Silver is the second of three quality distinctions for the honor awarded by the organization, recognizing long-term care facilities that meet the "rigorous" performance standards to improve the lives of their residents and staff.
"I am incredibly proud of our remarkable members for this achievement," Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement.
"This recognition is a testament to their unwavering dedication, passion, and tireless efforts to deliver exceptional services, innovative solutions, and transformative care for their residents and staff,” he said. “Their impact is undeniable.”Silver is one of three distinctions for the organization's quality awards, with the others being bronze and gold. To earn the Silver Award, a facility must have previously received the Bronze Commitment to Quality Award.
Bronze honorees were announced at the beginning of June.
"We are delighted to honor these incredible providers for being recognized at the Silver level," Cathy Bergland, AHCA/NCAL National Quality Award board chair, said in a statement. "I applaud their resiliency and dedication to the quality journey and for this outstanding achievement."
Gold Quality Award recipients will be announced in August, and awards for all three distinctions will be presented during Delivering Solutions 23, the AHCA/NCAL Convention and Expo, October 1-4, 2023, in Denver, Colorado.
Colleges and universities are doing their part to develop a talent pipeline for aging services.
Despite the sector's incredible growth, home health care agencies are struggling to meet the demand for services. In addition to the ongoing workforce shortage, there is a lack of interest in geriatric medicine and eldercare among new generations of healthcare workers.
To combat this issue, some providers have partnered with higher education institutions to develop relationships with potential talent while they're students. Additionally, some institutions have taken it upon themselves to provide students opportunities to work with elderly patients.
Here are three HealthLeaders stories spotlighting institutions giving students a chance to explore eldercare and careers in aging services.
In addition to research and innovation surrounding fall risk in older adults, the KU Cares Research Center is also developing best practices caregivers and nurses can use in the field.
The school's faculty also note that quality of life and social interaction play a considerable role in the way fall injuries impact a patient's health.
"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," Dr. Abiodun Akinwuntan, the school's dean, said.
The college has incorporated geriatrics, previously an elective, into the core clinical rotation of its physician assistant program. Faculty are hoping the experience will increase student interest in geriatric medicine.
"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," Dr. Jennifer Vincenzo, an associate professor, said.
Chad Cole, MPA, is using his experience working in geriatric medicine to help students develop an interest in working with elderly patients. Students’ hesitation to work with elderly patients stems from ageism and believing their conditions are more complicated than those in younger generations, according to Cole.
"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," Cole said.
Numerous site surveys found 'substantial' noncompliance with Medicare rules and regulations.
Two Louisville, Kentucky nursing homes—one of which was rodent-infested—have agreed to shut down and pay $1,026,409 in civil money penalties to the Centers for Medicare and Medicaid Services (CMS) for "substantial" noncompliance with Medicare rules and regulations.
From September 2022 to May 2023, the state division of health care performed numerous surveys of Hillcreek Rehab and Care and St. Matthews Care and Rehab Center, which found:
Hillcreek
Blood glucometers were used on multiple patients without being disinfected
Infested with rodents, with droppings in plain sight in various parts of the facility, including resident rooms
Left residents in soiled clothing and linens without appropriate checks from staff
Failed to implement care plans for multiple residents, all of whom later suffered serious harm
Improperly kept medications past expiration and unlocked
Blood glucometers were used on multiple patients without being disinfected
Personnel files failed to show that complete and proper background checks had been performed
Failed to develop and implement care plan interventions for residents with physicians’ orders for oxygen
Both facilities filed federal lawsuits in May 2023, seeking injunctive relief against the United States to help them remain open. After a hearing on June 1, Hillcreek and St. Matthews agreed to terminate their provider agreements with Medicare, dismiss their cases, and close within 30 days.
"CMS takes seriously our role in promoting the health and safety of nursing home residents," Chiquita Brooks-LaSure, CMS administrator, said in a statement. "As was shown during onsite inspections, the residents of these two nursing homes did not receive the care they were entitled to."
Hillcreek and St. Matthews are required to safely transfer Medicare and Medicaid residents to other facilities. Due to their noncompliance with federal rules and regulations, they will have to pay $636,752.75 and $389,656.25, respectively, totaling $1,026,409.
Rinn will succeedcurrent president and CEO Dr. Steven Landers, MPH.
Visiting Nurse Association Health Group (VNAHG), a nonprofit provider of home health, hospice, and community-based care has appointed Christopher Rinn as its CEO.
He will assume the role in August, after current CEO and president, Dr. Steven Landers, MPH, leaves to become president and CEO of Hebrew SeniorLife aging services.
"We wanted someone who understands our sophisticated network of programs and services and has the skills and experience to oversee our various programs and services, and Christopher checks all the boxes," Patrick McMenamin, VNAHG board chairman, said in a statement.
McMenamin helped lead the search committee for Landers' successor alongside vice chairman Robert Dibble.
"Christopher is a compassionate servant leader with a deep passion for public health and a drive to ensure high-quality services are provided to the community," Landers said in a statement. "As a respected healthcare policy and public health leader, Christopher is an excellent fit for our future."
Throughout his career, Rinn has worked in public health, policy, and community health. He's served as CEO for VNA of Central Jersey Community Health Centers (CHC) since 2017.
Before joining the organization, he served as acting health commissioner for the New Jersey Department of Health, as well as executive director of emergency medical services (EMS) and government affairs for Jersey City Medical Center.
"[The board and I] will work closely with Dr. Landers and the whole team to ensure a smooth transition," Rinn said in a statement. "As a longtime member of the VNA family, I heartily welcome this opportunity to help move healthcare forward for all our communities."
In the letter, the organization emphasizes the “astounding” lack of attention given to infection control in the nation's nursing homes. It also references multiple government reports that have highlighted the results of the lack of attention.
In 2019, at the height of the COVID-19 pandemic, one-third of deaths were associated with nursing homes. In 2022, a White House fact sheet found that many nursing homes are still providing "sub-standard" care leading to avoidable harm coming to residents.
The time for better infection prevention and control efforts is "long overdue," Devin Jopp, EdD, CEO of APIC, said in a statement.
"We urge the Biden Administration and Congress to ensure that residents of these facilities receive at least the level of protection from deadly infections as they would in the hospital," he said.
APIC included actionable recommendations in its letter, including employing at least one full-time infection preventionist on staff whose sole responsibility is infection prevention. Relying on a director or staff member who has little background or training in infection control and prevention is ineffective, the organization noted.
Another recommendation called for the adequate funding of the Centers for Medicare & Medicaid Services (CMS) Surveyor workforce, along with the proper training for the surveyors themselves.
Lastly, the APIC recommended long-term care facilities use the Center for Disease Control and Prevention's (CDC) healthcare associated infection tracking system, the National Healthcare Safety Network (NHSN), to continue to report infection data to build on reporting requirements. Prior to the pandemic, nursing home data was submitted voluntarily.
"While having the appropriate level of nurses is important in nursing homes, that alone is not enough to keep patients safe from harm," Patricia Jackson, RN, MA, CIC, FAPIC, APIC president, said in a statement.
"These facilities must be required to have at least one full-time, dedicated infection preventionist to ensure they have the necessary protections and safeguards in place to keep our loved ones safe from preventable infections and other emerging infectious diseases."
As the demand for home health services continues to rise, organizations and agencies are looking for solutions to accommodate it.
With more people preferring to age in place in the comfort of their homes, they're also preferring to receive care there as well.
The home health care sector has responded in kind with a slew of mergers and acquisitions between large organizations and smaller agencies, increasing service offerings, and investing in their employees to retain staff amid a severe workforce shortage.
Here are three HealthLeaders stories featuring insights from home health executives whose organizations are keeping pace with the sector's growth.
Culture is Key
After joining Harbors Home Health and Hospice as its CEO in December 2022, one of Ryan Larsen's goals was to foster a culture of education and creativity. From his observations, agencies that did similarly were better able to navigate the post-pandemic climate.
"I'm starting to see first-year clinicians that are coming out of school showing interest in home health and hospice care, but for them to be successful, agencies are going to need to create some sort of educational culture where we're not throwing these first-year therapists and nurses into the deep end," Larsen told HealthLeaders.
"At Harbors, we're trying to create that training culture."
Putting Things in Perspective
Interim Healthcare CEO Jennifer Sheets, began her career in healthcare as a nurse. Having that background, she believes, has helped her as a leader, enabling her to understand what her own employees in the field experience.
"We talk a lot about results, just like anybody else, but we also spend a lot of time talking about how we engage our workforce," she told HealthLeaders. "How we find, train, and keep the best people, how we add real consumer-directed care."
Collective Collaboration
When preparing his testimony for a Senate hearing on healthcare's workforce shortage, Leonardo Seoane, MD was assisted by other departments within the Ochsner Health System. Seoane, who serves as the system’s executive vice president and chief academic officer, spoke on the group's behalf to give legislators an idea of the struggles he and his colleagues are facing due to the workforce shortage.
Through additional collaborations with local partners, the system has created some solutions—for example, collaborating with community colleges to develop a pre-apprenticeship LPN program for high school students.
Grams suggests the sector pursue a partnership model to increase value-based care and reduce total cost.
Home health is quickly becoming the preferred method of care for older adults, with many organizations and agencies expanding their businesses service offerings as a result. However, with the ongoing workforce shortage, there's a struggle to maintain enough staff to accommodate the demand for care.
David Grams, CEO of Compassus, which provides clinical home health care services, has noted the sector's growth and invested in employees to foster a positive relationship with employees and a strong organizational culture.
HealthLeaders spoke with Grams about the sector's growing popularity, the hindrance of the workforce shortage, and how organizations and agencies should navigate this period of growth with discernment.
HealthLeaders: Did you have any healthcare experience prior to joining Compassus?
David Grams: I've been in and around healthcare services for 25 years. I've spent time in the hospital space, physician practice management, physical therapy, surgery centers, imaging centers, and then the kidney care business.
HL: Having worked in acute and post-acute care, how does that help you in your role as CEO?
Grams: I have a lot of empathy and awareness of the challenges our overall healthcare system is facing at the present time. Specifically a lot of the burden in the pandemic fell to health systems and we saw that from where we sit as enabler of health system success.
I feel passionate about helping our partners and, as an integrated home-based care provider with the service lines we have and the innovation we have, we are a great enabler of success to health systems.
I understand what's on the minds of health system executives and I love being associated with a solution, and that solution is integrated home-based care where we can care for people where they live. We can advance the clinical outcome and we can reduce the total cost of care.
HL: The demand for aging services, particularly home health and private duty caregiving, has grown exponentially in the aftermath of the pandemic. How do you think this will change or affect the acute care sector?
Grams: This is what society wants. This is what aging citizens want. They want to receive care in their home.
If you just think about innovations in transportation, if you think about innovations in retail and shopping and food service, you know we have got to advance in healthcare.
One of our areas of focus is we must be a place where caregivers want to align and spend their time personally and professionally. We aspire to be the partner and employer of choice and it starts and ends with our teammates.
Most people that are in healthcare are passionate. Some people are at varying levels of connectedness to their current situation and employer. We want to take passionate people and connect them to what we're doing for patients and families.
HL: As CEO, how have you enriched Compassus' organizational culture?
Grams: I've been here two-and-a-half years and in my current role for a year and a half, and this is one of the three areas we're going to try and distinguish ourselves: with our people strategy.
Each one of our 250 care locations is a community and in each of these communities we have 10 to 40 teammates. My executive team and I need to enable the success of each of those communities.
We made investments in our benefits. We've made investments in our paid time off. We made investments in leadership development. We made investments in communication and recognition. We've updated our core values. We've just recently evolved our mission and vision.
I'm proud to report we did an engagement survey this year, as we do every year, and we were very pleased with the results. Our engagement scores went up in some cases meaningfully across the things we track.
In a world full of turmoil, it was a milestone in terms of the progress we're trying to make with connecting, engaging, enabling our workforce to deliver great patient experiences and clinical outcomes.
HL: How do you think your investments will help when it comes to recruiting and retaining talent?
Grams: Our turnover statistics year over year have improved significantly across the core functions. Home health growth is constrained by how many caregivers you can attract and retain, and our nursing cohort in the home health space is up significantly. And that really makes me happy.
It's a proof point that we're progressing both in talent acquisition, orientation, operational connectedness, and then hopefully retention. I would still love to have another 100 caregivers tomorrow, and that is the constraint to growth, but we've made good progress at adding to our nursing population.
HL: Some providers have begun recruiting students while they're still in school or partnering with institutions to develop programs to develop a pipeline of talent. Has Compassus made similar efforts?
Grams: We have a program we started with a nursing school where we have recruited a cohort of students that will receive some tuition reimbursement with coming to join us after they graduate. We're going upstream to try and align with students that want to predetermine that they might enjoy joining Compassus.
We operate according to our proprietary Care Delivery Model, which is a formalized program with guides for clinical pathways by job type. If you have a young caregiver who's not as experienced and wasn't sure about being in a home without the benefit of [having worked] the hall in an inpatient facility, we're giving them an application on their phone that helps them with what they should be looking for, what they might experience. It has videos, it has a checklist, it has expectations around the care delivery process for clinical pathways by disease state.
I've gotten good feedback in my town halls, I've been thanked by caregivers who say this is an amazing resource to give a less-experienced teammate the confidence to perform at a high level in a home setting.
If the home-based care industry is not successful at providing sufficient levels of high-quality care, our population is going to be pretty upset, and they're going to miss out on something that they deserve in their life journey.
We are one amongst many organizations that need to rise to the challenge. We need to enable our caregivers to do a great job with patient satisfaction and clinical outcomes, and we think our care delivery model aids that process.
HL: How can home health care agencies and organizations offering those services navigate the sector's growth wisely, while remaining attentive to the needs of the population they serve?
Grams: First, our industry needs to be successful at attracting and retaining talent because those are the folks that go forward and give the patient experience and clinical outcome in the home.
Second, our industry is too fragmented. Our industry needs to consolidate, so we are just getting started with that. You're going to continue to see organizations come together and align around a common set of processes, increasingly common set of products, and use of innovative ways to advance a caregiver capacity and caregiver outcomes.
We enable the success of people in value-based care. We can't do it on our own. We do it in collaboration with our partners. We set a set of objectives. We pursue a partnership model that that has checkpoints for accountability and performance, and then we and they must increasingly share data that outlines that our care is differential and people in our care have a lower overall cost experience.
Everybody knows that, subjectively. We and they need to enhance the tools to present it and embrace it objectively.
77% of facilities worry they'll have to shut down from lack of workers.
Due to the ongoing workforce shortage, nursing home providers are having to turn away potential residents, downsize their facility, or shut down completely.
A new survey by the American Health Care Association and National Center for Assisted Living found this is attributed to the lack of interested and qualified caregivers. The survey also emphasized that proposed solutions such as federal staffing mandates would be impossible to meet considering these conditions.
To provide quality care to residents, the survey found that 98% of providers have had to ask staff to work overtime or extra shifts, 75% have had to hire costly agency staff, and 55% have had to limit the number of residents they admit.
"Every sector is dealing with a labor shortage right now, but for long-term care, this crisis is historic, persistent, and unsustainable," said Mark Parkinson, president and CEO of AHCA/NCAL in a statement.
Despite efforts such as increasing wages and offering bonuses, Parkinson said, the sector continues to struggle to find workers—and that it can't solve this problem by itself.
As a result of the workforce shortage, many older adults’ access to care has been indirectly limited, with more than one-fourth of nursing homes having to close a unit, wing, floor, or shut down their entire facility, with 21% of facilities downsizing the number of beds they can offer.
Nearly three-fourths—72%—of facilities are worried they'll have to shut down their facility because of hiring challenges.
Some providers have begun taking initiative to recruit students before they graduate. There are even some schools, like the Linda University's School of Allied Health Professions, that have begun working to change student's perception of working with the elderly.
In a previous HealthLeaders story, Chad Cole, MPA, and an instructor in geriatrics for the school's physician assistant program, emphasized the importance of pushing eldercare to the forefront for students.
"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."
In addition to lack of interest or qualifications from potential candidates, another obstacle providers face when trying to recruit talent is the financial situation of the candidate. With the reimbursement structure barely covering the cost of care, nursing homes can’t afford to offer wages to compete with larger providers such as hospitals.
"We need Congress to invest in long-term care and make it possible to build a robust workforce," Parkinson said, adding that the Biden administration's proposed staffing mandate won't help unless there are other resources and recruitment programs implemented alongside it.
"We urge policymakers to instead focus on comprehensive solutions, such as the ones AHCA laid out in our Care for Our Seniors Act, that will support our caregivers and protect access to care for our nation's seniors."
The agency owes back wages to 1,230 current and former employees.
Prestige Home Care Agency has been ordered by a federal court to pay more than $7 million in back wages and liquidated damages after failing to pay overtime wages.
The Philadelphia-based agency, established in 1995, provides home health care and private duty caregiving services.
After two years of litigation, the U.S. Department of Labor found that the agency owner, Alexander Dorfman, failed to pay overtime wages by not including employees' time for work-related travel when calculating wages.
"Unfortunately, our investigators found yet another Philadelphia-area home health agency willfully shortchanging employees and skirting the law," James Cain , Wage and Hour Division district director said in a statement.
"In this case, Prestige Home Care Agency denied 1,230 current and former employees more than $3.5 million in wages they earned for putting in long hours to help vulnerable people in our community."
The back wages and liquidated damages will be paid to those employees, he said.
The Department of Labor's investigation found that Prestige Home Care Agency paid certain employees straight-time hourly rates for all hours worked—including for hours over 40 in a workweek—and segregated types of work performed by certain employees during a workweek rather than combining all hours worked when computing overtime wages due.
The agency also failed to keep accurate time and payroll records as required by law, the investigation found.
"The court's judgment affirms the Department of Labor's position that home care employers must pay employees for travel time, which is an essential part of their job duties," Deputy Regional Solicitor Samantha Thomas said in a statement.
"The outcome in this case serves as a stark reminder to other home care employers that the consequences for shortchanging employees can be costly both to the company's bottom line and to its industry reputation."
Leticia Caballero and Norman Rokeach will be recognized as recipients of the 2023 Joe Warner Patient Advocacy Award. The award is given to AHCA/NCAL members who work directly to educate members of Congress about the issues and needs of long-term and post-acute care and patients, and how to advance quality care.
Caballero serves as the director of government relations for HMG Healthcare, with more than 25 years of experience advocating at the state and federal level. She has also served in senior roles within the Texas House of Representatives, director of governmental affairs for the Texas Health Care Association, and as the state's regional federal political director for AHCA/NCAL.
Rokeach is the founder and president of Marquis Limited and principal/partner of Tryko Partners' Healthcare Division. Beginning his career as a facility administrator, he went on to serve as regional director of operations at Global Health, and later CEO once Marquis Health was founded in 2011. Rokeach has also previously served on AHCA's board of governors.
AHCA/NCAL have also announced this year's recipients of its Bronze National Quality Awards. The award, the first of three distinctions through the organization's quality award program, honors facilities for their commitment to quality. This year's recipients include 277 skilled nursing facilities, 57 assisted living communities, and 60 facilities that offer both services.
"I applaud all of these providers for taking this important first step in their quality journey," Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement. "The work that they have accomplished lays the groundwork to continue to improve the lives of the individuals who live and work in long-term care."
AHCA/NCAL has published a list of all of this year's Bronze Award recipients to their Quality Award website. Honorees for the Silver and Gold awards will be announced at the end of June and August, respectively.
The National Quality Awards will be presented during the AHCA/NCAL Convention and Expo, Delivering Solutions 23, set for October 1-4, 2023 in Denver.