20+ years, has a lot of experience to bring to the table.

Despite its importance, rehab predominantly stands apart from the rest of a nursing facility and often administrators don’t completely understand its complexities.

For this reason, facilities often outsource the entire rehab team to third party vendors. It can create an internal rift between the rehab team and the rest of the team.

Freda highly recommends the integration of in-house rehab but warns that attempting it alone has its own risks.

Administrators don't have the time or expertise required to manage the billing and oversee the productivity of rehab programs. They also typically lack the clinical expertise necessary to ensure therapists are complying with the rules and regulations and keeping up to date with current practices.

Seeking out an in-house rehab management corporation such as QRM will alleviate these risks and also other challenges the rehab department may encounter, such as staffing and communication.

FIND OUT MORE ABOUT QRM!

• QRMhealth.com

Related Episodes

• Teletherapy During Covid-19
• What is PDPM and How Will it Affect You? With Marc Zimmet of Zimmet Healthcare

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LinkedIn isn’t just another social media platform.

When done correctly, it can potentially provide a staggering number of views and engagement every week as well as a space equipped for all sorts of transactions.

LinkedIn has great potential to help the senior care industry by amplifying innovations geared towards the 60+ market and connecting such startups with Venture Capital Firms.

Despite the power and reach of this platform, only 1% of users regularly post content and consequently reap rewards of up to billions of views per week. Judi provides some tips to help business owners and professionals gain a place in this minute but incredibly influential sector.

These include:

• Sharing the spotlight with others
• Showing up as a leader not just as a professional
• Commenting to start conversations

FOLLOW JUDI!

• JudiFox.com
• Judi on LinkedIn
• The Judi Fox Show

Related Episodes

1. Ep. 12 - LinkedIn Marketing with Shanee Moret
2. Ep. 37 - Why Should I Post on LinkedIn - Moe Rabi

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Tony Braswell is a veteran in this space and has been in the Nursing Home staffing industry for 29 years.

Most of that time was spent on the excruciatingly slow task of calling up nurses one at a time trying to get them to come to work. This tedious process needed to be faster.

Much faster.

A brainwave hit Braswell one day when his son purchased just a single bottle of ketchup from Amazon. He realized that with the scope and advancement of modern technology, nursing home staffing could be automated and accomplished much more quickly and efficiently.

The Gale App’s method of flexible scheduling is key in a country already short 1,000,000 nurses and losing more every day from burnout.

The strict schedules, bi-weekly paydays, and exhausting last minute double-shifts of the past don’t work anymore.

It's time for facilities to adapt to the changing demands of the senior care industry.

Over 20,088 nurses have already signed on with the Gale App, and, as the U.S. is rapidly developing into a gig-economy, the technology is set to become a serious contender in the nursing staffing sphere.

LEARN MORE!

• Learn more about the Gale App and Tony Braswell at https://www.usegale.com/!

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In today’s episode we meet Eric Harter, president of Rapid CPAP, who goes into detail on how to correct and prevent breathing and respiratory problems in short-term patients.

It is a frustrating reality that many patients referred to Nursing Homes from hospitals will often suffer these issues in the very first days of adjustment. This may be the result of details about additional health constraints being left out of a patient’s report.

This unfortunate pattern is particularly prevalent in this new world of COVID, where many nursing home are really struggling to keep a healthy census.

Eric explains how implementing a program to address these problems will not only succeed in decreasing the rate of short-term patient returns but also demonstrate a nursing home’s proactivity and show hospitals that they are a good place to refer patients.

Rapid CPAP programs include telehealth experts and respiratory therapists who educate nursing staff on correct procedures for respiratory equipment and write recommendations for patient care and measure outcomes of treatment.

Follow Eric!

• LinkedIn
• https://www.rapidcpap.com/
• Keep an eye out for Eric’s new podcast! The Hey Can Someone Please Call Respiratory Podcast

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The case managers in the hospitals need to know what level of care is available in the community that will be appropriate for the patient they are trying to discharge.

A nursing home is not always the best solution for a hospital discharge. There can be other community-based options that are better for the patient.

It's like Expedia for travel. Before Expedia, you'd have to make dozens of calls to hotels, flights, and rental car companies to make the arrangements for a trip.

That's where the current landscape looks like for hospital case managers. They don't have that one resource, the Expedia if you will, to streamline all this information in one place.

With CareAvailibility - you can literally insert the needs of a particular patient, check off all the boxes and the system will spit out the best solution for them.

Learn more about Care Availability - www. CareAvailability.com

Follow Michael on LinkedIn

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In this episode, we meet the founder and CEO of Oasis Day Center, Israel Lavrinoff. 

Israel is a young and energetic entrepreneur who's clearly identified his passion.

Let's stop waiting for our seniors to die! Let's give them the qualify of life they deserve for as long as possible.  After all we are all going to die someday, so let's live life to the fullest. 

Israel best describes the role of his center as 'monitoring the social blood pressure' of the participants. 

Learn more about Israel and his work at OasisDayCenter.com

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Normal humans make decisions based on the recommendations of their friends and social circle. They will make serious financial and health decisions based on their peers opinions regardless of their level of expertise.

This leaves the opportunity for providers share actual valuable content to your target audience and you'll become that trusted peer that they'll turn to for help and guidance

If you create real content that people actually want to see and share, you'll cultivate a following that trusts you. Additionally, you may start getting some earned media attention which will further grow your trust points online.

Even if that doesn't happen, but a quick Google search will reveal your Google reviews AND your own content. Take the opportunity to control that experience.

Follow Brian!

• NowSourcing - NowSourcing is an award winning nationally recognized infographic design agency. Founded in 2006.
• Linkedin - check out Brian on LInkedIn for all his latest content.

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Shmuel: Can you really do effective therapy remotely without any physical contact?

The Guttmanns: We were actually somewhat surprised at how well it worked out. In the past, we were able to successfully implement teletherapy for our out-of-town clients. However, we had the luxury of planning for it properly by having an initial in-person session to prepare them for the remote sessions.

Covid-19 did not give us time to prepare and this presented several additional challenges including:

• the technology
• additional prep work for the therapists
• equipment availability
• an assistant to help the patient in person

The bottom line is that it's really so rewarding when this all does go well. Teletherapy can significantly support an ongoing therapy process and was never intended to completely replace the in person therapy sessions.

If in-person sessions is not an option, then we have to explore how we can maximize this form of therapy until it's once again possible to do them in-person.

Resources for this Episode

• My other podcast (which I'm not promoting :) - The Love Your 9 to 5 Show
• Www.handsonotrehab.com
• Www.handsonapproaches.com - Discount code SNF15 for $15 off the course
• Www.instagram.com/handsonapproaches
• Podcast: https://handsonapproaches.com/quiet-the-noise-podcast/

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Even if you're ranking really well organically, you still need to have paid ads. This is especially true on a mobile device where you will not even see the organic results 'above the fold'.

There are 4 paid ads that show up before all the organic results show up.

Can paid ads actually increase your census today? Yes!

You can have Google ads showing in specific locations and after a few days the campaign will be optimized further. It gets smarter and smarter as time goes on.

Call Extension Ads - these are Google Ads that go directly to your admissions' phone. This is the hottest lead possible. The person just looked you up online, clicked on your ad and is now calling your phone. You just gotta be sure that someone is really there to answer the phone. You can't afford to miss the call!

If you get a contact form, call within 3 minutes because most likely this person filled out the form for other sites as well.

Learn More About Karina and Her Work!

• SeniorCareClicks.com
• Linkedin

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Meet the Founder

Charles Mann - founder at Accushield - was steeped in the world of senior care since his early childhood when his dad opened up one of the earliest assisted living facilities in Atlanta, Georgia. 

Around 10 years back, Charles wanted to create a facility that would help bridge the gap between nursing homes and assisted livings. 

Once involved in 'boot on the ground' operations of the ALF world, Charles identified the need to address visitor management. There had to be a better way than the paper check in system. 

Hence the birth of Accushield - an electronic check in system that provides a better way for facilities to manage their visitation process. 

Additionally, we get to meet Josh Harris, director of sales for Accushield, as he shares his 'why', the reason he loves selling this service to the facilities in the senior care space. 

Special Offer!

Mention that you heard of Accushield on The Nursing Home Podcast for a 10% discount! Restrictions apply. 

Learn More

• Accushield.com

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In this episode, we meet the founder and CEO of Athene Telehealth, Freida Srisuk.

Freida is best equipped to address nursing home marketing because of her extensive background as a clinical liaison on the nursing home side and managing a hospitalist group on the hospital side.

So here’s the short version of Freida’s response: the short answer is yes, case managers are an important factor and these things are important as well.

• do what’s best for the patient
• have outstanding clinical outcomes
• educate your clinical team on the role census plays in the operations of the facility
• and then your hospital relationships will help you build an even stronger census.

Learn More About Freida and Athene Telehealth

• fsrisuk@athenetelehealth.com
• AtheneTelehealth.com

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* We apologize in advance for the audio quality in today's episode. It was recorded remotely but was too good not to share. *

In today's episode, we meet Kathy Parry - The Resilience Expert, who helps professionals stay energized, engaged, and effective especially during disruptive and traumatic events.

Kathy shares the science behind responding to unexpected traumatic events. There are critical issues that are bubbling beneath the surface and are being suppressed to enable coping with the issue at hand.

However, if not dealt with it will grow and fester until the point of breakage.

Kathy compares it to a rubber band being stretched and stretched. As long as it's intact, the stress creates lots of potential energy, but if stretched a bit too far the rubber band (our healthcare workers) can snap.

Some nursing homes and hospitals are addressing this head-on and have made resources available to their staff to ensure they are in a good place mentally and physically.

It's imperative that this is a focus area even or especially in times of crisis like these days, to ensure the safety and well being of our healthcare staff, and by extension, our patients and residents.

Reach out to Kathy

• kathy@kathyparry.com - for your free downloadable resilience toolkit!
• KathyParry.com

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Brianne Schmitz actually graduated college with a music therapy degree and started doing music therapy in a nursing home. 

When the administrator noticed her interest in the business end of the operations, she was encouraged to pursue this.

Brianne is uniquely equipped to fully understand the journey and the subtleties of the resident experience having entered the role from the softer, music therapy side. 

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In this episode we meet Michael Citronenbaum of Unclaimed Financial, a company that finds money that's rightfully theirs. These funds are from unclaimed insurance claims, forgotten accounts and other sources.

Today we learn about the recent financial assistance programs available to nursing home providers which puts them in a much better financial position for the short term.

This will enable them to manage some of the immediate financial challenges while managing this crisis.

• HHS - government funding initiative for care providers
• PPP - Payroll Protection Program

Reach out to Michael!

• UnclaimedFinancial.com

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In this episode, we meet a nursing home administrator, Nicole Verdon, who passionately share the dedication and devotion of the nursing home caregivers and the lack of adequate funding for even the basic level of care pre Covid19.

A nursing home loses an average of $38/day per Medicaid Patient in Massachusetts. With an average 70% Medicaid census, this business model simply does not work!

It's time for a change!

• Nicole Verdon on LinkedIn
• TNHP episode with Mark Parkinson, CEO of the American Health Care Association.

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Robin shares with us the perspective of the surveyor when entering and surveying a nursing home. They have pressure from their managers to complete the survey in a specific time frame (usually 4-5 days).

The regulation requires that all surveys are completed in 9-15 months and that can be a challenge when a facility is not prepared and ready to go.

I wait, hope and pray for the day when all surveyors will be on the same page and will work together to ensure the residents receive the highest level care that they truly deserve!

Contact Robin

• Call - (917) 991-1093
• Site - seniorconsultantsny.com

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Moe Rabi, COO of Senior Care Therapy, transitioned from selling DME (durable medical equipment) to his current role. He explains the transition, as a natural move from helping to helping.

People do business with people. We need a personal relationship with the business we are working with. We are social animals and we crave genuine human connection.

Personal profiles have much more engagement than company pages because of the human connection.

Resources

• The Love Your 9 to 5 Show
• Senior Care Therapy

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** we apologize for the audio quality on this episode but this was too good not to share :) ****

The nursing homes have always been the dumping grounds for the hospitals.

Patients that cannot be safely discharged back to the community find themselves discharged to nursing homes.

This introduces multiple challenges in the nursing home setting when new residents are introduced into a setting of the traditions 'little old ladies' of the nursing home.

Nursing home operators need to train their staff to identify and manage their substance abuse residents. This will empower them and support them to manage these difficult residents.

Learn more about Marcia Amarsingh

• On LinkedIn
• Renewal Sober Living
• Amarsingh Integrated Counseling Services
• aicsllc@outlook.com
• (508) 981-3301

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There are lots of ways to show appreciation to the folks in the nursing homes:

• Send food - doughnuts and coffee goes a long way to boost morale.
• Hazard Pay- nursing home owners can adjust their pay to reflect this challenging work situation.
• Treat the staff like the heroes that they truly are :)

What the nursing homes can/should do:

• community relations is everything. Create, maintain and cultivate real relationships.
• over communicate with your community
• post on social media consistently sharing your SNF's events.

Check out Dr. El's site here!

Here's the McKnight's article that connected Dr. El with The Nursing Home Podcast.

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Outbreaks were happening even after facilities were closely monitoring the residents' temperatures. The challenge was getting ahead of this problem.

Here's the NY Times article by Dr. Levitan explaining the strange nature of Covid19 pneumonia having almost no symptoms at all until its too late to intervene.

After digging through the data, Shalom and his team discovered that the oxygen levels had significantly decreased up to 2 weeks prior to the onset of high fevers.

Action on this information, operators have the ability to detect the Covid19 and address it while they still can. Days or even weeks prior to the onset of any detectable fevers.

Visit MegaDataHS.com for the full infographic here

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Practical steps to manage Coronavirus:

• Sick staff should really stay home. (we know that nurses make for the worst patients. They'll come to work not feeling well because of how greatly they care for their patients. Now is not the time for that.)
• Use proper protective equipment including full face shields.
• If possible, assign one staff member to care for a positive coronavirus patients to minimize the traffic in the room.
• Practice your infection control policy. For real.

CONTACT MEGAN

• Email Megan at mcrosser@nodmd.com
• nodmd.com

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Nursing homes have been hesitant to embrace social media for a variety of reasons. HIPAA concerns, legal reasons and of course marketing concerns.

What many centers don’t realize is that content will appear online regardless if they allow it or not. Pages are auto-generated for facilities where residents and even employees are already posting information.

By fully engaging on the various social channels, the facility can then control the conversation and direct their raving fans to share the positive experiences.

CONTACT JONAH TODAY!

Text: (551) 587-1850

Typoductions.com

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Lots of the regulations governing the telemedicine space were relaxed in an effort to bring the skilled physician care to the patients in real time.

This is a great step forward in the med/tech space and we hope this will have a lasting impact on the industry.

Brad and Dr. Carpenter point out that telemedicine is simply a technology to connect physicians with patients. However, the bottom line is that it's the clinical team behind the tech that make all the difference.

Sound Physicians was started as a physician group and will remain just that. Pairing the expertise of such a team with the new tech is a win/win partnership.

Click HERE for the Special COVID19 Offer - be up and running with telemedicine oversight for your SNF in just 72 hours!

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In this episode we meet...

Ari Shabat, CEO of Reside Admissions, a new innotive onboarding solution for nursing homes to streamline the admissions process.

The software asks simply worded questions to fill complex forms on the back end.

Really fascinating episode!

Watch the demo reel at here to best understand the power of Reside Admissions.

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In this episode...

We meet Eva Vennari where she gives us the tools to actually look after ourselves while caring for those we love most.

Reach out to Eva at TheElevateInstitute.com

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In this episode...

We meet, Steven Zaidman, a Licensed Medicare Insurance Specialist, and he walks through the process of planning and paying for long term care.

Many times the children of the patient are hit with this cost unexpectedly. They have very limited intimate knowledge of their parents finances and sometimes in for some surprises.

Having a conversation earlier on with parents regarding long term care insurance can go a long way to alleviate this eventuality.

Contact Steven:

steve@zaidmanhealth.com

Phone 732-497-2273 (Work)

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There are keywords that the nurses are documenting that can be clues or early signs for coronavirus symptoms.

Megadata's new tool reports on these small changes early on and gives clinicians the ability to detect them early on and prevent the spread of the virus.

TAKE ADVANTAGE OF THIS FREE OFFER!

EMAIL: Covid19@megadatahs.com

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Directors of nursing/Admins:

• support your staff
• help them grow, even if they will outgrow your facility
• understand their challenges and address them
• Don't be overly punitive

It's a tough environment to lead or be led. The bottom line is that anyone in the industry should be there only because they genuinely care.

Jennifer's new Business

Silverstar LTC Advisors

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In this episode we explore this fascinating service with John Freitag of All American Hospice.

Here are some issues covered in this broad-ranging episode:

• Did you know that patients can graduate from hospice?
• Who pays for hospice?
• What types of treatments and medications can be continued while on hospice care?
• Why should nursing home operators partners with hospice providers?
• The role of the hospice staff in the nursing home.

Here's the link to John's Linkedin group for Senior Healthcare Professionals of Philly, Bucks and Montco.

All American Hospice

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Adult day care centers are an untapped resource for nursing homes and hospitals.

Both are concerned with successful community transitions (read:sending the residents home and having them stay there) and adult day care centers can be really effective in accomplishing this goal.

It's time for the nursing home professionals to seriously and fully utilize our professional community partners.

Reach Out to Mordy

• http://ambassadordaycare.com/
• Phone (609) 489-9518

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Here are some of the topics we covered in the packed episode:

Alternatives to nursing home care: independent living, home care, adult day care and technology remote care.

We've discussed telehealth in the past on this show with Mordy Eisenberg of Tapestry Healthcare and with Michael Smith of Marquis Health Services.

Are tattooed advanced directives legally binding?

FOLLOW DAVID

• Eldercaredirection.com

Originally recorded live on Linkedin and Facebook

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It's critical for the leadership team to display a strong front and be action focused and forward thinking. Hysteria, nerves, and standing on edge does not help with this or any crisis. 

If you are following your infection control policy, follow basic hand washing procedures, you are far on your way of managing and preventing the spread of this and any other virus. 

There are clear actions or guidelines that could and should be followed. The more we focus on action items that we can do, we diminish unnecessary stress and can focus on actually managing this crisis until it blows over. 

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** RECORDED LIVE ON LINKEDIN AND FACEBOOK **

We discussed the prevention and management of COVID-19, the problematic strand of the coronavirus and get a better understanding of this latest outbreak.

As a nursing home administrator, I can relate to the pain, suffering, and misjudgment of the Life Care Center facility in Kirkland, WA, and the residents; families are going through and I pray that they can contain this outbreak to begin the recovery and healing process.

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This was originally recorded on Linkedin and Facebook live to address the growing concern of nursing home professionals, the residents and their families with dealing with the Coronavirus. 

Dr. Sarfraz Sidhu shares that all nursing homes and healthcare facilities already have infection control policies in place. We need to be vigilant in following those procedures, and educating ourselves and our staff on the latest that the CDC and our state agencies share about the virus. 

Ultimately, this virus will pass as our communities build an immunity to this strand of the Coronavirus, however, in the meantime this episode deals with the management process. 

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David Carvelli is an RN and spent more than half of his career at the bedside and then transitioned to the LTAC (long term acute care) world where he was hired as a liaison/marketing role.

David quickly grew to the VP of marketing role until the reimbursement structure forced many LTACs to close their doors.

Since then David has been with several nursing home companies helping them succeed financially with their census requirements and business goals.

Shmuel: Why were liaisons welcomed into the hospitals in the past?

David: Ease of access. The case managers were able to give a name to a liaison and have them work out the discharge.

The liaisons were actually assisting the case managers in the discharge process. This facilitated a successful transition and significantly expedited the process.

Shmuel: Why has this changed? Why are the liaisons no longer welcomed in the hospitals?

David: Security and privacy. Also, with the electronic referral systems, the case managers can send a referral to many facilities with the click of a button. This makes it less necessary to have liaisons seeing them in person every day.

Other Actions for Clinical Liaisons

• Be available and accessible to discharge planners
• Go out into the community and share educational materials and trainings
• Attend conferences and events that are important to your acute care providers (hospitals)
• Be active with your local senior centers and adult day care centers

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After spending a few years in a major accounting firm and subsequently hired as a recruiter from those firms to smaller companies, Aaron finally bit the bullet and joined the family business selling wound vacs to nursing homes.

KCI has always been the gold standard in wound vacs and they had a heavy patent on the device and the dressing kits. The concept of suction therapy has been around for hundreds of years, and the expiration of KCI's patent has opened the door to competition.

Learn More About Wound HT

• Visit https://woundht.com/
• Email: aaronl@woundht.com

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Mark is a 3rd generation nursing home operator and he recalls his grandmother’s advice, stick your nose into every department to learn everything about them.

Shmuel: Why is it so hard to attract and retain excellent nursing talent in nursing homes?

Mark: The nurses and CNA’s who provide direct care to the residents of the nursing home have a very difficult task. It’s difficult to provide care for seniors who are no longer in the prime of their lives, can be uncooperative, combative and challenging.

If upper management genuinely sees the residents as humans, as people, as deserving of our utmost respect and admiration, this can and will trickle down to the line staff as well.

This small mind shift can make it possible to provide excellent care even in the most trying circumstances.

By creating an environment where the nursing teams feel accomplished, you greatly diminish the chances of them leaving for your competition.

There’s no greater feeling for a nurse than to watch a stage 4 wound heal and watch their patients thrive.

Provide them with opportunities to grow professionally and they won’t be looking to leave.

Most nursing home operators genuinely cares deeply for the residents under their care.

Links

• 11-year-old girl grants wishes to nursing home residents
• Moving Poem! 2 Mothers
• Follow Mark on Linkedin
• Aventura Health

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Joe Goldberg's 2+ decades experience shows this dramatic shift in the method of filling nursing home beds. Personal relationships with hospital discharge planners no longer cut it.

Hospitals are now responsible for their outcomes even once the patient leaves the hospital. The CMS star rating and results or recent Department of Public Health surveys will play a much bigger role in the case managers decisions.

Nursing home marketers are discouraged and sometimes straight out forbidden from entering the case managers offices which in the past were open doors.

There are a number of factors affecting this change but the bottom line is that we need to find a new way to market nursing homes to our acute partners. We need to find new ways to share our facilities with them.

• Episode with Mordy Eisenberg of Tapestry Telehealth
• Episode with Shalom Reinman of Megadata

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I love professionals like Michael Smith.

Mike climbed the ladder from a CNA to housekeeper to nurse to RNAC to director of nursing to administrator and now to director of operations. He really knows this industry well and has an excellent understanding of home this complex puzzle comes together.

In this episode we discuss the effectiveness of a telehealth program in the nursing home setting.

A good telehealth program empowers the nurses to effectively communicate and actually show the on call physicians exactly what's going on in real-time.

The system is manned by hospitalists that are trained to provide remote care in the nursing home setting. This has dramatically reduced the rehospitalization rates for these facilities and the residents are being effectively treated in the SNFs.

• Linkedin - Mike Smith
• Facebook - Marquis Health Services
• Linkedin - Marquis Health Services
• Marquis Health Services

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The care provided by telehealth is on par with in person visits. The nurse acts as the hands of the doctors in the room.

Not every clinician will be skilled working with telehealth because theres a skill set necessary to work in this environment.

Additionally, there's the human element. A good clinician is able to connect with the patient and let the screen melt away to be present with the patient.

• Linkedin
• Tapestry.Care

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Business structure is critical to long term success in the nursing home business and in any organization.

This is not the rigid org charts with the CEO, COO, CFO etc. rather its ensuring that information flows from the top to the bottom of the organization.

Many nursing home chains are owned by leaders that have a very clear idea of how they want to deliver the highest level of care to their patients, residents and families.

The challenge is that the 'boots on the ground' are sometimes not even aware of this vision, and certainly don't have a clear idea of how to implement that vision.

A company with a solid structure will ensure that leaderships' goals are known and implemented all the way down the chain.

David is brought on to companies that have hit a ceiling of growth or are not functioning in this method and he creates the structure necessary to support and implement the leaderships vision. 

Follow David on Linkedin here!

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Not everyone that has a large following on Linkedin will automatically attract clients.

However, all of those professionals have parents and loved ones that are candidates for senior care. Although they are not actively looking now, you are now on their radar and when the need arises they will come to you first.

Linkedin is a B2B platform but remember that all those B's are also C's. They are working to finance their consumption. So cast a strategic net and connect with a everyone in or near your space and let the magic begin. 

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In this episode, we meet Tuli Kraus of Fresh Scents, a company that believes scent changed the way we experience life.

This innovative product has been introduced into nursing homes. Unique smells are introduced to recreate environments where staff and residents feel safe and comfortable.

Reach out to Tuli on LinkedIn here and check out Fresh Scents Inc here.

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In the episode we discuss the challenges and opportunities the new payment model present to operators and how they will affect the residents and patients of these facilities.

Here's a partial list of what we discussed in this episode.

Who will be affected most by these changes?

What is the best way for providers to successfully navigate this transition?

What are the 3 biggest myths 'outsiders' perceive regarding the nursing home industry?

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Steven was privileged enough to have known what he wanted when he was young. He took up nursing and realized that he wanted to be involved in caring for the elderly, being someone who was close enough to live with his grandparents.

Then took up a graduate degree in Gerontology.

Steven also worked in clinical care in Hebrew SeniorLife in Boston. He then transitioned in research and training institute and became a part of the development team for other projects where he developed the importance of standardized clinical assessment, its reliability and validity, and the power of what can be done in the datasets for this assessment.

Recruited to Pointright, he started studying the data and creating proprietary algorithms to help operators, nurses, and other professionals to have data driven insights about the industry.

This has given the professionals and stakeholders with real-time, actionable information.

Being involved with a lot of information and assessment data, Steven realized his passion in filling the gap between the quality of clinical outcome and the lack of fully grasping the financial aspect .

It was then that he joined Zimmet Healthcare, with his enthusiasm for analytical thinking on the reimbursement models and how to best equip their clients and was appointed as the Chief Innovation Officer to lead the Zimmet team in discovering new ways to help the providers and stakeholders in achieving great nursing service.

Steven has pointed out the sad truth of the current payment structure, which doesn’t motivate people to think about a systematic approach to end of life. He gave various examples showing that should have been of financial advantage, elders would have been given better care.

Shmuel shared his insights on how the system has been rigged with thinking that the financial impact gets the better tilt on the scale as it provides viability to the business, overlooking the quality of services that it should have been prioritizing in the first place, as it was the major force to improve the financial aspect of the business.

Steven explains how the PDPM is an improvement to the current healthcare system that will be beneficial to everyone involved in the business, since nursing is more fund-centered.

As he goes teaching classes for PDPM, he points out the mix of people included in seminars that is involved and interested in this model, and he appreciated how well aligned these people are into listening and getting as much information as they can to prepare for the common goal.

The Therapists’ Role in the SNF

A great example that he mentioned are the therapists being boxed in their reimbursements per minute.

For him, therapists are one of the most commonly overlooked health care provider, and they are being valued only per minute, even though they provide healing and rehabilitation, which are incredible.

PDPM will allow them not only to be reimbursed with the timed service they provided, but to be comfortable in giving the quality service that is required of them without the hesitation of being underappreciated.

The new model allows everyone from the management to skilled workers to join together, be in the table together and discuss the appropriate care needed for the patients, which minimizes the tension in between departments.

PDPM Concerns

Although beneficial, Steven still emphasizes his few concerns with PDPM. Since it will be all about the patient, he believes that behavior will have to change come October.

Terms will also have to change accordingly. In nursing facilities, residents will no longer be called “residents” but “patients”.

He also acknowledges the importance of documentation as it will be heavy in implementation of PDPM. This change will also mean taking the rules of the past and trying to apply them to the future.

If you want to gain a better understanding about PDPM and how this new model works, listen to the podcast as Steven and Shmuel intelligently discuss about this change and gives their deep analysis about it.

Steve’s final thoughts on PDPM:

I hope my passion and excitement about this change comes across. I just think that we are in such an unbelievable inflection in our industry.

PDPM is not certainly propped for success. PDPM is here for five years before, it will be replaced by another system, and that other system is already foretold. We are going to site neutral reimbursement where all institutional post-acute settings will get the same rate.

PDPM and the data that we are now collecting is really going to demonstrate that we are the best game in town.

We’re providing the best outcomes at the lowest cost. So this is just a simple stepping stone, if we crush this we are going to do exceedingly well in the future.

Shmuel’s Take on SNFs

People come in completely paralyzed and walked out the front doors; we get the trimmest, leanest reimbursement, and many times we get outstanding results, and if that (PDPM) is the way to the future, then that is really amazing news for providers.

Key Takeaways:

08:24 When the clinical results and the clinical product have a direct financial impact, that’s when everybody wins; that’s when the residents win, that’s when the operators win, that’s when all the various partners win.

10:34 How can it be that in the industry that is created to care for elders, how can we be so bad at identifying someone’s at the end of life? How can we struggle so much with identifying people who are in pain. It is because our system does not reward that.

17:40 You push on one side of the water bed and the other comes up.

32:16 CMS believed PDPM will be budget neutral and there’s no way it’s going to be budget neutral. These changes are never budget neutral because behavior changes, we play by the rules, we change our behaviors, we start documenting things we never documented before.

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Shalom shares with the listeners how he has a strong financial background in accounting, finance and business intelligence.

Throughout his career, he was drawn to the details and power that a strong understanding of the numbers had on actual day to day business decisions.

In one business, Shalom’s company inherited a business intelligence technology which Shalom built out into a real functioning system that produced the intelligent reporting systems that were important and applicable in real time.

These successes prompted Shalom to finally go out and create the full blown business intelligence system that he knew the SNF (nursing home) clientele really need.

Weren’t we always able to get similar information from regular back office reporting?

There are 2 problems with the old system of getting information.

1. There is a labor cost incurred every time your run a report.
2. Many times the information is too old to act on by the time your receive it.

With Megadata, the information is automatically available in real time. This allows the operators who embrace this technology to act on information that others won’t know for 45-60 days.

Who is this ideal for?

If you are a small organization with just a few facilities, this solution is probably not for you. The tool helps organizations that are growing into the mid level size.

When they are operating at that level, it’s critical to know this information to keep all the facilities in sync and operating at their highest level.

Admin Dashboard

There is a new feature developed by the Megadata team that shows a facilities administrator an overview of the most crucial information that a nursing home administrator needs to plan his day. This is a feature that is extremely beneficial on a facility level.

Visual Data

You don’t need to have a background in finance or analytics to understand the metrics in Megadata. The reports are very visual and easy to understand. Most importantly, they are easy to implement and act on.

Links

SNF Vision - learn who owns and operates nursing homes

MegaDataHS.com

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Let’s meet Chris Caulfield RN, NP-C, co-founder and chief nursing officer at Intelycare. He has been a nurse for 10+ years and experienced a variety of work settings within the nursing industry.

Chris tells us more about Intelycare, from why it was conceived and how it continuously helps both hospital administrators, nursing homes and nurses with a system that is reminiscent of Uber.

The nursing home industry, specifically from the nursing home staffing standpoint, there is definitely significant struggle. There are more open shifts than LPN’s. There are simply more nurses that are needed than there are nurses available.

Intelycare, as in ‘intelligent way of caring for residents’, aims to address the problem. Nursing agencies that works with nursing homes are typically doing blocked book assignments.

Intelycare is best known easing the gap between nurses and nursing homes, and they are continuously adding to those services.

Chris also discussed how their system rates their shifts. It is both rated by the nurses that you are passing the assignment on, and also the administrator, the DON and the scheduler.

He also relates to us how Intelycare deals with compliance, background check and licensing.

From going with a traditional agency type of recruiting, verifying licenses and references and adding more ways to verify nurses background.

He discussed the pricing standpoint of their system compared to a traditional nursing agency. He tells us how nursing homes who have used Intelycare has increased their staffing ratings, improving their future profitability.

There are also nursing homes that are exclusively using Intelycare staffing solutions, as Chris also tells us, because they can meet all their needs including consistency.

A total of 8,000 nurses and nursing assistant have worked with Intelycare.

Intelycare aims to provide a complete staffing solution for nursing homes. Helping them mange, maintain, retain their own internal staffing while supplementing as necessary.

Intelycare is currently expanding in Illinois and New Jersey.

Intelycare website:

https://www.intelycare.com/

Intelycare Facebook:

https://www.facebook.com/IntelyCare/

Intelycare Twitter:

https://twitter.com/intelycare

The Nursing Home Podcast website:

http://thenursinghomepodcast.com/

LinkedIn:

https://www.linkedin.com/in/shmuelsep/

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Scott Reib is known as America’s Legal Coach. He’s the official Zig Ziglar Small Business Lawyer, a Ziglar Legacy Certified Trainer, and he has over 20 years of experience as an attorney.

For the last two decades, Scott has been helping business owners, entrepreneurs, coaches, and service providers to “shatterproof” their businesses and succeed in the

professional world.

Scott is a firm believer that seeking legal advice doesn’t have to be intimidating or expensive if we treat lawyers like primary care doctors instead of ER doctors.

Through his subscription-based Access Plan legal service, Scott is making great strides in shifting that perspective.

In the past, clients were scared to call Scott or any attorney because they were nervous about the cost of the conversation.

This led them to let things go on fire before they called out for help.

With the Access Plan, clients pay a flat rate per month. This ensures that they are both on the same team, and they can call him as necessary before things become serious issues.

Book Your Free 15 Consultation with Scott Today!

Reach out to Scott

ScottReib.com

ReibLaw.com

scottr@reiblaw.com

Linkedin

Twitter

Phone - 940-691-7009

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What does Zimmet Healthcare actually do?

Zimmet Healthcare is a consulting support firm specializing in skilled nursing facility reimbursement, compliance and strategic planning.

Initially started as a service vendors creating cost reports and appeals for Medicare and expanded as the industry has matured.

Zimmet Healthcare currently employs about 60 people servicing about 300 facilities across the country.

Do you see a significant trend in the reimbursement method for SNFs from when you started out to today?

There’s a complete shift in SNF reimbursement.

To be frank, clinical reimbursement is a complex topic and the goal of this conversation is to get a better understanding of the big picture, the coming changes and how they will affect day to day operations of your nursing home.

With that in mind, let’s go back to Marc’s answer.

In the earlier days, reimbursement was based on the costs a facility incurred when caring for a particular resident.

The more the facility spent on the resident, the more was their reimbursement within reason.

This is now changing to a model that is based on price and not cost. There is a fixed rate per day for a residents’ condition, diagnosis and plan of care.

The facility will get reimbursed at that rate regardless of the actual costs incurred by the facility.

Why is Medicare Changing the Reimbursement Methods?

One of the biggest challenges with the current PPS/RUG method of reimbursement is that there is too much of an emphasis on the therapy received by the resident.

For example, if there are to residents who receive the same level of therapy, the facility will receive similar reimbursement for them even if one has significant other clinical challenges (such as wound care or cognitive issues etc.).

PDPM - Patient Driven Payment Model

PDPM which is starting October 2019, enhances the reimbursement sensitivity of the all the different payment drivers and takes the focus away from therapy as the primary driver of payment.

PDPM Vs. RUGs

To understand the difference in reimbursement consider the following.

We are going from a RUG system which has 66 RUG scores (of which we only use 20 or so of them), to PDPM which has almost 29,000 rate composite possibilities, which boils down to 15-20,000 rate combinations that will actually be used.

In simpler terms, with more words in the language we can be that much more precise.

How Does This Affect the MDS Process?

The MDS job description will change a bit. There will be fewer assessments, however, it will require working more extensively with the other disciplines.

Whereas in the past the reimbursement was driven primarily by therapy and ADLs, now the other disciplines will play a significant role in the reimbursement process.

For example, dietary will need to capture a mechanically altered diet. The psychologists, respiratory therapists and others will play a large part in this process.

Who is Pushing for These Changes?

The federal government is pushing for these changes. MedPac (The Medicare Payment Advisory Commission) has been almost begging congress and CMS to implement a patient specific payment model that does not recognize the frequency and duration as the payment driver because it provides an incentive to over treat the patient.

Is the Government Trying to Save Money With This?

Theoretically, this is supposed to be budget neutral.

It’s a redistribution from facilities that focus primarily on the therapy intense patients, to facilities that take the sicker, more compromised patients on the vents and trachs.

The medically complex patients reimbursement will go up considerably and the therapy intense patients will go down.

Will Facilities Make More Money in PDPM?

Zimmet Healthcare expects that facilities will get better at taking credit for the care they provide and in the first year Medicare will actually spend more than their budgeted amount.

This will be followed by a rate reduction that will recalibrate the dollars to make it budget neutral.

So perhaps in year 1, the facilities that learn and implement programs to accurately take credit for the care they provide, may make some extra money.

However, once the rate is adjusted, it should remain budget neutral.

Who Gains by These Changes?

Ultimately, these changes are indeed in the best interests of the patient.

The problem with the system is that you almost have to provide a high level of therapy in order to keep your doors open.

Let’s take the dialysis patient as an example.

In the RUG reimbursement model, the facility would lose money.

The rates are simply inadequate.

Facilities would try an aggressive treatment approach where they would take the resident to therapy early in the morning knowing that the resident will not be able to tolerate the therapy on their return.

With PDPM, this will not be necessary because the other clinical challenges will be considered as well in the reimbursement rate.

What is Changing in the Medicaid System?

Being that Medicaid is not a national system, and each state runs their own program, it’s difficult to speak about the specifics of the program.

However, in general terms, Medicaid started out as a cost based model, many states then went to a case mix and acuity model, to a priced based system and finally to managed care. This is not universal but is the general trend.

More importantly, every state has x number of dollars to spend on their Medicaid program. The main concern is not the distribution of reimbursement for the program, rather, it’s the overall total funding of the program.

An astute operator will learn to maximize their Medicaid reimbursement dollars in any Medicaid system. The problem lies in the total dollar amount that the state allocates to the Medicaid program.

Are the Articles That State the Amount a Nursing Home Loses Per Day Accurate?

It may be true that the rates are inadequate, however, the facility was never going to be profitable just by the reimbursement payments.

In order for a facility to be profitable they will need a good short term rehab census as well. This together with the Medicaid payments can make the facility viable and profitable.

If the facility was 100% filled with Medicaid patients with the right acuity mix, and everyone had Medicare Part B you would not be losing $37 a day.

Is Owning and Operating Nursing Homes Still as Profitable Now as it was 25 Years Ago?

In the early 90’s it seemed like a really simple business to run. Nowadays, it’s a very complex business.

Today, there is tremendous potential in the post acute care continuum which SNFs are such an important part of, is where the opportunity lies.

In post acute care management, there real opportunity to meet the new demands of the new nursing home residents.

A stand alone nursing facility that is well managed can absolutely be a profitable business and serve the community well.

Where are Those Baby Boomers?

We are always being fed information by the media that with the baby boomers are coming of age and nursing homes will have to scramble to meet the need.

While in reality, nursing homes are struggling to survive due to lack of patients.

As mentioned earlier, there are a variety of variables that are causing this to happen, including the push to provide for these elders within the community.

However, the statistics do show a sharp increase in the Altzheimers disease in the coming years of which 75% of those over 80 will need to be admitted to a SNF.

That is something that will significantly increase the utilization of SNF care and should sharply affect the overall occupancy.

Contact Marc Zimmet and learn more about Zimmet Healthcare at

ZHealthcare.com

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In this episode we meet, Sarah Rayburn of VCorp Services.

Sarah went to school for broadcast journalism.

When she realized that it was a real cut throat industry, a recruiter reached out to her and brought her into VCorp Services.

With her self admitted, ‘work ADD’, she was able to quickly learn the business and she took a liking to the compliance side of the business and that became her niche.

While attending a conference at the American Health Care Association, Sarah noticed how so many nursing home organizations were struggling with precisely this level of compliance.

Often, this was not given the attention that was needed for this and the results showed for themselves.

It’s never pleasant when the facility is giving a tour to a potential resident’s family members and a police officer enters the facility and serves the lawsuit.

It’s not good for marketing.

The staff begin to wonder about the stability of their jobs and all of this could have been avoided had the facility arranged a registered agent.

This information can be shared exponentially when this event is shared on social media and before you know it, this has become common knowledge.

A registered agent will receive any notices or legal notices, service of process, state notices and other types of legal documents. The agent is then responsible to share the information with the facility.

Contact Sarah

VCorp Services

Sarah@vcorpservices.com

8885282677

Mention that you heard this episode for 10% off on your service fee!

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Intro Episode

My name is Shmuel Septimus.

I’m a nursing home administrator, podcaster, online marketer, lover of effective communication and networking.

There is a dearth of knowledge when it comes to understanding the inner working of the nursing home industry.

On this podcast we will interview the mover and shakers of the nursing home industry. They will share their unique perspectives and experience with us.

We learn together how to best navigate our way through this complex and ever-evolving world of long term care.

Looking forward to taking this journey together!

Check out my other podcast as well - The Love Your 9 to 5 Show

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Alvin Kahn -Principal, Executive Director of Recruitment at Alvin Kahn and Associates

30 years ago, Alvin started recruiting for hospitals across the country. Eventually Alvin was promoted to working in the corporate office doing trainings and continued to recruit.

In 1995, Alvin started out on his own, with Alvin Kahn and Associates, a recruitment company specifically focused on the nursing home industry.

What pulled to the nursing home world from the acute care/hospital industry?

There was a group from Milwaukee Wisconsin, that started working with the rehab in the nursing home industry and they needed someone to manage their Eastern operation. Alvin was hired by this company to help out with in several states.

When that company eventually sold, Alvin was able to use the relationships he had built to go out on his own and as they say, the rest is history.

Do you help fill line staff for nursing homes for RNs, LPNs and CNAs?

AK focuses primarily on management level and above and the facilities work internally to fill the other positions.

What is your magic trick to find the candidates that are the right fit for the specific positions requested? What can you do that the facility cannot do?

Facilities reach out to us because the candidates and the facilities are concerned that the job search should be kept confidential. That’s a reputation that was earned and created over time.

--

The employer does not want the current employee to know that they are looking and the candidate does not want their current boss to know that they are looking, lest they lose their jobs before they are ready to move on.

We only send over candidates that are qualified and have a really great potential of being an actual fit for the position.

If you work with an online resource such as Indeed.com or Craigslist.com, even if you put the ads up correctly and sponsor them, you will still receive many, many candidates that are completely not qualified.

A good recruitment firm will only send over pre-screened candidates which they genuinely believe have an excellent chance of success. That is what is done at Alvin Kahn and associates.

The firm actually works hard to establish a relationship with the candidates to really see the full picture and understand their background. Equipped with this information, there are much better chances that the candidate will be the right candidate for the position.

Do you find a practice that the nursing home operators or candidates are doing that are surprising to you?

At times, a candidate will share more information than we find necessary. When asked why they are looking to make a change, they may share more information and details than we feel we need to know.

We understand that there are always at least 2 sides to every story.

At times there are candidates that have had a troubled past. The facilities will generally pass right over these candidates because they don’t have the time or resources to fully vet out the candidates.

As a recruitment firm, we encourage candidates to be upfront with their past and that they share any skeletons that they may have in the closet. This is in their past interest, because they will come out later and at that point, it can derail the entire process.

Retainer vs. Contingency

Retainer search firms are paid an amount in advance to be available to fill positions as the needs arise. Contingency search firms, like Alvin Kahn and Associates, are paid only if and when they successfully place the candidates in their positions.

Over The Phone

Almost all of the work that is done in finding and screening candidates is done over the phone. It’s still really effective to speak over the phone (INSERT LINK TO PHONE LIVE), and it’s working.

When a candidate comes into the office, there is lots of wasted time on the part of the candidate and the firm that could be better used to find the right candidates.

The firm is now looking to do video conferencing to add the face to face connection to the process without compromising on the efficiency and use of everyone’s time.

Is there any particular piece of advice that you wish someone would have told you earlier on in your career?

There are 2 points here.

You must have mentors and you need to learn from everyone to some extent. However, don’t listen to everyone else’s advice. What works for them, works for them. You must infuse your professional activities with your own unique talents and personality.

Additionally, it’s critical to focus on the recruitment results when speaking with candidates. You are not their social worker and all conversation and engagement should focused on that end goal.

What’s your favorite part of your business that lights you up inside?

The greatest excitement is when we find are able to successfully place a candidate with a company. We actually make a toast together to celebrate the event.

And no, it’s not just because that’s when we make our money. We get that special sense of accomplishment and joy when the candidate was not able to find employment without our help. Or when the employer was not able to fill the position on their own.

Parting Advice

The process must be taken seriously. Candidates should know the facilities well before approaching the recruiters and the facilities should also be equally invested in the process.

Links and Resources

• Phone 732-901-6070
• Website AlvinKahn.com
• Social - Linkedin
• The Career Podcast - The Love Your 9 to 5 Show Podcast

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Innovating Healthcare with Software and Technology with Alan Dworetsky

Alan Dworetsky is the director of sales and marketing for Approved Admissions.

Alan has been in the medical space for nearly 15 years started by selling durable medical equipment and then transitioned into wearable ultrasound devices. At that point, Alan found the opportunity at Approved Admissions to move into the software part of the healthcare space.

The healthcare is solid and is not going away anytime soon making it a very stable industry for the long run. Software is becoming a become part of our daily lives.

What is Approved Admissions?

There are 2 functions for Approved Admissions.

1. It can be used to verify the payor sources for potential admission of new residents to the nursing home. Through the system the admissions director can verify that the prospect has active insurance coverage that will cover that nursing home admission.
2. The second critical function that Approved Admissions serves, is that it periodically runs audits on the payor sources for all the residents to ensure that they are still current and up to date.

Family member will at times make changes to their HMO (insurance) plans in a way that they will no longer be covered without notifying the facility. They had no intention of paying privately and would never have done so, had they fully understood the implications of their actions.

Now Approved Admissions will notify the facility in their report that there was a change and the business office will be able to address the issue in real time.

The Manual Method

Without a software that automates this process, the facility either will wait for the denial letter from the insurance company at which point its much more complex to fix the issues.

Additionally, there would have to be someone who is manually checking every resident’s insurance individually. This is a very time consuming process and leaves the facility wide open to human error.

The goal of any software innovation is to minimize the reliance on human beings.

When was the last time a traffic light was incorrect and it displayed green instead of red?

You Must Trust the System!

If you don’t rely on the system, you will not get the full benefit out of it.

A GPS will only get you to your destination in a timely manner, if you shut off your brain’ and allow the system to help your navigate.

From Your Perspective, Where Do Nursing Home Operators Need to Improve?

There seems to be a strong push back from the nursing home staff in regards to accepting and embracing new technologies.

These innovations will actually make their jobs easier and improve the quality of the care we are all striving to provide. However, in the present, they present as a change and disruption to what has always been common practice.

Institutional Memory

Just because you are used to doing things a certain way doesn’t make it the correct way anymore. There is a great reluctance to change in any organization and that is a barrier to innovation.

Limited Resources

Unfortunately, nursing homes have limited resources which forces them to maximize the efficiency of whatever and whoever is available to them. In this environment, it’s challenging to introduce change even if it will produce significant improvements.

The bottom line is that it means more work right now and that is unthinkable in many facilities who simply trying to survive moment to moment.

What Commendable Practice Have You Noticed in Nursing Facilities?

Some nursing homes are putting kiosks in the lobby’s for family members to leave their feedback on their interaction with the facility.

They may leave a glowing 5 star review or share some criticism and a one start review. It’s encouraging to see nursing facilities that are open to hear the truth and act on the feedback they receive.

Repute iPad Review System

Repute is a system that we work with here at SNF Marketing to encourage family members and anyone who engages with the facility to share real and actionable information.

If there is a negative review, it will actually create a ticket that is emailed to the administrator and cannot be closed until the issue is resolved.

Truth be told, seeing a large iPad in the lobby of any building give the impression that the facility is up to date and pays close attention to detail. This is even before you fully understand the functionality of the system.

What is the Biggest Myth Regarding Your Product?

People believe that they can do a better job than the software or the AI can do.

This is incorrect.

Countless times the system find spelling mistakes and incorrect numbers that would have affected the claims and they ultimately would have been denied. By finding this information in real time, they facilities are savign real time and money.

Aren’t Software Companies Like Yours Rolling in Dough?

Being that your product is a software, the cost is fixed and should not matter if you have 10 facilities or 1000 facilities. So does that mean that you’re company is attaining larger and larger profits as it grows?

The real answer is that, yes, it’s true, that the cost is not affected dramatically when there are additional clients who sign up on the software side. However, Approved Admission, is constantly reinvesting back into the system.

The software is ever evolving based on changes in the marketplace, the needs of the customers and upgrading the software. An entire team of developers created, maintain and upgrade the system.

So, yes, the cost may be close to fixed to onboard another facility, but there is still a significant expense to constantly update and upgrade the system.

Links and Resources

Check Out Approved Admissions Here!

Repute iPad Check in Kiosks

The Love Your 9 to 5 Show

Reach out to Alan

• Phone - 917-525-2716
• ApprovedAdmissions.com