Assisted Living, Health & Wellness, Senior Living, Senior Services

PBS and Scan Foundation Host Long-Term Care Discussion

Very exciting senior care news…

Today, in Washington, D.C., PBS and the Scan Foundation (health insurance for the 65+ crowd) host a conversation about long-term care models from around the world.  Panelists will discuss the possibility of successfully implementing some of these models, as well as regional ones, across the U.S. The taping event is sold out but keep your eyes open for the air date. Wish I could be there!

Here is the official announcement:

The PBS NewsHour’s Hari Sreenivasan will lead an exploration of long-term care, from across the global village to Main Street U.S.A. After looking at different models for providing long-term care and benefiting from expert commentary, the event will aim to answer the question: can what works there, work here?

The conversation will feature:

An interview with Dr. Bruce Chernof, President & Chief Executive Officer of The SCAN Foundation and former chair of the federal Commission on Long-Term Care
Video and expert discussion of models for long-term care, including examples from California, Minnesota, Washington, D.C., Finland and Taiwan
We will be joined by:

Dr. Laura N. Gitlin, Director, Center for Innovative Care in Aging, Johns Hopkins University
Howard Gleckman, Resident Fellow, The Urban Institute
Jennie Chin Hansen, Chief Executive Officer, American Geriatrics Society
Dr. Mark McClellan, Director, Health Care Innovation and Value Initiative, The Brookings Institution
Dr. E. Percil Stanford, President, Folding Voice LLC
Debra Bailey Whitman, Executive Vice President, Policy, Strategy and International Affairs, AARP

Assisted Living, Health & Wellness, Senior Living, Senior Services

John Gonzales on Emeritus Senior Living Exposure

Here below is a well considered article by Assisted Living insider John Gonzales brought to my attention by Steve Moran’s Senior Living Forum.   It is worth reading…

Dangerous Bridges – – A Commentary on the PBS Expose of Emeritus Assisted Living — 31 July 2013

I asked John, who has become one of my favorite writers if he would be willing to write an insiders perspective. This is what he sent me and it is terrific. – Steve Moran

When I was asked to write this commentary, I assumed I too would take the familiar position dictated by my “corporate instinct” and rush to the defense of our industry, because one of our own was being attacked. “Let him without sin cast the first stone,” right? Those of us who can claim the moniker of senior housing “veteran” know all too well the challenges we face with a transient employee base, 24/7 operations and the risks and potential for human error inherent in an industry that seeks the promotion of decision making and independence in a frail population.

After all, who among us can claim to be deficiency free in 100% of our surveys? Anyone receive a call or letter from a current or former employee complaining about being short staffed? Anyone else make decisions driven in large part by the requirement to make the bottom line?

I think we can agree that perfection may be something we strive for, but the reality of achieving and maintaining it is rare in any business. When I read and saw the expose on Emeritus, I felt that many of the criticisms arguably fell into the category of “reasonable imperfection.” Human error will be here as long as there are humans. I touched on this in my piece, “The Dirty Secret about Assisted Living.”

Come with me on a little metaphorical trip. You’re driving with your family when you come upon a sign that states, “Warning – Structurally Deficient Bridge Ahead! – US Dept. of Transportation” Would you drive yourself and loved ones over the oncoming bridge span? Maybe, if you were being chased by an angry international drug cartel firing bullets at your vehicle and this was the only escape. How about a bridge with the same warning sign that happens to be part of your daily commute? Fact: one in nine bridges in our nation are currently classified as “structurally deficient.” That’s roughly 66,000 bridges, on which more than 260 million trips are made each day. But, according to the Federal Highway Administration, the fact that a bridge is classified as “structurally deficient” does not imply that it is unsafe. I imagine that the people who lost friends and family in 1997 when the Interstate 35 Bridge collapsed in downtown Minneapolis might disagree.

Using the above scenario, replace the “bridges” with Assisted Living communities; cars and their passengers with residents; and the number of trips across the bridge with resident days. In our industry, we have to “do it right” 100% of the time – each day a resident lives in our community (each trip across the bridge) has to be safe. Does a survey deficiency, a complaint, a fall or medication error make a community unsafe? Does it make all communities unsafe? No. But I imagine that many of the family members of residents who’ve experienced negative outcomes – like those featured in the PBS documentary – might disagree.

Now, here’s where I take leave of my comfort zone. Maybe it’s my Jerry Maguire moment, although I hope not…I don’t like Tom Cruise movies in general. There are several very troubling issues highlighted in the PBS expose that from all appearances seem to be driven – either intentionally or not – from Emeritus’ corporate office. The either tacit or overt direction to disregard state regulations to expedite move ins, the low priority given to staff training, and the culture of revenue over residents are egregious and shameful.

Having worked in nearly every community-level position before moving into regional and corporate roles in the industry, I can tell you that there are many executives in our industry that have lost sight of our residents – if they ever had it. If you have a passion for seniors and work in this industry, hearing the term, “heads in the beds” should make you nauseous. A corporation can create brochures and beautifully crafted mission statements, but – as I point out in, “Pop Rocks for Dinner,” this is meaningless unless backed up with actions and resources. One truth I’ve learned in my 27 years in senior housing is that there are far too many people sitting around corporate conference room tables that shouldn’t be there. I can give you a few names if you’d like.

Before you think me naïve, I am all too well aware that this is a business; and no one benefits from a poorly run or failing business; not the residents, not the staff, not the stake holders – not us. I’m continually reminding colleagues that this business requires a constant balancing of the head and the heart; of compassion and business sense. If, as a community, regional or corporate level manager, you are not in a constant state of conflict, then you’re doing something wrong – something is out of balance. Ladies and gentlemen of the jury, something appears to be dramatically out of balance at Emeritus, and it’s to our collective shame.

I hope and pray that this public exposure of what can and will happen when a company gets out of balance, placing the desires of shareholders over the needs and rights of the residents, will be a wake-up call for our industry – especially for those of us fortunate enough to work in the decision-making positions of senior housing. A former company executive with whom I worked, would often respond to my residents-should-come-first objections to bottom-line driven decisions, with the trite phrase, “We follow the golden rule. Whoever has the gold makes the rules.” Hmm, maybe that should have been on our brochure. Besides, aren’t the residents really the ones with the gold? Someone forgot to tell me that our mission statement to “do the right thing” stopped at the door to the conference room.

What’s your mission statement? Is it being lived out? Prioritized? Funded?

No doubt this publicity will prompt renewed calls for federal oversight of our business, or for increased state regulations. If you’ve been in senior housing for any length of time, you know that the states are struggling to keep up with adequate oversight of assisted living. This lax oversight creates an opportunity for some providers to skirt safeguards and regulations in favor of greater expense control, occupancy growth and increased revenues. But, we can do better. Our staff deserve it. Our residents deserve it. Our shareholders deserve it.

I remember when our industry reached out and began serving the dementia population by developing secured care units and alarmed wings within our assisted living communities. We ratcheted up the stakes by expanding the scope of our services, and increased our rates as well as our risk. Caring for the most vulnerable of the senior population – those with high physical and mental needs – requires even more heart, compassion and care – but even more – it requires additional training, resources and a clear understanding and acceptance by providers of this great responsibility.

Many of us saw this evolution as a huge opportunity to provide innovative services and programs to a population that had been under served, in an environment that still promoted independence and dignity. I know many communities are striving to do just this. Unfortunately, some in our industry are all too eager to accept the increased revenue without ensuring their ability (or willingness) to provide the necessary resources under mounting pressure to perform financially.

Perhaps because of ignorance, perhaps driven by greed, and perhaps because of a disconnect that occurs once a company becomes too large to ensure that its vision, mission and priorities to the field aren’t distorted as it filters through the many layers of management; but for some providers, accepting higher acuity residents and those afflicted with dementia and related diseases – and all that goes with this – may have been going a bridge too far.

Health & Wellness, Senior Services

Dedicated, Loving, Well-Trained Nurses of Any Nationality Should Be Able to Work in the US

Please find below my comments an article from (health blog section) about a request from the U.S. nursing home industry to include a “viable” guest worker program in any immigration reform.

I second this request.

Dedicated, loving, well-trained nurses of any nationality should be able to work in the USA.  

North America does not have enough nurses and geriatricians as it is.  The work is hard.  It takes an open heart and deep concern for the well-being of all, especially the elderly and infirm.

It is my experience with most nurses from Canada, Columbia, Ecuador, El Salvador, Italy, and the Philippines, for example, that they are truly caring and connect well with their patients.  (I do not have experience with nurses from countries other than those mentioned).  

It goes without saying that the U.S. has a remarkable corps of nurses.  The point of the comments, however, is that there are not enough nurses to fulfill the needs, not to mention future needs with the ever-growing senior population.

Caring is an intangible talent that goes beyond borders.

It also goes without saying that all those who would be welcome on the guest worker program would be qualified.

By Sam Baker – 03/13/13 10:34 AM ET

The nursing-home industry said Wednesday that Congress should include a “viable” guest worker program in any immigration overhaul, and should also lift caps on employer-sponsored visas for healthcare workers.

The American Health Care Association (AHCA) said immigration reform should recognize the needs of employers — including nursing homes and long-term care providers, who rely heavily on immigrants for positions such as nurses.

“Members of the long term care community employ immigrants and boost the economy. Any visa program must give employers, not the government, the primary say in which workers they need to staff their businesses,” the AHCA said. “In addition, the labor market should also have the primary say in how many workers enter the country annually in a legal program.”
The group is scheduled to testify at a House hearing Thursday on immigration reform.

AHCA said the supply of skilled nurses in the U.S. will fall more than 30 percent short by 2020 if Congress does not act. The nursing-home group said immigration reform should allow employers to access “previously unused” temporary visas for healthcare workers.

Health & Wellness, Senior Services

Medicare to Penalize Hospital Readmission Rates Oct 2012; What Does This Mean for You?

An interesting dilemma: hospitals and their readmission rates.  Catch 22.  Hospitals remove patients as soon as possible (often too early) to follow dictates of insurance, however many patients are readmitted shortly afterwards.

Medicare will begin to penalize hospitals for high readmission rates in October; many hospitals that serve the poor (not all) have high readmission rates attributable to patient lack of funds for doctor visits and medications.  What does this mean if you are low income?  The indications are the hospital will pay a high premium and may not be able to stay in business and you would have to consider other options.   The article does not address this situation.  What is the solution?

Senior care colleague Steve Moran from posted the report from a hospital chain’s point of view (link + text included below).  Posting of this is merely to present information.  The subject requires much discussion; there are no easy answers… and as with any new policy, it may evolve and be tweaked over time.

Medicare To Penalize 2,211 Hospitals For Excess Readmissions

By Jordan Rau

KHN Staff Writer

AUG 13, 2012

More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.

Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. In a few months, hospitals also will be penalized or rewarded based on how well they adhere to basic standards of care and how patients rated their experiences. Overall, Medicare has decided to penalize around two-thirds of the hospitals whose readmission rates it evaluated, the records show.

The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of the records shows.  Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School.

“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands, senior vice president for quality at Beth Israel. “It is not completely understood what goes into an institution having a high readmission rate and what goes into improving” it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has unusually low mortality rates for its patients, which he says may reflect that the hospital does a good job at swiftly getting ailing patients back and preventing deaths.

Penalties Will Increase Next Year

The maximum penalty will increase after this year, to 2 percent of regular payments starting in October 2013 and then to 3 percent the following year. This year, the $280 million in penalties comprise about 0.3 percent of the total amount hospitals are paid by Medicare.

According to Medicare records, 1,933 hospitals will receive penalties less than 1 percent; the total number of hospitals receiving penalties is 2,211. Massachusetts General Hospital in Boston, which U.S. News last month ranked as the best hospital in the country, will lose 0.5 percent of its Medicare payments because of its readmission rates, the records show.  The smallest penalties are one hundredth of a percent, which 50 hospitals will receive.

Dr. Eric Coleman, a national expert on readmissions at the University of Colorado School of Medicine, said the looming penalties have captured the attention of many hospital executives. “I’m not sure penalties alone are going to move the needle, but they have raised awareness and moved many hospitals to action,” Coleman said.

The penalties have been intensely debated.  Studies have found that African-Americans are more likely to be readmitted than other patients, leading some experts to be concerned that hospitals that treat many blacks will end up being unfairly punished.

Hospitals have been complaining that Medicare is applying the rule more stringently than Congress intended by holding them accountable for returning patients no matter the reason they come back.

Hospitals That Serve Poor Are Hit Harder Than Others

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher readmission rates, which the hospitals attribute to the lack of access to doctors and medication these patients often experience after discharge. The analysis of the penalties shows that 76 percent of the hospitals that have a lot of  low-income patients will lose Medicare funds in the fiscal year starting in October. Only 55 percent of the hospitals treating few poor patients are going to be penalized, the analysis shows.

“It’s our mission, it’s good, it’s what we want to do, but to be penalized because we care for those folks doesn’t seem right,” said Dr. John Lynch, chief medical officer at Barnes-Jewish Hospital in St. Louis, which is receiving the maximum penalty.

“We have worked on this for over four years,” Lynch said, but those efforts have not substantially reduced the hospital’s readmissions. He said Barnes-Jewish has tried sending nurses to patients’ homes within a week of discharge to check up on them, and also scheduled appointments with a doctor at a clinic, but half the patients never showed. This spring, the hospital established a team of nurses, social workers and a pharmacist to monitor patients for 60 days after discharge.

“Some of the hospitals that are going to pay penalties are not going to be able to afford these types of interventions,” said Lynch, who estimated the penalty would cost Barnes-Jewish $1 million.

Atul Grover, chief public policy officer for the Association of American Medical Colleges, called Medicare’s new penalties “a total disregard for underserved patients and the hospitals that care for them.” Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: “It’s really ironic that you penalize the hospitals that need the funds to manage a particularly difficult population.”

Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or better on the measures than hospitals without substantial numbers of patients of low socioeconomic status.” Safety-net hospitals that are not being penalized include the University of Mississippi Medical Center in Jackson and Denver Health Medical Center in Colorado, the records show.

Bill Kramer, an executive with the Pacific Business Group on Health, a California-based coalition of employers, said the penalties provide “an appropriate financial incentive for hospitals to do the right thing in terms of preventing avoidable readmissions.”

The government’s penalties are based on the frequency that Medicare heart failure, heart attack and pneumonia patients were readmitted within 30 days between July 2008 and June 2011. Medicare took into account the sickness of the patients when calculating whether the rates were higher than those of the average hospital, but not their racial or socio-economic background.

The penalty will be deducted from reimbursements each time a hospital submits a claim starting Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted a claim for $20,000 for a stay, Medicare would reimburse it $19,800.

The Centers for Medicare & Medicaid Services has been trying to help hospitals and community organizations by giving grants to help them coordinate patients’ care after they’re discharged. Leaders at many hospitals say they are devoting increased attention to readmissions in concert with other changes created by the health law.

Sally Boemer, senior vice president of finance at Mass General, said she expected readmissions will drop as the hospital develops new methods of arranging and paying for care that emphasize prevention. Readmissions “is a big focus of ours right now,” she said.

Gundersen Lutheran Health System in La Crosse, Wis., and Intermountain Medical Center in Murray, Utah, were among 1,156 hospitals where Medicare determined the readmission rates were acceptable. Those hospitals will not lose any money.  On average, the readmissions penalties were lightest on hospitals in Utah, South Dakota, Vermont, Wyoming and New Mexico, the analysis shows. Idaho was the only state where Medicare did not penalize any hospital.

Even some hospitals that won’t be penalized are struggling to get a handle on readmissions. Michael Baumann, chief quality officer at the University of Mississippi Medical Center, said in-house doctors had made headway against heart failure readmissions by calling patients at home shortly after discharge. “It’s a fairly simple approach, but it’s very labor intensive,” he said.

The problems afflicting many of the center’s patients—including obesity and poverty that makes it hard to afford medications—make it more challenging. “It’s a tough group to prevent readmissions with,” he said.

Data for individual hospitals are available as a PDF file and as a CSV spreadsheet.

Health & Wellness, Senior Services

Health Care Experts Discuss Implementation of Affordable Care Act aka Obamacare

Hello world,

And welcome to Wellness Shepherd, a new blog launched under the new moon on a spectacular August day.

I am writing from West Hollywood, CA, an enclave that offers a number of free educational health events at its main library, the senior center, and other venues around town. Today, the National Council of Jewish Women hosted a discussion about the implementation of the Patient Protection and Affordable Care Act (ACA).

The distinguished panel of experts included Susan Berke Fogel, an attorney and women’s rights advocate at the National Health Law Program; moderator Michael Hiltzik, a Pulitzer Prize-winning journalist and author who writes about public policy for the Los Angeles Times; Jim Lott, EVP of the Hospital Association of Southern California; Mark A. Peterson, PhD, Professor of Public Policy, Political Science and Law at UCLA School of Public Affairs; and Paul Song, MD, Board of Directors, Physicians for a National Health Program California.

“We cannot afford not to have healthcare reform,” and “transformation of the US healthcare system is necessary,” were the mantras of the speakers.

They touched on the importance of preventive health programs that will raise public health standards so spending can be reduced, changes in healthcare access (more access for more people), and the continuing shortage of doctors nationwide. It was pointed out that most young physicians have $200,000 of debt from their medical school studies, and, there is an ever increasing number of seniors as the number of medical school graduates dwindle.  Seniors tend to have more health challenges than any other segment of the population.

Four of the panelists are advocates for some form of universal health care, preferably a single payer system.  No one mentioned that of the 33 developed democratic nations in the world, the U.S. is the only country that does not offer universal health care to its citizens.  There was no mention of what happens to those who are indigent and under 65 years of age who do not have employer insurance, nor the ability to pay for government insurance and health services of any kind.

The audience was encouraged to read up on the new program, to ask questions, and to remember ACA is a beginning, that it is necessary to look at the long-term goals, not short term results, and to understand the program has the capacity to evolve and improve. It was noted that when Medicare was founded in 1965 the initial program had its challenges; it was very different from the program in place now – it was improved, innovations were implemented.  Ditto for Social Security.

For more information on the new ACA, please see Anna Wilde Mathews Wall Street Journal 16-page article of December 12, 2011, “The Future of U.S. Health Care” at

Blessings of health,