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Special Focus Facility program

CMS ‘Retooled’ Special Focus Facility Program Pushes for Faster Upgrades to Troubled Nursing Homes

CMS is going to put troubled nursing homes on a fast-track to improve with a ‘retooled’ Special Focus Facility program as reported by Bloomberg Law. Those who don’t make it will have their certifications revoked. This effort is designed to bring problem providers into compliance more quickly. But according to David Grabowski, Nexus Fellow and Harvard Medical School professor, there could be a downside to consider.

This new approach could be “taking dollars and access away from beneficiaries who don’t have anywhere else to turn,” says Grabowski, adding that “there’s not always operators lining up to enter into those markets.”

There are approximately 15,500 Medicare and Medicaid certified nursing homes in the United States. Approximately 2,500 of them have one star ratings.

Read more at Bloomberg Law.

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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

 

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covid cases and nursing homes

Covid Cases in Nursing Homes Are Clogging Up Hospitals

Dr. David Grabowski, Nexus Fellow and professor of health care policy at Harvard Medical School, stated last month in The Guardian that staff shortages in nursing homes and post-acute settings–mostly from Covid cases–are causing a problem for hospitals. Typically, hospitals will discharge patients to a stepped-down care setting when they are well enough.

“Things are condition critical today. [Hospitals] can’t find an empty or staffed bed out there,” said Grabowski. Hospitals can’t discharge patients who are healthy enough to move to a lower level of care because they can’t find any place to put them, according to Grabowski.

This in turn means that hospitals can’t admit new patients. “That’s a huge problem,” said Grabowski, “because they’re occupying a bed that would otherwise go to a new patient.”

Read the full article in The Guardian.

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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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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.

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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.

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Nursing home strike in Pennsylvania

Understaffed, underpaid and unsafe: Nursing home strike in Pennsylvania

David Grabowski, Professor of Health Care Policy at Harvard Medical School, and Nexus Insights Fellow, was recently interviewed by The Times in a story about 12 nursing homes in Pennsylvania that have voted to authorize strikes

Nurses, nurse aides and other caregivers have authorized issuing a 10-day strike notice at 12 nursing homesIssues include “a growing crisis involving the COVID-19 pandemic, chronic understaffing and low pay, and industry regulations in desperate need of reform,” according to the workers’ union, SEIU Healthcare PA.

Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, cites two major issues affecting the industry, a shortage of workers and declining Medicaid reimbursements.

A statement from the union states that the workforce has been, “Stretched to the breaking point after decades of understaffing, lack of investment in a workforce that makes poverty wages, and a pandemic that took an unimaginable physical, mental, emotional and financial toll on caregivers who have dedicated their lives to our most vulnerable.” There were more than 13,000 COVID-19 nursing home deaths in the state.

Owners and workers both express a concern for the health and safety of residents.

Read the full article.

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Nexus Insights Fellows News 2021

Nexus Fellows Flash Bulletin: June 2021

The Nexus Fellows are leaders in the aging industry, helping to shape public policy and redefine aging and aging services. From books to podcasts, here’s a sample of some of the work they’ve been doing in the past month:

  • Jay Newton-Small, CEO of MemoryWell, is wrapping up a second year of their joint contest for Hilarity for Charity, Seth and Lauren Miller Rogen’s Alzheimer’s charity and Humans of Dementia Storytelling Competition. It’s a competition for high school and college students to write the best profile of someone living with Alzheimer’s. Winners will have the chance to meet Seth and Lauren Rogen during the virtual celebration. Additionally, MemoryWell has added three new members to their team.
  • Jacquelyn Kung, CEO of Senior Care Group at Activated Insights, was interviewed by Skip Lineberg, host of The Main Thing Podcast, about elder care, and her passion to improve the aging experience. “The main thing I’ve learned in my lifetime so far is that getting older is what you make of it. And I see it as full of good news. Socially, we get happier as we get older, and the research shows that.”
  • Jill Vitale-Aussem, president and CEO of Christian Living Communities, sat down with Senior Housing Investors Podcast to talk about her book, “Disrupting the Status Quo of Senior Living: A Mindshift.”
  • Sarah Thomas, CEO of Delight by Design, delivered the keynote on designing products and services for the aging population with Chief Medical Office of AARP, DR Charlotte Yeh. Additionally, she moderated two panels featuring the important work of seven agetech startups at the Rehab Tech Summit mini-Summit. Thomas was an expert judge at the AOTA 2021 Inventors Showcase, where 11 startups pitched their innovative products designed to serve people across the lifespan. The winner designed a novel gait belt that improves the safety of caregivers and residents in senior living and beyond.
  • Dr. Bill Thomas, founder of The Eden Alternative, The Green House Project, and Minka, recently traveled the country, talking with elders and their care partners in more than 125 cities. He learned about their hopes and fears, and listened to their stories. What did he discover? That people want better alternatives for senior living. “It turns out that older people pretty much want what everyone else wants: to belong to a community that includes people of all ages and remain connected to the living world,” Thomas said.
  • Nexus Founder & Fellow, and NIC Strategic Advisor, Bob Kramer, has joined the Edenbridge Health Board of Advisors to help expand access to comprehensive, integrated, community-based and person-centered care for the frail elderly through innovative applications of the PACE Program.
  • In the blog post, “Just Move It,” CEO of SmartLiving 360, Ryan Frederick talks about the importance of physical exercise for older adults. “Inactivity is the fourth leading cause of death and about 1.5 billion people in the world are inactive to the point that it risks their long-term health. At a health care conference several years ago, four recent surgeon generals were asked for one tip for successful aging. They coalesced on one word: move.”
  • Nexus Fellow Kelsey Mellard, CEO of Sitka, sat down with Sanjula Jain Jo on Her Story for a candid conversation about being a healthcare leader and her transition from the Midwest to DC to Silicon Valley, building a resilient team, and overcoming challenges.
  • Longevity economy expert, Jody Holtzman, formerly of AARP is proud to be on the advisory board of Intuition Robotics, which is mitigating loneliness among older adults with the companion robot ElliQ. “The growing mismatch between the number of people in need of caregivers and the availability of caregivers is a multifaceted challenge for individual families and society more broadly. Technology must be part of the solution. Companion robots like ElliQ and others in this space, like my friends at Joy for All/Ageless Innovation, have an important role to play.”
  • Caroline Pearson, Senior VP of Health Care Strategy at NORC at the University of Chicago, announced the release of new research from NIC and NORC that looks at the impact of the pandemic on seniors by care setting. “Mortality rates increase by complexity of care, but, in lower acuity settings such as independent living communities, they are comparable to surrounding populations.”

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long-term care infrastructure op-ed in The Hill

America’s long-term care infrastructure: A road to nowhere – Op-ed in the Hill co-authored by Nexus Insights

In a recent op-ed in The Hill, Nexus Insights Fellows Anne Tumlinson, David Grabowski and Robert Kramer, raise an important point that has been missing from recent discussions around transforming long-term care following the pandemic. The Biden Administration has proposed a $400B investment in home- and community-based services (HCBS). We assert this investment is necessary but not sufficient. Without additional spending on services to help families navigate and manage long-term care services, this HCBS investment is basically a “road to nowhere.” We argue for the need to create a network of long-term care service hubs across the country to help families navigate services.

As you know, there have been A LOT of thought pieces around improving long-term care going forward, but we have not seen this point made elsewhere. Thus, we believe it would be an ideal time to make this point as policymakers consider the Biden proposal.

Excerpt:

Long-term care is complex. Few Americans plan ahead and most wait until a crisis pushes them into a frantic search for solutions. It doesn’t have to be this way.

Every day older adults lose their ability to care for themselves. Often, they are discharged from the hospital too weak or confused to be left alone or care for themselves. Now what? Who will take care of them? Is home- or facility-based care the best option? How much will it cost and who will pay? Does Medicare cover it? Does Medicaid? If home care is the answer, how do you find a qualified and affordable caregiver? Where do you even start? Life-changing decisions must be made, and fast.

Read the full op-ed in The Hill.


Anne Tumlinson is CEO of ATI Advisory and the Founder of Daughterhood. David Grabowski is Professor in the Department of Health Care Policy, Harvard Medical School. Robert Kramer is the founder of Nexus Insights, and the co-founder and Strategic Advisor & former CEO of the National Investment Center for Seniors Housing & Care (NIC).

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Update on Nexus Fellow May 21s

Nexus Fellow Flash Bulletin: May 2021

As the United States shifts gears from pandemic crisis management to a new post-COVID normal, we must now deal with the aftermath and identify what went wrong and what we can do better. Issues of transparency and loneliness in nursing homes linger. Large corporations that once were oblivious to the older population have found a new market. How will we address the age-old problem of social connection for those who are still isolated, a problem seniors have faced for decades? The entire industry, the way we view older adults, the options for living independently and the implementation of technology, must all be urgently addressed and thoughtfully designed into an actionable plan for the future of aging and longevity.

Our Fellows continue to strive for innovation and reform. Here’s what they’ve been up to:

NEWS:

  • Nexus Fellow David Grabowski, was quoted in an article by the Associated Press on nursing homes’ requirement to report COVID-19 vaccinations at nursing homes. “This is an important development that is months overdue,” said David Grabowski, a Harvard health policy professor who has tracked the industry’s struggles with the outbreak. “Many of us argued that this information should have been published starting in December when the federal long-term care vaccination effort began.”

 

  • Dr. Bill Thomas, Nexus Fellow and creator of The Eden Alternative, Minka, and the Green House Project, is helping value-based care innovator Lifespark (which acquired Tealwood Senior Living.) Dr. Thomas will be leading the efforts to combine the two companies’ operations. He has also created Kallimos Communities, new multi-generational communities with small dwellings clustered around shared green space. Additionally, he has a new project he’s working on with Signature Healthcare — currently called “Canopy” — a cluster of small ADA-accessible houses built close together.

 

  • Bob Kramer, Founder and Fellow of Nexus Insights, was interviewed by Nancy Griffin for SeniorTrade Blog. He defines 5 Boomerville Segments likely to flourish in the future: Wellnessville, where residents will focus on healthy lifestyle, diet and exercise; Margaritaville, resort-style independent living (Minto Communities’ Latitude Margaritaville has three wait-listed locations with more in development); Serviceville, where the emphasis is on volunteerism, mentorship and giving back; Collegeville, where residents focus on continued learning in a communal living environment, and Changeville, for those concerned with making a difference in the world and creating a legacy.

 

  • Preordering is now available for “Right Place, Right Time, a book by Nexus Fellow and CEO of SmartLiving 360, Ryan Frederick. “Place plays a significant yet often unacknowledged role in health and happiness. The right place elevates personal well-being. It can help promote purpose, facilitate human connection, catalyze physical activity, support financial health, and inspire community engagement.”

 

  • Nexus Fellow Kelsey Mellard, CEO of Sitka, sat down with Sanjula Jain Jo on Her Story for a candid conversation about being a healthcare leader and her transition from the Midwest to DC to Silicon Valley, building a resilient team, and overcoming challenges.

 

  • Will seniors continue to buy groceries online post-pandemic? Jody Holtzman, longevity economy expert, formerly of AARP, thinks seniors will split their shopping, using online for staples such as canned goods and going into stores for fresh foods. Some senior consumers claim it’s a social outlet for them. “As the necessity imposed by the pandemic lessens,” Holtzman says, “retailers will have to start to play the price game.” Read more at Blomberg.com.

 

Out and About:

  • Jill Vitale-Aussem, president and CEO of Christian Living Communities, and Nexus Insights Fellow, recently spoke at a session, “Finding success in increasing diversity and inclusion,” at the 2021 Women of Distinction educational webinar. We’d also like to congratulate Jill on joining the SeniorTrade Advisory Board.

Jill Vitale-Aussem joins SeniorTrade Advisory Board

  • On June 30, Nexus Fellow Sara Zeff Geber will be joining experts and thought leaders in the areas of aging, retirement and thriving for the “Boomers Thriving After the Pandemic” virtual summit, hosted by Wendy Green from Hey, Boomer. Other speakers include Helen Dennis and John Tarnoff. Part of the proceeds will go to Meals on Wheels Greenville and The Walk to End Alzheimer’s. For more info visit the virtual summit’s Eventbrite page.

Sara Zeff Geber on Hey Boomer

  • Sarah Thomas, CEO of Delight by Design and Nexus Fellow, recently presented at the Rehab Tech Summit sponsored by AARP Innovations Labs. She spoke about designing for all, including age tech, universal design, living with purpose and designing beautiful products for everyone at every age.

 

COMPANIES ON THE MOVE:

  • Jay Newton-Small, CEO of MemoryWell, is growing MemoryWell. After a successful capital raise, she’s been adding some amazing new talent to her team including Sarah Jones from Healthsense, GreatCall and Best Buy Health.

 

  • Jacquelyn Kung, CEO of Senior Care Group at Activated Insights, is working with her team to create recognition programs for senior care providers, based on their resident and family surveys. The goal is to tie the data to outcomes and impact metrics, and to use machine learning to identify patterns in those who improve to apply across a broader population of providers.

 

NEW RESEARCH:

 

 

VIDEO DISCUSSIONS:

 

 

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Events

NYSHFA NYSCAL

David Grabowski Keynote at NYSHFA | NYSCAL’s Annual Conference & Expo

Nexus Fellow David Grabowski, professor of healthcare policy at Harvard Medical School, will be keynote speaker on Day 2 of the conference.

COVID and Long-Term Care: Where Do We Go From Here?

Dr. Grabowski will review the most recent COVID data relating to skilled nursing and assisted living providers. In light of these data, he will discuss both potential short-term and long-term changes impacting the industry. What might the future look like and how can policymakers facilitate this model?

 

The Annual Conference & Expo is NYSHFA | NYSCAL’s largest event. In addition to offering three days of education, covering a wide variety of topics that have appeal across many disciplines, this event includes an exposition to showcase the latest products and services available to the long-term care community. The audience is typically comprised of Owner/Operators, Administrators, Executive Directors, Medical Directors, DONs, and members of the Clinical Teams for SNFs, as well as all staff of Assisted Living Facilities. You won’t want to miss out on this opportunity to see inspiring speakers, attend great education, and network with industry peers!

More info at NYSHFA | NYSCAL

NYSHFA NYSCAL 72 annual conference

NYSHF | NYSCAL 72nd Annual Conference

Session: “The Findings… COVID-19 Research & More” featuring David Grabowski

One of the top national health care policy experts, David Grabowski, PhD, will share his research on long term and post-acute care, specifically during the COVID-19 pandemic. Learn how this research is being used to influence future initiatives.

Register: https://www.nyshfa-nyscal.org/events-education/conferences/annual-conference/