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.
Agencies are having a difficult time finding caregivers for the patients who want them. HealthLeaders talked to one expert about solutions.
The demand for home care services has grown exponentially in the aftermath of elderly patients recovering from the pandemic. Yet due to the workforce shortage, agencies are struggling to find caregivers for the clients who want them.
With 20% of the nation's population anticipated to be over the age of 65 by 2030, home care and other aging services are unprepared to meet the steadily growing demand for geriatric medical needs.
Dr. Michael Apkon, a member of the board of directors for Homecare Hub, an organization that innovates in home care and housing solutions, spoke to HealthLeaders about workforce solutions for home care. Apkon is a pediatrician and the former CEO at Tufts Medical Center in Boston.
"Not only are we in the peak of the baby boomer aging wave, but we also began to have a lot more people that needed some sort of post-acute care setting as they were recovering from COVID," he explained.
"Add on to the factors that … people didn't want to come to the hospital—they wanted alternatives—and hospitals needed to find alternatives to their inpatient beds so they could preserve space for those patients [who] needed it."
Healthcare leaders need to think about new care models to address workforce challenges, Apkon said, including ways to use staff more efficiently and embrace technological innovations.
"[V]irtual nursing that augments in-person care at the bedside, nurses with remote patient monitoring, centralized command centers where nurses can intervene virtually into a patient's room or with the rest of the care team," he explained. "I think those kinds of solutions can also be helpful in addressing some of these issues."
Apkon said that a "much broader, systems-oriented approach to thinking about the healthcare ecosystem" is needed.
"Things like virtual or augmented reality that can create experiences that help people preserve social connections when they're isolated and at home with different kinds of care needs, or to be able to have a range of experiences that might help them clinically," Apkon said. "I think those things could be important over the next five to ten years as the industry develops further."
Despite the complexity of their roles, home health nurses and aides continue to be woefully underpaid.
Home health nurses and aides prove their tenacity and dedication to their profession every day, yet they continue to struggle against obstacles like low wages, lack of benefits, and numerous regulations on how to do their jobs.
To raise awareness for the tireless work of these individuals, BAYADA Home Health Care founded Hearts for Home Care. Operating as a separate entity from BAYADA Home Health, Hearts for Home Care is working to educate politicians, media, and decision-makers on the challenges home health and home care workers face.
"We're raising awareness to the legislators so that they know what we're doing and what's happening in the home care sector, trying to get the nurses the pay that they deserve, and making sure that it’s fair and equitable," Karen Fitton, director of BAYADA Home Health, told HealthLeaders.
In addition to her role as director, Fitton also is a senior ambassador for the Hearts for Home Care Ambassador Program.
Beginning her career as a nurse, Fitton has worked in different areas of healthcare including the elderly, before joining BAYADA Home Health. Her clinical experience, she said, has made her a stronger director and advocate because she has the perspective of a home health/home care worker.
"The majority of [BAYADA Home Health's] directors are business majors, not nurses, so I feel like I have an advantage over them," Fitton said. "Of course, we have to run a business, but to me, it's more about making sure that our families are well taken care of, they're safe at home, and we have good, qualified nurses."
Pam Soni serves as BAYADA Home Health's director of managed care for adults, with years of experience as an LPN. After discovering a passion for advocacy, she began working with Hearts for Home Care as one of its leading recruiters and ambassadors.
Like Fitton, Soni believes that having nurses in administrative roles within an organization enables them to better serve their patients.
"Each one of them has individual needs that need to be met," she said. "And I get emotional about it because people don't know how to navigate the healthcare continuum and they underestimate the value of keeping folks in their home, safe, in the environment that they love, surrounded by the people that they love."
Another aspect of being a home health/home care worker, Soni noted, is that sometimes they're the only support their patient or client has.
"The staff that goes into the homes, they're walking into a stranger's home providing intimate care, medically complex care," she added.
"I feel the world doesn't understand how talented our field staff is on being great diagnosticians, and just the pressure that's put on them, that somebody's life is in their hands with no backup. There is no doctor down the hall. There's no call bell."
Recently, Soni attended a lobby day at the Pennsylvania legislature where she spoke for Hearts for Home Care about the challenges of home health and home care workers. Some are policy-related, like LPNs not being qualified to sign death certificates uring the public health emergency or nurses and aides getting ticketed or having their cars towed for parking in a certain area while attending to a patient.
With the ongoing workforce shortage, wages are a big challenge for agencies trying to recruit workers, because low reimbursement rates keep them from offering competitive wages. BAYADA Home Health has been looking at more creative ways to recruit staff, including building brand awareness among students and new graduates, Fitton said.
"We know this is a long game," Fitton said. "We have been going to nursing schools, making presentations, [visiting] classrooms, going to job fairs and career fairs trying to not only increase our brand awareness … [but] educating the students that are coming out and showing them that this is a viable career."
Caregivers at home care agencies can serve as liaisons between patients and family members to address Alzheimer's disease and symptoms.
More than six million people aged 65 and older currently live with Alzheimer's disease, according to a new report by the Alzheimer's Association.
The report, published in March, found that oftentimes, individuals with concerns about cognitive decline and memory loss don't mention them to their physicians.
That's why it's important for agency owners to train their caregivers to watch for signs of cognitive decline in clients. Because caregivers work closely with clients, helping them with personal tasks like cooking, getting dressed, and bathing, they should be on the lookout for any changes—even slight ones—in a client. Caregivers can serve as liaisons between agency owners and patients, and between patients and family members about cognitive changes they see.
Jeffrey Franck, senior vice president and general manager of operations of AccentCare, a personal home health and hospice care provider, said it's vital that caregivers regularly update their office team about a patient's significant behavioral changes.
"This not only helps to keep everyone informed, but also helps facilitate effective coordination of care for the patient," he said.
"Additionally," Franck said. "Emphasize the importance of maintaining open and honest communication between all parties involved in the patient's care plan to ensure that everyone is on the same page and working together towards the best care for the patient."
Training caregivers as liaisons to family members of the patient can also help reassure the family that while managing cognitive changes can be difficult for everyone, resources and support are available.
Franck added it's important that when caregivers initiate difficult conversations with families that they express empathy, sensitivity, and compassion, while also being as factual as possible.
"Providing the best possible care for Alzheimer's disease requires conversations about memory at the earliest point of concern and a knowledgeable, accessible care team that includes physician specialists to diagnose, monitor disease progression and treat when appropriate," Maria C. Carrillo, PhD, chief science officer for the Alzheimer's Association, said in a statement.
The funds were issued to help nursing homes and other residential care facilities recover from the COVID-19 pandemic.
As many of the nation's nursing homes struggle to maintain operations under strained finances, the state of Maine is lending its own facilities a helping hand.
On April 27, Governor Janet Mills' administration recently issued $25 million in COVID-19 supplemental payments to 129 long-term care organizations and 262 service locations throughout the state to help in the continued recovery from the pandemic. The funds will come from MaineCare (Medicaid) payments as part of the supplemental budget that Mills signed into law in February.
The funds will be distributed according to facility need, determined by historical revenue, resident vacancy rates, and spending on contract labor due to the workforce shortage.
"Long-term care facilities provide critical services for Maine people, and they are still feeling the lingering impacts of the pandemic—challenges that have only been made more difficult by increased cost," Mills said in a statement. "I am pleased we are getting these resources into the hands of our nursing facilities and other caregivers so they can continue to do their important work."
This is the second time this fiscal year that the Maine Department of Health and Human Services has provided COVID-19 payments to nursing homes and other long-term care facilities. In August 2022, the Maine DHHS issued $25 million to state facilities.
Angela Westhoff, president and CEO of the Maine Health Care Association, said in a statement that the state's long-term care facilities are still struggling financially in the aftermath of the pandemic, as well as with the staffing shortage affecting all of healthcare.
"This supplemental support comes at a critical time as nursing home and residential care facilities are experiencing atypical and exorbitant costs," she said. "We are grateful for the administration and the legislature's support and look forward to a continued partnership to address the workforce crisis and preserve access to long-term care."
This round of payments will be available for the duration of the current 2023 fiscal year, into the 2024 fiscal year.
The sooner a stroke is treated, the less damage to the brain's nervous tissue.
May is Stroke Awareness Month and OSF HealthCare is doing its part by encouraging caregivers and home health nurses for older adults to B.E. F.A.S.T.
The acronym is intended to help people remember the common signs of stroke and how to respond. To B.E. F.A.S.T, ask the individual the following questions:
Balance: Are they having sudden difficulty with balance?
Eyes: Are they experiencing vision problems in one or both eyes?
Face Dropping: Ask them to smile. Does one side droop?
Arm Weakness: Ask them to raise both arms. Does one arm drift downward?
Speech Difficulty: Ask them to repeat a simple sentence. Are their words slurred?
Time to call 911: If they show any of these signs, call 911 immediately.
"If you or a loved one has ever had a stroke, you may be familiar with the phrase time is brain—meaning time is of the essence when treating a stroke," Dennis Sands, MD, chief medical officer of OSF Saint Anthony's Health Center said in a statement. "With each moment that a stroke goes untreated, the nervous tissue in the brain is rapidly and irreversibly damaged."
Strokes are the fifth leading cause of death in the United States and the leading cause of serious long-term disability; however, OSF HealthCare says 80% of strokes are preventable. Lifestyle changes to control blood pressure and cholesterol levels, as well as medication, can help reduce someone's risk for stroke.
Other common signs include sudden dizziness or trouble walking, sudden severe headache with no known cause, sudden numbness of the face, arm or leg, and sudden confusion or trouble understanding others.
Sands spoke to HealthLeaders about how caregivers and nurses for older adults should be particularly attentive to these signs in their patients and clients.
"This is why getting the word out to the community on [strokes] is important as most people are not medically trained," he said. "It is especially true to be very observant and cautious with a patient/client if they have suffered a previous stroke as they are at increased risk for another event."
Any person of any age can have a stroke, with around 800,000 experiencing them each year; one in four are recurrent strokes. Factors that can increase risk of stroke include age, gender, ethnicity, along with habits such as smoking, excessive drinking, and not getting enough exercise.
Washington is creating ‘barriers’ to staffing nursing homes, LTC official charges.
The U.S. State Department’s freezing of green card and visa petitions will keep seniors from getting the long-term care they need, a long-term care official charges
"At a time when the Administration plans to propose a federal staffing mandate for nursing homes, Washington should not simultaneously create barriers to recruit the nurses we so urgently need," Clif Porter, senior vice president of Government Relations for the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), said in a statement.
The freeze directly affects the healthcare sector, which has begun to lean on foreign workers—namely nurses—who have helped alleviate its workforce shortage. Foreign workers who filed green card petitions prior to June 2022 are the only ones allowed to proceed to the interview stage for employment; all other petitioners waiting for an interview are "paused," according to the bulletin issued by the state department.
Nursing homes lost approximately 200,000 workers over the course of the COVID-19 pandemic —the most of any healthcare sector.
AHCA/NCAL has long been pushing for "common-sense" immigration reform to address long-term care's workforce struggles. It's included among other workforce policy solutions as its own agenda, the Care For Our Seniors Act.
About 20% of nurses working in the United States are immigrants, and 5,000 foreign nurses are waiting for their visa to be processed so they can join them, , according to the American Association of International Healthcare.
"We need Congress to expand and expedite opportunities for caregivers who wish to live and work in the United States, especially those who are willing to care [for] our nation's seniors," Porter said. "Immigrants make up a vital part of our workforce and are critical to helping us address this historic labor crisis."
AHCA/NCAL is urging Congress to reintroduce and pass the Healthcare Workforce Resilience Act, which would recapture unused visas from previous fiscal years for nurses and their families.
The organizations, alongside the American Hospital Association, have also proposed that Congress develop and push a temporary visa option, specifically for RNs and other healthcare workers so vitally needed in the United States.
The executive order ‘bolsters the home care workforce while punishing nursing home providers for shortages,’ industry expert says.
President Joe Biden’s executive order to improve access to and affordability of long-term care and child care largely ignores skilled nursing facilities, instead focusing more on home care and home health, an industry expert says.
"The order bolsters the home care workforce, while punishing nursing home providers for shortages—despite the reality that employers in both care settings navigate the same challenges in a competitive labor market," said Katie Smith Sloan, president and CEO of LeadingAge.
The nonprofit association of aging services providers, alongside providers and other advocacy groups, has long called for policymakers to act on issues affecting aging services. LeadingAge has previously suggested the White House develop an Office on Aging Policy for a more focused approach on doing so.
"Over a million older adults rely on the specialized care only nursing homes provide. Already, nursing homes around the country are closing or limiting admissions due to staffing shortages," Sloan said. "Why take that option away from the people who need it by implementing punitive policies that potentially worsen, rather than remedy, the ongoing staffing crisis? We are particularly concerned by the threat of withholding Medicare payment if providers don’t have workers—when workers simply don’t exist. "
When nursing homes are mentioned in the executive order it reiterates the possibility of staffing mandates with, as Sloan mentioned, a portion of Medicare payments being withheld depending on how well they retain their workers.
"We still desperately need to remedy the severe workforce crisis in long-term care," Sloan said. "In addition to increasing reimbursement and wages, the country must address immigration to build a pipeline of new workers through proven programs and pathways for those ready and willing to work in our field."
The workforce shortage has aging services struggling to provide quality care to vulnerable patients.
Despite the rise in demand for aging services, nursing homes and home health agencies are struggling to accommodate it. The workforce shortage is preventing providers from being able to provide care to the patients who need it.
Here are three HealthLeaders stories that examine the workforce shortage, its impact on aging services, and what can be done.
In 2022, the Biden administration proposed implementing a minimum staffing requirement for nursing homes to combat the workforce shortage. However, a report by the American Health Care Association (AHCA) stated that a staffing mandate wasn't a "feasible solution," as many facilities are already severely underfunded.
According to the report, 94% of nursing homes wouldn't be able to meet the proposed 4.1 hours per resident day (HPRD) minimum. One-third of nursing home residents could potentially be displaced if facilities were unable to maintain the staffing minimum.
Throughout the COVID-19 pandemic, skilled nursing facilities relied on the flexibilities that the public health emergency (PHE) permitted, such as the temporary nurse aid waiver, for relief.
However, with the PHE coming to an end May 11, providers need policymakers to act on legislation, such as the Building America's Health Workforce Act, to ensure they'll be able to provide residents the care they need.
A poll conducted by the nonprofit association representing aging services providers found that 64% of providers' workforce issues haven't improved since the previous poll.
Low reimbursement rates not covering the cost of care, being unable to pay workers as much as hospitals or larger organizations, and lack of action from policymakers have contributed to the providers' frustration.
The poll does note that some providers found an answer to their workforce struggles by hiring foreign workers through work-based visas or on refugee status. However, even this solution needs action from policymakers to help expedite the process of hiring them.
