BrightStar Care, a home care franchise, has promoted Teresa Celmer to chief marketing officer. Celmer previously served as the franchise's senior vice president of marketing and has been with the organization since 2019.
"Teresa Celmer truly embodies the heart and soul of BrightStar Care, and through her tremendous work, she has taken the brand to extraordinary heights," Shelly Sun, founder and CEO of BrightStar Care, said in a statement.
"The state of the healthcare workforce has fluctuated over the years, and being the solution-oriented professional she is, Teresa has swiftly pivoted marketing efforts toward attracting healthcare workers," Sun said. "Teresa is a trailblazing marketer who focuses on the interconnectedness between our customers, staff, and partners and strategically aligns marketing to fit each audience seamlessly."
As CMO, Celmer will manage the vision, leadership, and execution of all BrightStar's marketing program and initiatives under the BrightStar Group Holdings umbrella. This includes BrightStar Care, BrightStar Senior Living, and BrightStar Care Homes.
She'll also oversee the development and execution of the franchise's long- and short-term marketing strategies to accelerate brand awareness and increase brand sales and customer count.
"I'm thrilled to be stepping into the role of chief marketing officer of BrightStar Care and am expertly positioned to continue leading the BrightStar Care marketing team with passion and excellence," Celmer said in a statement. "From the start, I have been committed to BrightStar Care's vision of enriching lives, and I am ready to continue leading the brand forward through creative and innovation channels."
Earlier enrollment in hospice services can increase Medicare savings.
A new study by the National Opinion Research Center (NORC) at University of Chicago found that hospice care contributed to $3.5 billion in savings for Medicare in 2019.
Within the healthcare continuum, hospice services prioritize a patient's comfort as they approach the end of their life. Iin addition to the study confirming what hospice providers already knew to be true—that hospice care improves the end-of-life journey for patients and families—it can also save tax dollars, Ben Marcantonio, chief operating officer and interim CEO of the National Hospice and Palliative Care Organization (NHPCO), said.
Key findings
Medicare spending for individuals that received hospice care was $3.5 billion less than that of individuals who didn't.
The total cost of care to Medicare for beneficiaries who used hospice services was 3.1% lower that for those who didn't use hospice services.
Earlier enrollment in hospice reduces Medicare spending even further. Hospice is associated with lower Medicare end-of-life expenditures when lengths of stay are longer than 10 days.
Hospice stays of six months or more result in an average 11% savings for Medicare.
Indeed, earlier enrollment in hospice—and longer lengths of stay—is beneficial to reduced Medicare spending and improved end-of-life care, Marcantonio said.
“This research, along with American’s growing demand for hospice care, shows that any effort to save money by reducing hospice expenses will backfire,” he said. “In fact, we should increase the investment in hospice, both to save money and to increase the quality of end-of-life care.”
Policy makers, health systems, and healthcare payers should pay attention to these findings and put their support behind patient interests and family well-being, said William A. Dombi, president of the National Association of Home Care and Hospice.
"Our research shows that hospice is an essential component of end-of-life care and should be prioritized in any attempts to secure the future of Medicare solvency," Dianne Munevar, vice president of Health Care Strategy at NORC, said in a statement.
"For patients and families, our research provides one more reason to have conversations about the end-of-life care before it is needed and to seriously consider hospice so that when the time comes their wishes and preferences are respected."
Home Sweet Home is the provider's first Michigan-based agency.
PurposeCare has acquired Home Sweet Home In-Home Care, an independently owned St. Joseph, Michigan-based home health care agency. Home Sweet Home has been servicing southwest Michigan clients since 2011, fostering a positive rapport in the community amongst its clients, referral partners, and payers.
"We are thrilled to join the PurposeCare family as their mission and principles align well with ours," Eric Pumfery, chief executive officer and founder of Home Sweet Home, said in a statement. "Being part of something bigger during a time when home care is becoming a significant portion of the healthcare landscape is very exciting."
The acquisition makes Home Sweet Home PurposeCare's first Michigan-based agency, bringing in 400 patients and more than 300 caregivers, and furthering the provider's expansion in the Midwest.
PurposeCare provides home care and home health services to more than 3,000 clients a week, most of whom are dually eligible for Medicare and Medicaid.
"We are excited about our new unifying brand and this expansion into Michigan with a like-minded organization dedicated to empowering care teams to ensure clients live their best lives in community," Rich Keller, chief executive officer of PurposeCare, said in a statement. "We truly believe that 'at PurposeCare, your care is our purpose.'"
PurposeCare is a portfolio company under Lorient Capital, and the parent company of agencies including Purpose Home Health, Alliance Home Health Services, A1 Home Health Care, A1 Nursing Care, Newsome Home Health Care, and Honor Home Health, all of which were acquired in November 2022.
Here are four HealthLeaders stories with sector insights from its newest executives.
Almost four months into the new year, with winter thawing into spring, organizations have set their goals and objectives for the next eight months. Some have even brought new hires into their C-suite.
As the first quarter of 2023 comes to a close, here's a look back at some of profiles and Q&As featuring recently appointed post-acute executives and their plans for their new roles.
AccentCare Chief DEI Officer Hoping to Lead by Example in Post-Acute Sector
Rafael Fantauzzi has the distinction of being AccentCare’s first ever chief diversity, equity, and inclusion officer. He brings a wealth of experience from his previous DEI experience in areas like civil rights advocacy nonprofits, saying that at the end of the day, it's all about people.
To encourage organizational transparency both internally and among its competitors, AccentCare released an infographic illustrating its organizational demographic data. The provider's current DEI index rating is 74%, and has established a goal of achieving 80% or above in the future.
"That we're a company that is respectful to our employees, we don't just see each individual as a number or medical staff, we see individuals for who they are and if people feel comfortable," Fantauzzi told HealthLeaders. "If people feel that they belong in our organization, then they're able to bring that innovation and their passion also to our workplace so that we can actually provide better care."
Charter Healthcare Announces New CEO, COO
In February, Cheryl Lovell and Anna-Gene O'Neal were announced as Charter Healthcare's chief executive officer and chief operating officer, respectively. The provider offers different post-acute services, including home health, hospice, and complex care management.
Together, Lovell and O'Neal have more than two decades of healthcare experience. Lovell has more than 22 years of management experience in home health, hospice, home care, and mobile physician sectors. She also previously founded and served as CEO of her own post-acute consulting firm.
O'Neal has 35 years of experience as an RN, in addition to having previously held executive management positions at different healthcare companies.
New PurposeCare COO Aims for Success With 'Good Processes'
Before joining the home care and home health services provider as chief operating officer in January, Rob Barrow worked closely with PurposeCare’s leadership as part of Lorient Capital, the investment private equity firm that developed and invested in it.
He credits his engineering background for the process-oriented mindset that he believes has helped him manage large-scale people organizations, regardless of the industry or sector.
"Patients are looking for a good quality outcome wherever they go, now it's in the home. I think a lot of agencies that are short staffed maybe take shortcuts around that," Barrow said. "But we put our quality outcomes as the top four or five key performance indicators for our business. We have to ensure that we're providing quality care."
Q&A With Caring Senior Service COO Jeff Bevis
Prior to his current role as Caring Senioir Service chief operating officer, Jeff Bevis had almost 20 years of experience in private duty and 10 in franchise operations. In his conversation with HealthLeaders, he explained that franchise owners need to leverage technology and data and they relate to delivering services.
He also explained the importance of branding and messaging in private duty, while noting that many brands and agencies fail to establish themselves as a solid brand.
"I don't think it’s a matter of who has the largest checkbook," Bevis said. "I do think there's some efficiency, some proactive branding steps that even smaller brands can take to look as big as the rest of the industry and to do a good job."
The organization's first DEI officer is hoping their transparency will inspire other organizations to follow suit.
AccentCare, one of the nation's largest post-acute health providers, released its organizational demographic data for the first time, in an effort to encourage transparency with diversity, equity, and inclusion efforts in healthcare.
The data, available in an infographic on the provider's website details the gender, ethnicity, and even generational groups (ex. GenX, millenials, GenZ) its almost-30,000 workforce belonged to for the year 2021.Its DEI index rating is currently 74%, and the infographic notes that the company’s goal is to achieve an 80% or above rating.
Rafael Fantauzzi serves as AccentCare's first chief diversity, equity, and inclusion officer, having DEI experience from working in the travel industry, consumer packaged goods, and civil rights advocacy nonprofits. At the end of the day, he said, it's all about people.
"The reason I wanted to be involved with the [previous] civil rights [nonprofit] is to really understand what the community needs, so that I can become that bridge between corporate America and the community to be able to be more effective," he told HealthLeaders. "And understand more clearly how to break down those barriers of inequality that exist in our society."
Fantauzzi credits Catalyst, a women's advocacy group for gender equality, for the formula AccentCare is following in its DEI work: belongingness + uniqueness = inclusion.
Belongingness: "It's a human need that we all have to want to belong to something greater than who we are as individuals. That's the culture of the organization and we can measure that."
Uniqueness: "That's the real work around diversity, equity, and inclusion, which is trying to make sure that we celebrate people for their individuality. People are more than just a gender, a professional career, a faith, an ethnicity, or race."
Inclusion: "The work that entails is to make sure that as an organization we validate who you are, all the different things that you are, as best as we can, and that's relevant to our customers as well.
Providers supply better care once they understand the needs each person has as an individual, Fantauzzi explained.
Prior to and particularly after the pandemic, healthcare has increased efforts to tackle its inequities, especially as it relates to the quality of care being provided. In making its organizational demographic data available to the public, AccentCare is following through on its DEI efforts, while encouraging other providers and competitors to follow their model of transparency.
"I think it’s an encouragement to my counterparts in other organizations for us to work together toward trying to increase the workforce pipeline," he said, "but also to elevate the quality of service because when we are intentional about including folks that are in our communities, we will service [them] better."
"That we're a company that is respectful to our employees, we don't just see each individual as a number or medical staff, we see individuals for who they are and if people feel comfortable," he said. "If people feel that they belong in our organization, then they're able to bring that innovation and their passion also to our workplace so that we can actually provide better care."
Cheryl Lovell and Anna-Gene O'Neal bring a combined six decades of experience to their new roles.
Charter Healthcare has named Cheryl Lovell and Anna-Gene O'Neal as its new chief executive officer and chief operating officer, respectively.
The post-acute provider serves almost 13,000 patients across eight states under the umbrella of Pharos Capital Group. Services they provide include home health, hospice, complex care management, and palliative care.
"I am excited to be working with the Charter and Pharos teams to support and expand the company's mission of ensuring a comfortable patient experience while lowering the costs of care," Lovell said in a statement. "The need for quality palliative care is large and growing, and it is gratifying to offer patients and families the high-quality essential services they deserve."
Lovell has more than two decades of experience in healthcare, including experience in home health, hospice, home care, and mobile physician settings. Before joining Charter, she founded and served as CEO of her own consulting firm where she offered her expertise in healthcare, operations, and finance to assist post-acute providers.
O'Neal brings 35 years of experience as an RN to her new role, as well as executive management experience from her roles at healthcare companies. Prior to Charter, she worked as an independent consultant supporting operational analysis for post-acute companies. Before that, she served as the division president for Brookdale Healthcare Services—now part of HCA Healthcare—where she guided them through the pandemic.
"Charter plays a unique role in bringing a human touch, personalized care, and a family-centered approach to patients navigating the last years of life," she said in a statement. "And I am proud to join a company whose goals for growth include providing compassionate care to more people in more places."
A small percentage of the aging services providers the nonprofit association represents has found success hiring foreign workers through work-based visas.
In a recent poll, 64% of aging services providers stated their workforce situation hasn't improved since June 2022.
The poll, conducted by LeadingAge, a nonprofit association representing aging services providers across the country, shows that providers continue to struggle with hiring and retention, worsening financial burdens, and frustration with policymakers’ lack of action.
"The hours are insane for the pay people get. It is not uncommon to have staff routinely working 60+ [hours] per week because they do not want to let their residents go without," a LeadingAge member stated. "I have been doing this for 32+ years and this is the most dire time I have ever seen."
LeadingAge last surveyed its members in 2022 on similar issues to gain insight on their struggles.
Staffing struggles
Results of the poll showed that the three most difficult positions to hire for are registered nurses (86%), licensed practical nurses (85%), and certified nursing assistants (85%). Many have found that current staff are leaving their positions for better-paying roles (78%) and better hours (53%).
Another 73% are leaving due to burnout.
Member comments included with poll results note that some providers turn to agencies for staffing, which can be costly. As a result, nursing homes and home health agencies are limiting the number of patients they serve to ensure they can provide quality care with the staff they have.
Getting creative
70% of respondents said they've implemented different strategies to help with recruitment efforts, including offering sign-on bonuses (69%), flexible scheduling (61%), and emphasizing career advancement opportunities (56%).
92% of providers have offered increased hourly wages to employees in hopes of retaining them.
"We have closed units or delayed filling apartments … due to insufficient staff to provide quality care in SNF and memory care assisted living;" one provider commented. "Staffing continues to get worse, so [we] anticipate additional measures may need to be taken if it doesn't turn around."
Other options
Some organizations have found success in recruiting foreign workers to work in the United States through work-based visas (12%) or on refugee status (5%). The interest in foreign recruitment overall is high, according to almost 200 member comments from the poll. To make this process easier, they will need help from policymakers.
"We are in the process of starting a foreign workers program, but our approval for prevailing wages has been pending for 6+ months," one provider said. "There seems to be no urgency among the government agencies involved in this process."
Since 2015, more than 1,000 nursing homes have ceased operations.
Besides intensifying a workforce shortage, the COVID-19 pandemic exacerbated another issue in healthcare: the closing of nursing homes.
More than 1,000 nursing home have closed since 2015—776 of which occurred prior to the pandemic, and 327 during, according to a 2022 report by the American Health Care Association.
"Before the pandemic we had chronic staffing shortages, we had chronic Medicaid underfunding, we had these huge systemic issues in long-term care that we knew were mounting," Rachel Monger, CEO of LeadingAge Kansas, said. "And we're waving the red flags and trying to get attention to the sector to very little avail."
LeadingAge is an association made up of nonprofit, mission-based providers of aging services, including skilled nursing facilities. Monger added that overall, healthcare was unprepared for the impact the pandemic would have, but the added financial burden and persisting workforce shortage made things worse.
A former administrator for Bloomfield Healthcare and Rehabilitation Center in Iowa, which closed its doors in April 2022, attributed it to the pandemic, the workforce shortage, and the facility's need for repairs.
"[The] reality is that we would have had to build a new one. They'd done cost analysis, whether it'd be cost effective to build a new building, and it [would've been]," the administrator told the report's authors. "But the staffing issues made the county board decide against it."
Staffing issues forced Bethel Home & Services in Viroqua, Wisconsin to cease operation as a skilled nursing facility and pivot to a community-based residential facility in early 2021, despite raising wages to compete in the labor market. In coming to terms with the changes, Debbie Stout-Tewalt, Bethel Home's CEO, viewed it not as a failure, but as "facing reality."
Once a facility makes the decision to close, the administration must find other facilities for their current residents, which is not without its own difficulties. In areas like rural Kansas, where Monger said the nearest facility could be 30-40 minutes away, residents are having to move away from family who wouldn't be able to visit and advocate for them as much as they were used to.
"It's very hard, and it's hard on the community where the nursing home closes," she said. "Those jobs, that tax base, is also really important to rural communities. Almost all the time, once you lose a service in a rural community, the chances of getting it back are almost zero."
HealthLeaders has previously reported how 20% of the nation's population will be over the age of 65 by 2030, with the demand of aging services to continue to steadily increase. Monger, alongside many of LeadingAge's state partners, have advocated before their state legislatures to bring policymakers’ attention to the crisis in the nursing home sector.
However, despite their best efforts and putting forth proposals at federal level to invest in workforce, training, and developing talent pipelines, she fears that the government may not act until the situation becomes truly dire.
"Part of getting more workers is making it an attractive field and job," Monger explained. "We cannot do that without adequate funding."
Most care older adults receive is through Medicaid, and aging services providers have long called for reimbursement rate reforms. As more older adults begin to consider their long-term care options and find that they're unable to find quality care in their communities, Monger hopes to see more advocacy from their side as well.
In the meantime, she urges providers to pay attention to the systems and tools they use and ensure they're doing what needs to be done for government ratings. She also encourages providers and facilities alike to develop a social media presence to help educate the public as more people look into these services.
"We've seen a much bigger focus on social media and web presence, even for the kind of homes that LeadingAge Kansas represents, which tend to be small and rural," Monger said. "You don't have to be in an urban setting anymore to know that social media and web presence is a big thing no matter where you are in the sector."
The transition of the HealthKeeperz locations to BAYADA should be completed by spring 2023.
HealthKeepers has signed an agreement to sell its home health business to BAYADA Home Health Care.
With more than 150 caregivers throughout the state, HealthKeeperz provides palliative care, equipment, and services to patients and their families.
The sale expands the reach of the not-for-profit home health provider across North Carolina, bringing HealthKeeperz's Fayetteville and Laurinburg locations under the BAYADA umbrella.
The "transition" of its home health services is part of the organization's evolving commitment to providing quality health care to in the southeastern region of the state, Tim Brooks, HealthKeeperz president, said in a statement.
"By partnering with BAYADA, we can concentrate on the areas of healthcare where we have long-term strategies to scale and innovate, such as hospice care," he said.
The HealthKeeperz locations are expected to fully transition to BAYADA operations by this spring, with efforts being made to minimize the impact on current employees, patients, and partners.
BAYADA transitioned to a not-for-profit organization in 2018 to assist with the organization's mission of "finding, training, and supporting employees who take pride and joy in healing and helping" to provide a spectrum of home health services. Headquartered in Philadelphia, North Carolina, BAYADA has more than 50 locations across the state.
"BAYADA is thrilled at the opportunity to partner with HealthKeeperz to continue their strong commitment to the North Carolina community and to continue to grow in this region," David Baiada, CEO of BAYADA, said in a statement.
"We look forward to welcoming the HealthKeeperz Home Health staff and patients into the BAYADA family, and to work together through this mission-aligned partnership to continue to improve health care outcomes in our region."
Facilities can use the analysis' findings to guide their operations going forward as the demand for aging services increases.
A new analysis report on the nursing home sector shows that on a national and regional scale, there has been an average net loss per patient day (PPD), accompanied by lower occupancy rates, rising expenses including those for raising wages, and a stagnant reimbursement rate.
Marcum LLP, a national accounting and advisory service firm recently released the 2023 Nursing Home Statistical Review. This annual report is an analysis of nursing home operations from 2019–2021.
Data from the report can provide nursing home operators guidance on how to navigate the pain points within the sector. This year's report examines the state of the nursing home sector before, during, and after the COVID-19 pandemic.
In addition to the immense amount of negative news coverage in the early days of the pandemic, the nursing home sector lost the most workers and continues to struggle financially due to low reimbursement rates not covering the cost of care.
The analysis uses data from the Centers for Medicare & Medicaid Services (CMS) database of Medicare cost reports, which are filed annually by nursing homes across the country. More than 38,000 cost reports were reviewed and presented in both a national and regional perspective.
Fifteen financial and operational categories were analyzed, but the most notable findings were related to employee wages, general service costs, and Medicare gross revenue PPD.
Employee Wages
Between 2019 and 2021, the average hourly wage increased by 13.27% across the country.
Providers and health systems alike have raised wages over the last few years in effort to recruit and retain workers. With the nursing home sector losing the most workers over the course of the pandemic, many facilities followed suit, with some even offering signing bonuses.
Over the three-year period, the Southeast saw the highest percentage increase at 13.30%, yet wages in the Southwest and Southeast regions continue to be on the low end of the average hourly rate at $21.02 and $21.31, respectively.
General Service Costs
In addition to nursing expenses, nursing homes also incur other additional costs for residents. Due to resident safety and infection prevention concerns, facilities spent more on housekeeping and laundry services and the cost of these services continue to rise.
The pandemic also brought an increase in dietary expenses, as a result of the rise of hourly wages to retain dietary staff, bonuses given to workers, and inflation of food prices. Between 2019 and 2020, the dietary salary PPD increased by 12.10% nationally. There was a 3.67% increase from 2020 to 2021, but the analysis considers these anomaly years due to the pandemic.
The total general service cost PPD increased each year from 2015 to 2021, both regionally and nationally. From 2020 to 2021, the total general service cost PPD increased by 5.56% nationally, with the southwest regions having the largest increase at 8.52%.
"Based on the trend over the past seven years," the analysis stated, "we can expect general service costs to keep increasing on a year-to-year basis as [skilled nursing facilities] try to distinguish themselves from other competing facilities."
From 2019 to 2020, the total general service cost PPD increase was larger than usual, 14.09%, due to the pandemic and facilities taking on additional expenses to ensure the safety of their residents and staff.
Revenue and Medicare Gross Revenue
The Medicare payer mix percentage increased each year from 2019 to 2021, due to the three-day hospitalization waiver which covered nursing home stays, longer illness periods for COVID-19 patients, and renewed coverage without patients having to begin a new benefit period if they'd already exhausted their nursing home benefits.
Excluding public health emergency (PHE) funding, there was a 3%–6% increase in total revenue per patient, regionally, with a 4.73% increase, nationally. On a national scale, patient days declined by 5.54% from 2020 to 2021 and the percentage increase for reimbursement has remained between 3% and 4%.
The net loss per patient day is $12.51 (excluding PHE funding), with every region incurring net losses—the Midwest having the highest at $19.65 and the Pacific having the lowest at $1.74. The analysis shows that costs have not slowed for the industry and reimbursement rates are unable to keep up.
Facilities raising employee wages and offering bonuses also increased their financial strain.
The analysis notes that while Patient Driven Payment Model (PDPM) for Medicare reimbursement was intended to be budget neutral, that is not the case. It is also difficult to determine how the pandemic affected Medicare Gross Revenue, since the PDPM model was implemented in October 2019.
During the first year using the PDPM model, the increase in Medicare gross reimbursement were significant throughout every region. The Midwest saw the highest increase at 9.30%, or $14.15 PPD, and the Southwest saw the smallest increase of 6.86%. However, their average daily increase was $35.90 PPD.
