The Nursing Home Podcast

Mark is a 3rd generation nursing home operator and he recalls his grandmother’s advice, stick your nose into every department to learn everything about them.

Shmuel: Why is it so hard to attract and retain excellent nursing talent in nursing homes?

Mark: The nurses and CNA’s who provide direct care to the residents of the nursing home have a very difficult task. It’s difficult to provide care for seniors who are no longer in the prime of their lives, can be uncooperative, combative and challenging.

If upper management genuinely sees the residents as humans, as people, as deserving of our utmost respect and admiration, this can and will trickle down to the line staff as well. 

This small mind shift can make it possible to provide excellent care even in the most trying circumstances.

By creating an environment where the nursing teams feel accomplished, you greatly diminish the chances of them leaving for your competition. 

There’s no greater feeling for a nurse than to watch a stage 4 wound heal and watch their patients thrive.

Provide them with opportunities to grow professionally and they won’t be looking to leave.

Most nursing home operators genuinely cares deeply for the residents under their care.

Links

• 11-year-old girl grants wishes to nursing home residents
• Moving Poem! 2 Mothers¬†
• Follow Mark on Linkedin
• Aventura Health
   

Joe Goldberg's 2+ decades experience shows this dramatic shift in the method of filling nursing home beds. Personal relationships with hospital discharge planners no longer cut it. 

Hospitals are now responsible for their outcomes even once the patient leaves the hospital. The CMS star rating and results or recent Department of Public Health surveys will play a much bigger role in the case managers decisions. 

Nursing home marketers are discouraged and sometimes straight out forbidden from entering the case managers offices which in the past were open doors. 

There are a number of factors affecting this change but the bottom line is that we need to find a new way to market nursing homes to our acute partners. We need to find new ways to share our facilities with them. 

• Episode with Mordy Eisenberg of Tapestry Telehealth¬†
• Episode with Shalom Reinman of Megadata

 

 

I love professionals like Michael Smith. 

Mike climbed the ladder from a CNA to housekeeper to nurse to RNAC to director of nursing to administrator and now to director of operations. He really knows this industry well and has an excellent understanding of home this complex puzzle comes together. 

In this episode we discuss the effectiveness of a telehealth program in the nursing home setting. 

A good telehealth program empowers the nurses to effectively communicate and actually show the on call physicians exactly what's going on in real-time.

The system is manned by hospitalists that are trained to provide remote care in the nursing home setting. This has dramatically reduced the rehospitalization rates for these facilities and the residents are being effectively treated in the SNFs.

• Linkedin - Mike ¬†Smith
• Facebook - Marquis Health Services¬†
• Linkedin - Marquis Health Services¬†
• Marquis Health Services¬†

The care provided by telehealth is on par with in person visits. The nurse acts as the hands of the doctors in the room.  

Not every clinician will be skilled working with telehealth because theres a skill set necessary to work in this environment. 

Additionally, there's the human element. A good clinician is able to connect with the patient and let the screen melt away to be present with the patient. 

• Linkedin
• Tapestry.Care

Business structure is critical to long term success in the nursing home business and in any organization.

This is not the rigid org charts with the CEO, COO, CFO etc. rather its ensuring that information flows from the top to the bottom of the organization.

Many nursing home chains are owned by leaders that have a very clear idea of how they want to deliver the highest level of care to their patients, residents and families.

The challenge is that the 'boots on the ground' are sometimes not even aware of this vision, and certainly don't have a clear idea of how to implement that vision.

A company with a solid structure will ensure that leaderships' goals are known and implemented all the way down the chain.

David is brought on to companies that have hit a ceiling of growth or are not functioning in this method and he creates the structure necessary to support and implement the leaderships vision. 

Follow David on Linkedin here!

Not everyone that has a large following on Linkedin will automatically attract clients.

However, all of those professionals have parents and loved ones that are candidates for senior care. Although they are not actively looking now, you are now on their radar and when the need arises they will come to you first.

Linkedin is a B2B platform but remember that all those B's are also C's. They are working to finance their consumption. So cast a strategic net and connect with a everyone in or near your space and let the magic begin. 

In this episode, we meet Tuli Kraus of Fresh Scents, a company that believes scent changed the way we experience life.

This innovative product has been introduced into nursing homes. Unique smells are introduced to recreate environments where staff and residents feel safe and comfortable.

Reach out to Tuli on LinkedIn here and check out Fresh Scents Inc here.

 

In the episode we discuss the challenges and opportunities the new payment model present to operators and how they will affect the residents and patients of these facilities. 

 

Here's a partial list of what we discussed in this episode.

 

Who will be affected most by these changes? 

What is the best way for providers to successfully navigate this transition? 

What are the 3 biggest myths 'outsiders' perceive regarding the nursing home industry? 

Steven was privileged enough to have known what he wanted when he was young. He took up nursing and realized that he wanted to be involved in caring for the elderly, being someone who was close enough to live with his grandparents.

Then took up a graduate degree in Gerontology.

Steven also worked in clinical care in Hebrew SeniorLife in Boston. He then transitioned in research and training institute and became a part of the development team for other projects where he developed the importance of standardized clinical assessment, its reliability and validity, and the power of what can be done in the datasets for this assessment.

Recruited to Pointright, he started studying the data and creating proprietary algorithms to help operators, nurses, and other professionals to have data driven insights about the industry.

This has given the professionals and stakeholders with real-time, actionable information.

Being involved with a lot of information and assessment data, Steven realized his passion in filling the gap between the quality of clinical outcome and the lack of fully grasping the financial aspect .

It was then that he joined Zimmet Healthcare, with his enthusiasm for analytical thinking on the reimbursement models and how to best equip their clients and was appointed as the Chief Innovation Officer to lead the Zimmet team in discovering new ways to help the providers and stakeholders in achieving great nursing service.

Steven has pointed out the sad truth of the current payment structure, which doesn’t motivate people to think about a systematic approach to end of life. He gave various examples showing that should have been of financial advantage, elders would have been given better care.

Shmuel shared his insights on how the system has been rigged with thinking that the financial impact gets the better tilt on the scale as it provides viability to the business, overlooking the quality of services that it should have been prioritizing in the first place, as it was the major force to improve the financial aspect of the business.

Steven explains how the PDPM is an improvement to the current healthcare system that will be beneficial to everyone involved in the business, since nursing is more fund-centered.

As he goes teaching classes for PDPM, he points out the mix of people included in seminars that is involved and interested in this model, and he appreciated how well aligned these people are into listening and getting as much information as they can to prepare for the common goal.

The Therapists’ Role in the SNF

A great example that he mentioned are the therapists being boxed in their reimbursements per minute.

For him, therapists are one of the most commonly overlooked health care provider, and they are being valued only per minute, even though they provide healing and rehabilitation, which are incredible.

PDPM will allow them not only to be reimbursed with the timed service they provided, but to be comfortable in giving the quality service that is required of them without the hesitation of being underappreciated.

The new model allows everyone from the management to skilled workers to join together, be in the table together and discuss the appropriate care needed for the patients, which minimizes the tension in between departments.

PDPM Concerns

Although beneficial, Steven still emphasizes his few concerns with PDPM. Since it will be all about the patient, he believes that behavior will have to change come October.

Terms will also have to change accordingly. In nursing facilities, residents will no longer be called ‚Äúresidents‚ÄĚ but ‚Äúpatients‚ÄĚ.

He also acknowledges the importance of documentation as it will be heavy in implementation of PDPM. This change will also mean taking the rules of the past and trying to apply them to the future.

If you want to gain a better understanding about PDPM and how this new model works, listen to the podcast as Steven and Shmuel intelligently discuss about this change and gives their deep analysis about it.

Steve’s final thoughts on PDPM:

I hope my passion and excitement about this change comes across. I just think that we are in such an unbelievable inflection in our industry.

PDPM is not certainly propped for success. PDPM is here for five years before, it will be replaced by another system, and that other system is already foretold. We are going to site neutral reimbursement where all institutional post-acute settings will get the same rate.

PDPM and the data that we are now collecting is really going to demonstrate that we are the best game in town.

We’re providing the best outcomes at the lowest cost. So this is just a simple stepping stone, if we crush this we are going to do exceedingly well in the future.

People come in completely paralyzed and walked out the front doors; we get the trimmest, leanest reimbursement, and many times we get outstanding results, and if that (PDPM) is the way to the future, then that is really amazing news for providers.

Key Takeaways:

08:24 When the clinical results and the clinical product have a direct financial impact, that’s when everybody wins; that’s when the residents win, that’s when the operators win, that’s when all the various partners win.

10:34 How can it be that in the industry that is created to care for elders, how can we be so bad at identifying someone’s at the end of life? How can we struggle so much with identifying people who are in pain. It is because our system does not reward that.

17:40 You push on one side of the water bed and the other comes up.

32:16 CMS believed PDPM will be budget neutral and there’s no way it’s going to be budget neutral. These changes are never budget neutral because behavior changes, we play by the rules, we change our behaviors, we start documenting things we never documented before.

Shalom shares with the listeners how he has a strong financial background in accounting, finance and business intelligence.

Throughout his career, he was drawn to the details and power that a strong understanding of the numbers had on actual day to day business decisions.

In one business, Shalom’s company inherited a business intelligence technology which Shalom built out into a real functioning system that produced the intelligent reporting systems that were important and applicable in real time.

These successes prompted Shalom to finally go out and create the full blown business intelligence system that he knew the SNF (nursing home) clientele really need.

Weren’t we always able to get similar information from regular back office reporting?

There are 2 problems with the old system of getting information.

With Megadata, the information is automatically available in real time. This allows the operators who embrace this technology to act on information that others won’t know for 45-60 days.

Who is this ideal for?

If you are a small organization with just a few facilities, this solution is probably not for you. The tool helps organizations that are growing into the mid level size.

When they are operating at that level, it’s critical to know this information to keep all the facilities in sync and operating at their highest level.

Admin Dashboard

There is a new feature developed by the Megadata team that shows a facilities administrator an overview of the most crucial information that a nursing home administrator needs to plan his day. This is a feature that is extremely beneficial on a facility level.

Visual Data

You don’t need to have a background in finance or analytics to understand the metrics in Megadata. The reports are very visual and easy to understand. Most importantly, they are easy to implement and act on.

Links

SNF Vision - learn who owns and operates nursing homes