Nurse and senior man playing chess

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.

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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

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Jay Newton-Small and Bob Kramer discuss MemoryWell and person-centered care

Putting the Person Back in Person-Centered Care: Jay Newton-Small and Bob Kramer on the Power of Data to Transform Senior Care

Are your residents truly known, valued, and seen as people by your staff? Are they known as more than the sum of their ADL needs or underlying health conditions? 

Bob Kramer, Founder & Fellow at Nexus Insights and Co-founder and Strategic Advisor for NIC, talked with Jay Newton-Small, founder and CEO of MemoryWell and Nexus Fellow, about the value of data to deliver improved care and quality of life for residents of senior living.

A TIME contributor, Newton-Small developed the concept for MemoryWell from her own experience with her father. She wrote a narrative story of his life to help his care staff understand him better, and to provide better, more personalized care. 

Now her company has taken it further, working with senior living communities to foster connections between residents and other residents, and between residents and staff, based on connections, interests, lifestyle, and historical experiences revealed by their life stories. The company is able to help communities understand what services are needed, and who would most likely use or benefit from those services. 

“We shine the light to help you see who are the people you’re serving.” – Jay Newton-Small

“Where we are now is a shot in the dark,” said Newton-Small. “We shine the light to help you see who are the people you’re serving. So you can market, plan, sell and care for these people in a more focused way, that takes the guesswork out of it.”

The data has other powerful uses as well, which Newton-Small describes in the interview, which aired on Foresight TV. It can be used to get to the root causes of health issues. And, when aggregated, can be used in a predictive way, to help with prevention. “Right now our health care system is a reactive system. It’s an incredibly expensive system because we react to a problem,” said Newton-Small. “But if we know that a problem is coming down the pike and we can match people with resources that are available, then we can delay, defer and even sometimes prevent those problems from happening.”

See the whole interview.

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Bob Kramer and Anne Tumlinson discuss HCBS

Foresight TV: Bob Kramer & Anne Tumlinson – What Does HCBS Mean For LTC?

With the federal government considering an investment in the country’s infrastructure, a new light has been shed on the importance of infrastructure. And from the resulting discussion, a broader understanding of what is vital infrastructure is emerging. That infrastructure necessarily includes a system of long-term care for the nation’s aging population and a trained workforce to deliver that care.

“We have an outdated, crumbling infrastructure in nursing homes. We have non-existent infrastructure in home and community-based services (HCBS). And we have millions of older adults living longer, many of whom will need services and supports,” said Bob Kramer, Founder and Fellow for Nexus Insights, and Co-Founder and Strategic Advisor for the National Investment Center for Seniors Housing & Care (NIC).

Kramer recently interviewed long-term care expert Anne Tumlinson about the importance of long-term care and changes needed in how it’s delivered and how it’s paid for. Tumlinson, the Founder and CEO of ATI Advisory, and Founder of daughterhood.org, offered recommendations for the policy changes needed to make long-term care financially viable for more seniors and their families. Her recommendations also addressed the critical need for a living wage for the shrinking pool of caregivers who work in long-term care, and the important role of HCBS in helping seniors thrive.

“We don’t have a system; instead, every single family has to create their own system, over and over again. What is out there that could help me? How do I find it, set it up, coordinate it? There is currently no system or function in our society to handle that,“ said Tumlinson.

The interview was hosted by Senior Living Foresight. View the entire discussion.

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long-term care

The Future of Long-Term Care Depends on Trust, Transparency, Liability Relief – Bob Kramer

In a recent op-ed with Morning Consult, Bob Kramer, Nexus Insights founder and Fellow, argues for the importance of transparency in nursing homes. But the situation isn’t a simple one, as he points out. With transparency comes the need for liability protections, and policy makers must look to history to understand the unique risks and requirements of the skilled nursing industry. 

The following originally appeared in Morning Consult. Reposted with permission.

No one is arguing that America should be satisfied with our current nursing home system. But we can expect to hear a cacophony of arguments on how to fix it over the coming months and perhaps year.

Nursing home operators will rightly point to chronic underfunding and the failure to address the real costs of long-term care for poor, frail seniors on Medicaid. Their critics will demand more regulation and enforcement, higher staffing requirements and better wages. Some will argue that any additional funding for long-term care should go to home and community-based services. If unfunded increases in requirements for nursing homes lead to increased rates of bankruptcy — and closures — across the sector, so be it.

It would be careless and unrealistic to argue that the skilled nursing industry is without value. Harvard’s David C. Grabowski, among other experts, has argued that it is necessary, and requires increased investment. Studies show that Americans are growing older and more frail; many have no family or are beyond the capabilities of those that they have, increasing numbers are homeless and millions will require 24/7 care, often in specially equipped and staffed facilities. Furthermore, as highlighted in the landmark “Forgotten Middle” study conducted by NORC at the University of Chicago, a giant influx of middle-class seniors is coming. Neither qualifying for Medicaid nor being able to afford private-pay seniors housing, many will “spend down” their resources and rely on Medicaid. That is simply not a tenable solution.

Twenty years ago, another industry crisis precipitated a dramatic decrease in the availability of skilled nursing facilities. Lawsuits had become so damaging that nursing home operators began to flee certain states in which plaintiffs’ attorneys, seeking insurance-mandated settlement payoffs, triggered a feeding frenzy. Insurance for operators became either unaffordable or unobtainable. As a result, many families who found themselves unable to care for an elder at home were left without appropriate options, unable to secure care for their loved one at any price.

In response, nursing home owners and operators began to develop limited liability partnerships in increasingly complex — and opaque — business relationships, all designed to shield assets from trial lawyers. That system exists today in many places, particularly with respect to larger, multi-facility operators. It enables these businesses to exist — but it also raises questions as to where the money is going.

This is why I have been advocating for even greater transparency throughout the long-term care industry. To be entrusted with a greater investment from government, owners and operators of care facilities must open up their books and allow regulators and policymakers to see that their investment is going to increased staffing, pay and benefits for those on the front lines, as well as toward improvements in technology, and enhanced infection prevention and control. In short, they need to build trust in order to gain dollars.

But should skilled nursing providers provide real transparency into their financials, without liability reform or relief from lawsuits? It would only benefit the same attorneys who benefitted from transparency in the 1990s. It would quickly become impossible or prohibitively expensive to get insurance again — and again, operators would seek to protect themselves. And again, dollars intended to go to the care and housing of our low-income seniors would go instead to ever more expensive legal actions or insurance premiums.

This is where policymakers must step up. Without liability protections, increased transparency will lead only to increasing costs, as opposed to improving the wages and benefits for front-line workers. The real losers will be the millions of poor, frail, complex-care residents who need 24-hour care, and the staff to care for them. Operators will have to agree to greater transparency and accountability. Advocates will have to understand that targeted liability relief is essential. Policymakers hold the keys to both sides working together.

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 35 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly.


Bob is founder and Fellow at Nexus Insights. He co-founded the National Investment Center for Seniors Housing & Care (NIC), where he now serves as strategic advisor. Nexus Insights is a think tank that brings together a diverse group of researchers, policy experts, entrepreneurs, and executives, each of whom are distinguished and well-established thought leaders on aging and aging services.

Read the op ed

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