Aging can cause numerous changes to an individual's body, and the brain is no exception.
Private duty and home health caregivers have firsthand knowledge and experience in noting changes in the clients they care for. A recent article from the Brain Sciences journal offers suggestions caregivers can use to help their clients nurture and maintain brain health so they can remain healthy—and at home—as possible
The article, which focuses on a study of basic structures of brain function by the Norwegian University of Science and Technology, explains that an active lifestyle contributes to the development of the central nervous system and combats brain aging. The abstract also notes that interpersonal interactions assist cognitive resilience to decline, and pursuing passions influences the development and maintenance of the brain.
Get active
Ease of mobility can decrease with aging, but the worse thing an individual can do is remain stagnant for long periods of time. According to the study, exercise has been shown to increase brain function.
"Published research has shown that very diverse types of physical training, such as, for example, juggling training, mindfulness body-mind training, ballet dance training, and gymnastic training can all affect brain structure," the study stated.
In a reference observational study, it was noted that an active lifestyle helped individuals of all ages maintain cognitive and neurological health.
Get social
Maintaining and creating social ties requires effort and interpersonal communication skills, but they can enhance brain cognition in the long run.
"Studies suggest that people with poor relationships have poor cognitive functions later in life," the study explained. "However, there are some inconsistencies in findings as other studies have indicated no relationship between social relations and cognitive function later in life."
Get inspired
Exploring individual interests and hobbies is another way to encourage good brain function. Recent research has found that the more older adults are involved in leisure activities such as hobbies, the better their well-being, the study mentions.
"An individual's passion towards a certain theme, topic, ability, or activity is important in maintaining an active mind," the study stated. "Working with and practicing in the activity through deliberate practice is important.”
More than 161,000 employee surveys were used to determine ranking.
Fortune magazine has released its annual lists of the Best Workplaces in Healthcare. The two lists recognize the 30 best large workplaces and the 50 best small and medium workplaces.
Rankings were determined based on feedback from more than 161,000 surveys by employees from Great Place to Work-certified companies, and were then analyzed by the global people analytics firm.
For this certification, the firm required "statistically significant" survey results, and reviews of anomalies in responses, news, and the organization's financial performance.
The surveys consisted of responses to 60 statements and two open-ended questions. The statements centered on employee experience, considering the "trust, respect, credibility, fairness, pride, and camaraderie" of an organization.
Companies also provided data on size, location, industry, employee demographics, roles, and levels. By comparing the survey responses across demographic groups and roles within each organization, the firm was able to assess the quality and consistency of employee experience in each.
HealthLeaders has listed the Top 10 from each list:
Top Ten Best Large Workplaces in Healthcare
Texas Health Resources (Arlington, Texas) – Hospital, 24,261 employees
Elevance Health (Indianapolis, Indiana) – Insurance provider, 67,655 employees
Southern Ohio Medical Center (Portsmouth, Ohio) – Hospital, 3,213 employees
Blue Shield of California (Oakland, California) – Services, 7,537 employees
Northwell Health (New Hyde Park, New York) – Hospital, 66,234 employees
Baptist Health South Florida (Coral Gables, Florida) – Hospital, 21,774 employees
Ask not what the job candidate can do for you, but what you can do for the job candidate.
Job candidates exploring the direct-care job market are wading through a “sea of sameness,” where one agency looks just like the others, said Leigh Davis, owner of Davis+Delany, which helps companies implement unique methods for attracting and retaining top hourly talent.
Agencies not only tend to use the same online job boards, which further contributes to the sea of sameness, but these listings are usually written based on an old methodology where agencies emphasize themselves and their needs, and don't engage with the applicant, Davis told HealthLeaders.
"We want to start immediately changing the direction away from 'look at what we've got, aren't we great'," he said. "We want to turn that direction around and engage the applicant by giving them more and better information about the opportunity."
Generic headlines such as “Now hiring caregivers” or “CNAs needed” doesn't tell an applicant anything about the opportunity, Davis explained.
"Let's tell them what the opportunity is,” he said. “Let's give them information so we're magnetic."
Focusing on the applicant will engage and draw in a job candidate, so one way is to start by asking a question in the job listing’s headline that reflects what the job seeker wants, such as recognition, flexibility, to be part of something, to be valued and appreciated, and communication, to name a few.
Using Davis’ advice, an advertisement that reads, “Nonmedical home health caregivers needed” could be written in a more dynamic, engaging way: “Are you a caregiver who enjoys working in a one-on-one setting?” or “Are you a caregiver who needs a flexible schedule?”
"What we're doing is we're telling stories that engage the reader—the applicant, the caregiver," Davis said. "And we give them enough information where they're like, 'Oh, that looks interesting.'"
Such listings create trust, authority, and offer candidates a value proposition, Davis said, and as a result, agencies will begin to attract the best candidates—the ones they want in their organization.
Hiring the right people
Hiring the right people is crucial because the role of private duty caregivers in the care continuum cannot be understated; while they do not have medical training or certifications, the time that they spend with their clients is often equal to, or more than, that of the family, Davis said.
"They see the personality changes. They can sometimes see what's coming before the medical professionals see it coming," he said.
"They're giving the subtleties, the color, the inflections, the tone of what's happening and changing with that client so that the healthcare provider, the skilled care folks, can deliver better patient outcomes," Davis said.
Davis, who has nearly three decades of experience in the caregiving sector, knows the effects of subpar caregiving firsthand. His parents, who took care of his grandmother, dealt with a number of callous situations from caregivers, including theft, neglect, and inattentiveness.
With less rules and regulations at the time, Davis described the caregiving market then as "the Wild West," with companies sending anyone without screening beforehand.
Davis+Delany was created to develop processes and methods to form a framework to find better caregivers, he said.
In learning the innerworkings of caregiving agencies, Davis focused on recruitment and retention and discovered agencies were still using methods dating back to the 1940s to attract baby boomers.
"The words we're using, the methods we're using were developed to try to recruit folks that are a different generation," he said.
With that knowledge, Davis began building methods from the ground up that would be more applicable to current generations.
Prior to the pandemic, agencies had a balanced need for more caregivers and clients. Now, according to Davis, while most agencies aren't struggling to find clients, they are struggling to make good hires.
"There's also been this work-life assessment which has caused the caregiver to look at what they really want out of life," he said. "Is it all about work? Is the paycheck all I'm looking for? When the pandemic first hit and everyone was getting paid to stay at home, the number one [thought] was pay. Now, as the reality of life sets in, there's a little more of a balanced look."
The organization's recent acquisition will expand its reach in coordinating outpatient care.
CVS Health's $8 billion acquisition of home health care provider Signify Health reflects the industry's renewed emphasis on home health, which had long been considered outdated.
With innovations such as telehealth and increased flexibility for providers, home health now presents an opportunity for organizations to expand their reach, as well as the services they provide.
Using the CVS Health acquisition as an example, the American Hospital Association examined different ways the organization's reach will expand.
The acquisition gives CVS access to 10,000 physicians and clinicians, adding on to the 40,000 it currently employs through in its 1,100 MinuteClinic locations. The providers serve all 50 states, enabling CVS to coordinate outpatient care for millions of people.
With the organization's commitment to reducing cost of care for insurers like Aetna, which it also owns, the acquisition also gives it control of Signify Health's Caravan subsidiary. Signify Health acquired Caravan in March, which helps health systems and clinicians "operate successfully in value-based care arrangements."
CVS now has a competitive edge with Medicare Advantage carriers UnitedHealth Group and Humana, both of which have established themselves in the health risk-assessment market.
Signify Health has a goal to be in 2.5 million homes in 2022, and with the acquisition, CVS will now have direct contact with customers beyond its retail locations.
The AHA noted that CVS had also had plans for a major primary care merger or acquisition, which hasn't happened yet, but still appears to be a possibility.
Investors shouldn't read too deeply into the organization's decision to pursue a home health provider rather than a primary care service provider, according to Shawn Guertin, chief financial officer of CVS Health.
The company's primary objective, he said, it to find the right asset, with the right scale, technology, and team.
Stricter controls 'will help people move more gracefully toward the end of life,' infection control industry leader says.
Infection control tended to be part of a list of responsibilities in most nursing homes, but now that the Centers for Medicare & Medicaid Services (CMS) is requiring facilities to have at least a part-time infection preventionist on-site, that focus on patient safety will make a difference, an industry leader said.
"Prior to COVID, I would venture to say there were some types of plans in place. Some places probably had better plans than others, and I know that there are places that reached out and got external expertise to try and guide their plans," said Linda Dickey, president of the Association for Professionals in Infection Control and Epidemiology (APIC). "But having someone on site, at a facility, watching practices, is really important."
Before the CMS requirement, if someone was in charge of infection prevention, it was one of many responsibilities they carried, without any dedicated time or expertise, Dickey said, adding that an infection preventionist increases the focus on patient safety.
Duties of an on-site infection preventionist would include gathering and reporting data on different infections to the state and the U.S. Centers for Disease Control and Prevention and doing rounds through the facility to observe direct care practices, providing coaching and feedback if necessary. If a resident had previously been treated for an infection, the preventionist would follow up with them.
They also are charged with training staff to ensure they understand the importance of basic practices, such as getting flu shots, not just for their own safety but for the residents’ safety as well.
If there is an outbreak, the infection preventionist is responsible for coordinating with public health investigations on how those transmissions occurred, as well as performance improvement to change practices and behaviors.
Adding an infection preventionist to a facility's staff won't be a quick or easy fix. The post-acute sector is struggling alongside other parts of the industry to hire during a staffing shortage, further exacerbated by the pandemic. Dickey noted that a large number of infection preventionists have begun retiring, and because it isn't a well-known profession, there's not a large pipeline from which to choose.
"Of the infection preventionists that are out there, there's not a huge number that specialize in long-term care," she added. "That may be part of what they know, but it isn't their sole focus."
There is currently no job code for the role of infection preventionist, and APIC is reaching out the nation's department of labor to correct that. A job code will help with salary benchmarking so that facilities can begin to market the role and its responsibilities.
Building a pipeline
To help with the lack of qualified talent, APIC has developed an internship program that would give healthcare professionals an introduction into what infection preventionists do. The program framework APIC provides has the worker reviewing topics and information over the course of 10 weeks, with the organization able to lay it out in a way that best suits their employees.
APIC also plans to partner with colleges and universities, and begin reaching out to high schools to introduce students to the career path. They're also developing academic pathways focusing on infection prevention that can be imbedded in nursing, public health, lab, or microbiology programs.
"There are programs out there and internship programs for infection prevention," Dickey said. "But they're not, I don't think, widely known. And there aren't a lot of degree programs where you can specialize in infection prevention, so that's what we're trying to bolster."
Typically, an individual has a degree in nursing, public health, or laboratory discipline prior to getting the infection prevention and control certificate (CIC) and must have at least two years of experience. While there's no specific medical degree required to pursue the certification, Dickey notes that most facilities won't hire someone unless they have a background in some sort of health-related degree.
"I don't think it’s just a money thing for these organizations. They want to do a good job and I think that they will see that there's value in infection prevention and doing it well," Dickey said. "It will save money, it will improve care, it will help care, and it will help people move more gracefully toward the end of life."
Payment cuts proposed by the Centers for Medicare and Medicaid Services could affect the stability of the home health sector.
Medicare beneficiaries overwhelmingly support home health services and believe that Congress should protect these services, a recent poll indicates.
The poll, released by the Partnership for Quality Home Healthcare, found that 97% of Medicare beneficiaries want the government to maintain its coverage for home health services, while 88% of those surveyed believe Congress should pass legislation preventing cuts by the Centers for Medicare and Medicaid Services (CMS) to these services. .
Other findings from the poll:
91% of older Americans and Medicare beneficiaries prefer receiving short-term recovery or rehabilitation care at home
92% of registered voters think the government should maintain Medicare coverage for home health services so seniors are able to recover and rehabilitate in their own home
65% of voters oppose the proposed cuts by CMS
60% of those surveyed and more than 76% of voters over 65 would be less likely to support their congressperson if they were in favor of the proposed cuts
78% of voters think Congress should pass legislation to push back against CMS' proposed cuts
"The American people have made it clear that they overwhelmingly support and prefer home health care services," Joanne Cunningham, CEO of the partnership, said in a statement. "We must continue to protect access for Medicare beneficiaries by preventing these vital services from facing permanent and temporary reductions as proposed in the CY 2023 Prospective Payment System."
Cunningham added her hope that lawmakers in Congress will pass the Preserving Access to Home Health Act, which would ensure that the Medicare Home Healthcare Program would be protected. If enacted, the act would delay the proposed 7.69% cut from being implemented until 2026 and prevent an additional $2 billion "clawback" cut on services that were provided during the first two years of the COVID-19 pandemic.
"Without action,” Cunningham said, “Medicare home health services are at severe risk." Cunningham said.
A new report details the healthcare industry's new emphasis on home health and its place in the health care continuum.
When the Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care At Home Program in 2020, the goal was to allow patients to receive intensive treatment in their homes to alleviate the strain hospitals were facing due to the COVID-19 pandemic.
Now, two years later, numerous health systems have begun offering home health services, which have been received with enthusiasm from patients.
A recent Wellsky report on post-acute care noted a significant increase in home health referrals versus skilled nursing facility referrals between 2019 and 2022. The data, gathered by the Partnership for Quality Home Healthcare, showed that in 2021, some 86% of adults preferred to receive "post-hospital, short-term healthcare" at home, while only 5% preferred a nursing home.
In addition to the Hospital at Home program, the Choose Home Care Act also allows for patients to receive care at home for a period of about 30 days.
HealthLeaders spoke to Sharon Harder, president of C3 Advisors, and author of the Wellsky report about the possibility of programs like Hospital at Home and Choose Home becoming permanent. With both pieces of legislation holding a lot of promise and having bipartisan support, she said she doesn't see why they wouldn't pass at some point.
"It would clearly require a new set of conditions of participation and new rules and reimbursement structure, but all of that would essentially be accomplished during that period during which the secretary of health and human services needs to come up with regulations, and that's part of the bill as it’s written," she said of the Hospital at Home program.
Many health systems are adding home health to the services they offer, something Harder believes would have happened eventually but was expedited by the pandemic.
"If you look back 10 years or so, hospitals that owned home health agencies got out of that business," she said. "Now they're coming around full circle and getting back into those lines of business because it suits them in terms of patient outcomes."
Health systems have to make sure that once a patient leaves a hospital, they don't come back for an avoidable event, Harder said. That can result in readmission penalties, which many hospitals struggle with, she said.
"As they enter into risk-based contracts, [patient] outcomes and bundling are really important," she said. "So if they control more of the stops on the continuum, if they can control all of those providers in terms of delivery and how a patient moves along the continuum of care, they have more control over patient outcomes and more control over total cost of care."
Like other sectors of the industry, post-acute providers are also struggling to recruit and retain talent. The extraordinarily high rate of COVID-19 cases and deaths in nursing homes, which was widely publicized in the early months of the pandemic, is contributing to potential talents’ reluctance, Harder said.
"The other reality is that neither skilled nursing facilities, nor home health providers, can offer the kind of remuneration that hospitals can," she added. "They cannot come up with the signing bonuses that hospitals are able to offer, and they cannot come up with some of the salary differentials that hospitals and other organizations are offering, so they're hamstrung in the marketplace because they just don't have the dollars to compete."
In August, Baptist Health System appointed Vicki Gulczewski, RN, MSN, as chief executive officer of St. Luke's Baptist Hospital, headquartered in San Antonio, Texas. The hospital is operated by Baptist Health System, which is a part of Tenet Healthcare Corporation.
Having previously served as the hospital's COO since 2015, Matt Stone, group CEO of Baptist Health System, said Gulczewski was an obvious choice for the role due to her clinical knowledge and operational skills.
"Vicki not only connects with patients in San Antonio," he said in a statement. "She is well respected by our physicians and staff. She brings a unique a valuable perspective that helped steer St. Luke's forward throughout the Covid pandemic and to our current successes."
Now a month into her new role, HealthLeaders recently spoke with Gulczewski about her 30-year career with the health system and being a leader in the post-Covid landscape.
This transcript has been edited for clarity and brevity:
HealthLeaders: Did you always want to work in healthcare leadership?
Vicki Gulczewski: I have always wanted to work in healthcare. Growing up I was not familiar with all the different aspects of what working in healthcare entailed, so I went to school and became a nurse. During my career at the bedside I was encouraged to take on several different leadership roles by both physicians and nursing leaders. I have been fortunate to work for a system that supports professional growth and gives people opportunities to learn and grow within the organization. In leadership I really found my true passion; I wanted to make a difference that impacted not only the patients we care for but for the organization overall.
HealthLeaders: How would you describe your leadership style?
Gulczewski: I describe my leadership style as collaborative, thoughtful, and decisive. I make a point to get to know the people and the area involved. I believe you always need to be willing to change, be innovative, and to challenge ourselves to do better.
HL: What are some of your preliminary goals as you begin the CEO role?
Gulczewski: As I start this journey as CEO, I hope to continue to build upon the great reputation that St. Luke's Baptist has already established in the community. As we continue to emerge from the pandemic, recruiting and stabilizing staffing is of utmost importance to support our continued service line growth and to meet community needs.
HL: The pandemic stretched the healthcare industry to its limit. As it bolsters itself back up, what should organizations keep in mind to ensure their strength and efficiency?
Gulczewski: To ensure our strength moving forward, I believe that we will need to continue to become more flexible and to think how we can do things differently with less. Staffing and supply chain are at a premium. Creating a culture that is open to change enables us to introduce new and more efficient staffing models, whether it be in nursing units or in the OR with anesthesiologists and CRNA’s, while continuing to be fluid with new and replacement products as others are difficult to obtain or are no longer available.
HL: While progress has and continues to be made to bridge the gender gap, as a woman in healthcare leadership, what would you like to see in the future as the gap gets smaller?
Gulczewski: I would like to continue to see more women across all executive level roles in healthcare. Healthcare is predominately female, however the majority of women are in clinical roles. We need to create an environment where women are given opportunities to build relationships outside of the clinical areas in order to cross the line between clinical and executive leadership.
I believe this starts at a young age. Girls need to be exposed to any and all opportunities that boys are exposed to. We need to teach our girls to be strong, independent women that bring just as much value to the table. I am proud to have been selected for this role and have received overwhelming support along my journey. I hope to be an inspiration to other women and provide the encouragement needed to do achieve anything their hearts desire.
See which healthcare executives have moved organizations recently.
There have been numerous additions and changes in the C-suite of various healthcare organizations recently, some groundbreaking and others set to pave the way for a successful third and fourth quarter. To keep up with the recent leadership moves, HealthLeaders' compiled a list of new healthcare executive appointments.
Conners will succeed current CEO Tommy Inzina, as he plans to retire. Conners officially takes the role in 2023, making her the first female CEO in the system's 25-year history. Throughout her decades-long career, she has served as a bedside and trauma nurse, then moved up to serving in hospital administrative roles. She currently serves as COO at Jefferson Health.
The system's co-founder and president will add CEO to his role of responsibilities beginning in 2023. Toy's appointment to the role had been in the works since he joined the organization as its chief technology officer. Current CEO and co-founder Vivek Garipalli, praised Toy's "unique" approach to technology and business strategy, praising his "grit" when it comes to problem-solving.
The Minnesota hospital announced the appointment of Halstenson as its CFO in early August, who has over a decade of healthcare experience. Before joining the healthcare industry, he also spent a decade working in investment management, overseeing individual and philanthropic assets.
Bean initially joined Centerstone in 2014, serving as vice president of finance prior to her promotion to CFO. In her new role, she will manage the system's revenues, and alongside the chief information officer, she will oversee the information technology department.
Krishnaswamy rejoins the Modesto, California–based hospital, succeeding previous CEO Warren Kirk. Krishnaswamy previously served in executive administrative roles within the Tenet system, which operates Doctors Medical Center Modesto, with his most recent role being vice president of operations for the system's Dallas headquarters.
Cacchione will serve as Jefferson Health's CEO effective September 6, leaving his current position as executive vice president of clinical and network services for Ascension. As CEO, he will be tasked with advancing the organization's growth strategy.
Brown has over twenty years of industry experience in finance. His new role will have him overseeing the daily operating expenses of Orlando Health Central and Orlando Health Horizon West hospitals, as well as developing key performance indicators for the organization.
With a 25-year tenure with MemorialCare, Sicaeros now serves as its chief strategy officer and dean of the organization's leadership academy. As CSO, she will lead the system's growth initiatives. She previously served as chief operations officer for the MemorialCare Medical Foundation.
Kelly brings over twenty years' experience to her new role, having most recently served as CFO for Universal Health Systems in Nevada and previously in Alaska.
Having served as interim CFO since October 2021, the system has permanently appointed Doll to the role. In the over four years that she's been with the organization, Doll has managed its Intergovernmental Transfer Program, developed the financial model for its graduate medical education program at the Hillsboro Medical Center, and oversaw its transition from an annual budgeting to rolling forecast model.
Editor’s note: This story has been updated with a correction to Stephanie Conners’ current role and organization.
The pandemic further exacerbated a labor shortage in the industry, with nursing home staffing at a 30-year low.
Nursing homes were the most heavily affected sector of healthcare during the pandemic and as the industry works toward stabilizing itself amid an ongoing labor shortage, they're working the hardest to recruit and retain talent, an industry leader says
Since the pandemic, nursing homes have lost more than 223,000 workers, said Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association (AHCA).
And while nursing homes have been increasing wages more than any other area in the industry—going up by 9.5% in 2020 and 6.3% in 2021—staffing levels are nearing a 30-year low, Harmon said
"What I would say is nursing homes providers have been doing everything they can to address the labor crisis, but nursing homes are uniquely reliant on government funding and therefore the resources are limited," she told HealthLeaders.
The fixed Medicaid reimbursements that nursing homes rely on, Harmon said, don't always cover the total cost of care. That, in addition to rising labor costs, have begun to stretch facilities' resources thin.
"The biggest call for help is that we really need policymakers to put their support behind prioritizing long-term care and support of getting resources and programs that will build a pipeline of caregivers that will sustain nursing homes for today and the future with recruitment and retention," she said.
"And ultimately," she added, "there's not on silver bullet, or one answer to this. It really [requires] a comprehensive set of approaches that we believe would bring some stability to the workforce and support our caregivers into the future."
Despite recent wage increases, due to the economic strain of inflation, nursing homes are struggling to compete with other industry sectors when looking for talent. According to Harmon, 98% of nursing homes are experiencing difficulty hiring staff, with their main obstacle being the lack of interested or qualified candidates.
"Nursing homes would love to hire more staff, more nurses, more aides to support the increasing needs of residents living in the nursing homes," she said. "However, nursing homes cannot meet additional staffing requirements when they can't find the people to fill those open positions, or if they don't have the resources to be able to compete with other employers."
Harmon notes that nursing homes offer an array of benefits such as flexible or self-scheduling, mentorship programs, and career development opportunities, and are continually innovating and developing others to improve their marketability.
Some of these methods include facilities providing childcare assistance and loan forgiveness for employees who've worked there for a certain amount of time. With education, the AHCA's reform agenda proposes developing partnerships with local institutions to help train students, creating a mutual investment where the students are provided on-the-job instruction and the facility has a pipeline of talent.
"Nursing homes also will empower staff, whether clinical or nonclinical, to lead efforts in the home or facility to improve care, and that's really important," Harmon said. "In the culture of the facility, there's multiple efforts that leaders in nursing homes do to have an engaging culture with those individuals."
"We have a number of other ideas of how we can help really elevate the nursing home profession for individuals that are out there and want to serve our elders," she said. "But they aren't able to get their foot in the door because of whatever challenges might exist, and how we can have programs in place that might welcome them and help retain them."
