Tag Archive for: David Grabowski

Long-Term Care Solutions

Navigating the Maze of Long-Term & Post-Acute Care: A Report by Nexus Insights

When an older adult experiences a crisis that requires post-acute or long-term care services and supports, they and their caregivers must make critical decisions, fast. What awaits them, however, is a maze of dead ends and poor information that stand in the way of getting the help they need.

“Older adults and their families enter a maze of twists and turns, dead ends, and wrong way streets when a life crisis forces them to consider their care options. Critical decisions about long-term care must be made quickly, with scarce information or resources, let alone supportive guidance to assist them in their time of crisis.” – Bob Kramer, founder of Nexus Insights

In February 2022, Nexus Insights hosted their inaugural ‘Nexus Voices’ session with 18 leading experts in the fields of aging policy, long-term care, senior housing and caregiver advocacy to talk through and tackle this issue.

The Outcome: A Nexus Voices Report

The result is the recently published report, “Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers”. This comprehensive and actionable report highlights the lack of infrastructure to help guide older adults and their families to long-term care services. The report proposes “Navigation Hubs” to help families understand their long-term care needs and select the best options for them. These hubs would serve as central doorways to existing supports and services—whether it’s home-based care, transportation or meal services, senior housing or nursing home care. The hubs would have a national presence but a hyper localized focus with counselors, or navigators, who understand the resources available in their communities and how to help older adults and their families access them.

“The factors that shape care decisions vary from family to family, but all families need an easy-to-use, accessible hub of information that clearly communicates the options that are available to them in their community,” said Anne Tumlinson, CEO of ATI Advisory and a contributor to the report. “With a growing number of older adults needing care, we have to act now to build the care infrastructure families need.”

Discussion participants outlined four primary responsibilities of the Navigation Hubs. They are:

  • Discover & Assess the long-term care needs of older adults, their families, and caregivers.
  • Educate older adults, their families and caregivers on the housing and caregiving support available to them as well as funding sources.
  • Select & Connect older adults with the best long-term care setting, supports, and services that meet their needs.
  • Reevaluate the needs of older adults as their health and financial statuses change.

“You can’t solve a problem until you’ve identified it and defined it,” said Kramer.

“Then you’ve got to define what are the key components of any solution. And we’ve laid that out with the navigation hubs and their four functions. And then we asked what we could learn from the failures and the successes of programs to date, to create our criteria. Finally, the path forward must be a joint effort involving both the public and private sectors. We demonstrated that there are aspects of differing programs from government-funded resource centers to tech-enabled employer options to private-pay models that could be incorporated into this solution.”

An Urgent Problem

In its conclusions, the report urges quick and decisive action to build navigation services for older adults that put families in the center. The family in crisis needs help now and cannot wait for lawmakers and government agencies to overhaul the long-term care infrastructure. This requires a national commitment to increased funding and an openness to reimagine existing solutions. Existing public, private-pay and employer-based programs could work together to make these hubs a reality by combining their infrastructure, experience and delivery models.

The Nexus Voices Participants

Nexus Insights Host Committee

  • David Grabowski, PhD, professor, Harvard Medical School, fellow, Nexus Insights
  • Bob Kramer, founder & fellow, Nexus Insights, co-founder, former CEO & strategic advisor, National Investment Center for Seniors Housing & Care (NIC)
  • Caroline Pearson, senior vice president, health care strategy, NORC at the University of Chicago, fellow, Nexus Insights
  • Sarah Thomas, CEO, Delight by Design/MezTal, fellow, Nexus Insights
  • Anne Tumlinson, CEO, ATI Advisory, fellow, Nexus Insights

Discussion Participants

  • Gretchen E. Alkema, PhD, former vice president, policy and communications, The SCAN Foundation
  • Alice Bonner, PhD, senior advisor for aging, IHI, and adjunct faculty, Johns Hopkins University School of Nursing
  • Ryan Frederick, founder & CEO, Smart Living 360, fellow, Nexus Insights (facilitator)
  • Lindsay Jurist-Rosner, CEO, Wellthy
  • Ruth Katz, senior vice president for policy, LeadingAge
  • Sean Kelly, president & CEO, The Kendal Corporation
  • Suzanne Kunkel, PhD, executive director, Scripps Gerontology Center, Miami University
  • Katy Lanz, chief strategy officer, Personal Care Medical Associates
  • Brian Petranick, group president, Neighborly
  • Cheryl L. Phillips, M.D., president and CEO, Special Needs Plan Alliance
  • Paul Saucier, director, Office of Aging & Disability Services, Maine Department of Health and Human Services
  • John Schall, CEO, Caregiver Action Network
  • Bill Thomas, chief independence officer, Lifespark, fellow, Nexus Insights

Read the Long-Term Care Access Report

Read the full report
Read the executive summary
Read the press release

About Nexus Insights

Nexus Insights is a think tank advancing the well-being of older adults through innovative models of housing, community and healthcare. We are a diverse group of thought leaders and stakeholders in aging and healthcare. Our goal is to spark change by sharing innovation across traditional silos, convening leaders from differing perspectives and bringing positive, life-affirming ideas into the public domain.

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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:

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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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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

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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Tag Archive for: David Grabowski

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