Georgia is the statewide association of over 150 key not-for-profit and
other mission-focused organizations dedicated to providing quality
housing, health care, community-based and other related services for
older Georgians. The mission of LeadingAge Georgia is to represent and
promote the common interests of its members through leadership,
advocacy, education and other services in order to enhance each
member's ability to serve older Georgians.
Conversations with Ginny
"The best way to find yourself is to lose yourself in the service of others." —Mohandas Gandhi
One of my favorite things about LeadingAge Georgia is that it is chock full of servant leaders. I was told that our annual conference is like old home week and I was able to see that for myself at our conference in Greenville. I actually feel bad for any of our members who didn't get to attend and hope that you put next year's conference on your calendar now so you don't miss out. The conference will be in Hilton Head March 27th through the 29th.
Coming back from the conference reminds me of when we were kids and would go back to school after the Christmas holiday and tell our friends what we got for Christmas. If our conference was a Christmas present it would be a kaleidoscope. Just as a kaleidoscope bursts with colors, our conference burst with ideas and solutions thanks to the servant leader mentality of our members who are eager to share ideas for the good of those we serve. It was a joy to watch the exchange during the CEO Roundtable with leaders discussing how to position to meet new CMS rules, ideas for using technology to keep up with the needs of those we serve and ideas for meeting the needs of our clients as we navigate changes in payment sources like Medicare including through shortened hospital and rehab stays. Our single-site reception gave our members the opportunity to be with staff from other single-site communities and the foundation was laid for ongoing support for these members. The conference was a source of inspiration too as new concepts were shared – like the session on blue zone design and biophilia. If you missed that session look it up on the app. Other sessions from the opening session, the keynote session and the breakout sessions were inspiring and informative. The Scrabble game on the lawn was a blast, with referees, great food, networking and a winning word that involved two z's.
The Town Hall Conversation held at our conference was outstanding. Our members were thoughtful and articulate as they shared concerns that can be addressed through policy on the federal level. It felt like an A team was at bat as everyone expressed areas for improvement from keeping affordable housing for seniors viable, to improving the survey system for nursing homes, making adjustments to policies to reflect our changing environment allowing individuals to age in place, fortifying the workforce and shoring up mental and behavioral health and Hospice for those we serve. We had the support of our national association and we know they will do a great job taking our ideas and concerns back for drafting future legislative agendas.
Our conference would not be possible without our premier sponsors and our exhibitors. They are our partners and I encourage you to do business with them. You can find them in our directory.
In closing, I'm grateful for the glimpse I had of our servant leaders in action at the conference. Gandhi said "You must be the change you wish to see in the world." Our members get it.
Affordable Housing: An Imperative for Preventing Homelessness Among Older AdultsBy Ginny Helms
When older adults with limited income search for housing, finding affordable housing through one of our HUD homes is like finding a life-line. Yet, more and more of the homes have waiting lists and as the demand for affordable housing increases more older adults will find themselves on long waiting lists with limited hope for getting accepted into a HUD home. Recently, a geriatric psychiatrist told me that their hospital releases older patients to homeless shelters and a discharge planner from a major hospital called and asked if we could help locate a shelter bed for an older adult. HUD homes can be the answer for these calls -- if there is availability. The good news is we have some great operators of HUD homes as our members and with adequate funding, they will step up and meet the demands for affordable housing. The other good news is that we have outstanding leadership in our national association who have some rock solid initiatives before Congress that will help shore up HUD housing for seniors. But, it will take some serious advocacy work nationwide to secure the support we need to fortify affordable housing. Be on the look-out for alerts about contacting Congress for funding HUD programs. We need your help with the lifting on this important issue. Take a look at what my counterpart in Missouri posted recently and then send an email to me (ghelms@LeadingAgeGA.org) and let me know you want to help here in Georgia.
Hello State Execs-
I wanted to share with you what one of our Academy Fellows has been up to in his home state of Missouri. After visiting low income housing during a Leadership Academy visit in December, and learning more about waiting lists, affordability, and Medicaid, Nathan Torno at Bethesda Communities launched an advocacy effort to make the case for closing the budget gap between what senior living costs and what Missouri pays in Medicaid funding. He recruited and educated elders and staff and they are being HEARD by lawmakers, as you'll see in the clip and supporting photos/articles below. The cool thing about Nathan's efforts is that he is doing this because, through his Academy experience, he feels compelled to take a stand, to right a wrong. Not because it's in his job description. We need more Nathans.
LeadingAge GA|SC Annual Conference on Aging was Simply Marvelous! Whether you were seeking transformation in your work experience, new ways to lead more impactfully, or just in search of your purpose…I'm sure you achieved your goal during our Life on Purpose conference. Many thanks for the outstanding Professional Development committees, Board members, and Bi-state staff planning team for hosting yet another memorable conference for over 400 aging services providers, business partners, sponsors, exhibitors, and dynamic speakers. We encourage you to focus on what you specifically learned and applaud you for reinvesting what you've learned in your staff, colleagues, people you serve, and the community who is depending upon us to make a difference!
Check out the photo gallery by clicking HERE
Town Hall Conversation Recap
We had an outstanding Town Hall Conversation at the annual conference in Greenville with a great platform and incredible dialogue. Ruth Katz, the senior vice president for public policy and advocacy for LeadingAge National facilitated the conversation and national board member Danny Sanford joined us to hear concerns from Georgia members and bring them back to the national board.
LeadingAge Georgia board member Gwen Hardy and Tom Rockenbach, co-chair of the public policy committee were very effective at engaging members for input. Board chair Mark Lowell helped set the tone of the conversation and our members shared candid concerns in areas that can be improved on with policy efforts. Hot topics included concerns about the work force shortage for all provider types. Our members voiced having a difficult time hiring enough staff members to meet the needs of individuals served. They also expressed concerns about the way nursing homes are surveyed and excessive regulations. Members expressed concern that policies on the federal and state level need to keep up with the needs of consumers as more and more people are aging in place – like the fact that in Georgia nurses in assisted living homes are not allowed to provide wound care or make judgments about medications – a particular concern for serving residents in Hospice care. Other concerns included the need for more affordable housing units for seniors and the need for better support from HUD for payment for service coordinator positions and activity budgets. Members indicated it is common to have a one to two year waiting list for HUD units and no affordable housing in many areas of the state. Issues were voiced about the need for help with mental and behavioral health in all housing types. Members indicated the interest in shoring up payment for services and indicated an interest in having the PACE program come to Georgia. Concerns were expressed about the need to shore up Hospice policies to ensure consistency and quality of care and to shore up the expectation of long-term care homes when Hospice is brought in. They voiced that it is common for staff in long-term care to cease providing routine care when Hospice is brought in – noting a pattern of "oh good, Hospice is here." Finally, there was a common cry for the need to better support the workforce including adequate staff training for all positions and a creating a culture that appreciates the value of individuals serving older adults.
LeadingAge National will be compiling the comments from each Town Hall Conversation across the country and will use the information to help shape policy and legislation. National has a very strong public policy team and they are adding to it now with some key positions. The public platform in place reflects a lot of the concerns expressed at the Town Hall Conversation and will likely be made even stronger from the input from our members and members across the country voiced in Town Hall Conversations.
Professionals Share Aging Network Workforce Solutions
Late in March providers and professionals in Georgia's aging network spent a day identifying solutions and new best practices for building, and sustaining, a robust workforce for the aging network. With almost 100 people in the room, administrators, educators, millennials, and more seasoned workers, shared ideas, successes, and smart failures, for attracting the best and brightest to pursue careers in aging network.
In addition to panel presentations, table top break-out sessions focused on education, policy, nursing, direct care, and home care. Speaker presentations are available here.
The convening partners for the event, the Atlanta Regional Commission, Georgia Gerontology Society, LeadingAge Georgia, Thanks Mom & Dad Fund®, and Work Source Georgia, are already discussing topics for another event next year.
►How much does your community spend on janitorial and housekeeping supplies? Do you know if you are getting the best prices?
A cost study is an excellent management tool for determining if you are getting competitive pricing for what you purchase. From paper towels to cleaning chemicals, LeadingAge's group purchasing organization, Value First, can compare what you are currently paying to pricing available through the GPO. Your community's janitorial supplies distributor may already be affiliated with Value First. To do a cost study, you provide the list of items you want to compare. Value First does the analysis.
►Does your community use a different group purchasing organization for janitorial supplies?
Even if you are purchasing through a group purchasing organization other than Value First, Value First can do a cost study for you. The primary goal is to work with LeadingAge members to make sure they are getting the best pricing—with Value First or through other sources.
►Not sure if you want to use Value First for housekeeping supplies?
The choice is yours. You can continue with your current arrangement. Or, if the cost study results indicate potential savings, you can consider purchasing through Value First. This is your GPO!
►How do you request a cost study for your community?
Contact Value First representative Vanessa Ceasar at email@example.com. Call (404) 421-3956 or click HERE.
Value First is a group purchasing organization owned by LeadingAge national and twenty five state associations, including LeadingAge Georgia. Value First is designed to leverage the buying power of thousands of senior service providers across the country to get the best pricing on a comprehensive array of products and services.
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Alpharetta, GA 30004
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assist with planning, we are sharing information
holidays and observances for each month
2 months early.
This month we are sending you information for July
July 4 Independence Day
July 14 Bastille Day
July 15 National Ice Cream Day
July 18 National Hot Dog Day
July 23 Parent's Day
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LeadingAge Georgia Public Policy Report
By Tom Bauer, LeadingAge Georgia Policy Advisor
The 2018 Georgia General Assembly concluded on March 29. Governor Deal has 40 days (until May 8) to take action on legislation passed this year. As of this writing the governor has acted on very few bills, and a flurry of activity is expected from May 3- May 8.
State Budget/Adult Day
As noted in past reports, LeadingAge Georgia is very proud of the advocacy efforts by multiple members and staff resulting in a 5% increase in reimbursement rates for adult day (health) centers. As is the case with other legislation, we are awaiting action by Governor Deal on the budget.
LeadingAge Georgia advocated and/or closely monitored several bills affecting provider members, as well as the seniors they serve. The following bills await gubernatorial action
SB 406 (Strickland)- This bill, which was introduced on behalf of Governor Deal, evolved from one of the priories of CO-AGE (the Coalition of Advocates for Georgia's' Elderly), creation of an Elder Abuse Registry. It was covered extensively in last month's public policy report. In a nutshell, SB 406 would revise the law requiring background checks on personal care and nursing home employees to require a fingerprint check for all applicants and current employees who have direct access to patients, residents, and clients of the following:
- Nursing homes
- Assisted Living Communities
- Personal Care Homes
- Adult Day Centers
- Home Health agencies
SB 444 (Unterman)- This bill creates the Georgia Alzheimer's and Related Dementia Advisory Council to provide input to the Georgia Alzheimer's and Related Dementia State Plan. It also directs the Department of Human Services to staff a position for the Advisory Council and serve as the State Plan coordinator.
HB 635 (Cooper)- This bill is called The Disabled Adults and Elder Persons Protection Act and encourages the creation of coordinating teams similar to what has been created in Augusta to increase prosecution of elder abuse in the area.
SB 370 (Wilkinson)- This bill exempts the first $25,000 of a person's assets from estate recovery under the Medicaid program. Currently only estates that have $25,000 or less get an exemption from recovery so this bill is an effort to create fairness for all families facing estate recovery.
HB 803 (Willard)- This bill creates the criminal offense of trafficking an elder or disabled person for the purpose of appropriating the financial resources of the person for one's own personal or another's benefit.
Medicaid Non-Emergency Transportation (NET)
LeadingAge Georgia was well represented at a recent forum hosted by the Department of Community Health (DCH) to explain plans for both NET and Electronic Visit Verification (EVV) - see below. This was the first of several forums to be held throughout the state.
Medicaid Non-emergency Transportation is, of course an issue with which LeadingAge Georgia adult day members have been involved for several years. At the forum DCH announced that it would be issuing a new Request for Proposal (RFP) for brokers (the previous RFP was postponed), although no target date was provided. Following the forum James Peoples of DCH indicated that LeadingAge Georgia was welcome to provide further input into requirement for NET brokers.
Electronic Visit Verification (EVV)
A new federal law (the 21st Century Cures Act) requires states to implement Electronic Visit Verification (EVV) by January 1, 2019 for Medicaid finance Personal care Services and for Home Health Care3 Services by January 1, 2023. DCH will be issuing an RFP for a vendor in the future. Basically, EVV automates gathering of service information by providing the "time, attendance and care plan information entered by a home care worker at the point of care."
Stay tuned for further information….
Leadership Academy - Third Event
May 9, 2018
Life Plan Community/CCRC Symposium (LPC/CCRC Members Only)
May 11, 2018
Mental Health First Aid
July 12, 2018
Registration coming soon
GAAP Summer Symposium
July 20, 2018
Registration coming soon
Fair Housing & Ethics Symposia
July 25, 2018
Registration coming soon
Leadership Academy Fourth Event
August 15, 2018
Maintenance Professionals Forum
August 29, 2018
Registration coming soon
Dementia & Mental Health Symposium
September 13, 2018
Registration coming soon
Center for Positive Aging Golf Tournament Fundraiser
October 8, 2018
Leadership Academy Fifth Event
October 10, 2018
Adult Day Services Symposium
October 19, 2018
Registration coming soon
LeadingAge National Conference
October 28-31, 20018
Philadelphia Convention Center (Georgia Night Dinner TBA)
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Older Americans Month: Engage at Every Age
This is a special month ... it is when we celebrate and recognize Older Americans, Senior citizens and baby boomers. The theme for 2018 is "Engage at Every Age."
This theme is something in which we should all actively engage most of the time. Not just in our inner circles, but with our expanded circles as well.
Optimal health and wellness are important at every age, and as we acknowledge Family Wellness this month, engaging all family members is vitally important. As Older Americans, yes this includes me ... I/we must engage our younger generations by modeling what optimal health looks like. We are their role models. Even when not in the best of health, they are observing our actions. It is therefore our responsibility to portray what to do to achieve optimal health. We must also let them know what not to do so they can avoid health adversities that will have a negative influence on their future health status. If we are concerned about our family's overall wellness, we must not sit back and say or do nothing, we must engage all family members, regardless of age.
Carolyn L. Hartfield, Guest Contributor
Carolyn's experience in the health and wellness arena started when she opened her first health food store in 1985 and expanded it to 4 locations. She received her Health Coach certificate from Emory University. She is a 2016 recipient of the LeadingAge Georgia Profiles in Positive Aging Award, representing AARP. She is a National Senior Games (NSG) Athlete earning numerous gold and silver medals; she is featured in the 2017 National Senior Games Non-Ambulatory Athlete Exercise Videos; featured on the TV News Magazine for Baby Boomers 50Plus Prime; she was featured in the Atlanta Journal Constitution (AJC) newspaper; the cover story for the GirlFriends Lifestyle - A Women's Guide to Healthy Living Magazine, Special Edition for the White House Conference on Aging; and interviewed for various other media outlets. She is the founder of Hartfield's Hikers, Older People with Active Lifestyles (OPALs), Atlanta African American Baby Boomers and the Walk Outdoors for Wellness! (WOW!) program. For more information visit www.CarolynHartfield.com or send Carolyn an email at CH@CarolynHartfield.com
Participation Leads to Transformation
As an Active Aging Strategist at Lenbrook, a Life Plan Community in the heart of Atlanta's vibrant Buckhead neighborhood, I work with my team to plan and coordinate a large variety of events with and for our residents. Many of these events involve unique performances, special lecturers or interesting activities that I always try to capture on film or video. One day, when my scheduled photographer did not show up, I asked Myles Smith, a Lenbrook resident and accomplished photographer, to help out.
Myles was happy to step in and document our planned art and music event that day, but was worried about leaving his wife, Ortrude, who has Alzheimer's. Since I knew how much Ortrude loved music, I told Myles: "Bring her - I'll visit with her while you take pictures!"
When Myles and Ortrude arrived, Ortrude wanted to participate in the art event, and soon was smiling and laughing with the kids and grandparents. When I complimented her work, she told me she was an Artist and an Architect. This opened my eyes to how much more Ortrude had to give.
I asked Ortrude if she would like to come to an Art Critique I was doing the next week in Lenbrook's Art Studio. She was enthusiastic, and eager to show her work.
Initially, most participants were not familiar with the critique process, which includes suspending judgement, looking at the use of line, composition, color and how the eye moves through the work. They were hesitant about the entire exercise and even more uncomfortable when they realized I had invited Ortrude. The sentiment in the room was pervasive …"She has Alzheimer's, and she doesn't belong in this group!"
I calmly told them I had invited her and that she had some impressive work to share. She was here to participate.
To start the Art Critique, we first practiced on one of my own pieces. The group began to get the feel for the process – and then Ortrude said she wanted to go next, which made some people uncomfortable.
Ortrude went to the easel, stood up tall and proud next to her work, and said "My name is Ortrude and I have Alzheimer's. I'm also an artist. This is a watercolor painting I did a while ago."
Suddenly, the feeling in the room moved from resistance to acceptance. The people were now engaged. They were finally participating with Ortrude, and were rooting for her to be successful.
I was humbled by what was happening. Up until then, I had thought that I was helping Ortrude - but instead, Ortrude transformed us. She brought us all a sense of connectedness, a deeper love. We all learned that day that Art is magic and it is for everyone.
A bit later, we asked Ortrude to host a collage workshop, and some 15 people attended, including some who had never done any art before. Ortrude was nervous and told me she felt she didn't have the words she needed, so I assured her that I would be there to help. She brought all the supplies, as well as some examples. She began the class with the following opener: "I want you to approach this with fun and love like you are 8 instead of 80".
The tone was set: she made everyone laugh and feel comfortable. We had a great experience and Ortrude was celebrated all over campus. Remember, until then, both Myles and Ortrude had been fairly quiet in the community – but after taking part in community life as a photographer and an artist they quickly became widely known.
Throughout Lenbrook, they were greeted with "Hello, I saw the photographs you took!" and "I heard about your art work and your workshop." By participating, they were both transformed. Myles and Ortrude participated in life at Lenbrook, and were truly changed. It was clear, that they now felt they belonged to the Lenbrook community.
Myles became our unofficial, "official" photographer for numerous events and Ortrude continued to share her Alzheimer's story with others. She even joined me at the Leading Age Georgia "Culture Change Summit" and told her story. Again, she amazed everyone with her openness as she said "I am Ortrude White and I have Alzheimer's. I choose to live my best life everyday". After her presentation, there was not a dry eye in the house, and many people came up to thank her.
In 2017 I spearheaded a project called "pARTicipate in the ART of Life". We focused on transformation, combining the dimensions of wellness and domains of wellbeing within two themes: "The lifespan of the Monarch butterfly" and the song "Lean on Me."
Ortrude created a butterfly for the ART of Life canvas and was present when we shot our video about the project. I am grateful that Ortrude was able to pARTicipate in this journey though she was not able to be there for the day of the event.
Transform Yourself and Others
These days, Ortrude is spending most of her days asleep, and is unable to articulate her feelings. But when I go to visit her and hold her hand, she opens her eyes and says "yes". She loves music and has an iPod filled with her favorite songs. Myles has surrounded her with photos of friends and family, including photos of the two of them through the years. Ortrude's art is displayed at eye-level – all to remind her of who she is.
Ortrude has shown us the power of participation. By taking part in what life has to offer, she taught us how it can lead to our own transformations. Ortrude has made it so very clear that life is about participating in the journey. She has shown us that life is about compassion, love, and understanding. She has shown us the transformative power of being who you are, and through her willingness to participate, she has encouraged others around her to do the same. Thank you, Ortrude.
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2018 CCNG Advisory Group Meeting Dates & Update
Friday, August 24, 2018 | 9:30am – noon | Location: TBA
Friday, October 12, 2018 | 9:30am – noon | Location: TBA
Adult Day Services Symposium: SAVE THE DATE
October 19, 2018
Information coming soon
2017 GADSA Leadership Team
President: Claire Russell, The Homeplace
Vice-Presidents Public Policy: Ned Morgens, Skylark Senior Care;
Aysha Cooper, SarahCare of Snellville
Vice-Presidents of Members: Carla Jones, Rosswoods; Peggy Padgett, Georgia Infirmary Adult Day Health
2018 Training Events
July 20, 2018 GAAP Summer Symposia - Save the Date
Activity and Life Enrichment professionals are a critical asset to creating an environment for lives worth living in the senior living and aging services arena.
That's why we're happy to announce the return of the Georgia Associaiton of Activity Professionals! Your significant involvement will ensure the future of this great organization contiues its mission of providing Activity Professionals with quality and affordable opportunities for professional development and personal growth.
2018 GAAP Leadership Team
President: Scott Bassett (Philips Tower, Decatur) firstname.lastname@example.org
Vice-President: Amanda Bennett (Campbell-Stone Sandy Springs; Atlanta) email@example.com@campbellstone.org
Program/Education: Liana Sisco (Lutheran Towers; Atlanta)firstname.lastname@example.org
So much of the success of activities professionals depends on the networking and ideas shared by those of us "in the trenches." Opportunities for collaboration with peers, in addition to the vendors and speakers, helps to expand our knowledge, our inspiration, and our personal emotional investments in our communities. Every community is different, to be able to attend events that encourage the sharing of our success stories and positive experiences, is vital for the industry as a whole.
- Amanda Bennett, Campbell-Stone Sandy Springs
But the history of population health management predates fee for service payments or the American colonies and contributes significantly to the story of modern day medicine. It is a fact that for all the attention that is generated with the advent of new drug therapies or invasive procedures for the health-related maladies that plague mankind today the greatest reductions in deaths from diseases throughout written history are largely due to our collective ability to identify and document the cause of the congenital or acquired conditions and, where possible, mount society supported efforts to eliminate or eradicate them. The mobilization of the communities of Europe during the bubonic plague of the 1300s, the use of Variolation in Africa in the 1700s to provide immunity from smallpox, the eradication of the London Cholera epidemic of 1854, the 1860 publication of The etiology, concept and prophylaxis of childbed fever by Ignaz Semmelweis which led to the widespread practice of routine handwashing by physicians, iodization of salt in 1924 to reduce thyroid disease, the fortification of bread with niacin in 1934 to reduce pellagra, the enrichment of milk with Vitamin D in the 1930s to reduce rickets, the addition of fluoride to community water supplies in 1945 to reduce tooth decay, the vaccines for polio, German measles, diphtheria, and influenza, the Framingham heart study, the eradication of blindness from guinea worm infestations, safety belts for automobiles, the detection and removal of colon polyps to reduce colon cancers and the distribution of clean needles and condoms to reduce the spread of HIV. None of these advancements would have been possible in the absence of the collection, aggregation, analysis, reporting and utilization of data on populations of afflicted individuals in conjunction with a perception of the benefit to society at large from the reduction of illness from these conditions. The importance of this element of the transformation of medicine is critical. First because all of these are examples of primary and secondary prevention-based interventions versus treatment for an individual. Of equal importance, no direct transactional benefit is accrued to the individuals allocating the resources to support them. These advancements are not possible without first understanding the cause of the condition and then designing, developing and deploying resources first for the benefit of those at greatest risk for acquiring the affliction and, as is often the case, on reducing the burden of illness on those in the earliest stages of affliction. Many of these interventions have their origins in the military. Most of them required a level of organizational structure, processes and outcome monitoring and management beyond the singular scope of even the best practitioners of their day. All of them were aided by the marshalling of the resources of society either through civic, non-profit or governmental support for the benefit of the community at large.
The true origin of population health management, then, lies here; in the understanding that even as we have evolved newer methodologies to treat and cure diseases it is our society-funded advancements in prevention and early detection that have led to the greatest decreases in human suffering. Regardless of your political proclivities the evidence here suggests that it takes a village to eradicate or control the greatest health threats to a population. The one patient at a time business model of fee for service medicine evolved alongside and benefitted from the collective wisdom gained from managing community health issues. The aggregation and management of victims of tuberculosis led to the specialty of thoracic surgery, the treatment of injuries in the theater of war led to the field of trauma surgery, the development of antibiotics and the use of helicopter transport for emergency medical services. But with each new diagnostic and therapeutic modality the cost of health care escalated to the point where the expense incurred from the treatment of one individual with a severe illness could exhaust the generational wealth of an entire middle class family. The desire to reduce the risk of financial ruin from catastrophic illness was, in part, the genesis of employee sponsored health insurance. The subsequent belief as a nation that American seniors should be protected from destitution related to the cost of medical care led to the establishment of the single-payer, national social insurance program known as Medicare.
The introduction of Medicare Part A and Part B in 1966 were game-changers for low-income seniors in communities around America and, frankly, for the hospitals and providers that had served them for years without compensation. Prior to the establishment of this citizen-funded, government-managed health insurance option many of these seniors had been turned away from some hospitals or impoverished due to the cost of treatment for a catastrophic illness. But as beneficial as Medicare was its Fee for Service model led to misaligned incentives by compensating for the treatment of illness and not the prevention of disease. The predictable consequence spawned the medical industrial complex, with the design and development of larger brick and mortar medical treatment infrastructures, the buying up of providers of care and the arms-race-like acquisition of health centered technologies to attract and retain this new revenue stream. Early on it became evident that the system as implemented provided little supervision with regard to over-utilization of diagnostic and therapeutic resources, showed disregard for site of service as a variable in care delivery and rewarded poor performance by paying for complications and their resultant prolonged hospitalizations. The financial impact was so great that many of the medical groups, hospitals and drug manufacturers that were opposed to the passage of Medicare in the beginning became less vocal in their protestation of "government intervention in health care" as they began to reap the benefits of more patients with the ability to pay for the increasing cost for their services. By 1973 Congress and the President were enacting legislation in an attempt to manage the rising costs of government funded health care. But despite the best efforts of the executive and legislative branches U.S. healthcare costs as a percentage of Gross Domestic Product continued to grow at non-sustainable rates. This backdrop sets the stage for the tectonic shift in the U.S. healthcare landscape euphemistically known as managed care.
The epochal shift in the health care terrain is being driven by the convergence of three distinct but related factors in managed care: 1) the lack of personal accountability of a large segment of society for their health and well-being, 2) the realization that the fee for service employer-based and government sponsored insurance models reward the treatment of disease vs the prevention or reduction of illness and has led to the current medical industrial complex and 3) that the cost of primary or even secondary prevention of illness is cheaper than treatment by orders of magnitude for most conditions. Health policy in the United States for the last 45 years has been shaped around the second and third of these factors. We have not focused on the first because as a society we lack the desire or the capacity to hold individuals accountable for the modifiable risk factors that drive the majority of preventable deaths in this country. It is a fact that diet, sedentary lifestyle, obesity, smoking and alcohol are the cause of the majority of premature deaths in this country. We have decided as a nation to hold the providers and underwriters of health care costs accountable for increasing the engagement, education and empowerment of individuals with regard to their health.
All substantive health policy in the U.S. since the Health Maintenance Organization Act of 1973 has attempted to shape U.S. health care based on these two premises. The legislative solutions have attempted to catalyze the collaboration of payers, providers and high performing integrated care delivery system by ratcheting down the pool of inflation adjusted per capita dollars available for total cost of care. The architects of these social engineering policies are aware that the current state individual provider's practice, designed for optimization of the fee for service model, lacks to tactics, the team and the tools to successfully meet the performance and quality benchmarks to be competitive in this new environment. One recent study observed that for the average primary care provider with a panel of 2300 members it would take 21 hours a day for them to provide all of the annual acute, chronic and preventive care functions necessary for their membership3. Health policy architects are counting on market forces to drive the evolution of new symbiotic relationships while eliminating non-competitive models and rewarding those that lower costs, improve quality and enhance the experience of the member receiving care. The most sweeping and recent of these solutions is the Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. The stated intend of the legislation is to improve access, increase quality and lower the cost of health care through (among other mechanisms) moving the majority of government sponsored health payments to value-based compensation and away from volume based fee for service compensation. As could be expected all major commercial health plans have quickly followed this trend.
So while the Fee for Service based health care delivery industry has invested time, talent and resources toward maximizing profits in a volume-based, unit-cost maximizing, specialist incentivizing, complication rewarding treatment of disease-based business model the payers of health care are economically catalyzing an antithetical care management model that rewards prevention, health maintenance and reduced utilization of services. As in the case of the ice shipping service and refrigeration these two models could co-exist together for a time. But in the same way that the Industrial Revolution gave the refrigeration proponents a competitive advantage over the ice shippers, the Information Revolution that the electronic age as spawned will provide opportunities to change health care delivery in ways that have yet to be imagined. And those changes are not 100 years into the future but are happening today.
Simply stated health care providers today are first and foremost in the information management business. The successful emerging health care organizations will be the ones that collect, store, analyze, report and utilize health information in a manner that delivers the most value to health care consumers and payers. The tactics for doing so and the importance of population health in achieving this goal are the topic of the next installment in this series.
3Annals of Family Medicine; www.annfammed.org; VOL. 10, NO. 5; SEPT/OCT 2012 396
By: Michael Vincent Smith, MD
News Throughout the Spectrum of Aging Services
Assisted Living Communities/Personal Care Homes
Antipsychotic Use in Long-term Care Settings: Real Solutions
By Ginny Helms
A new study released from AARP Public Policy Institute reports that antipsychotic use for residents with dementia has decreased in nursing homes but has increased in assisted living homes.
Over the last several years, there has been a lot of talk about the need to reduce antipsychotic use among residents with dementia in nursing homes. While we have succeeded somewhat in reducing antipsychotic use, we haven't really acknowledged and addressed the fact that anxiety, fear and agitation are a real part of dementia and lead to the over-use of antipsychotics. Our focus needs to be on reducing anxiety and fostering a sense of well-being. To get there, we need person-directed care, workplaces where staff is valued and their sense of well-being is passed on to the individuals they serve, adequate staffing and appropriate staff training. In the last couple of years, with the leadership of Alliant Health Solutions, our state's outstanding Quality Improvement Organization, nursing homes in Georgia have made progress with decreasing the use of antipsychotics.
Even with the great work that has been done as nursing homes across the state have worked to reduce antipsychotics it remains a challenge for the industry. The good news is that there are interventions available to help decrease anxiety and promote well-being. Two technology based programs designed to enhance quality of life and decrease anxiety are It's Never too Late and SimpleC. One of our members indicated that SimpleC was found to put their residents with dementia at ease before bath-time – the number one time when individuals with dementia get agitated and a nurse calls the physician for medication and an antipsychotic is prescribed.
More good news is that the Center for Medicare and Medicaid (CMS) has funds available for grants that will pay for a interventions that enhance quality of life for CMS certified nursing homes. With funding from CMS and leadership from the Georgia Healthcare Association, homes across Georgia have brought in a music integration program featuring Music & Memory, a person-centered music program that decreases agitation and fosters well-being.
Through a partnership and funding from Alliant Health Solutions, Inc., LeadingAge Georgia brought Eden at Home, person-directed care training to Georgia. I'm hearing from our members that the Eden model has helped with reductions in antipsychotics and in staff turn-over. On a recent visit to A.G. Rhodes Health & Rehab on the Wesley Woods campus, I was greeted with the sound of music from the 40's and it was one of many things the A.G. Rhodes team is doing to embrace a culture of person-directed care. If you ask the A.G. Rhodes team, I believe they will tell you it was a lot of work to implement the model but it works to increase well-being and they have one of the lowest antipsychotic rates in the state.
I recently asked a geriatric psychiatrist how older adults in the community are treated when they have anxiety and agitation and he said he often prescribes an anti-depressant and gives them a home-work assignment to do something that provides purpose and meaning. This too, is less harmful than antipsychotics. If we are going to be serious about reducing antipsychotics in nursing homes and assisted living homes, we need to be part of the solution. It will entail a commitment to increasing well-being for individuals living with dementia. There are a lot of good models available to help foster environments where there's less anxiety, fear and agitation and less need for antipsychotics. It will take effort to truly make a difference but what a gift it will be to people living with dementia.
See the AARP article below.
Antipsychotic Drug use Increasing in Assisted Living, AARP Says
Although the off-label use of antipsychotic medications has decreased in nursing home residents who have dementia, it has increased in those with dementia who live in assisted living communities or at home, according to a new analysis of insurance claims data released today by the AARP Public Policy Institute.
Federally Assisted Housing (HUD-Subsidized)
HUD Rent Proposal 'Would Immediately Impact Seniors' if Passed, LeadingAge Says
Rent reforms proposed April 25th by Housing and Urban Development Secretary Ben Carson "would immediately impact seniors" living in subsidized housing if passed, despite assertions to the contrary by federal officials, LeadingAge Vice President of Housing Policy Linda Couch tells McKnight's Senior Living.
Importance of Incorporating Fair Housing into Staff Training
Most people know that the Fair Housing Act makes it illegal to discriminate based on race, color, national origin, religion, sex, familial status, or disability in a variety of housing and housing-related activities. What many people may not know is that 2018 marks the 50th anniversary of the Fair Housing Act. The enactment of the federal Fair Housing Act on April 11, 1968 came only after a long and difficult journey. From 1966-1967, Congress regularly considered the fair housing bill, but failed to garner a strong enough majority support for its passage. However, when the Rev. Dr. Martin Luther King, Jr. was assassinated on April 4, 1968, President Lyndon Johnson utilized this national tragedy to urge for speedy Congressional approval of the bill.
Taking Steps Toward Financing Housing Plus Services
"How will we pay for services?"
That's the number-one question I get during presentations and conversations about implementing housing plus services models in affordable senior housing communities. Unfortunately, I generally don't have a good answer. Right now, these communities are funding services through a variety of mechanisms: they squeeze money out of their operating budgets, apply for grants, collaborate with community partners, solicit in-kind donations, or come up with other creative maneuvers.
Home and Community Based Services
CMS Officially Adds Non-Skilled In-Home Care as Medicare Advantage Benefit
Non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans in 2019, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued April 2nd. The benefit marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage.
Initial Approval for 41 States' HCBS State Transition Plans
Approval is granted because these states completed their systemic assessment, included the outcomes of this assessment in the STP, clearly outlined remediation strategies to rectify issues that the systemic assessment uncovered, such as legislative changes and changes to contracts, and is actively working on those remediation strategies.
At-Home Meal Delivery Reduces Hospital Readmission Rates
Addressing some of the social determinants of health can boost patient outcomes and help lower overall health care costs. Along these lines, researchers have found that
home-delivered meals are a big deterrent to hospital readmissions. Lack of access to nutritious food for people who are dually eligible for both Medicare and Medicaid is a problem that likely leads to higher readmission rates, according the study,"Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries," which was published in April issue of Health Affairs.
How Home Care Could Be Re-Shaped if Walmart Acquires Humana
In the midst of acquiring a stake in the largest home health provider in the nation, insurance giant Humana (NYSE: HUM) might also be in early stage talks to itself be acquired by retail behemoth Walmart (NYSE: WMT). The combination of Humana and Walmart, though far from certain, would potentially be a game-changer for home care and the overall health care delivery and payment system for U.S. seniors.
CMS To Be Flexible in Enforcing Medicaid Home Health Rule
A deadline for states to comply with a 2016 Medicaid home health final rule is
approaching, but the Centers for Medicare & Medicaid Services (CMS) won't necessarily enforce all compliance areas right away, according to an announcement issued April 5th.
Greater Proportion of Home Health Agencies Earn 5-Star Rating
About 5% of U.S. home health agencies earned a 5-star rating for quality of patient care in the latest update to the Home Health Compare website, which occurred on April 11. That's an uptick from 4% as of January 2018. The percentage of 4.5-star agencies also increased in that time period, from 10% to 12%, according to an analysis of the data from Fazzi Associates, a consulting firm specializing in home health and hospice
Hospice Compare Now Includes Consumer Survey Data
The CAHPS Hospice Survey results are now included on Hospice Compare. Hospice Compare is a user-friendly web tool. It provides information to help patients, their families, caregivers, and providers make more informed decisions about choosing a hospice. Hospice Compare allows users to select up to three hospices at a time to compare the clinical quality of care provided and patient experiences with these hospices.
CMS Proposes $340 Million Increase in Hospice Payments for 2019
Hospice providers could be getting a 1.8%, or $340 million, bump in reimbursements in fiscal year 2019, the Centers for Medicare & Medicaid Services (CMS) proposed April 27th. The proposal is higher than the 1% increase given to providers in 2018.
Life Plan Community/CCRC
Life Plan Community/CCRC Symposium
May 11, 2018 10:00am - 3:00pm
Click HERE for information and to register (LPC/CCRC members only)
LeadingAge Nursing Home Study Deadline Reminder
The LeadingAge Nursing Home Salary & Benefits study deadline of May 7th is fast approaching. Members that need additional time past the deadline of May 7th, may contact Rich Cioffe, RJCioffe@hhcsinc.com for an extension. Questionnaires are available at: http://www.hhcsinc.com/survey-questionnaires.html
The HCS study is conducted in cooperation with LeadingAge and cover 98 jobs, fringe benefits, shift differentials, turnover rates, and more. LeadingAge participants may purchase the results at the reduced rate of $165, compared to the $350 non-participant rate. The published results will report data by revenue size, profit type, bed-size, region, state, and CBSA.
Hospital & Healthcare Compensation Service (HCS), the leader in healthcare salary and benefits research, has been providing the healthcare industry with reliable and comprehensive compensation studies since 1971.
Many thanks for your continued support of these important industry studies!
For more info contact:
Rosanne Zabka | Director of Reports
Hospital & Healthcare Compensation Service
201.405.0075 ext. 11 | email@example.com
Members of Congress Ratchet up Pressure on Nursing Homes
Four influential Republican Congressmen sent a letter to federal regulators Tuesday, requesting sweeping answers about the Centers for Medicare & Medicaid Services' oversight of nursing homes. It is part of the House Energy and Commerce Committee's official inquiry into how well the agency oversees skilled nursing providers nationwide.
Momentum Grows for in-room Cameras at Nursing Homes
Under a measure advancing in the Louisiana statehouse, families would be able to install video cameras in loved ones' nursing home rooms. Rep. Helena Moreno (D-New Orleans) said her proposal would offer peace of mind to family members monitoring a parent or grandparent while also ensuring residents' safety. During a hearing last week, Louisiana resident Lucie Titus testified about finding her mother with a black eye and severe back pain that the Alzheimer's patient couldn't explain.
Kaiser Study: Nursing Homes have Fewer Residents, but Those Residents Need More Help
Though occupancy rates fell between 2009 and 2016, the needs of nursing home residents have grown considerably — placing more demands on sometimes unprepared nursing staff, according to an in-depth analysis published by the Henry J. Kaiser Family Foundation.
What's New with Therapy Coverage After the Congressional Budget Deal The February congressional budget deal eased long-standing concerns by lifting a threat that some types of therapy might be restricted. But potential barriers to accessing this type of care remain. Click here for a look at how Medicare now covers such services.
Using Housing as A Hub For Senior Services Most seniors want to age at home rather than move to a senior living facility. But this choice brings many challenges, including the risks of social isolation, limited access to medical care and supportive services, and the potential for falls or other injuries that come from living in a home that is unsafe for a frail older adult. But there are ways to reimagine community-based housing as a resource for senior services, rather than a frequent impediment. In a new paper, Stuart Butler and Marcela Cabello of the Brookings Institution describe some exciting models and make important recommendations for ways to use housing as what they call a "hub" for senior services.
Managed Care Organization Funds In-Home Behavioral Health Care Behavioral health challenges can compromise the wellbeing of older adults, but few home health care providers have the resources to tackle these issues. However, one senior care organization is treating homebound seniors for anxiety and depression, at no cost to the consumer, in hopes that overall wellness will improve and overall health spending will decrease.
Wake-Up Call from the IOM: We're Not Ready to Meet Geriatric Mental Health Needs I've spent the last year working with a very distinguished group of geriatricians and behavioral health experts to gauge the older population's need for mental health services and substance abuse treatment, and to assess our nation's capacity to meet that need.
The Institute of Medicine (IOM) convened our group last summer at the request of the U.S. Department of Health and Human Services (HHS). Being a member of the Committee on the Mental Health Workforce for Geriatric Populations was a rewarding and eye-opening experience for me. I'm hoping the committee's final report will serve as a wake-up call for consumers, policy makers, mental health professionals, and providers of long-term services and supports.
Four Creative Approaches to Mixed-Use Senior Living Mixed-use development in senior living is on the rise, and the creative thinkers are winning. Whether including senior living or not, a common template for residential mixeduse is a single building with public retail, dining or both on the building's ground floor, and apartments and condos above. This model is popular in senior living, too. But a new report from Senior Housing News shows the creative ways senior living providers are delivering the value inherent in mixed-use, while thinking outside the box to create new avenues for care delivery and business success.
Boosting Adult Vaccination Rates Through Practical CMS Tactics
The U.S. healthcare system currently stands under incredible pressure. The grinding national debate about costs and coverage has hit new highs (or lows), and the policy conversation has become centered on questions of who pays for what and how much. The answers to these questions are essential and this debate must occur.
Yet a broader view of healthcare in the U.S. brings into perspective two deeper, more fundamental developments that, if left unaddressed, will doom any ostensible solutions for payment and coverage.
First, the U.S. population is growing older, and life expectancies that were once rare have become the norm. As we live into our 80s, 90s, and even 100s, we require more and costlier care. In other words, our changing demographics have increased the demand for health care services, and the subsequent supply carries a ledger. Second, thanks to decades of breakthrough innovations and developments, treatments that were not long ago viewed as "miracles" have become standard practices. These miracles are indeed saving countless lives – but they're not free.
Click HERE to read the white paper.
Livable Communities Roadmap to Livability Series Age-Friendly Atlanta, Augusta, and Macon encourages you to review Book # 3 "The Housing Workbook". It's one of 6 workbooks which provide strategies and solutions that make a community great for people of all ages. Download your free copy NOW by clicking HERE.
'Misuse' and 'Physical' Data Breaches are Most Common in Senior Living, Report Says The most common types of data breaches in nursing and residential care facilities (NAICS 623) are related to misuse or paper copies of records, according to Verizon's"2018 Protected Health Information Data Breach Report." The good news is that there are steps the industry can take to lessen the chances of a breach occurring, a cyber security expert tells McKnight's Senior Living.
'Smart' Dresser Under Development Could Help Those with Dementia Dress Alone
A "smart" dresser that has been tested in the lab ultimately could help people with dementia get dressed with automated help and nobody else in the same room.
"Our goal is to provide assistance for people with dementia to help them age in place more gracefully, while ideally giving the caregiver a break as the person dresses —with the assurance that the system will alert them when the dressing process is completed or prompt them if intervention is needed," Winslow Burleson, Ph.D., said.
Administrator - Calvin Court
See full job description at: http://leadingagega.org/jobmart/public/job/213/
Chief Operating Officer - A.G. Rhodes Health & Rehab
See full job description at: http://leadingagega.org/jobmart/public/job/211/
Director of Operations - Athens Community Council on Aging
See full job description at: http://leadingagega.org/jobmart/public/job/212/
Executive Director - Campbell-Stone Apartments
See full job description at: http://leadingagega.org/jobmart/public/job/208/
Executive Director - Clairmont Place
See full job description at: http://leadingagega.org/jobmart/public/job/219/
Home Services Director of Nursing - Lanier Village Estates
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Life Enrichment, Assistant Director - Clairmont Place
See full job description at: http://leadingagega.org/jobmart/public/job/218/
Manager of Resident Services - Wesley Woods Towers
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New, Free Tools to help with Future Plans In partnership with the Institute for Alternative Futures, LeadingAge has developed the 2030 Aging Services Scenarios Toolkit to explore the future need for and delivery of aging services in the context of expectable, challenging and visionary futures. Tap in to this member-only, comprehensive toolkit created to assist provider member organizations in conducting their own scenario planning workshop and considering implications the scenarios may have on their own strategies and plans for the future.