In the years since, that idea has blossomed into the Elder Vacations program at Signature HealthCARE’s Hometown facilities, which celebrated its 18th trip in November.

In total, more than 1,000 residents have taken trips to places such as New York City, Boston, San Antonio and Panama City Beach. The tours are a massive undertaking, explains Angie McAllister, Director of Cultural Transformation-Hometown for Signature.

The groups usually comprise more staff than residents since the travelers require skilled nursing care on the road. But the benefits of the trips are worth it, McAllister says. Residents get a rehab goal to work toward — such as climbing enough steps to board a Disney World trolley — and get to experience parts of the country they may not have seen otherwise.

McAllister remembers one 90-year-old resident who sat on her hotel balcony in Myrtle Beach, listening to the ocean for the first time.

“She had never been out of this little town in Tennessee in her whole life, and she had never stayed in a hotel,” McAllister said. “She said, ‘I can’t even see because it’s dark, but I can hear it. And I’ve never heard anything so beautiful.”

University of East Anglia and Stockholm University have found that employees who believe they are treated unfairly at work are at a higher risk of being out of the office for illness.

The treatment of employees by managers is called “interactional justice” and is defined as both informational justice, which is receiving truthful information, and interpersonal justice, which is respect from a manager.

Researchers used data from more than 19,000 employees in Sweden to look at the relationship between these types of justices and frequent and long sickness absences. When employees sensed lower levels of justice at work, they often were out longer and sicker.

Higher levels of job insecurity also turned out to be a predictor of absence.

The results underline the need to treat employees fairly in order to keep the workforce healthy, said Constanze Eib, Ph.D., a lecturer in organizational behavior at Norwich Business School.

Results were published in BMC Public Health.

One place to start, a new study suggests, is to recognize that the majority of smokers are unhappy about their cigarette addiction.

More than 80% of current smokers report high or very high discontent due to inability to quit, perceived addiction and regret about starting smoking in the first place, according to Georgia State University researchers.

Among 1,200 smokers, the most common thoughts associated with the word “cigarette” included “cancer,” “addictive,” “nasty” and “expensive,” they found. Policymakers should emphasize less the idea that smokers who quit are losing “pleasure,” researchers said.

“All individuals, young and old, including non-smokers, need to be made aware of the overwhelming regret and dissatisfaction that smokers experience in association with their decision to smoke,” they wrote.

Among healthcare professionals, licensed practical nurses are still the group that smokes the most, at around 25% in 2011. The authors suggested that there should be more focus on smokers’ subjective well-being when they quit, such as how ex-smokers report being happier.

Results of the study were published online Nov. 28 in Tobacco Control.

Although the Centers for Medicare & Medicaid Services already has conducted two rounds of probe and educate reviews in home health agencies, SNFs are not exempt for the newest cycle, which rolled out on Oct. 1, 2017. We already have seen a number of SNFs starting to have requests for records.

The target appears to be the RU RUG Category. You will receive a letter alerting you if you are being targeted.

This targeted probe and educate will continue for three rounds for those facilities that do not achieve a 15% or lower payment error rate.

You may appeal any denial. However, a win on appeal will not improve your error rate. You may elect to receive education before another round begins. If, after the third probe, the error rate is greater than 15%, the SNF will be referred to CMS for further action, including extrapolation, 100% pre-payment review, ZPIC or UPIC reviews.

Prepare for this now. You can review your latest PEPPER report and/or your monthly RUGs levels to see if you are an outlier that might be targeted.

Medical necessity of care is a focus. Make sure you have a triple-check process in place so you know that your claims are submitted correctly.

Now is the time to designate a person who is in charge of paper flow of additional development requests (ADRs). Get assistance. Medical review at this time is very specialized. An expert will assist you in gathering the right information, identifying all records that meet the requirements and submitting a letter of justification. This is not an easy process. 

Remember, these are pre-payment reviews. That means you do not get paid until you prove your case.

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

In a report citing $95 billion in improper payments paid by the two programs in 2016, the GAO said the healthcare agency is lacking in a fraud-risk assessment and strategy for combating fraud and waste. CMS’s anti-fraud initiatives also only “partially align” with the GAO’s fraud risk framework, the report notes.

“By developing a fraud risk assessment and using that assessment to create an antifraud strategy and evaluation approach, CMS could better ensure that it is addressing the full portfolio of risks and strategically targeting the most significant fraud risks facing Medicare and Medicaid,” the watchdog office said.

The report also criticized CMS for giving some stakeholders, such as providers, anti-fraud training but not doing the same for its own employees. In response, the Department of Health and Human Services said it plans to develop risk-based strategies for both programs, following completing of an ongoing fraud-risk assessment of the federal healthcare marketplace.

The opportunities for nursing homes opened up in late November, when CMS finalized its previously announced cancelation of mandatory bundled payment models for hip fractures and cardiac care. CMS Administrator Seema Verma stressed that the agency wanted to focus on voluntary models, details of which she said were forthcoming.

CMS “continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending,”  but wants to develop different bundled payment models and engage more providers, she said.

That’s “great news for nursing home providers,” said Keely Macmillan, general manager of BCPI for Archway Health, to McKnight’s. “This really clears the way for SNFs to be engaged in these voluntary programs,” she noted.

Macmillan and Dave Terry, CEO of Archway, predicted future voluntary models would focus on diversifying the type of provider that can own the bundle, as well as arrangements that “engage a broader provider community” and incorporate outpatients.

“Our advice to providers, whether it’s SNFs or other types, is to apply to these programs,” Terry said. “You get a tremendous amount of data to look at and see how you compare to others in your market, and where your opportunities are for improvement. Just look and see how you might improve outcomes … there’s no downside to getting that information.”

Have a consistently enforced social media policy that defines the improper usage of social media and the disciplinary measures that will be taken if the policy is violated.

Keep in mind the National Labor Relations Act says employees can be legally protected when they post on social media to complain about work conditions, their pay or their performance evaluations. These protections apply only when an employee is engaging other employees in group action or discussion and do not apply to individual gripes.

Employer policies that restrict employee rights under the NLRA have been found to be unlawful. Employers must also be aware of their state’s labor laws, which may protect the o -duty lawful use of consumable products, such as tobacco and alcohol.

Additionally, Title VII of the Federal Civil Rights Act prohibits employers from discriminating in any employment decision on the basis of religion. This discrimination would include disciplining an employee for acts contrary to the employer’s religious beliefs.

However, religious organizations get an exception to this. This allows religious senior care organizations to discipline employees based on religious grounds. But it is important to have a policy that is consistently enforced and formalizes what the organization’s religious beliefs are.

Only the religious beliefs of the organization — not any specific board member — can be the basis for employee discipline.

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

The facilities are owned by Los Angeles-based Brius Management Co. In its announcement, the U.S. Attorney’s Office for the Central District of California claimed employees paid discharge planners at San Diego’s Scripps Mercy Hospital to direct patient referrals to the facilities. In addition, a whistleblower lawsuit alleged the facilities filed false Medicare and Medi-Cal claims for residents who were referred from Scripps.

The four facilities — Point Loma Convalescent Hospital, Brighton Place-San Diego, Brighton Place-Spring Valley and Amaya Springs Health Care Center — entered into Deferred Prosecution Agreements with the attorney’s office in 2016, in which they admitted workers had paid kickbacks without Brius’ knowledge.

Employees used corporate credit cards to purchase gift cards, massages, tickets to sporting events, and a cruise on a charter vessel, giving them to the hospital’s planners as kickbacks, according to authorities.

Brius Management could not be reached for comment.

In addition to the settlement, the facilities have entered into corporate integrity agreements with the Department of Health and Human Services.

“Kickbacks for patient referrals are illegal under federal law because of the corrupting influence on our nation’s healthcare system,” said Acting United States Attorney Sandra R. Brown. “This settlement demonstrates our resolve to combat fraud that compromises the care provided to patients served by a government healthcare plan. This case further shows the power of whistleblowers to shine a light on corrupt activities.”

Juana Walsh filed the lawsuit in November against Hearthstone Communities in Woodstock, IL, arguing that the company violated the Illinois Whistleblower Act when it fired her in November 2016. The suit names Hearthstone, its parent company, its administrator and nursing director.

According to the lawsuit, Walsh was checking on a male resident several days before her firing and the resident told her he was “very afraid of” a male nursing assistant, who he claimed had treated him roughly when he had asked the employee to fix his pillow.

Walsh reported the concern to her supervisor and the community’s human resources director, who Walsh says then asked her to put together a report about the man’s claims, after he repeated them to a social worker. The human resources director allegedly told Walsh the claims wouldn’t be looked into because the resident was “confused,” and accused her of coaching the resident on what to tell the social worker.

Walsh shared the report with the resident’s brother, and when Hearthstone’s administrator found out, she accused Walsh of “stealing” the man’s information, saying that she had put the agency and everyone’s job — including her own — at risk, according to the lawsuit. Walsh was then fired and escorted off the property. Representatives from Hearthstone did not respond to McKnight’s requests for comment.

“You cannot fire someone under retaliation that is … clear public policy, [and] they fired her for reporting suspected abuse,” said Walsh’s attorney Jim Harrison.

The case resumes Feb. 28 in McHenry County Court.

Senior living communities shouldn’t have a monopoly on advanced contemporary design, and with Stratford Commons, skilled nursing residents enjoy the same environmental benefits as their peers in independent and assisted living.

The $7.5 million, 43-room skilled nursing center expansion adds a much-needed component to the community in Overland Park, KS, which now offers the entire spectrum of long-term care services.

“With the addition of skilled nursing and rehabilitation services, we will be able to offer a full continuum of care — much like a traditional CCRC — without requiring an initial large cash outlay by residents,” says Joe Tutera, CEO of Tutera Senior Living and Healthcare Group.

“Much of skilled nursing is behind the times and underdeveloped,” notes Anna Wiles, designer with the Austin, TX-based design firm StudioSIX5. “So we were delighted to bring the boutique experience to skilled nursing at Stratford Commons.”

What comprises a “boutique experience,” exactly? For the design team, it means creating an environment that showcases style, fashion, sophistication and flair in its aesthetics, atmosphere, floor plan and hospitality for residents. For instance, high ceilings in common areas were a priority, Wiles says.

“Many older SNFs have low ceilings, making them feel crowded and stuffy,” she says.

Wiles says the design team wanted to replace traditional upholstery style elements with a more progressive approach that features light green carpets, travertine tiles, modern light fixtures, light maple vinyl planks and cool neutral tones with flashes of bright color to provide a high contrast, but welcoming décor.

“The ambiance is very warm, hospitable and playful,” she says. The design scheme isn’t just about aesthetics, however; there also is a profound functional element that is intended to help staff better serve residents and to make the entire operation more efficient.

The attention to detail extends to how the workstations were built to improve nurses’ workflow and comfort, with such modifications as bar- and desk-height counters so they can chart standing up or sitting down. Tutera also was adamant about “staying ahead of the curve” with innovative electronic records.

As evidenced by the progressive approach to Stratford Commons, taking skilled nursing design to the next level appears to be gathering steam with firms such as StudioSIX5. The trend should continue, Wiles says.

“We aren’t just looking at what is trending within senior living; we are drawing from trends in hotels, restaurants and spas,” she says. “We’re taking all these inspirations and using them to create new experiences for each community.”