The Ocean Healthcare Network in Lakewood, NJ, has installed such remote monitoring services in three post-acute care centers. It will tap into telemedicine during times when doctors are not on duty — overnight, during the weekend and on holidays.

Such services used in the pilot program are provided by TripleCare, which is based in New York City and specializes in remote monitoring for SNFs. During those off hours, docs will perform duties such as virtually visiting the bedside, and work in concert with Ocean Healthcare nurses to decide if patients can be treated in place or need a transfer to the hospital.

“It is known that one of the biggest challenges in skilled nursing care is ‘off’ hours — evenings and weekends,” Joseph Kiernan, Ocean Healthcare’s chief strategy officer and senior vice president of network development, said in an announcement. “While we have physicians on staff, it isn’t realistic to have doctors onsite around the clock to respond to every emergent situation. In the past, we would likely have sent patients to the ER to ensure their stability.”

Mary Jo Gorman, CEO of TripleCare, said there has been increasing interest from longterm care recently; the company has inked similar deals with 16 other SNFs in seven states over the last six months.

In late March, TripleCare announced another partnership with Asbury Communities, which has eight locations in four states. Providers are getting creative too, using telemedicine with other parts of the care team, such as remote doctors to examine wounds. Tele-mental health, too, is an emerging use, as providers find ways around specialist shortages.

“It’s becoming broadly adopted in a lot of healthcare settings, and a lot of the kinks have been worked out from earlier years, for all kinds of provisions of telemedicine,” Gorman told McKnight’s. “So adoption is strong.”

British and American researchers compared diabetes prevalence among 47,000 night-shift workers against that of 225,000 day workers. They used the UK Biobank, which includes information on diabetes diagnoses, age, sex, race, family history of diabetes, alcohol use, sleep duration, body mass index and other health characteristics.

The scientists found that the more often people worked overnight, the more likely they were to be diabetic.

“Our findings show that night shift work, especially rotating shift work including night shifts, is associated with higher Type 2 diabetes odds and that the number of night shifts worked per month appears most relevant for Type 2 diabetes odds,” wrote the authors, who were led by Céline Vetter, an assistant professor at the University of Colorado.

All people working night shifts experienced higher rates of diabetes, but the likelihood rose to 44% among those who worked frequent night shifts. Odds of a worker developing diabetes ticked upward with number of nights worked.

It really depends on the state you are from whether this is a different process or not.

Those states that previously were Quality Indicator Survey (QIS) will find that much of the new survey process is the same, with some tasks incorporating the old traditional survey process. Those states that remained in the traditional survey process will see more of a change.

Some states have not seen much difference and the outcome of the surveys have compared quite the same as previous years. Others, not so much the same.

This new process reflects the focus on resident-centered care. It is essential that everything you do keeps the resident in focus. Whether it is daily routines, individualized care plans or choices in care, the resident’s voice is primary.

More deficiencies have been seen in some areas with more carryover of issues from one deficiency to another. The most important thing is to remember that the survey process is nothing more than verifying you are providing good care, giving your residents a voice and following standards of practice.

Your preparation should include completing all the paperwork that is included on the Entrance Conference checklist. You can find that online. You need to have your staff keep this paperwork up to date on a weekly basis. This will prevent you from rushing to get it done when the surveyors arrive. This is the same type of information you used to prepare for the old survey process.

By preparing your staff for the process and completing your paperwork to meet the requirements, you should be able to have a successful survey. 

Please send your payment-related questions to Patricia Boyer at ltcnews@mcknights.com.

The Centers for Medicare & Medicaid reports 10% of all 2017 payments involved incorrect reimbursement rates or unneeded or non-covered care. The Government Accountability Office has also called Medicaid a “high-risk” program since 2003, noting its susceptibility to fraud, abuse and mismanagement. Medicaid is far and away the No. 1 payer of skilled nursing care in the United States.

Lawmakers have traditionally seen cutting improper payments as a way to offset rising costs. In March the Council for Medicare Integrity asked Health and Human Services Secretary Alex Azar to expand audit capabilities. The Trump administration has broadly backed Medicaid reform, ranging from instituting block grants to states to beneficiary work requirements, cutting funding and considering lifetime limits.

But San Francisco attorney Judith Waltz told Bloomberg Law that it’s become harder to target waste such as improper payments in the age of Medicaid managed care.

“You now not only have the 51 state systems [including Washington, D.C.] processing claims but you have multiple Medicaid managed care plans and their subcontractors processing Medicaid claims,” agreed attorney Ellyn Sternfeld. “What’s considered an improper claim in Kentucky may not be an improper claim in Washington.”

Waltz said that in response, the federal government has increased its Medicaid antifraud enforcement much more than in the past, when enforcement was largely left to the states

The study — conducted by Leavitt Partners and the DukeMargolis Center for Health Policy — looked at data from the Medicare Shared Savings Program, which rewarded providers for coordinating care between 2013 and 2016.

 Researchers found that money spent on SNFs decreased, while dollars spent on physicians in accountable care organizations increased. A 1% decrease in spending on SNFs accompanied a 0.82% increase in savings for ACO participants. Overall, ACOs that saved in the first four years spent 0.36% less on inpatient costs, 0.31% less on SNFs and 0.16% less on home health.

“The ACOs that improved their savings rate most rapidly were those that had shifted SNF and inpatient expenditures more dramatically. This finding indicates that the degree to which ACOs shift their expenditures matters and that significant additional savings can be gained by shifting inpatient and SNF spending toward physician services,” authors wrote.

Further research is needed to understand why ACOs are making these moves, and what actions are being taken to decrease dollars toward SNFs, they concluded.

There has to be a balance between innocent until proven guilty and feeling like the last thing you want around vulnerable elders is someone who could be or is alleged to be violent.

It is very difficult for any employer to discipline or discharge an employee for off-duty conduct or conduct not involving coworkers or people served by the employer. Moreover, it is extremely difficult for an employer to attempt an adverse action against an employee based on allegations, without a court finding the allegations were true or without the employee admitting that the allegations were true.

If an employee were found guilty by a judge or admitted to be physically abusive to an elderly resident, then the employer entrusted with the care and protection of the resident may be able to fire or discipline the employee for violating the employer’s policy not to abuse a resident. Certain employers are able to take actions against an employee for off-duty conduct.

For example, a church that is opposed to abortions can prevent its teachers or other employees from publicly endorsing abortions because such public actions undercut the school’s Christian faith community and oppose the belief of the church employer. The church employer should have a written policy or clause in the employment contract prohibiting off-duty conduct that is contrary to the beliefs of the religious church employer.

Thus, without more of a connection between the misconduct and the propensity to be violent to the residents, it would be difficult to discipline or discharge the employee based solely on the allegations by his wife during divorce proceedings.

Please send your legal questions to John Durso at ltcnews@mcknights.com.

According to the complaint, filed in the U.S. District Court for the Eastern District of Wisconsin, Barnell Williams asked Lasata Care Center for a religious exemption from the facility’s mandate that all employees receive a flu shot.

The nursing home asked that she provide a note from her clergy leader supporting the exemption. After Williams could not provide the letter because she did not belong to a church or organized religion, the nursing home administrator did not offer an alternative way of verifying her religious beliefs, the lawsuit claims.

Williams agreed to the flu shot, despite her objections, for fear of being terminated, and then allegedly suffered emotional distress that included withdrawing from work and her personal life, sleep problems and anxiety. The lawsuit seeks compensatory damages for Williams’ “pain and suffering” and “additional relief as justice may require.”

The Justice Department said in its complaint that Lasata’s requirement violated Title VII, a federal statute that prohibits employment discrimination because of religion.

“When employees’ religious principles conflict with work rules, they should not have to choose between practicing their religion and keeping their jobs if a reasonable accommodation can be made without undue hardship to the employer,” said Acting Assistant Attorney General John Gore, with the Civil Rights Division, in a press release.

In an email to McKnight’s, Ozaukee County Administrator Jason Dzwinel said, “The county will file a motion to dismiss the Justice Department lawsuit and believe that current case law will support our motion.”

The county has since eliminated the letter requirement, according to the complaint. Williams is no longer employed at the nursing home.

It alleges the facility fired two pregnant employees, rather than accommodate work restrictions ordered by their physicians. The complaint alleges that Scottish Pines Rehabilitation & Nursing Center violated the Pregnancy Discrimination Act when it terminated two certified nursing assistants because of their pregnancy-related restrictions.

In one case, according to the EEOC, Scottish Pines placed CNA Mary Jacobs on unpaid leave in 2014 when she asked the center to accommodate a pulling, lifting and pushing restriction placed on her by a physician, then terminated her employment.

The center reportedly fired CNA Laketa Watts for similar reasons in 2015.

“We do not believe we discriminated against those employees,” Bob Gilliam, president of Scottish Pines and its management company, said in an email to McKnight’s.

The EEOC alleges the nursing center had the ability to accommodate such restrictions because they had previously for non-pregnant employees who suffered work injuries. The suit seeks policy changes at the company, as well as back pay, compensatory damages and punitive damages for Jacobs and Watts.The EEOC said it tried to reach a settlement before bringing suit in U.S. District Court for the Middle District of North Carolina.

“Employers must generally treat the work restrictions of pregnant employees just like those of non-pregnant employees,” Lynette A. Barnes, regional attorney for the EEOC’s Charlotte District Office, said in a press release. “Companies must be careful not to violate federal anti-discrimination law when they pick and choose which employees to accommodate.”

Rockingham County Rehabilitation and Nursing Center is a shining example of what can happen when a county-owned long-term care community gets the full support of its governing body.

The Brentwood, NH-based skilled nursing and rehab facility now sports a much-needed $12 million facelift due to the efforts of the Rockingham County Board of Commissioners and Delegation, which spearheaded the project.

“If you have the support of the commissioners, there is nothing stopping your ideas,” says Administrator Steven Woods. The approximately 60,000-squarefoot renovation opened in 2017 and includes 18 short-term rehabilitation wing beds and a total of 202 long-term care beds.The Rockingham campus is nearly 250,000 square feet and sits on 50 acres.

Woods explains that the project started a couple years ago as “a nugget of an idea” that blossomed into a vision for an expanded and upgraded care environment. With the help of his management team, Woods presented the plan to the board and was elated when he got a positive response.

“We are so blessed that our three commissioners have a great vision and are enthusiastic about taking care of everyone we serve — residents, rehab clients, families, volunteers and staff,” Woods says. “They want our county home to do the best job possible.”

A showcase of the building’s design is the entrance and courtyard, which has been named in honor of Karl Singer, M.D., who has been associated with Rockingham since 1975. Under Singer’s leadership as medical director, clinical staff and resources have been enhanced so that residents receive the same level of care they would in a hospital. 

“Our approach is to provide the same treatment, no matter which walls you are within,” Singer says. All rooms are single with private baths, which is not only good for resident morale, but is a clinically sound practice for “combatting all the bad bugs out there,” Singer says.

Ubiquitous windows let in ample amounts of natural light and a color scheme featuring soft-tone blues and browns provides a relaxing atmosphere. Black-and-white pictures of local landmarks, such as train stations, lighthouses, markets and the coastline, grace the corridors, lobby and dayroom to provide residents with meaningful memories.

Architect Jonathan Halle of the Warrenstreet design rm says the commissioners and delegation “have been very progressive in their leadership and support” of the project vision. It is that support, he says, that enabled him to commence with a design aimed at providing all the infrastructure elements necessary to build a state-of-the-art community.

“Without being flamboyant, the goal was to provide a clean, contemporary renovation that equaled or surpassed any private facility delivering comparable services,” Halle notes with pride.

1. Meal and menu planning require special care. Ruth Drew, director of information and support services for the Alzheimer’s Association, advises serving only one or two foods at a time. “Too many foods at once may be overwhelming,” she says. Still, be mindful of each resident’s individual preferences and choices whenever possible, urges Christopher Krause, director of rehab at iN2L. Many dementia patients can be finicky, making ample menu choices important. “You have to anticipate what a resident likes to eat,” says Cheryl Frazier-Trusty, MS, RD, LDN, a long-term care consultant dietitian with Dietitians on Demand. “Having different choices is imperative.” Liberalizing a dementia resident’s diet regimen is important to optimize meal planning, she adds. Moreover, dementia patients may suddenly develop new food preferences or reject foods that were liked in the past, as Drew observes. One way to help ensure residents will at least nibble is providing plenty of “finger food.” “Be prepared for grazers, with portable food options ready any time,” says Lindsay Casillas, senior vice president of business development, Sodexo Seniors. Another plus with finger food is it avoids the cognitive challenges some have with utensils, Krause adds. Finally, consider visually plating two main entrees instead of printed menus, says Jenny Overly, MS, RD, the director of nutrition, health, and wellness for Unidine.

2. Presentation is a critical consideration. Drew encourages high contrast solid colors in dishes and placemats and avoiding overly complex table settings. And it helps to make the food as visually appealing as possible. “For the most part, residents eat with their eyes,” says consultant Frazier-Trusty. “Something as simple as a garnish or a dipping sauce may help to make a meal more appealing.” Inviting smells from the kitchen also are sensory pluses, according to Jacki Zumsteg, director of interior design for Invacare Interior Design. Both Overly and Casillas encourage preparing meals in visual range of residents as one important way to set the stage for a pleasant meal.

3. Quick meals have no place with dementia resident dining. Always allow more time than usual for meals. Most say 45 minutes to one hour is typical. This accomplishes many things. One is ensuring that residents are relaxed, not rushed. It also gives time for individuals to carefully chew and digest their food.

4. Take extra safety precautions. Many memory care residents have difficulty discerning extreme hot and cold, so make sure to check the temperatures of foods and beverages before serving, says Drew. Avoid glassware and sharp atware. Krause advises providing adapted utensils for those who need and can use them. And as Zumsteg cautions, “mood lighting” should be avoided during meals to better maximize high contrasting colors and various textures. If you insist on using china, choose a plate that has an increased center depth that creates a “ledge” prior to the outer ring. This minor feature helps individuals push the food onto their forks or spoons, says Overly.

5. The physical environment is important. It’s all about creating a warm, relaxing, uncluttered and inviting ambience. This is not unlike dining areas for other populations, but dementia patients views and preferences sometimes are given short shrift. “You want to have a dedicated dining space that is calm, quiet and relaxing,” says Zumsteg. “A person with dementia tends to get distracted more easily. So keeping interruptions to a minimum is key.” Ensuring residents sit in the same location each meal also is a plus. Anna England Chaney, lead contract designer-healthcare, for Flexsteel Industries, advises use of specially designed dining chairs that offer maximum comfort and stability. No one likes to be distracted by furniture that needlessly draws attention to itself or makes it hard for someone with a lesser attention span to concentrate.

6. There’s no substitute for dining among familiar faces. This is especially crucial with memory care residents. “If family members can accept a ‘new normal,’ mealtime can offer an incredible opportunity to connect,” Drew said. “The experience of sharing a meal with family can be one of life’s great joys. The disease steals a lot of that, but we often see moments of connection during mealtime, even during later stages of the disease.” And remember, as Casillas urges, “Make dining a social experience. A leisurely meal is engaging — not a task to be completed.”

Mistakes to avoid

■ Offering a highly restrictive menu. Memory care residents can be picky eaters, and their preferences can sometimes turn on a dime.

■ Neglecting distractions such as complex table arrangements and excessive noise. Create a calm ambience that allows diners to focus.

■ Ignoring safety hazards. Unlike typical senior dining, glassware and sharp flatware can be dangerous. Encourage finger food as another way to minimize risks.