Green replaces CFO Mary Connick, who has been serving as interim CEO.
The San Francisco Campus for Jewish Living (SFCJL) announced today that Adrienne Green, MD, has been selected as its new CEO. Green will officially step into the role on July 18.
For the last 150 years, the SFCJL has provided a spectrum of services for seniors as they age, including long- and short-term care at the Jewish Home and Rehab Center and assisted living and memory care at its Frank Residences facility.
Green previously served as the nonprofit's organization's chief medical officer for adult services, as well as the vice president for regulatory and medical affairs at University of California San Francisco (UCSF) Health.
"As a trustee of the board, I have come to not only admire the care provided at SFCJL, but also find myself more invested in all components of the organization," Green said in a statement.
"As a physician, as an engaged member of our Jewish community, and as someone who cares deeply about our elderly patients and staff who work in senior care, I am inspired and motivated by this opportunity. It brings my passion, training, and expertise together in a most meaningful way."
Green's interest in the skilled nursing space began while she worked as a hospitalist in the skilled nursing unit of Mount Zion Hospital. As medical director for case management, she got involved in discharge planning and became familiar with the greater post-acute and skilled nursing landscape.
While working on the launch of UCSF's first skilled nursing facility and home health collaborative in 2014, she had the opportunity to collaborate with SFCJL and learn more about the organization.
"We are excited that Adrienne, a former member of our Board of Trustees, has accepted this role," David Lowi, board chair, said in a statement. "I am confident that Dr. Green will exemplify one of my favorite Jewish sayings, 'From strength to strength may we be strengthened.'"
Like the temporary nurse aide waiver enabled by the public health emergency declaration, the Building America's Health Care Workforce Act would give temporary nurse aides (TNAs) currently working in nursing homes 24 months to become certified nursing assistants (CNA).
"Hundreds of thousands of temporary nurse aides stepped up to serve vulnerable seniors during [the pandemic], supporting residents with non-clinical tasks and offering companionship," Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said in a statement.
With many states dealing with a significant backlog in CNA training and testing, the bill would allow TNAs to apply their on-the-job experience and training to the required 75-hour federal training requirement.
The Ensuring Seniors' Access to Quality Care Act serves to address the nationwide CNA shortage directly by ensuring that nurse aides are able to access the training they need. In particular, the bill allows skilled nursing facilities that were required to terminate their in-house education programs to resume them once the noted deficiencies are corrected.
Providers will also have access to the National Practitioner Data Bank where they can conduct background checks to help identify the best candidates for open positions.
"Nursing homes have experienced the worst job loss out of any healthcare sector during the pandemic, and now more than ever we need solutions like the Ensuring Seniors' Access to Quality Care Act to help nursing homes vet and train crucially needed caregivers," Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement.
Nursing homes were the most heavily affected sector of healthcare during the pandemic, relying on many of the PHE waivers and flexibilities to sustain operations.
When the public health emergency (PHE) declaration for the COVID-19 pandemic ended May 11, along with it went flexibilities and waivers on which many providers had come to rely.
For skilled nursing facilities in particular, the end of the PHE means the expiration of the three-day waiver, which waived the three-day inpatient hospital stay requirement prior to a Medicare-covered, post-hospital, extended care service.
Due to lack of staff at the acute setting, potential residents will now be subject to shorter hospital stays and risk being discharged before they're ready or truly well enough to leave, according to Allison Salopeck, president and CEO of northeastern Ohio's Jennings Center for Older Adults.
"The fact that they [implemented the wavier] was because the hospitals needed to make sure that they had room for other, particularly COVID-positive, patients," she explained. "And so, they recognized that if they made that three-day waiver go away, they would reduce the pressure on the hospitals and have those folks continue their care needs in skilled nursing."
While hospitals no longer have an overabundance of COVID-positive patients, they—much like skilled nursing facilities—are under pressure from not having enough staff to keep all their beds open, Salopeck said.
In the days after the PHE expiration, aging service providers like Jennings Center are attempting to transition operations back to normal. The greatest concern, Salopeck said, has been Medicaid enrollment and reauthorization.
"Everybody gets redetermined at the same time," she explained. "But as that rolls through, I am concerned about people's care potentially being interrupted by something that may have happened during the course of that time with their eligibility."
The center took advantage of the flexibilities for telemedicine, using iPads for residents’ remote psychological treatment when face-to-face appointments weren't feasible due to social distancing requirements.
"We know that particularly people who have dementia do much better face to face as opposed to the strangeness of looking at a screen," Salopeck said. "Otherwise, it has been extremely helpful, I think, especially around mental health."
One waiver the Jennings Center didn't take advantage of was the use of temporary nurse aides, which allowed nursing assistants to work prior to certification and have those hours apply to their training. The waiver was a point of contention for some facilities, regarding the use of untrained aides to work with vulnerable residents.
Skilled nursing facilities were the most negatively affected sector of healthcare over the duration of the pandemic, because of media scrutiny, high numbers of resident deaths, and the highest loss of employees. Now, with low reimbursement rates not covering the full cost of care, which means nursing homes are unable to offer wages to compete with larger providers, they are struggling to rebolster their workforce.
Providers and advocates alike have begun championing nursing homes and their workers, calling for providers to reevaluate the reimbursement model so that facilities will be able to offer wages that will attract workers.
Recently, Salopeck met with state legislators in Ohio to discuss the issue as they begin developing the state's budget.
"They've heard the pressures, they know that this is about taking care of Ohio's elders," she said. "I think if they ignore that, we're going to be in a lot of trouble."
"There's not a lot of adjustment other than closing down [facilities] and unfortunately, in some cases, entire communities, that we can do."
In one scheme, the former administrator allegedly paid a hospital supervisor for patient referrals.
Morris Park Nursing Home, a skilled nursing facility in the Bronx, New York, has been found to have violated the False Claims Act and Anti-Kickback Statue.
According to the civil fraud lawsuit, cash payments were allegedly made to a supervisor at a nearby hospital for patient referrals from January 2017 to December 2019. A statement on the settlement said Morris Park paid the supervisor $150 for each referred patient admitted to the facility, coming to a total of approximately $5,000-$10,000, according to a press release from the U.S. Attorney’s Office, Southern District of New York.In addition to the cash payments, Morris Park also gave the supervisor tickets to New York Yankees baseball games, invited them and their staff to a holiday party sponsored by the facility, and arranged for food to be delivered to their office.
From January 2018 to December 2019, at the direction of former administrator Tzodik “Justin” Weinberg, residents were disenrolled from their self-selected Medicare Advantage plans and enrolled in original Medicare without their consent.
In the summer of 2018, Morris Park retained Maier Arm, a friend of Weinberg's, to assist with the improper disenrollments. Arm was paid $1,000 for each resident he switched to original Medicare, with Weinberg pocketing half.
As part of the settlement, Weinberg and Arm will have to pay $495,000 and $115,000, respectively. The estate of the owner of Morris Park at the time these events occurred will have to pay $2.85 million.
For skilled nursing facilities, which rely on Medicaid reimbursements to maintain operations, admitting residents enrolled in Original Medicare (Medicare Parts A and B) is more profitable than admitting those enrolled in Medicare Part C Advantage Plans—also known as MA Plans. With Original Medicare, the Centers for Medicare & Medicaid Services (CMS) directly reimburse providers on a fee-for-service basis. MA Plans have a fixed, capitated amount reimbursed each month for each beneficiary.
Switching a resident's coverage could potentially change their co-payments and deductibles, meaning they could lose the supplemental coverage they had with their MA Plan. There could even be limitations on when the resident would be able to re-enroll in their MA Plan should they leave Morris Park.
"The misconduct that occurred at Morris Park exhibits the prioritization of profits over residents' best interests," Naomi Gruchacz, U.S. Department of Health and Human Services, Office of the Inspector General Special Agent in Charge, said in a statement.
"This nursing home paid illegal kickbacks to manipulate the resident referral process and changed patients' health coverage selections without properly obtaining their consent, with no apparent concern for how these events could negatively impact residents."
William Walders will serve as the system's new CIO, and James Haislip as vice president of system finance.
BayCare, a leading not-for-profit healthcare system including home care services, has announced a promotion and new hire at its executive and C-suite levels.
William Walders, CHCIO, CDH-E, had been hired as its new chief information officer. Walders previously served Melbourne, Florida-based Health First in the same role, as well as senior vice president of operations support.
In addition to more than 20 years of leadership experience in healthcare and information systems, Walders is also a retired U.S. Navy commander and recipient of the Defense Meritorious Service Medal.
In 2022, he was named Florida Large Enterprise CIO of the Year.
"William is well respected in the industry and brings a strong background of experience in digital health, insurance, and health system delivery technology to BayCare," CEO Tim Thompson, said in a statement.
"I am excited about the opportunity to join such a respected organization and to be a part of an exceptional culture of trust, respect, and dignity," Walders said in a statement. "I look forward to working with an amazing leadership team and the talented group of IT leaders and staff at BayCare."
Baycare also has promoted James Haislip to vice president of system finance. He'd previously served as the system's director of financial planning and analysis.
As vice president of system finance, Haislip will oversee the finance team that supports the regional leaders, including those for construction and information services.
"James has demonstrated the ability to collaborate with leaders and possesses strong analytical skills," according to Janice Polo, BayCare's chief financial officer. "He thinks outside the box, is accountable, and is a natural mentor to his team."
"I'm excited and grateful for the opportunity to work with our incredible team to ensure a strong future of providing the best care in our communities," Haislip said in a statement. "BayCare's history of excellence has put us in a great position to achieve that goal."
The university's School of Health Professions is also researching ways to decrease fall risks in older adults.
In furthering research for preventing fall risks, the University of Kansas School Health of Professions is also addressing the importance of older adults maintaining a good quality of life as they age.
Currently, the KU Cares Research Center is exploring neuro rehabilitation-emphasis in stroke recovery and treatment for Parkinson’s Disease, as well as diet and nutrition best practices that caregivers and nurses can consider for their clients and patients.
HealthLeaders spoke with a group of University of Kansas faculty to learn more about their efforts and how they can be implemented.
The following transcript has been edited for brevity and clarity.
HealthLeaders: When does an individual's range of mobility begin to decline to the point where falling could be a health risk?
Jacob Sosnoff (associate dean, Research, School of Health Professions): The first thing to consider is that falls happen throughout the lifespan. Really, where we're getting concerned about falls for older adults is because the injury risk goes up. It's complicated when that starts to go up, but it's things like the tissue strength decreasing, bone density decreasing, and losing muscle mass, so you're not as reactive as you used to be.
The beautiful thing about humans is we're designed to move, but we're really designed poorly for balance and our neuromuscular system helps us do that. Then with age, it doesn't work as well and that's what ultimately puts us at risk for losing our balance.
If you have a good diet and you're physically active, your fall risk will stay relatively low for most of your life.
HL: How can home health workers nurses and caregivers work with their patients and clients to ensure they stay physically active and maintain a healthy diet?
Dr. Debra Sullivan, RD (department chair, Dietetics and Nutrition): It depends on any preexisting conditions they have, like if they have a medical condition that is going to require them to follow some sort of specialized diet. But you can always be very clear by making sure that person does have an adequate, healthy diet and that they're eating enough. Making sure that they're not losing weight, that they're getting enough protein, that they're getting enough of the vitamins and minerals that they need to support their muscles, brain health, and bones.
Those are probably the key things that you worry about with those individuals. Increasing fruits and vegetables is great. Then you also must know if their teeth are strong enough to chew those foods. Do they need softer foods?
Dr. Hannes Devos, PT, FACRM (associate professor, Physical Therapy, Rehabilitation Science, and Athletic Training): There's two interesting features when we're looking at how to increase mobility in older adults, and that is from the person and the caretaker, the partner, the spouse, but also what environmental improvements can be done. We have seen that many studies focus on exercise or diet. They show how they can reduce the risk of falls.
One of the challenges that we have at this time is how we can implement that into a lifestyle intervention—how we can encourage older adults to continue to be physically active, to continue with the diet that has proven to reduce fall risks. But then one of the interesting improvements that are being made now is looking at houses of the future and how ambient technology can help detect early changes in case patterns that can pick up an increased risk of falling. I think these will be very helpful in early screening, diagnosis, and monitoring of false risk in older adults.
Sosnoff: One thing that we've been doing is trying to look at mobile apps to measure fall risk. Giving the non-clinical care team tools that they can look at to determine if this person has a fall risk or not.
One of the challenges we're going to be facing with the increase in the older adults population is that we're not going to have enough clinicians. Especially if you go out into rural areas, there's just a lack of care, so not everyone can make it to the doctor. How do we triage that? Leveraging tools that are already out there, like smartphones.
Then, we must understand that risk factors vary from person to person. If someone's primarily using a wheelchair, their fall risk factors are much different than somebody who's ambulatory with and without a device. In my experience, a lot of times when we have someone we're working with who has impaired mobility, they start with a wheelchair. People are excited because they think that's going to solve their mobility needs, but it's just a different level of challenge. There's still risk for falls. There's probably greater risk of a catastrophic injury because usually at that point, they're deconditioned.
HL: What are some things that you feel caregivers should be paying attention to, to detect that risk?
Sosnoff: It’s looking at those changes in performance. If someone was able to do an activity and now suddenly, they're not, that's going to give pretty us a critically important understanding of what's normal. Looking at that change can help us understand it.
You start working with somebody, knowing where they are, and look for that change. Something too, that we don't give enough credit to is just social interaction.
Sullivan: Another thing to think about is quality of life. How are those changes impacting their quality of life? How does it impact their social interactions?
Dr. Abiodun Akinwuntan, MPH, MBA, FASAHP, FACRM, FAMedS (dean, KU School of Health Professions): I have read enough articles that have shown that isolation and lack of social contact has been a major cause of declining quality of life. It has led to depression and has led to untimely death in many places. I like the concept of KU Cares, particularly because we are looking at the concept of social integration from multiple angles. Is it from the nutritional angle, from the community ambulation angle, from the driving perspective, or from the inevitable fall?
Our goal is not to be afraid of falling, but to be better prepared for falls and know how to fall safely. All of those things intrinsically coincide to the level of social interactions that people have with one another. And you know, for Drs. Sosnoff and Devos, who are particularly looking at the pathophysiological aspect of all the things we've talked about, and being able to detect the earliest form of decline in any of the areas that will eventually lead to that, the decrease in that social interaction and addressing it before it gets full-blown again is the strength of the KU Cares Center.
HL: How would you like to see the research and efforts of the KU Cares Center implemented?
Akinwuntan: What I hope to see is that our research can create the global awareness of what we each can contribute to increasing the quality of life of our older folks, from how to advise them on the use of commonly used mobile devices to what resources are available to help them continue to have good quality of life. Also, showing that all those interventions have had positive impacts on our increasing longevity with good quality of life.
It seems to me that our holistic approach of looking at social interaction from different angles—nutrition, fall risk enablement, rehabilitation—and even understanding the process of developing different conditions that older people typically have is a unique component of the KU Care Center. And that's what's exciting about what we do.
Blacker has more than 20 years of administrative and management experience in home care.
Boost Home Healthcare announced Larry Blacker will be serving as the company's brand president.
Blacker has more than two decades of experience in the home care sector. In his new role, he will oversee business operations, procedures, and the organization's continued expansion efforts.
"His experience will play a key role in continuing to scale the business across the country, allowing us to bring Boost Home Health services to more people," J.J. Sorrenti, CEO of Best Life Brands, Boost's parent organization, said in a statement.
"With his background and leadership and our desire to continue to grow Boost, it's an ideal fit."
Blacker recently served as home care administrator for Seabrook Village in Tinton Falls, New Jersey, overseeing the integration of two standalone home care agencies into one department. Prior to that, he was the executive director for GrayHawk Home Care, managing the organization's multi-site home care business providing services in the five-county Philadelphia region.
"I'm honored to be part of Best Life Brands, as I have a deep appreciation for their mission to help seniors live their best life possible," Blacker said in a statement. "I look forward to overseeing the growth of Boost and the important work of providing a personalized and safe environment for patients to maintain their independence while receiving the care they need."
The Loma Linda University School of Allied Health Professions is helping students see the benefits of working in geriatrics.
Like most medical students, Chad Cole, MPA, didn't begin his studies with the intent of working in geriatrics.
Initially interested in surgical specialties, it wasn't until after he graduated and completed his boards in primary care and later family medicine that his interest shifted to eldercare.
Now as an instructor in geriatrics for the physician assistant program at Loma Linda University's School of Allied Health Professions, he's hoping to encourage more students to consider specializing in geriatrics and eldercare.
Despite the uptick in demand for aging services, nursing homes and home health agencies are struggling to compete with larger providers and organizations that can offer higher wages. With the anticipated influx of older adults into the latter half of the healthcare continuum, it's important that eldercare be pushed to the forefront for students.
HealthLeaders spoke with Cole about introducing students to geriatric healthcare. The following transcript has been edited for brevity and clarity.
HealthLeaders: How many students do you see coming into the program already knowing they want to work in geriatrics?
Chad Cole: The voiced interest in my class and in a lot of the students that I see has not been that great in geriatrics. What we're hoping to do is get them a little more clinical experience in their clinical year training, working with me in the geriatric clinic, and maybe show them the kind of challenges we face, the resources out there, and hopefully spark a greater interest to go into geriatric medicine.
HL: Why are students hesitant about working with older patients?
Cole: I think our society doesn't value older patients in general as much as others. We kind of shy away from aging and I think we need to really realize what a valuable resource those patients can be, with their wisdom and all the experiences they've had in their lives. From a clinical standpoint, I think students view geriatric patients as much more complicated than standard adult or family medicine patients since they tend to come with more comorbid conditions and more medications.
Then you're having to think of what the potential interactions of everything else are, and as a new graduate, I think that perceived level of complexity can be somewhat intimidating.
HL: Does geriatric medicine have any similarities to other areas of healthcare?
Cole: In pediatrics they require a lot more care, they're less independent, and it kind of gets back to that. We watch them as they age, especially in memory care, starting to lose areas of independence, and we assess these things called “activities of daily living:” Can you bathe yourself? Can you feed yourself? Those start to become a bigger burden, especially in Alzheimer's or dementia as the disease progresses, where they start losing those abilities to be independent.
Their biggest goal is often to remain independent and in the home as long as possible, so we have certain resources to try and help. There's adult daycare centers and in-home support services to really try and get them as much help as possible to remain as independent as possible.
HL: Could introducing students to geriatric medicine before they graduate create a pipeline of talent for post-acute/aging services providers?
Cole: If we can catch the students during their clinical year, give them that that exposure, [I can] share my own experience—we can maybe help them to think about ways they can help their own family. Maybe spark an interest in geriatric medicine as well, and really encourage them to look into the growing challenges in the upcoming decades with our aging population, and the opportunity that creates for them after graduating.
HL: Healthcare is a calling, so for an area like geriatrics, does it stem from compassion or empathy? Or does it develop over time?
Cole: It can be both. In my experience, compassion and empathy develop out of some personal experience before school, as far as seeing community caregivers, seeing parents or grandparents age. Oftentimes if [students] had grandparents living in the home and they helped with the care, those are the ones who tend to come already with that built-in compassion and desire to do this job.
I'll joke around sometimes with students or friends that there's easier ways to make good money. If you're doing the job just because you think you're going to make a good living, there's better reasons to do it and easier ways to do it.
For me, it was watching my parents care for their parents, how much work that involved, and watching some of that loss of independence over time. Also, sparking that interest of really wanting to know what else is out there and what can be done to honor that stage of a person's life.
HL: How can skilled nursing facilities and home health agencies attract students to their organizations?
Cole: When I got hired in geriatrics at Loma Linda, they were hiring one person for the outpatient clinic, which is where I started, and they hired one more classmate for the skilled nursing facility, which was a registered dietitian at a skilled nursing facility previously. I think they may want to consider recruiting from people who have worked in [similar environments].
Those candidates have seen what the job entails, the challenges, and hopefully have developed a passion for it.
The university has added geriatrics into the core clinical rotation for the program.
At the University of Arkansas Medical Science (UAMS), the College of Health Professions has begun incorporating geriatrics, previously an elective, into the core clinical rotation for its physician assistant program to foster more interest.
The move is in anticipation that 20% of the nation's population will be over the age of 65 by 2030, and potentially be in need of some type of aging service. As the workforce shortage persists, providers are struggling to find and hire staff, with the demand for these services already outweighing the supply.
In addition to providers considering different strategies to attract talent, educational institutions, such as UAMS, are helping their efforts by getting students interested in geriatrics and eldercare before they enter the job market.
"For our program, it's less common for students to come in being interested in working with older adults," Edward Williams, director of the physician assistant program, said. "Most often students come in wanting to be physical therapists, to work with sports orthopedic populations, and they've tended to become interested in geriatrics when they go through their clinicals."
The department's faculty have different specialties they practiced in, including geriatrics, before joining the university, William said, and bringing characteristics from their practice to their teaching benefits the students.
"They see it in our past experiences as professionals, and I think that if we are expecting our students to have an affinity for or enjoy something, to see the importance of things like this with other disciplines; it may not be as exciting when they first come in … but we have to make sure they understand why it's such a key and important thing."
Dr. Jennifer Vincenzo, an associate professor within the department, also attributes the lack of initial interest to ageism and misunderstandings about the physical capabilities of older adults as they age.
Vincenzo recently received a million-dollar implementation science grant from the National Institute on Aging via the National Institutes of Health to research fall risks in older adults.
In addition to offering a research elective for students interested in helping with her research, she also serves on the board of the Academy of Geriatric Physical Therapy and encourages students to get involved to further their interest in geriatrics.
"If the students are [doing] clinicals, they're only seeing older adults who are having difficulty medically or physically, so they don't see the older adults who are independent, playing tennis, out on the river at 80-85 years old," she explained.
"It's trying to show them that they could potentially also work with people to continue to live a good quality of life and help them do that as they age."
The agency and its owner were found to have violated the Connecticut False Claims Act.
Hope Home Health Agency, a Connecticut-based home health provider, and its owner, Miledy Marmol, have reached a $150,000 settlement with the state to resolve allegations that it violated the Connecticut False Claims Act.
An initial investigation by the state's office of the attorney general found that the agency had been billing Medicaid for services delivered by aides who weren't trained to do so as well as delivering services to clients without a treatment plan signed by their physician.
"Hope Home Health Agency ignored basic training and treatment oversight requirements in place to ensure that patients receive the safe, professional healthcare they require and that the state pays for," William Tong, Connecticut attorney general, said in a statement. "Our investigation began after a [Department of Public Health] inspection and survey identified serious care deficiencies at [Hope Home Health Agency]."
After being notified of its care deficiencies in December 2017, Hope Home Health was required to find an independent trainer for its home health aides, according to a news release. Later, a consent order issued in August 2019 required them to employ an independent nurse consultant to monitor operations.
The consultant would report that the agency failed to address its care deficiencies, continued to train aides internally without a qualified independent trainer, and allowed them to continue providing services.
An additional investigation into the agency was then opened by the office of the attorney general, which found that Hope Home Health had also been billing Connecticut Medicaid for services without a treatment plan signed by their clients’ physicians first. In some cases, a treatment plan was never obtained.
Hope Home Health closed for business after the agency stopped billing the Connecticut Medicaid program in November 2019.
