With a recent investment, the agency plans to expand its caregiving services to include home health care.
Long before the current boom in aging services, Patricia McKinley and Theresa Williams predicted that the baby boom generation would need such services once they began developing health issues.
While completing her master's in business administration, McKinley began working for a home health care agency in quality assurance. It was there that she realized home care at that time left a lot to be desired.
"A lot of the clients who I spoke to were not happy. They were afraid to speak out. There were all kinds of issues," she said. "I decided I would like to do something to help people in that age group feel better about receiving services when they are incapacitated or needing service."
Together, McKinley and Williams started Around the Clock Home Healthcare Services in 1997, since renamed Aging & Diverse Home Healthcare. In their 25 years of business, the Philadelphia-based private duty agency has prided itself on being a community resource and employer.
Like other areas of healthcare, private duty agencies struggled to serve their clients during the pandemic. It was a rough time, Williams admitted, but they powered through.
"We consider ourselves to be a first responder, and for a lot of our clients, we could not stop servicing them," she said. "So, we made sure that we had as much protective equipment available as possible for our employees."
In addition to protective gear like masks, McKinley and Williams also educated their employees on the virus and provided transportation to and from clients’ homes. They also helped administer vaccinations at various locations around the city.
"A lot of people that came into our [office]; they were just ecstatic. They said, 'We need [this] here. We need a resource.' A lot of them, believe it or not, didn't know where to go or what to do," Williams said.
Though the COVID crisis has passed, it remains present, so McKinley and Williams are still taking precautions with their caregivers. For example, some clients don't want anyone in their home unless they've been vaccinated, so during the application process they request the applicants’ vaccination card.
McKinley also acknowledges that in the aftermath of COVID, and with the demand for caregiving services increasing, they've been struggling to hire caregivers. To help their efforts, they've increased their pay scale, but have still had to decline services to some clients.
"The majority of our aides give us an indication of what their availability is, whether they can do daytime or overnight," Williams explained. "By the nature of the work that we do, we tell people coming on board [that we have] a mandatory every-other-weekend policy, because we're a 365-day-a-year agency, and they understand that."
Branching into home health
Aging & Diverse Home Healthcare currently provides only private duty caregiving, but McKinley and Williams have plans to bring the agency fully into home health care. In April, the agency received a $250,000 investment from Exelon Corporation, the parent company of Philadelphia Electric Company, to assist their efforts.
"We have nurses and we have the skill set that is needed with our aides that are certified nursing assistants to take this to the next level," Williams said. "But it's a process with getting that accreditation."
"We're visible, we're active, and we're an employer and neighbors in the community. We employ people who primarily live in the area," McKinley added. "We're not a fly-by-night agency. We have longevity and a proven record."
Along with offering home health care services in the future, Williams and McKinley hope to work closer with hospitals and insurance companies and advocate for the needs and quality of life of the senior population.
"If we all live long enough, we're going to be experiencing some of the issues that our seniors are experiencing. After a certain age, you shouldn't have to worry about food or housing, or things that impact your life, and our seniors have those worries and concerns," Williams said.
"More has to be done for our seniors,” she said, “to make their golden years golden."
Nabb has previously served in C-suite roles at other home health and hospice organizations.
Larry Nabb has been named CEO of Jet Health, a regional provider of home health, hospice, and personal care services. He will be replacing current CEO Stacie Bratcher.
Jim Glynn, founder and chair of Jet Health's board of directors, described Nabb as a "solid strategic leader."
"He has been credited with inspiring a culture of growth and engagement across teams within the companies he has led," Glynn said in a statement. "Jet Health's board of directors believes Larry's extensive industry expertise and proven track record will position him for success in leading Jet Health forward."
Before joining Jet Health, Nabb served as CEO and board member for Providence Care, LLC, leading the company's acquisition strategy, bolstering its executive team, and expanding its footprint from single to multi-state, serving over 6,500 patients.
"Jet Health has steadily grown through acquisition as well as organically over the past several years, resulting in the strong presence it established and positive reputation it earned throughout the markets they serve," Nabb said in a statement.
"My background and experience, coupled with the company's solid footing in both the space as well as geographic areas it reaches, will serve as a springboard for taking Jet Health to the next level. I am confident in my abilities to help the company achieve its expansion goals over the short and long term."
The weeklong event will take place at the Hyatt Regency Washington on Capitol Hill beginning Tuesday, June 6.
In addition to presenting issues in long-term and post-acute care to legislators, they will also hear from House Minority Leader Hakeem Jeffries and U.S. Rep. Cathy McMorris Rodgers of Washington.
"It is crucial that we share our story with members of Congress, so it is amazing to see so many of our members here in D.C. this week to do exactly that," Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement.
"It is our job to help them understand the challenges we face, such as the ongoing workforce crisis, and the solutions we need to protect seniors' access to care. By working together, we can help improve the lives of our residents and staff."
Other topics to be discussed throughout the week include the Biden Administration's impending federal staffing mandate for nursing homes, supportive legislative solutions—such as the Building America's Health Care Workforce Act and the Ensuring Seniors' Access to Quality Care Act—to address the workforce shortage, and resuming typical protocols and transitioning out of the COVID-19 Public Health Emergency.
The importance of Medicaid for vulnerable seniors and individuals with disabilities requiring long-term care and the need to fully fund the program will also be discussed.
"This week, we need to convey what we go through on a daily basis to policy makers," Phil Fogg, AHCA board chair, said in a statement.
"We must share the meaningful and vital work we do in providing quality care to millions of Americans, the hurdles in place that make caring for our residents more difficult, and the need for policymakers to invest in our seniors and their caregivers."
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."