what makes innovation challenging

What Makes Innovation Challenging in the Aging Services Industry?

This week we are proud to highlight Nexus Fellow and industry expert, Jay Newton-Small.

In this Nexus video clip, she describes the unique challenges of the aging services industry and why it’s so difficult and complicated to innovate and make a meaningful impact.

“It’s such an inefficient industry and it’s so highly regulated. It’s a very intractable system that requires patience in innovating and ingenuity in innovating that other industries don’t require.”

Challenges for startups coming into the aging services space include selling into healthcare organizations that are under intense pressure due to rampant staffing shortages that have left them in a sustained state of crisis and placed a huge financial burden on them to maintain operations and meet basic regulations. The environment has been one of extreme stress, with little bandwidth or budget to invest in innovation or quality initiatives.

Information security protocols and other legal standards required to access patient data, while critical for protecting patient privacy, are also hard for small companies to meet on limited runways. And current fee-for-service payment models leave little room for innovation in holistic, person-centered care innovations.

“From the get-go, this is regulated in a really intense way, and there’s no way around that. So you have to think through, what is a way that we can innovate here that we can be able to have an impact, but also not harm people, which is a super important thing about health care. And also how can you find a way to make a profit and make your company viable. It’s one of the most challenging areas to innovate in.”

Newton-Small is the CEO of PlanAllies and the CEO and founder of MemoryWell, a tech-enabled patient engagement platform and SaaS that uses Natural Language Processing and “conversational interactions” proven to engage seniors and help Medicare Advantage plans lower churn. Unlike chatbots, MemoryWell uses journalists—or can train callers to interview like journalists using their proprietary software— to create real, effective dialogue with older Americans.

 

As a national journalist, Jay Newton-Small brings a unique perspective to the field of aging, insight into politics and policy, and a media platform. She also brings the heart of a personal-lived experience that led her to found her company, MemoryWell.

 

Related:

 

Want to be notified when a new blog is posted? Subscribe to our blog and receive posts in your inbox.

Grabowski at covid nursing home hearing

Problems We’ve Ignored for Too Long: A Hearing on the Impact of COVID In Nursing Homes

“COVID completely devastated nursing homes in the U.S.”

Dr. David Grabowski, a professor of health care policy at Harvard Medical School, and a Nexus Fellow, made this statement before a House subcommittee hearing on the impact of the coronavirus in our nation’s nursing homes.

Among the staggering statistics Grabowski shared with the subcommittee:

  • There were more than 1.2 million cases of COVID among nursing home residents, which led to roughly 172,000 COVID-related fatalities.
  • More than 2,600 nursing home staff members died from COVID, “making nursing home workers the most dangerous job in America.”
  • In the aftermath, both resident census levels and staff employment levels were down by more than 10% from pre-pandemic levels.

Drawing on his research, as well as his work on a commission with the National Academies of Sciences, Engineering, and Medicine, Grabowski made recommendations for reform to improve the situation for caregivers and residents going forward.

Grabowski urged policymakers to take a system-level approach to policy reforms to protect residents and caregivers. He emphasized that it is not too late. “We have an incredible opportunity right now to address problems that we have ignored for far too long.”

He proposed recommendations for short-run policies in two areas:

  1. Increase vaccination levels
    1. Extend the federal vaccine mandate for nursing home staff to include booster doses. Currently, only about half of all staff are fully vaccinated.
    2. Provide federally supported vaccination clinics for facilities with lower booster vaccine rates for staff and residents, to ensure that residents and staff have access to a vaccine clinic.
  2. Improve staffing
    1. Introduce a federal minimum staffing standard
    2. Increase staff pay and benefits
    3. Provide opportunities for career advancement
    4. Create a better work environment

“The way the U.S. finances and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable.” – David Grabowski

As a move towards a federal long-term care benefit, Grabowski suggested an approach for locally testing and creating benefit implementation with established criteria to evaluate success. He also emphasized the importance of accurate financial information to ensure payments are adequate to cover comprehensive nursing home care. In addition, value-based nursing home payment models should be created to reward facilities for providing better quality.

Additional panel members of the expert witnesses testifying before the House subcommittee included: Alice Bonner PhD, RN, FAAN; Adelina Ramos, Certified Nursing Assistant and 1199NE member, from Greenville, RI; and Jasmine Travers, AGPCNP-BC CCRN PhD RN, Assistant Professor of Nursing, NYU Rory Meyers College of Nursing.

See a video of the full hearing:

Want to be notified when a new blog is posted? Subscribe to our blog and receive posts in your inbox.

Senior Care Staffing Shortages

Senior Care Staffing Shortages

The skilled nursing industry has not recovered from staffing shortages spurred by the onset of the pandemic in 2020. According to Nexus Fellow and CEO of Activated Insights, Jacquelyn Kung, prior to COVID-19, employee turnover in senior care positions was 65%. It’s now at 85%.

“We need to look outside our own industry, we need to think about how we embed ourselves more in our communities and institute community hiring initiatives and rethink the requirements that we have in our role definitions,” said Kung.

An article, which appeared in Skilled Nursing News, poses possible solutions to staffing issues from experts in the aging industry.

  • Offer more hours to part-time workers
  • Provide work-life integration
  • Encourage workers to create their own solutions
  • Know what employees want in order to help retain and recruit

Read more at Skilled Nursing News.

Want to be notified when a new blog is posted? Subscribe to our blog and receive posts in your inbox.

Wage Increase for Long-Term Care Workers

Leading Industry Experts Support Wage Increase for Long-Term Care Workers

LeadingAge, the country’s second-largest long-term care association, has called upon President Biden to boost worker pay by $5 an hour, according to a report in McKnight’s Long-Term Care News. They are also asking for one-time relief payments of $2,000. These requests are part of a six-point relief proposal to address widespread long-term care worker shortages. The proposal was sent to President Biden in a letter from Katie Smith Sloan, CEO of LeadingAge.

David Grabowski, health policy expert at Harvard Medical School and Nexus Insights fellow, fully supports the plan. He is quoted in the article saying that we “would be in much better shape today if policymakers had put this in place at [an earlier] time” but adds that “it’s not too late to do this now.”

Grabowski says that supporting workers in long-term care will help alleviate the staff shortages that lead to overwork and burnout. “Policymakers must also increase benefits and ensure better working conditions. All too often, staff are overworked due to staffing shortages.”

Read the full article in McKnight’s Long-Term News

 

Want to be notified when a new blog is posted? Subscribe to our blog and receive posts in your inbox.

Nursing Home Staff Vaccination and Covid-19 Outcomes

The emergence of the delta variant of the covid-19 virus has raised new concerns about nursing home staff as a vector of infection among residents. This is especially true in facilities with low staff vaccination rates, but the actual relationship between staff vaccination rates and resident infection is not well studied. That is why a group of researchers used CMS data on more than 12,000 nursing homes to get some answers. That group of researchers included David Grabowski, Nexus Fellow and professor of public health at Harvard Medical School.

What they found is that in locations with high community transmission of the virus, low staff vaccination rates were associated with a 132% increase in resident cases, a 58% increase in staff cases, and a 195% increase in resident deaths. The relationships were not as strong in areas with low community transmission.

These findings were published in a letter to the editor in the December 2021 issue of the New England Journal of Medicine

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

 

Vaccination in Long-Term Care

They Don’t Trust it. David Grabowski Weighs in on Low Vaccination in Long-Term Care

Why aren’t nursing home caregivers getting vaccinated? David Grabowski, Ph.D., Professor of Health Care Policy at Harvard Medical School and a Nexus Fellow, discussed the issue recently with Arthur Caplan, Ph.D., Head of the Division of Medical Ethics at NYU Grossman School of Medicine, and Judy Stone, M.D., an infectious disease expert. 

The biggest concern: The lowest vaccination rates are among those who have the most contact with residents. “I have encountered quite a bit of hesitancy among nursing home staff. Unfortunately, the vaccination rates are lower among the nurse aides, those with the most direct contact with the resident,” Grabowski said. “And that’s been the greatest policy challenge.”

The cause? Grabowski believes it’s often an issue with trust. “Nurse aides are making close to minimum wage. Oftentimes, they don’t trust management or leadership,” he said. “They’re very resistant to authority and being told what to do. There’s just not a strong relationship between labor and management in this setting. This is a for-profit nursing home where this workforce hasn’t been treated very well historically and hasn’t been treated well during this pandemic. Remember that direct caregivers in nursing homes had the highest death rate among any profession in the U.S. during the pandemic. More so than commercial fishermen, and more so than logging workers.”

“Remember that direct caregivers in nursing homes had the highest death rate among any profession in the U.S. during the pandemic.” – David Grabowski

Another issue? “They don’t trust the vaccine,” Grabowski said. “I’ve heard some concerns about side effects. Hopefully, some of that has receded. Hopefully, they’ve seen their colleagues getting vaccinated and have seen few side effects. But there’s a lot of concern about long-term side effects and the overall safety of the vaccine.”

Stone agreed. What’s more, she suggested that incentives can actually increase distrust. “Why do you have to give me a gift card to take this? Is there something wrong with it? It sows suspicion.” In addition, she said that vaccine mandates may lead workers to believe that, rather than making them safer, it will instead lead to them working in a riskier setting.

See the full discussion.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

unvaccinated caregivers in long-term care

COVID on the Rise in Nursing Homes Again: Unvaccinated Caregivers is the Reason.

Here we go again. Despite the successful efforts nationwide to vaccinate nursing home residents, infections and deaths are increasing again in senior facilities. The reason? “Lagging vaccination rates among nursing home staff,” according to an Associated Press story in the Star Tribune.

Although nearly 80% nursing home residents are vaccinated, nursing home staff vaccination rates are much lower, about 59% nationwide, according to the story. This more closely matches the rate of vaccinated adults nationwide. The rates vary by state, however, with some states having vaccination rates as low as 40%.

The problem? This poses a danger to the unvaccinated staffers, and it poses a danger to the residents, even those who are vaccinated. Vaccinated older adults may be more vulnerable than younger people, particularly against aggressive COVID variants, such as delta. This raises concerns that “successes in protecting vulnerable elders with vaccines could be in peril,” the story reports.

“Vaccinating workers in nursing homes is a national emergency because the delta variant is a threat even to those already vaccinated,” according to Dr. Joshua Sharfstein, vice dean for public health practice at Johns Hopkins Bloomberg School of Public Health. “Older adults may not respond fully to the vaccine and there’s enormous risk of someone coming in with the virus.”

“Vaccinating workers in nursing homes is a national emergency because the delta variant is a threat even to those already vaccinated.”

David Grabowski, Professor of Health Care Policy at Harvard University, and a Nexus Insights Fellow, said “trust is the core question” among the unvaccinated, especially among low-wage workers who may not have confidence in recommendations from their management. “I think some of this mirrors what we see in the overall population, but among health care workers it is really disconcerting,” Grabowski said.

Read the full story.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

 

Relief ahead for health care worker burnout

Relief Ahead: HHS Funds 3-Year Program to Reduce Health Care Worker Burnout

Another cost of the COVID-19 pandemic? Caregiver burnout. Research firm Activated Insights conducted a two-year survey of 330 senior living and care workers. The results? “Worker burnout increased substantially during the pandemic at independent living, assisted living, memory care and skilled nursing facilities,” according to a report by McKnight’s Senior Living.

One of the surprising findings is that burnout declined by 12% for home care workers. 

In a conversation with McKnight’s Home Care Daily. Activated Insights CEO and Nexus Fellow Jacquelyn Kung suggested an explanation for the decline. Home care agencies “have adapted very quickly and are supporting their employees a lot more than they have in the past.” 

The good news? The U.S. Department of Health and Human Services (HHS) has announced $103 million in funding for a three-year program to Strengthen Resiliency and battle worker Burnout. 

“Worker burnout increased substantially during the pandemic at independent living, assisted living, memory care and skilled nursing facilities.”

“It is essential that we provide behavioral health resources for our healthcare providers — from paraprofessional to public safety officers, so that they can continue to deliver quality care to our most vulnerable communities,” HHS Secretary Xavier Becerra said in the announcement.

The McKnight’s report went on to say, “In awarding the money, HHS said healthcare providers face many challenges and stresses due to high patient volumes, long hours and workplace demands during normal time. During the pandemic, those challenges were amplified and had a disproportionate impact on rural communities and communities of color.”

Read the full article.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.