The presence of APRNs can prevent delays in treatment and expensive hospital transfers, explains recent research.
While nursing homes strive to provide residents with the care they need, too often residents are transferred to hospitals from these facilities due to developing severe illness. It's happening too often, with repeat residents, and it can be prevented, said Alisha Johnson, assistant professor at the University of Missouri (MU) Sinclair School of Nursing.
Johnson is part of ongoing research at MU to see whether including advanced practice registered nurses (APRN) into nursing homes reduces hospital transfers and impacts resident health outcomes. According to an MU press release, ''billions of dollars are spent transferring residents from nursing homes to hospitals,'' which could have been avoided through detection of early illness and faster clinical decision-making.
The presence of APRNs in nursing homes can be beneficial to the quality of care provided to residents, with APRNs' advanced training, Johnson said.
"The staff [who work] in nursing homes are wonderful, caring people, but what I found was often a lack of understanding of the beneficial expertise the APRNs can provide, as they have advanced training in pharmacology, diagnostics, lab work, blood tests, radiology, early illness detections and medications, and this broadens their ability to direct care decisions that ultimately improve resident health outcomes," Johnson said.
When a resident needs care, nursing home staff must find a physician to direct them, which delays formulation of a treatment plan. Delays like these can lead to miscommunications, negative health outcomes, and hospital transfers that are costly and stressful to the resident.
"APRNs have a huge opportunity to fill these care gaps, as research shows residents receive much better care if they stay in the nursing home where they live rather than being transferred to a hospital," Johnson said. "APRNs can see what is going on in real time and make care decisions much more quickly."
In 2021, the university did a study on the effectiveness of the Missouri Quality Improvement Initiative. The $35 million program was funded by the Centers for Medicare & Medicaid Services, implementing APRNs full time into 16 nursing homes.
Results showed that APRNs improved the quality of care residents received, lowering the number of hospital and emergency room transfers; leading to improved health and saving the state $31 million.
"Missouri currently has a state requirement that APRNs can't provide assessments or write orders independently, they must work under a physician, but research shows states that do not have this requirement have just as good health outcomes among their nursing home residents," Johnson explained.
"The number of physicians working in geriatrics is decreasing, and there are three times as many APRNs working in long-term care facilities than physicians. So, APRNs can provide tremendous benefits in nursing homes when given the opportunity."
Bevis has over 30 years of operational experience, with more than 20 years building successful home care brands.
Caring Senior Service, a private-duty, non-medical senior home care agency, has announced that Jeff Bevis will be joining the company as its chief operating officer.
Bevis brings over three decades of experience to his new role, with more than 20 years in home care. In 2009, he and his son founded FirstLight Home Care, which grew to be an Inc. 5000 company by its first year of eligibility. Leaving FirstLight in 2020, Bevis returned to consulting for tech, home health, and international companies.
"I'm excited to return full-time to the home care industry because I still see it as an evolving industry with so many unsolved challenges," Bevis said in a statement. "The industry needs clear, data driven leaders, and I'm convinced my experiences will help Caring Senior Service solve many of the challenges clients, caregivers, team members, and business owners face today."
Bevis and Jeff Salter, Caring Senior Service CEO and founder, have been acquainted for many years. In 2021, Bevis worked with the company as a consultant. Now he will be overseeing the company's operations team from its San Antonio, Texas headquarters.
"Jeff has a wealth of leadership and operational experience in the non-medical home care industry that is valuable to Caring Senior Service," Salter said in a statement. "His familiarity in growing home care companies like ours is unparalleled. The skillset Jeff brings to our table is certain to result in our expedited success."
"I'm thrilled to be back in the home care industry building a brand and creating new growth,” Bevis said.
The health system’s goal is to create a ‘one-stop shop’ for facilities to access resources to protect their patients and workforce.
UVA Health is increasing its COVID-19 infection prevention efforts through the help of state and federal grants, and has received $1.2 million to reduce infections in long-term care (LTC) facilities in Virginia.
With assistance from the Mid-Atlantic Telehealth Resource Center, UVA providers will develop a website—the Virginia Infection Control Center of Excellence—for infection control and prevention best practices where long-term care facilities can access resources.
"Our goal is to establish a trusted one-stop shop for long-term care facilities to help them protect their patients and staff," Laurie R. Archbald-Pannone, MD, UVA Health geriatrician, said in a statement.
Nursing homes were heavily impacted during the pandemic, resulting in many resident deaths and ongoing health challenges in others. Because of that, UVA Health created a program where long-term care facilities can consult with UVA system experts on infection control, called the Geriatric Engagement and Resource Integration for Post-Acute and Long-Term Care Facilities (GERI-PaL) program.
The GERI-PaL program provided COVID-19 guidance via telehealth, as well as regular discussions with nurse liaisons to ensure facilities had what they needed.
According to a UVA press release, a study of "the first two facilities with COVID-10 outbreaks assisted by GERI-PaL showed lower mortality rates—12% and 19%—compared with a 28% mortality rate reported at a long-term care facility in Washington state."
"One of the major takeaways from our GERI-PaL work was that providing educational resources in response to community needs can have a significant effect on enhancing care for some of our most vulnerable patients," Archbald-Pannone said. "We hope to build on that experience to provide a broader array of best practices to assist our colleagues in long-term care facilities across Virginia."
Research around a robotic simulation platform and its potential to assist people with disabilities shows promise.
There could be another solution to help with the caregiver shortage in the home care space: caregiving robots.
Researchers from Cornell University have developed a simulation platform, RCareWorld, which creates caregiving scenarios around patients who have motor disabilities or need modifications for accessibility in the home setting. Through a combination of avatars and caregiving robots in the simulator, users can work through caregiving scenarios, programming the robots to perform the tasks to care for the avatars with impairments like spinal cord injuries, brainstem stroke, and cerebral palsy. This platform could help stimulate more interest in the robotics field and ultimately help with patient care.
According to a press release, "An estimated 190 million people worldwide have conditions that impair their ability to move and function; assistive robotics has the potential to give these individuals more independence while reducing the burden on caregivers."
The first version of the RCareWorld will be available for use in February.
"There are a lot of barriers to entry to this field," Assistant Professor of Computer Science at Cornell, Tapomayukh Bhattacharjee, said in a statement. Bhattacharjee led the project, noting the lack of research around using robots as caregivers. He cited the team's own challenges of connecting people with limited mobility and clinical stakeholders, the need for an instructional review board to approve studies involving close contact with humans, as well as the cost of the robots.
"You need continuous feedback from the stakeholders—the care-recipients who would potentially use this technology, the caregivers and healthcare professionals—to know whether the technology we're developing is going to translate from the lab to real homes one day."
Bhattacharjee runs the EmPRISE lab in the Cornell University's College of Computing and Information Science. The lab is one of few working to design robots that can assist with physical caregiving, such as being able to feed, bathe, or dress a person. In addition, the researchers are developing solutions for "social caregiving," like reminders for medicine or instructions for exercise.
LeadingAge CEO Katie Smith Sloan says the healthcare sector is not prepared for the influx of older adults in 2030.
By 2030, older adults over the age of 65 will make up 20% of the nation's population; meaning there will be an increased demand for long-term care and aging in place services. However, the pandemic pushed the sector beyond its limits, with workforce shortages persisting and inflation causing more financial strain.
There's much work to be done in healthcare to prepare for the increasing elderly population.
In December, LeadingAge, a community of nonprofit providers of aging services and other mission-driven organizations, wrote a letter to the Biden administration to institute an Office on Aging Policy for a more focused approach to addressing the influx of older adults. While the department of Health and Human Services established the Administration for Community Living, that federal service focuses primarily on programs supported by the Older Americans Act and doesn't include nursing homes, home health, or hospice.
"It's very limited in its scope, and that's why we wrote this letter to the president," LeadingAge President and CEO Katie Smith Sloan told HealthLeaders.
Sloan explains there needs to be a central policy office that can look across the federal government at the many agencies related to aging policy and look for opportunities to connect the work each one is doing to improve the experience of aging.
Preparation for the influx of older adults should have begun years ago, and the workforce shortage and ways to pay for long-term care are two issues that must be addressed, she said.
Filling vacancies
"We simply don't have the people to fill the jobs in our sector. Whether those jobs are nursing assistant, physical therapist, nursing home administrator, nurses, hospice nurses, service coordinators, the folks aren't out there flocking to our field or evening learning about our field," Sloan said.
"It's a pipeline issue, a recruitment issue, a retention issue, [and] a training issue, and we have pushed for an all-of-government approach to solutions. Whether that be immigration, education, and training infrastructure, apprenticeship programs, and other ways to create meaningful jobs in our sector, so we can fill all those vacancies that currently exist."
To help with the workforce shortage, many healthcare organizations have made employee well-being and satisfaction a priority, which has helped with retention. Many health systems have begun establishing educational partnerships with colleges and community colleges in their communities to create a pipeline of potential talent.
"Lots of our members are partnering with their local community college, for example, helping to teach classes, provide placement for [student's] practicum, and that's kind of an all-of-the-above strategy— which we need—for workforce development," Sloan said.
Paying for long-term care
There have been arguments made for a public-private financing solution to pay for long-term care, and LeadingAge is hoping to garner some congressional interest as it investigates legislative solutions.
"A new Congress is coming in, and I haven't heard this as anyone's priority, but we're going to work hard on trying to find some champions in both the House and the Senate who are willing to take on these issues...so that we do have solutions before 2030," Sloan said.
There's no singular bill that could solve these issues, and there are various pieces that need to come together, but the need for congressional action is certain, she said.
It was previously estimated that 187,000 caregivers would be needed, costing $10 billion annually.
Last February, the Biden administration proposed establishing a minimum staffing requirement for the nation's nursing homes, but did not provide the monetary resources to accomplish the mandate. A recent report from CLA (CliftonLarsonAllen LLP), an accounting and consulting firm, estimated that for facilities to meet the requirement, over 191,000 nurse and nurse aides will need to be hired, estimated to cost $11.3 billion annually.
These numbers have grown from CLA's previous estimate of 187,000 caregivers to meet the requirement, with an annual cost of $10 billion.
According to the American Health Care Association (AHCA), throughout the pandemic, nursing homes have lost more staff than any other sector in healthcare—more than 200,000. As a result, some nursing homes say they can’t take new patients, and nearly three-quarters are concerned their facilities may close due to workforce shortages.
"This report once again highlights how our nation's policymakers should be investing in our long-term caregivers, not mandating quotas," AHCA President and CEO, Mark Parkinson, said in a statement. "Nursing homes have been doing everything they can do to recruit and retain staff—including increasing wages—but it has not been enough to stem the tide."
"If Washington wants to increase staffing in nursing homes, then they need to put their money where their mouth is. Otherwise, we'll fail to address the underlying issue here, and our residents will have fewer long-term care options."
With the ongoing workforce shortage and increasing labor costs, as well as facilities being severely underfunded, the staffing minimum is not a feasible solution for the workforce shortage in nursing homes. The report, released in December, found that 94% of nursing homes wouldn't be able to meet the proposed 4.1 HPRD (hours per resident day) minimum.
Additionally, more than one-third of nursing home residents would be at risk of displacement if a facility was unable to comply with the staffing minimum.
"The additional burden of meeting minimum staffing requirements with no funding mechanism will potentially increase the number of facilities operating with negative margins," Deb Emerson, principal at CLA, said in a statement. "Although there have been improvements in workforce availability in some areas of the country, nationally nursing homes are still challenged to find the appropriate workforce."
"If nursing homes are unable to increase their workforce, hundreds of thousands of residents could be impacted by census reductions."
According to a statement by the AHCA, the majority of nursing home residents rely on Medicaid and Medicare, whose reimbursement rates don't cover the full cost of care. As facilities begin to recover from the toll of the pandemic, inflation has further exacerbated strained finances. In separate report CLA referenced almost 60% of nursing homes were operating with negative margins.
"Unfunded staffing mandates do not create jobs or attract individuals to apply," Holly Harmon, RN, AHCA's senior vice president of quality, regulatory, and clinical services, said in a statement. "Investing in our caregivers, developing recruitment programs, and building a pipeline of caregivers will help us rebuild the long-term care workforce."
All eyes are on long-term care amid calls to hold facilities accountable for the care they provide.
The past year has brought an increase in long-term care oversight and regulations, primarily due to the Biden administration's call to hold nursing homes accountable for the quality of care they provide. Organizations like the Centers for Medicare & Medicaid Services (CMS) and the American College of Physicians are assisting these efforts by providing education, guidelines, programs, and recommendations for improvements.
Here are four articles from 2022 featuring changes to make long-term care better.
CMS increased its monitoring of poor-performing nursing homes in December. Eighty-eight nursing homes are participating in the Special Focus Facility (SFF) program, with four new revisions made to the program. Learn what those four revisions are.
The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) launched a four-part virtual program to improve trust between leaders and staff in long-term care facilities. The program is based on the science of trust building and provides tools and resources to help leaders build trust with their staff. Read about the four lessons included in the program.
A position paper from the Health and Public Policy Committee of the American College of Physicians examined challenges in long-term care and provided recommendations to improve quality, accessibility, equity, and affordability. Find out what the ACP recommendations included.
The Centers for Medicare & Medicaid Services issued numerous updates for long-term care facilities as part of the Biden administration's initiative to promote safety and improve the quality of nursing homes. Discover what the updates are.
The demand for providing care in the home makes for a busy market.
Home health organizations worked to grow their reach and resources this year to accommodate the increasing elderly population. Mergers and acquisitions (M&A) in 2022 helped organizations extend their services to more people, and some hospitals even began adding home health to their service lines.
Here are four HealthLeaders articles featuring home health organizations that expanded, purchased, or partnered with other organizations this year to grow their footprint.
Care Advantage, Inc., acquired Care Perfections Health Services, LLC, Virginia, an in-home care company, earlier this month. The completion of this deal marks the privately owned home health company's 19th acquisition since 2018, and its seventh since joining with Searchlight Capital Partners in 2021.
Post-acute leaders should pay attention to this increasing trend of private equity companies acquiring healthcare facilities and consider whether mergers of this type will be advantageous, weighing the pros and cons.
With the purchase of another Virginia-based company, Lighthouse, Healthcare, Inc, just a few days prior, Care Advantage's geographic reach has expanded to northern Virginia.
"After a strong year of growth, both in terms of organic and M&A, to add two new markets and ultimately increase the opportunities for us to care for more Virginia residents is very exciting," Tim Hanold, Care Advantage CEO, said in a statement.
This summer, Tampa General Hospital (TGH) entered a partnership with Visiting Nurse Association (VNA) to provide a home health care service line to its surrounding community. TGH Home Care powered by VNA of Florida allows patients to stay within the TGH network to receive home care, with an integrated network of services to improve quality of care and patient experience.
"Staying within Tampa General means our patients can make a seamless and safer transition home. They remain our patient, which means they can more easily access the combined resources of an academic medical center and an experienced home care agency, that supports improved quality, outcomes, and overall patient experience," Adam Smith, executive vice president and chief ambulatory officer for Tampa General, said in a statement.
Home health service AccordCare acquired Companion & Homemaker's Medicaid division, which will continue operating under the Companion & Homemaker's branding.
TheKey (formerly known as Home Care Assistance) acquired the private pay division of in-home care services provider Companions & Homemakers in November. TheKey is a provider of premium, private pay home care, currently operating in 29 states. The private pay division is now operating under TheKey's branding.
The two acquisitions mark the beginning of a partnership between TheKey and AccordCare, enabling each provider to leverage its offerings to deliver quality and compassionate care. Jet Health Acquires Trio Home Health and Hospice
In October, Jet Health, a home health provider, acquired the Denton, Texas-based Trio Home Health and Hospice. The acquisition is Jet Health's eighth in the last four years, furthering the provider's goal of becoming a leader in the home health and hospice sector in the western U.S.
Trio Home Health and Hospice will remain as its own brand, but operate as one of Jet Health's companies; thus extending the provider's reach to central Texas.
"With each of the acquisitions Jet Health has completed of late, we have always remained focused on broadening both our offerings while extending our reach," Stacie Bratcher, CEO of Jet Health, said in a statement.
The agency will offer high-touch, high-quality care to clients aging in place in the comfort of their homes.
A new privately owned home care agency has opened in Los Angeles.
Jason J. Kidushim, founder and CEO of Legacy Homecare LA, says the new agency fosters a client-centered approach with the goal of helping clients live with ease in their home environments. The approach consists of comprehensive care planning, weekly supervisory visits, family communication, physician coordination, organizing referrals, assisting with medical devices and equipment, and ad hoc interventions.
"We strive to create the best, every day, for our clients, employees, and their families by changing the way the world ages in place," Kidushim said in a statement.
Zehra Dhanani, RN, MSN, serves as the agency's director of client care services, with experience in medical-surgical, orthopedic, and pediatric nursing from Cedars-Sinai Medical Center. Her professional experience and years spent caring for relatives with various conditions inspired her to work with the elderly.
In addition to being a member of the American Nurses Association, she has been trained and received certification from the Alzheimer's Association. She also holds a Certified Dementia Practitioner certification from the National Council of Certified Dementia Practitioners.
These are four stories that private duty agency owners shouldn't miss.
About 6.5 million adults, aged 65 and older, live with Alzheimer's. The disease is the most common type of dementia, and caregiving can be a struggle. While researchers are still studying the disease and methods to prevent it, there has been some success in the effectiveness of certain techniques to decrease the risk of dementia or better support those who do have it.
Below are four articles that focus on different methods that private duty agency owners and their caregivers can use when caring for clients with dementia.
ComForCare and At Your Side Home Care developed an innovative training program for caregivers who have clients with dementia. The program specifically addresses a design flaw that ComForCare and At Your Side believe limited traditional dementia care training.
A study by the University of Southern California and University of Arizona found that when adults aged 60 and older avoid passive sedentary behavior, like watching television for long periods of time, they decrease their risk of developing dementia. Cognitive training can help caregivers lower their clients’ risk.
"It isn't the time spent sitting, per se, but the type of sedentary activity performed during leisure time that impacts dementia risk," David Raichlen, author of the study and professor of biological sciences and anthropology at the USC Dornslife College of Letters, Arts and Sciences, said.
Paula Perez was named Visiting Angels' Caregiver of the Year this summer, having been recognized for her compassion in caring for clients with dementia. Previously, alongside other family members, she'd been a caregiver for her mother who had dementia.
Perez offers three suggestions for caring for clients with dementia.
Researchers from Case Western Reserve University identified the reason women seem to be more susceptible to Alzheimer's disease. They found that female brain tissue reflects a higher expression of an enzyme that causes it to accumulate greater quantities of the tau protein, compared to male brain tissue.
The tau protein can build into toxic protein clumps in brain nerve cells, which leads to conditions called tauopathies, and Alzheimer's disease is the most well-known of these.
"We reasoned that if this could be identified, then it could provide a basis for the development of new medicine that could restore the proper balance of tau levels in the brain," David Kang, co-senior author of the study, said in a statement.
