Sheets has 25 years of healthcare experience, serving in both managerial and clinical roles.
Interim HealthCare CEO and president Jennifer Sheets has been elected to the National Association for Home Care & Hospice (NAHC) board of directors. Sheet's term began on January 1, 2023, and will last three years.
"I am thrilled to join the NAHC board of directors and serve among a group of industry leaders I so greatly admire," Sheets said in a statement. "The crux of my work over the past few years has centered around ensuring the stability and preservation of the vital services provided through home healthcare, and I look forward to helping further shape the future of our industry."
Along with her role as president and CEO for Interim HealthCare, a home healthcare organization, Sheets also serves as president and CEO of Caring Brands International, its parent company. With more than 25 years of experience in acute and post-acute settings, in both managerial and nursing roles, Sheets is a longtime advocate of the home healthcare industry.
She has worked with federal and state governments to expand home care worker protections, increase funding and reimbursement rates, and boost employee recruitment and retention by enhancing educational opportunities.
She and other home healthcare industry leaders recently met with key legislators and legal teams in Washington, D.C., which resulted in the bipartisan Preserving Access to Home Health Act. As the bill circulates through Congress, Sheets is working to build grassroots advocacy efforts among Interim HealthCare’s franchisees and stakeholders.
Sheets’ work as garnered numerous awards, including Woman of the Year by American Business Awards (2022), CEO World Awards Advocate of the Year (2021), and being named a Top Influencer in Aging by Next Avenue (2020).
NAHC represents the nation's 33,000 home care and hospice organizations, and its board of directors governs and guides its advocacy and education efforts to improve the quality of care delivered at home.
Sheets is one of nine elected members, alongside six appointed members, who make up the board.
Caregivers play an important role for older adults wanting to age in place.
Caregivers are an integral part of the post-acute care continuum. Whether certified healthcare workers or trained through an agency, they play an important role for older adults wanting to age in place, as well as their families.
"Frontline caregiving professionals are the backbone of aging services," Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. "These invaluable caregivers deliver the quality of care and extra help that allows millions of older adults to live life to their fullest. Without them, there is no care."
National Caregivers Day is acknowledged on February 17, to recognize the dutiful work and compassion of caregivers, as well as their need for more support.
These three HealthLeaders stories on private duty caregiving illustrate the important role that caregivers play in post-acute care.
Senators Bob Casey (D-Penn.) and Debbie Dingell (D-Mich.) introduced the bill in January, which would expand access to home and community-based services for older adults, as well as injured workers and individuals with disabilities, and improve pay and benefits for caregivers.
Aging in place is becoming a preferred option for older adults, and caregivers can help them do so safely and comfortably. However, currently home care workers earn an average of $13 per hour, receiving few or no benefits.
Caregivers making their capabilities and limits known early on in the hiring process can help agencies save time and money down the line.
"We have to stop trying to have caregivers fit what we need," Aishling Dalton-Kelly, a private duty consultant, told HealthLeaders. "We have to ask them what they like and what they don't like, what they're willing to do and what they're not, because that plays a huge role in servicing the needs of the consumer."
Agencies developing clear and effective communication with their caregivers, in addition to understanding factors about their home life, such as whether they have children, will allow them to avoid staffing and scheduling issues in the future.
Beginning her career as a licensed practical nurse (LPN), Candyce Slusher emphasizes the importance of an honest and trusting caregiver-client relationship as well as the caregiver-agency relationship.
Private duty agencies typically grow by word-of-mouth referrals, so the quality of care caregivers provide is important.
"It's being bold enough to have the conversations that need to be had, but gentle and professional enough that people are willing to accept corrective feedback," Slusher told HealthLeaders.
Other aspects include good communication, owning up to mistakes when they happen, and being open and honest about how they'll be fixed, she said.
Always Best Care Kingwood is the franchise's 12th location in Texas.
Always Best Care Senior Services, a private duty franchise, opened its fourth location in the Houston-metro area.
The franchise consists of more than 225 independently owned and operated locations throughout the United States and Canada. The new location is owned by resident and Houston native, Marissa D. Thompson, and will service Humble, Kingwood, and surrounding areas.
Jake Brown, president and CEO of Always Best Care, called Thompson a "savvy business professional" who noticed the demand for private duty services in her area.
"We know Marisa's passion of service and strong grasp of the needs of the local community will serve her clients well," Brown said in a statement.
Thompson's professional experience consists of 25 years as an information technology consultant for the gas and oil industry. She was inspired to pursue her goal of owning her own business after self-publishing a book last year. Wanting to give back to her community and provide support to families, she felt her values aligned with Always Best Care's mission.
"After working in the corporate world for over two decades, I wanted to find a business that would allow me to invest in myself and in helping others," Thompson said in a statement. "Backed by this brand's excellent training program and my growing team of professional caregivers, I look forward to expanding the senior service resources Always Best Care delivers throughout the Greater Houston area."
OIG new data brief's findings reflect a need to reexamine staffing minimums.
Findings in a recent data brief from the Office of Inspector General looking at nursing homes with high infection rates during the first year of the pandemic show the need for a new approach to infection prevention.
The brief, the second in a series of three, comes as a result of the devasting impact of COVID-19 on nursing homes and their residents. According to the brief, understanding the effects of the pandemic will help the Centers for Medicare and Medicaid Services (CMS), policymakers, and stakeholders make informed decisions as they try to improve care and protect residents.
Using Medicare claims data, the OIG looked at 15,086 nursing homes nationwide that had "extremely high" infection rates between spring and fall of 2020. Particularly, they looked at each facility's characteristics, whether they'd been cited with infection control deficiencies, as well as if their reported nursing hours met Medicare's minimum requirement.
Findings
More than 1,300 nursing homes stood out as having "extremely high" infection rates. For-profit facilities made up a disproportionate percentage of this group during the first and second surge of COVID-19. While 71% percent of nursing homes are for-profit, they made up 77% of the homes with extremely high infection rates.
Nonprofit nursing homes, which make up 23% of all nursing homes, made up 19% of facilities with extremely high infection rates during the first surge and 18% during the second surge. The 6% of nursing homes owned by government entities made up 4% and 5% of facilities with extremely high infection rates during the first and second surges, respectively.
In surveying the nursing homes, the OIG didn't identify any deficiencies in infection control for majority of homes with extremely high infection rates. In fact, 83% of nursing homes with the highest rates of infection didn't have any serious infection control deficiencies.
The same group of facilities also reported nursing hours at or above Medicare's minimum requirement of eight consecutive hours of registered nursing services per day and 24 hours of licensed nursing services per day.
"These findings raise questions as to whether the current number of nursing hours that Medicare specifies is sufficient to keep residents safe from infectious disease," the brief stated.
Recommendations
The brief affirmed what many in healthcare have come to believe, and that is that we were unprepared for a health emergency like COVID-19. Now as the disease is becoming endemic, the need for improvement is crucial.
The OIG suggested the following recommendations to CMS:
Re-examine current nursing staff requirements and revise them as necessary—Nursing homes with extremely high infection rates reported nursing hours that either met or exceeded Medicare's minimum requirement. OIG suggests the CMS revise these requirements, which were initially established in 1987, including assessing the level of nursing needed to adequately prevent and manage infection.
Improve how surveys identify infection control risks and strengthen guidance on assessing the those risks—Survey practices used to detect infection control issues should be reexamined in a broader capacity. CMS should also engage a broad range of infection control experts to develop more effective methods to identify risk factors in nursing homes.
Target nursing homes needing infection control intervention, providing enhanced oversight and technical assistance as needed—Further data analysis should supplement the survey process to identify facilities in need of intervention. CMS should review data from sources like the Medicare Enrollment Database and Certification and Survey Provider Enhanced Reporting System, among others, for example.
CMS Responds
The OIG shared its recommendations with CMS, which indicated it will continue to work to protect the safety and health of nursing home residents.
CMS agreed with the recommendations to reexamine and possibly revise staffing requirements, as they coincide with similar efforts by the Biden administration. The organization also agreed with targeting and providing assistance to facilities needing infection control intervention.
However, regarding the use of surveys to identify infection control risks and guidance on assessing them, CMS "did not concur or nonconcur." According to the brief, CMS explained it prioritized similar efforts at the beginning of the pandemic, sharing tools with nursing homes so they could review their own compliance.
Since the control surveys conducted in 2020 found no deficiencies in the majority of nursing homes with extremely high infection rates, the brief's findings raise the question of the effectiveness of the survey process. One suggestion the OIG offered was to convene a Technical Expert Panel to seek input from a broad range of experts in infection control.
Under the rule, facilities will be required to disclose whether they're private equity groups.
The U.S. Department of Health & Human Services (HHS) on Monday proposed a rule to increase the transparency of nursing home ownership and management. Early last year, the Biden administration made nursing home safety a priority and increased efforts to hold nursing homes accountable for the care they provide.
The proposed rule will require nursing homes to disclose ownership and management information to the Centers for Medicare & Medicaid Services (CMS) and states. Nursing home owners will also be required to disclose whether they're private equity investors or real estate investment trusts.
A study from Weill Cornell Medical College found that residents in nursing homes acquired by private equity groups are 11.1% more likely to have preventable emergency room visits and 8.7% more likely for a preventable hospitalization, compared to those not associated with private equity facilities.
Nursing homes enrolled in Medicare and Medicaid will also be required to disclose ownership information, as well as information on external entities providing administrative or clinical consulting services to the facility.
"We are continuing our unprecedented efforts to increase nursing home ownership transparency—because it's what the public deserves," Xavier Becerra, HHS secretary, said in a statement. "We are pursuing all avenues to shine a light on this industry. We will keep doing everything we can to ensure all Americans receive the dignity, care, and respect they deserve."
By increasing transparency, nursing home residents and their families will be able to make informed decisions about care, according to CMS.
Katie Smith Sloan, president and CEO of LeadingAge, an organization representing nonprofit aging service providers, agreed with the need for transparency in a statement.
"We agree with the administration that ownership and financing of nursing homes should be transparent to help ensure that owners or associated businesses do not profit at the cost of quality care," she said. "The proposed disclosure and reporting requirements set out in today's proposed rule are a step in the right direction."
Franchise owners were surveyed on their experience and satisfaction with their corporate team.
Caring Senior Service, a private duty home care agency, was named one of the 200 best franchise opportunities in the nation by Franchise Business Review for the second year in a row.
This is the market research firm's 18th annual ranking, with honorees chosen by rankings provided by franchise business owners.
"Not only are we thrilled to make Franchise Business Review's list for the second year in a row, we are humbled by the fact that we earned this honor because our owners have demonstrated how satisfied they are with our collaborative efforts," Jeff Salter, CEO and founder of Caring Senior Service said in a statement.
"Caring Senior Service's success relies on our franchise owners throughout the country. It speaks volumes that our franchisees feel that our corporate team is providing them with the types of support and engagement they need to remain successful."
The franchisees were surveyed on 33 benchmark questions about experience and satisfaction regarding different areas of their franchise systems: training and support, operations, franchisor/franchisee relations, and financial opportunity.
Survey results found that 87% of franchisees agreed Caring Senior Service cares about their success and that their specific franchise community was in support of the brand, while 93% of their franchisees said they're likely to recommend the franchise to others.
Clarion Forest Visiting Nurses Association serves Clarion, Forest, and Jefferson counties in Pennslyvania, which are predominately rural areas.
After six years as a neonatal intensive care unit (NICU) nurse, Lisa Steiner decided to switch to home health. With a 10-month-old at home, the flexibility in scheduling drew her to the sector.
"From when I started 30 years ago to what I'm seeing now, it’s just amazing the skills that we're doing in the home that we did not do when I first came," Steiner, CEO and chief nursing officer for Clarion Forest Visiting Nurses Association, told HealthLeaders.
Clarion Forest serves Clarion, Forest, and Jefferson counties in Pennsylvania, which are predominantly rural areas. Due to their location, Steiner's employees travel an average of 40-80 miles per day to care for patients.
All sectors of healthcare are struggling to fill empty roles amid a workforce shortage exacerbated by the COVID-19 pandemic. Besides having to compete with higher wages offered elsewhere, rural providers and agencies like Clarion Health are tasked with trying to convince talent, namely young people, to want to live in the area as well.
"Our slogan is 'neighbors taking care of neighbors,' and that's truly what it is," Steiner said. Most of her nurses live in the area because they want to raise their families in a rural area.
Last year, Steiner and other local healthcare leaders from nursing homes and hospitals formed the Clarion Regional Health Care Collaborative. Meeting monthly, they work together to figure out ways to get people involved in healthcare and keep them local.
A number of health care systems have formed educational partnerships with their local colleges and vocational schools to develop a talent pipeline. Similarly, Clarion Forest partners with the local university, allowing medical students to do their clinical rotations with her agency, shadowing one of her nurses for an eight-hour day.
Remote patient monitoring technology has become almost commonplace for home health agencies, but much of the area Clarion Forest services doesn’t have internet access or cellular tower service. While they're currently working with the county on getting those services, Steiner said it could be years from now before they see anything come to fruition.
She was able to get a grant that covers most of the cost of Clarion Forest's remote patient monitoring needs.
"Even though I have that, I still have to pay a monthly fee to actually have the data transmitted," Steiner added. "So, what we do is have those clients that don't have Wi-Fi or cell towers call in their readings to our office."
When it comes to selling the idea of living in the area, she boasts of the agency's family oriented culture and the community's support for her employees. When their clinical manager unexpectedly died last spring, the employees came together and offered extra assistance wherever they could. In September, when Clarion Forest held a golf outing in their teammate’s memory, much of the community came out and showed their support as well.
"My staff, we all know each other, we all care about each other. There's no better place to work," Steiner said. "When I say, 'neighbors taking care of neighbors,' the whole community just rallied together."
Making it work
She acknowledges that the agency's familial culture only goes so far when recruiting potential employees. According to an internal census from 2021 to 2022, they admitted 300 more patients than they did the previous year. However, due to low reimbursement rates and the role it plays in their financial well-being overall, it's often difficult to ensure that her employees receive a cost-of-living increase in their wages each year.
"This year when we looked at our budget, I cut as much as I could and just went to my board and said, 'How do I not give my staff a 3% raise this year with inflation?" Steiner explained. "How do I not do that? Then you've got to find those funds. I've tightened the straps as much as I can, so you try to figure out ways, look at everything you can look at."
It's an exhausting and frustrating situation, she said, because they're busier than they've ever been. Ideally, she wants to be able to offer a cost-of-living increase each year, but the low reimbursement rates don't always allow for it.
There have been calls from leaders in different sectors of healthcare for policy and lawmakers to do more to help them, especially regarding Medicaid reimbursements.
"The reimbursement [model] needs to be looked at. I have a couple of payers that are very fair, I have another that's not; they're well below substandard on reimbursement," Steiner said.
Across the board, she said, insurances need to be looked at, along with Medicare managed care products.
"Health insurance rates go up, so we're paying for health insurance for our employees and every year everything goes up," she added. "So if your reimbursement doesn't go up, how do you continue to stay afloat?"
While other topics had detailed plans of action, there seems to be no concrete plan in place to help aging services.
During Tuesday night's State of the Union address, President Biden recapped his administration's successes and current efforts in healthcare, including "cracking down" on nursing homes that commit fraud, endanger residents, or prescribe unnecessary medication to residents.
"Let's get seniors who want to stay in their homes the care they need to do so. And give a little more breathing room to millions of family caregivers looking after their loved ones," he said, urging the policymakers in the room to pass his Build Back Better Plan that would give seniors and individuals with disabilities access to the home care services they need.
While other healthcare efforts he mentioned were accompanied by plans of action such as capping insulin prices at $35, solutions regarding aging services are currently at a standstill until legislative action is made.
"The president was right to call for help for older adults who want care in their homes, and for millions of family caregivers," Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit providers of aging services, said in a statement.
"Nonprofit and mission-driven aging services providers need policies, waivers, and flexibilities that address the chronic shortcomings of our patchwork system and enable older adults to access the help and support they need wherever they call home."
LeadingAge has been vocal about the need for policymakers to address the issues regarding aging services, like the workforce shortage and nursing home reform, especially as older adults are expected to make up 20% of the nation's population by 2030. Most notably, the organization has called for the president's administration to institute an Office on Aging Policy to centralize government efforts and improve coordination efforts between other offices.
The report features data regarding COVID-19, the labor shortage, and access to care.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released its "State of the Nursing Home Sector," factsheet yesterday featuring data on issues affecting the post-acute sector. AHCA/NCAL released it ahead of President Biden's State of the Union address this evening, as a call to action to prioritize senior care.
Data was pulled from CMS, CDC, CLA, Kaiser Family Foundation, MACPAC, and AHCA/NCAL's own research.
While nursing homes have somewhat rebounded from the negative impact of the pandemic, according to Mark Parkinson, president and CEO of AHCA/NCAL, it's time for leaders in Washington to take further action.
"This report illustrates the impact that long-standing economic and workforce challenges are having on our seniors and their access to care," he said in a statement. "Nursing homes have done everything they can do to address these problems, but they need help."
Below are highlights from the factsheet.
Labor shortage
Nursing homes have struggled the most out of all health organizations, with 210,000 jobs lost over the course of the pandemic. The sector's 13% decline in workforce has lowered it to levels last seen in 1994.
At the current pace, the nursing home workforce won't be back to pre-pandemic levels until 2027. Currently, 84% of facilities are experiencing moderate-to-high levels of staffing shortages.
Providers are doing what they can, with 9 out of 10 increasing wages and offering bonuses to compete for talent in the competitive job market. Between 2020–2022, wages for nurses increased by 28%–34%. Regardless, 96% of nursing homes are struggling to hire staff, with another 97% attributing it to a lack of qualified candidates.
Financial struggles
According to the report, 62% of nursing home residents rely on Medicaid, while Medicaid only reimburses 86% of the cost of care. Combined with the inflation impacting the cost of nursing homes' goods and services, 55% of providers are operating at a loss.
Federal aids like the Provider Relief Fund, Medicaid enhanced FMAP, and state funding via the American Rescue Plan kept many nursing homes afloat during the pandemic, but that funding won't be available after this year. The report shows that at the rate things are going, 52% of nursing homes may not be able to remain open for more than a year.
Care accessibility
Due to the staffing shortage, 54% of nursing homes are having to limit their new admissions. Because of hiring challenges, 67% are worried they may have to close their doors.
There are 37,011 fewer beds available than there were in February 2020, and nationwide occupancy for nursing homes is at 76.6%. Over the duration of the pandemic, 465 facilities closed, with 41% being 4- and 5-star facilities.
Since 2020, 18,071 residents have been displaced due to facility closures, and 22 counties are now nursing home deserts.
What needs to happen?
Advocates have called for policymakers to make nursing home residents, the care that they receive, and their caregivers a priority. Staffing mandates and oversight measures have been proposed, but "do little to address the core challenges in long-term care."
The report suggests using a multifaceted approach to rebuild the sector's workforce and attract workers, passing bills like the Care For Our Seniors Act, and fully funding Medicaid.
"This is a call to action," Parkinson said. "We need lawmakers to pass meaningful reforms, both immediate and long-term, that aid providers in addressing our core challenges."
The additional measures are part of the Biden Administration's efforts to increase accountability for nursing homes.
The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced additional steps to increase safety and transparency in nursing homes.
The steps are part of the Biden administration's continued efforts to hold nursing home accountable for the quality of care they provide.
In January, CMS began conducting off-site audits to assess whether nursing homes were accurately coding residents with schizophrenia. Those who are misdiagnosed are at risk of being prescribed antipsychotic medication that they don't need, which have dangerous side effects for residents, including death.
"We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done," Chiquita Brooks-LaSure, CMS administrator, said in a statement. "People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medication."
In a separate action, CMS has also begun publicly displaying survey citations that nursing homes are disputing. Currently, when facilities dispute a survey deficiency, the deficiency isn't posted to Care Compare until the dispute process has been completed, which usually takes approximately 60 days, if not longer.
As of January 25, deficiencies are being posted to Care Compare while they're being disputed. As the citations are being displayed they won't be included in the calculations for the facility's Five-Star Quality Rating until the dispute is complete.
