ENGAGE Fall 2023

Get it Done AND THAT’S HOW YOU

Brookdale’s SIZE & SCALE OF

HURRICANE PREPARATIONS

eterans

UPHOLDING AMERICAN SPIRIT

AWARD WINNERS

YOUR TRUSTED SENIOR LIVING RESOURCE

ISSUE 6 | FALL 2023

THE IMPACT OF FSLA PASSING THE ALF MODERNIZATION ACT

IOR

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BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

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FLORIDA

is one of the most impactful states for the senior living industry.

WHAT OPPORTUNITIES LIE AHEAD FOR FLORIDA’S SENIOR LIVING COMMUNITIES & FLORIDA SENIOR LIVING ASSOCIATION

A MESSAGE

FLORIDA’S SENIOR LIVING INDUSTRY:

150,000 3,000 767 700 75 GENERATES $14.5

FROM OUR

ALFs

Board Chair

memory care communities independent living facilities and

joe jedlowski, mba/mha President, Distinctive Living

CCRCs

We were so excited to celebrate the association’s 10year anniversary during the ENGAGE 2023 conference in Boca Raton a couple of months ago. It was great seeing everyone and being engaged in the association’s educational sessions, fun events, and networking opportunities. I have been a board member with the Florida Senior Living Association (FSLA) for the past six years, and now, duly nominated to serve as the Chairman of the Board of Directors. I am truly honored and privileged to serve the Best of the Best, FSLA’s members and board.

a

economic impact, consisting of

57,000+ directly supported jobs, 53,000+ indirectly supported jobs, $647 million in government revenue, and $82.4 million in social responsibility.

Florida’s senior living economic impact is

At our core, we are dedicated to creating a thriving and supportive environment where our residents can enjoy their golden years to the fullest. The well-being and comfort of each resident remains our top priorities, and our board is committed to upholding the highest standards of care and excellence.

As members of FSLA, your input and feedback are invaluable to us. We encourage open lines of communication and welcome your suggestions, ideas, and concerns. Together, we will shape the future of the Senior Living industry and ensure that it remains a place where every resident and employee feel respected, cherished, and empowered. Here’s to a future filled with happiness, health, and shared moments.

Now that FSLA has celebrated its 10th anniversary, it’s time to begin looking forward to the next 10 years and the potential opportunities Florida’s senior living communities will have to enhance residents’ experiences. We’re also already examining how FSLA can continue to lead the nation in advancements for senior living providers while providing the best community opportunities.

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residents who reside in more than

Currently serves

greater than

HOTELS, ACCOUNTING or ELECTRIC POWER DISTRIBUTION

Florida’s population has the highest percentage of seniors in the nation.

This will continue to increase, and by 2040 more than 25 percent of Florida’s population will be over the age of 65. This will result in a need for more than 230,000 ALF staff members, up more than 170,000 for current numbers.

Predictions for Senior Living in the Next 10 Years Senior living communities must continue evolving to accommodate the changing preferences, needs, and abilities of the aging population, including more diverse living options, affordability, amenities, and activities to cater to different lifestyles, such as: • Providing unique, custom, and health-conscious physical fitness programs; holistic well-being, mental well-being, and emotional support care plans; • Eco-friendly designs; • Telehealth and technological advances; • Additional resident social connections with more personalized care and more access to natural settings; • Flexible communities that cater to seniors who split their time between their homes and an assisted living community; and

FLORIDA ALFs ALONE save an estimated

$

9 BILLION ANNUALLY

in Medicaid entitlements by providing an alternative to expensive, taxpayer-funded nursing homes that allows our cherished seniors to enjoy their twilight years with dignity in a home environment.

is proud to be the largest trade association representing

•

Increased access and affordability of communities to meet varying resident income and caregiving needs.

Continuous Growth and Adaptation for FSLA Over the next 10 years, FSLA will continue to focus on the following for the industry and members we serve by: • Elevating FSLA’s advocacy efforts and Political Action Committee to the next level. Through a larger collective voice, we will be able to more effectively influence policy decisions, collaborate with relevant stakeholders and amplify our impact on the issues that currently challenge our stability and future.

• Continuing growth in industrywide membership to deliver an expanded range of highquality services, fight emerging challenges from regulatory agencies and special-interest groups, provide comprehensive solutions, and increase the overall value to the industry.

• Increasing investments in workforce development, including training and retainment programs, and engaging and training foreign-born workers, retirees,

•

•

and collegiate/high school apprenticeships and partnerships.

Increasing opportunities for education programs for all staff levels -further enabling our members to connect and network at the state and local levels.

Providing ongoing communications to keep members informed about the latest trends, industry developments and regulatory changes that will impact their daily operations.

By implementing these strategies, FSLA will continue to effectively demonstrate value, build member trust and membership opportunities.

Additionally, long term sustainability for the association will create a more robust position, ensuring the longevity of our mission-driven work to continue fighting burdensome regulations and government overreach.

for Florida’s assisted living, memory care and independent living communities.

If you aren’t already a member, join now to influence the future of Florida’s senior living industry.

FLORIDA ALFs also enable more than

17 BILLION

$

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

Join FSLA

in productivity savings by allowing families to remain

in the workforce instead of taking time off or leaving their job to care for their loved ones.

floridaseniorliving.org | (850) 708-4972 | info@floridaseniorliving.org

YOUR TRUSTED SENIOR LIVING RESOURCE | 5

In THIS Issue FALL 2023

FSLA STAFF

Partnership, service, care The Optum care model and UnitedHealthcare Assisted Living Plan provide clinical care, specialized health care benefits and 24/7 telephonic support.

Learn more at optum.com/alc

Gail Matillo, MPA President & CEO Jason Hand, Esq. VP Public Policy and Legal Affairs Kristin Quirk, MS Membership & Partnership Director

Get a NO-COST CapTel Captioned Telephone!

The CapTel® Captioned Telephone shows captions

of everything a caller says, letting you read anything you cannot hear over the phone. To qualify for a no-cost phone, users only need hearing loss and an Internet connection! If you have difficulty hearing over the phone, contact your local Outreach Educator.

Mickie Oliva 954-415-9469 mickie.oliva@oeius.org

Several phones to choose from — for landlines, Internet, or mobile

FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON. Advanced speech recognition software is used to process calls, and, in certain circumstances, a live communications assistant may be included on the call. There is a cost for each minute of captions generated, paid from a federally administered fund. No cost is passed on to the CapTel user for using the service. CapTel captioning service is intended exclusively for individuals with hearing loss.

CapTel® is a registered trademark of Ultratec, Inc. The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc. and any use of such marks by Ultratec, Inc. is under license. (v1.7 01-23)

6|

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

4

Jimmie Fay Griffin, LPN Accounting & Membership Manager

EMERGENCY OPERATIONS 12 22

FSLA EXECUTIVE BOARD OF DIRECTORS

a message from our board chair

size and scale of brookdale senior living’s hurricane preparations are you prepared for the storm

HOSPITALITY & CULINARY 20 24

chef’s competition the restaurateur mindset

Chair: Joe Jedlowski, MBA/MHA President and CEO Distinctive Living

Treasurer: Lindsey Hacker CEO and CFO Inspired Living

Immediate Past Chair: Shelley Esden President and CEO Sonata Senior Living

Parliamentarian: Robin Khanal, Esq. Partner Quintarios, Prieto, Wood & Boyer, P.A.

LEGISLATIVE POLICY & LEGAL AFFAIRS

Past Chair: Melinda Skirvin Vice President Five Star Senior Living

Industry Partner Committee Chair: Matt Depenbrock Director of Business Development Guardian Pharmacy

8 10 34

Education Committee Chair: Marisa Strain Director of Quality Assurance SRI Management

OPERATIONS & REGULATORY

FSLI Chair: Gwen Thibault Divisional VP of Operations Legend Senior Living

14 17 30

Editorial and Business Offices 2292 Wednesday St. Suite 1, Tallahassee, FL 32308 850-496-2562 | floridaseniorliving.org

36

Vice Chair: Shelley Esden President and CEO Sonata Senior Living

Can’t Hear on the Phone?

BOARD SPOTLIGHT

CGB, CPM

Project Director

Katherine Upton Education & Engagement Director

Past Chair Emeritus: Mary Sue Patchett

© 2022 Optum, Inc. All rights reserved. WF6331817 02/22

Meredith Van Valkenburgh, MSAFA,

Secretary: Page Ensor Regional VP of Operations Brookdale Senior Living

Publisher: Gail Matillo gmatillo@floridaseniorliving.org

Creative Director: Katie Truelove ktcreative@me.com

Executive Editor: Katherine Upton kupton@floridaseniorliving.org

Advertising & Editorial Submissions engage@floridaseniorliving.org

ENGAGE, Volume 1, Issue 6 is published quarterly by Florida Senior Living Association, 2292 Wednesday Street, Suite 1, Tallahassee, Florida, 32308. Florida Senior Living member companies receive subscriptions for communities as part of their membership.

Free controlled subscriptions are also available to qualified individuals in the senior living business.

POSTMASTER, SEND ADDRESS CHANGES TO: ENGAGE, 2292 Wednesday Street, Suite 1, Tallahassee, Florida, 32308. Printed in USA. Copyright 2022. ENGAGE will not be responsible for the return of any unsolicited manuscripts or photographs.

Copyright © 2023 Florida Senior Living Association. All rights reserved. No part of this publication may be reproduced or transmitted in any form – print, electronic, or otherwise – without written permission from Florida Senior Living Association.

For media inquiries and advertising information, contact engage@floridaseniorliving.org.

Featured on the cover: The Winners of FSLA’s annual Chef’s Competition at ENGAGE2023. Winner, Chef Willie Enchill, Health Care Services Group, pictured center. Left to right: Chef Zachary Riordan, Chef Willie Enchill, and Chef Bagens Nerelus.

Other Chefs participating: Chef Mohamed Tarawneh, Retirement Unlimited, Chef Trevor Delaney, SRI Management, The Canopy of Hickory Creek, Chef Arthur Cox, Sonata East at Viera Photo Credit: Katie Truelove, ktcreative

38

and that’s how you get it done ahca update adrd training: what florida’s new laws require

best of the best awards out of sight, but not out of mind reducing risk through proactive quality management navigating polypharmacy in senior living ask monica

HUMAN RESOURCE INSIGHTS 18 29 32

ask a recruiter the what ifs understanding florida’s assisted living staffing requirements

EDUCATION & GRANTS 27

cna bootcamp

HO W AND TH AT’S

YOU •

• • •

•

by g a i l m at i l lo

Last month, I stopped by to visit a community and when I arrived, I was greeted at the front door by a beautifully-dressed resident wearing a Velcro belt to keep her from falling out of her wheelchair.

It immediately brought me pride & joy because she was a personal reminder of how FSLA is making a difference in the lives of the residents you serve every day.

You see, one day back in 2018, we received a call from a family member. He was very upset because his wife, who was living in one of our member communities, had fallen out of her wheelchair. Knowing his wife had trouble remaining safely in her wheelchair, the husband had devised a belt she could wear to keep her from falling out of the chair. However, when she moved into the assisted living community, the belt was technically classified as a restraint, and she couldn’t use it.

The resident’s husband was trying to keep his wife safe but was running into significant obstacles. We began looking into the situation to see how we could help him, which 8|

lead to researching additional technologies that could possibly be used in assisted living communities. We met with staff from the Agency for Health Care Administration (AHCA) to determine whether we could suggest legislative or regulatory changes. We also reached out to Natalie Campaneria, a Safety Management Consultant with the MEMIC Group, who met with us and AHCA to discuss various workplace safety equipment and new technologies on the horizon.

These conversations were revelatory. It was amazing to see so much new technology that residents could use to remain more independent and active while protecting their health and wellbeing. There were ways to lift residents out of bed without using Hoyer lifts; multiple safety devices, equipment and security measures for wandering, emergency response; opportunities to improve staff risk management; and devices for the general safety and security of the residents, staff members and communities.

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

With this information, we decided to draft legislation that would help communities and residents modernize the laws and rules to use technology to assist with their daily lives. The bill was called the ALF Modernization Act and it was sponsored by Senator Gayle Harrell (R-31) and Representative Michael Grant, Majority Leader (R-75). It provided policy-driven direction to modernize seniors’ assisted living experience; empower seniors with stronger consumer protections to better manage their care; and strengthen the community’s ability to serve seniors as residential models with a health care overlay in a competitive service industry.

Specifically, the bill: • Allows ALFs to admit or retain residents who need assistive devices, which are defined as any device deigned or adapted to help a resident perform an action, task, an activity of daily living, a transfer, prevention of a fall, or recovery from a fall; • Allows ALFs to admit residents who require 24-hour nursing care, or residents who are receiving hospice services,

if the arrangement is agreed to by the facility and the resident; additional care is provided by a licensed hospice; and the resident is under the care of a physician who agrees the physical needs of the resident can be met at the facility; Allows ALFs to admit residents who are bedridden if they are bedridden for no more than seven days, or no more than 14 days for an ALF licensed as extended congregate care; Allows the use of certain physical restraints in ALFs, including full-bed rails and geriatric chairs; Allows the State Long-Term Care Ombudsman Program to assist a resident who needs to be relocated due to a facility closure; Removes the requirement for ALF staff assisting with the self-administration of medication to read the label of the medication to the resident, instead requiring staff to, in the presence of the resident, confirm the medication is correct and advise the resident of the medication name and purpose; and Authorizes rules to address technological advances in the provision of care, safety, and security, including the use of devices, equipment and other security measures for wander management, emergency response, staff risk management, and for the general safety and security of residents, staff, and the facility.

“My community uses KARE and we love our Heroes!

We’ve hired several of our KARE Heroes!

I tell everyone I know to use KARE over an agency.

Quali Quality and much more cost effective.”

Plus... “KARE gave me a chance not to overwork my own staff.”

Becky Anderson Executive Director, Ponte Vedra Gardens

During FSLA’s short 10 years, we have passed six significant pieces of legislation to solve issues and challenges faced by communities and residents to create a positive experience and improve their daily lives. And, in this case, the ALF Modernization Act encourages communities to embrace technology and new innovations throughout Florida.

Examples like this emphasize the nature of our team to identify a problem, workshop potential options, present a solution, and see the effort through all the way to new laws being signed by the Governor. We’re proud of our reputation for getting things done well in a timely manner for our members!

WE TURN IDEAS INTO WORKS OF PEOPLE AND PURPOSE. For clients who seek a service-oriented design partner, our purpose-driven culture has lived strong for more than 30 years, resulting in facilities and communities that serve more than 100,000 patients and residents each week.

g a i l m at i l lo , m pa President/CEO Florida Senior Living Association

YOUR TRUSTED SENIOR LIVING RESOURCE | 9

by k i m b e r ly s m oa k , m s h , q i d p Legislative Updates SB 252 - Protection from Discrimination Based on Health Care Choices By 7/1/2023 the Agency for Health Care Administration (AHCA) and the Department of Health (DOH) shall jointly develop standards for the appropriate use of facial coverings for infection control in health care settings.

AHCA and DOH shall publish the standards on their respective websites and provide a link for persons to report violations.

By 8/1/2023 each health care provider shall establish facial covering policies and procedures complying with this law. These policies and procedures must be accessible from the home page of the provider’s website or conspicuously displayed in the lobby.

SB 1580 - Protections of Medical Conscience “Conscience-based objection” means an objection based on a sincerely held religious, moral or ethical belief.

Conscience with respect to entities is determined by reference to the entities’ governing documents; any published ethical, moral or religious guidelines or directives; mission statements; constitutions; articles of incorporation; bylaws; policies; or regulations.

A provider or payor has the right to opt out of any health care service with a conscience-based objection.

The individual must, at the time of the conscience-based objection or as soon as practicable thereafter, provide written notice of the 10 |

conscience-based objection to the health care provider’s supervisor or employer, if applicable, and/or document the conscience-based objection in the patient’s medical file.

HB 299 - Alzheimer’s Disease & Related Forms of Dementia Education and Training Act As of 7/1/23, the Department of Elder Affairs may develop rules.

Allowances are made during rule development for training completion.

Covered providers: nursing home, home health agency, nurse registry, companion or homemaker service, health care services pool, assisted living facility, adult family-care home, adult day care.

Upon hire: Basic written information.

Within 30 days of hire: One hour of training. The Department of Elder Affairs must make this training available online at no cost.

Training includes basics about the most common forms of dementia, how to identify the signs and symptoms of dementia, and skills for communicating and interacting with persons with Alzheimer’s disease or related forms of dementia.

Within 7 months after beginning employment for a home health agency, nurse registry, or companion or homemaker service provider, each employee who provides personal care must complete two hours of additional training including behavior management, promoting independence in activities of daily living, and Within 7 months after employment for a nursing home, an assisted living facility, an adult family-care home, or an adult day care center, each

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

employee who provides personal care must complete three hours of additional training including behavior management, promoting independence in activities of daily living, skills in working with families and caregivers, group and individual activities, maintaining an appropriate environment, and ethical issues skills in working with families and caregivers.

For an assisted living facility, adult family-care home, or adult day care center advertising or providing related care, there are additional training requirements at three and six months of employment.

There are also four hours of continuing training required each year.

HB 1471- Health Care Provider Accountability Effective as of 7/1/2023.

Provides ex parte injunctive authority relating to unlicensed activity (ULA).

AHCA may provide ULA inspection records to local law enforcement or the State’s Attorney without redaction.

Emergency Preparedness Reminders Comprehensive Emergency Management Plan: • Make sure your staff members have access to your emergency plan and are trained / well versed in the plan.

• Communicate with local authorities regarding your plan approval and throughout the event.

• Ensure you know who your local contacts are.

Evaluate Evacuation Plans: • Ensure you have confirmed agreements with your receiving facility (evacuation destination), to verify the agreements remain viable.

• Identify alternative options if your original evacuation sites are canceled or the route is impassible.

• Determine the emergency power options at the destination site

• •

including generator support and cooling equipment.

Confirmed agreements with your transportation providers.

Run through practice scenarios.

For example, will changes to your evacuation plans result in earlier movement of residents than usual?

Considerations for Receiving Facilities: • If you are a receiving facility, ensure you can accommodate the number of residents who will evacuate to your facility.

• During a power outage, will your generator-supported cooled space support your residents as well as evacuees?

• How will grouping residents and evacuees impact your use of this cooled space?

Confirm Emergency Power and Cooling Devices: • If your facility has a generator, perform all operation inspections and testing including monthly exercising of generators under load.

• Verify fuel for the generator is at capacity and any contracts with fuel distributors are in place for fuel delivery during a long-term utility power loss.

• Evaluate your generator and cooling device support.

Assess Onsite Supplies: • Ensure onsite supplies for sheltering are in place for an extended period of at least 72 hours. This should include the necessary food, water, medications and other critical items.

Review and Update the Health Facility Reporting System (HFRS) • Verify the contacts for your facility have registered and updated their information.

• Ensure previous contacts are removed.

• Designate a safety liaison.

• Verify information for each type of utility service is listed (list all utility account numbers for your facility).

• Verify the generator information

•

listed is current and complete.

Confirm the planned evacuation location(s) information is current and accurate.

CEMP Rule • 59A-36.019: Emergency Management • 59A-36.025: Emergency Environmental Control for Assisted Living Facilities • Workshop held: November 29, 2022. Next Steps: Rulemaking (myflorida.com) If you need assistance with HFRS please contact: Assisted Living Unit (850) 412-4304 Email: assistedliving@ahca.myflorida. com Top Ten Most Cited Tags Calendar Year 2022 1. A0081 — Training-Staff InService {429.52 and 59A36.011} 2. A0162 — Records - Resident {59A-36.015(3)} 3. A0078 — Staffing Standards Staff {59A-36.010(2)} 4. A0025 — Resident Care Supervision {429.26 and 59A36.007(1)} 5. Z814 — Background Screening {435.12 (2)(b-d)} 6. A0052 — Medication Assistance with Self Admin. {429.256(3-5) and 59A-36.008} 7. A0030 — Resident Care - Rights & Facility Procedures {59A36.007(5) and 429.28} 8. A0054 — Medication Records {59A-36.008(5)} 9. A0152 — Physical Plant - Safe Living Environment {59A36.014(3)} 10. A0084 — Training - Assistance with Self-Admin Meds and Med Management {59A-36.011 and 429.52(6)} Calendar Year 2023 {January 1 to June 16} 1. A0081 — Training - Staff In-Service {429.52 and 59A36.011} 2. A0078 — Staffing Standards Staff {59A-36.010(2)} 3. A0162 — Records - Resident {59A-36.015(3)}

4. A0052 — Medication Assistance with Self Admin. {429.256(3-5) and 59A- 36.008} 5. A0054 — Medication Records {59A-36.008(5)} 6. A0030 — Resident Care - Rights & Facility Procedures {59A36.007(5) and 429.28} 7. A0025 —Resident Care Supervision {429.26 and 59A36.007(1)} 8. A0152 —Physical Plant - Safe Living Environment {59A36.014(3)} 9. Z814 — Background Screening {435.12 (2)(b-d)} 10. A0083 — Training - First Aid and CPR {59A-36.011(5)} Reminder: Follow the AIRS reporting guide on the website.

Common Errors: • Medical history not provided.

• Cognitive status not provided.

• Not checking all applicable outcomes (Example: a fracture is checked, but the report said the facility transferred the resident to the hospital and transfer is not checked).

• Not identifying location/type of injury.

• Staff members involved in abuse were not identified if they were suspended.

Have Questions? Please contact the Office of Risk Management and Patient Safety directly at (850) 4123731, or by email at riskmgmtps@ahca.myflorida.com

kimberly smoak , msh , qidp

Deputy Secretary State Survey Agency Director Agency for Health Care Administration

YOUR TRUSTED SENIOR LIVING RESOURCE | 11

Eight of our communities were greatly affected by the storm, but all of our residents were successfully evacuated.

We were able to temporarily host most of them at other Brookdale communities and leverage our relationships with national hotel chains to accommodate the rest of our residents.

SIZE AND SCALE OF HURRICANE PREPARATIONS by lu c i n da “ c i n dy ” ba i e r

Hurricane researchers at Colorado State University have predicted the 2023 hurricane season will be above-average in activity, with 18 named storms, nine hurricanes and four major hurricanes of Category 3 to 5. Naturally, this kind of forecast makes senior living operators throughout the state of Florida more than a little nervous.

At Brookdale Senior Living, the comfort and safety of our residents is our top priority, especially during a natural disaster. With such a large geographic footprint across the country, we have experience with a wide variety of natural disasters.

Hurricanes, wildfires, floods and winter storms can happen quickly and sometimes without much warning. That’s why our communities do important work ahead of time before disaster strikes. This preparation is part of a comprehensive approach at Brookdale to plan for prompt action and effectiveness. We are determined to stay ready to help our residents and associates should a natural disaster strike.

12 |

As the largest senior living provider in the country, our size and scale provide great benefits to our residents and families. Our community associates and leaders are supported by a collectivelyseasoned management team at many levels of the organization, all the way up to our corporate leadership.

Communities are equipped with emergency plans and checklists to help prepare in advance. These plans include having supplies such as extra food, water, and batteries in the event they are needed. We also have emergency agreements in place with local pharmacies to provide medications during the storm. To help maintain the well-being of our residents, our emergency plan includes a course of action for staffing to provide for appropriate coverage 24 hours a day.

If we determine evacuation is the appropriate course of action, we have evacuation locations and plans already in place. In the unlikely event of an evacuation, we are often able to temporarily

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

Throughout every disaster, work hard to maintain the highest level of normalcy possible for our residents’ everyday lives. We believe relocate residents to another Brookdale community or work with hotels to secure rooms for our residents and supporting staff.

Brookdale’s scale also helps us maintain close relationships with vendors all over the country. These vendors help our communities acquire necessary equipment and supplies in a time of emergency. For example, contracts with bus vendors help Brookdale gain access to large commercial buses for evacuations, and our relationships with pharmacy vendors help establish action plans to provide medications as needed. Our relationships with our restoration vendors help damage recovery occur promptly so community life resumes as quickly as possible.

Those same relationships help facilitate access to food and supply deliveries just before and promptly after an emergency.

communication with our residents and their families is of the utmost importance and take great care to provide frequent status updates during an emergency affecting the community.

Brookdale is a mission-driven organization dedicated to providing our residents with quality care even under the most challenging circumstances. We believe that a well-coordinated natural disaster response clearly conveys our

commitment to help keep our residents safe. In the event of hurricanes or severe weather, we want residents and their families to experience genuine peace of mind.

So, while we never want to come face to face with a natural disaster… our team does prepare for the worst – in order to deliver the best.

lu c i n da “ c i n dy ” ba i e r

President, Chief Executive Officer Brookdale Senior Living

Lucinda (“Cindy”) Baier is the President, Chief Executive Officer, and a member of the Board of Directors of Brookdale Senior Living, the nation’s premier operator of senior living communities. As of year-end 2022, the $2.8 billion company operated 673 senior living communities and had the ability to serve more than 60,000 residents through its independent living, assisted living, memory care, and continuing care retirement communities. The company’s 36,000+ employees are taking care of America’s seniors.

Ms. Baier became Brookdale’s President, Chief Executive Officer, and a member of the Board of Directors on February 28, 2018. As CEO, she led the company through the largest public health crisis in 100 years by prioritizing the health and well-being of its residents, patients, and associates.

She focused the company’s efforts on increasing diversity, including the Board and executive leadership team approaching gender parity in 2020. Ms. Baier led Brookdale’s efforts to negotiate and restructure leases with its largest three REIT partners. She led the company through the sale of assets, including Brookdale’s interest in the unconsolidated entry CCRC ventures and the majority share of its home health, hospice, and outpatient therapy business. These deals unlocked significant value for Brookdale and shareholders. In 2022 Baier published her first book Heroes Work Here: An Extraordinary Story of Courage, Resilience, and Hope from the Front Lines of COVID-19.

When Hurricane Ian struck Florida’s west coast last year, Brookdale jumped into action and immediately activated our established emergency plans.

YOUR TRUSTED SENIOR LIVING RESOURCE | 13

by k at h e r i n e u p to n The FSLA Best of the Best Awards Program recognizes and honors individuals, nominated by their peers, from FSLA member providers and partners who provide extraordinary service to the residents and their community.

At Engage2023, Florida Senior Living’s Annual Conference, FSLA President/CEO Gail Matillo and Melinda Skirvin, FSLA’s Past Chair, VP of Five Star Senior Living, and one of FSLA’s founding members, had the pleasure of recognizing the recipients of our “Best of the Best” awards.

Employee of the Year: Nelson Ford, Director of Maintenance,

The Beacon at Gulf Breeze

“Nelson has cultivated a perpetual readiness, always poised to tackle potential emergencies. This persistent preparedness isn’t just about responding to crises swiftly; it’s about anticipating them. He maintains an acute awareness of Senior Living communities’ infrastructure, constantly monitoring its condition and planning for contingencies. His proactive approach means that he’s not caught off guard when emergencies occur but is ready with potential solutions.”

Caregiver of the Year: Qua’Vondra Sharp, Resident Assistant, Riviera Senior Living

“Mrs. Sharp always goes above and beyond when caring for and assisting her residents. She is always willing to lend a helping hand, support, or provide advice without being asked. If she knows something needs to be done, she will take the initiative and ensure all tasks are completed to the best of her ability. She assures that her residents always know and understand what is taking place when care is being provided, including that they have privacy.

She always makes sure that she provides direction cues, reminders, and choices to each resident when it comes to clothing, eating, and all 14 |

the daily needs or wants.”

Health and Wellness Director of the Year: Laura Ricks, Health and Wellness Director,

Sodalis Senior Living

“Laura knows the residents inside and out, and is very good with families, as well. She’s a hard worker who would never ask others to do something she wouldn’t herself to alongside them. Laura will assist at all levels in her own community but also at Sodalis’ sister communities. She believes in what is best for the residents always; they come first.”

Memory Care Director of the Year: Viveychka Otero, Memory Care Director, Discovery Senior Living

“Vivi not only concerns herself with ensuring our residents are provided with meaningful opportunities for engagement, but she takes care of the whole person. She is an exceptional team player who is not afraid to roll up her sleeves and get the work done. Vivi is an excellent advocate for memory care residents and team members. She concerns herself with ensuring that residents are taken care of, and that staff are happy, appreciated, and recognized.

Vivi brings in a wealth of creativity and most importantly, compassion to the team.”

Sales & Marketing Director of the Year: Brenda Pickard, Sales & Marketing Director, Legend Senior Living

“Brenda’s skillset consists of being forward-thinking, creative, and innovative. She supports always finding a way to meet the family’s needs by collaborating with her team and other resources alike to find the best possible solution, whether it’s with us or somewhere else. She is all in and truly sets the standard. Brenda is embedded in her community; she goes above and beyond lending her time and expertise to various charity events, local organizations, and supporting local businesses.”

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

Executive Director of the Year: Dan Weese, Executive Director, Grand

Villa of Palm Coast

“Dan is always involved in the resident’s day to day quality of life. He gets involved by dressing up for dinners and events… I’ve seen him dancing with residents at events as well. Dan inspires his residents and staff, as well as a group of students whose classroom is the ALF he oversees. Dan is instrumental in helping these young women and men of Project Search, students at Flagler County Schools, who get to see firsthand how they can make a difference in others lives. Dan is involved in their training throughout the year and their graduation ceremony.

Dan’s leadership skills go beyond teaching or being the boss.”

Emily Adkins Bright Star Award: Marshall Legard, Executive Director,

Employee of the Year: Nelson Ford

Memory Care Director of the Year: Viveychka Otero

Caregiver of the Year: Qua’Vondra Sharp

Sales & Marketing Director of the Year: Brenda Pickard

Health & Wellness Director of the Year: Laura Ricks

Executive Director of the Year: Dan Weese

Grand Villa of Altamonte Springs

Industry Partner of the Year Award: Aaron Fish, CEO/Founder, Trestle Hospitality Concepts

Leadership Award Recipients: Charles Dellaria, Executive Director,

Leadership Award: Charles Dellaria

Holiday by Atria Senior Living

Leadership Award: Noelle Laponte

Leadership Award: Tammy Tolley Hunt

Noelle Laponte,

Executive Director, Lexington Manor, a Five Star Senior Living Community

Tammy Tolley Hunt,

Executive Director, Brookdale Port Charlotte

Emily Adkins Bright Star Award: Name Name accepting on behalf of Marshall Legard

k at h e r i n e u p to n

Director of Education & Engagemen, Executive Editor of ENGAGE Florida Senior Living Association

Industry Partner of the Year: Aaron Fish

OUT OF SIGHT, OUT OF MIND

Caring for Veterans and Upholding the American Spirit According to a recent study, there are currently 2,000,000 residents in assisted living. Of these 2,000,000 residents, 42% are Veterans or the spouses of Veterans.1 According to these numbers, there are an estimated 840,000 Veterans/ Veteran spouses in assisted living today. To give context, there are only 139,147 recipients of Aid and Attendance, a benefit designed to help Veterans and their spouses afford senior care.2 Hypothetically, if only half of the 840,000 Veterans and/or spouses qualified for Aid and Attendance, then that leaves over 250,000 Veterans and/or spouses who are missing out on a benefit that could help them afford their senior care. Sadly, this estimate does not include the number of Veterans and/or their spouses who are going without care or are receiving care at home, which inevitably raises the number of potential candidates for aid. Although it is difficult to reduce this equation down to one number, it can be said with confidence that the number of Veterans/ Veteran spouses receiving Aid and Attendance. pales in comparison to the number of Veterans/Veteran spouses who could be receiving Aid and Attendance. Sadly, many of these potential candidates end up never receiving the care they need or crumble under the weight of care costs without assistance. This is why Patriot Angels exists.

1 2

A Growing Problem In his second inaugural address, Abraham Lincoln implored the American people “to care for him who shall have borne the battle and for his widow, and his orphan.” For many years, this was the motto of the Department of Veteran Affairs.

Today, their motto reads “To fulfill President Lincoln’s promise to care for those who have served in our nation’s military and for their families, caregivers, and survivors.”

It wasn’t President Lincoln, however, who introduced the idea of caring for Veterans and their families. For as long as our Nation has known war, our people have understood the need to care for those who fight for us. This is the part of the American spirit that Patriot Angels continues to uplift. How do we accomplish this? By assisting Veterans and their spouses receive the benefits that they have earned to afford the care they need.

call of Abraham Lincoln. It is our duty “to care for him who shall have borne the battle and for his widow.”

It is through our relationships with senior care communities that we can connect with those who have served our Nation, and in turn, keep our Nation’s heroes in a place where they can afford the care that they need. To quote our founder, Suzette Graham, “We exist the lead the change to protect the vulnerable.”

In a time when our culture is moving increasingly faster, it can become easy to leave behind those who are at a stage of life when they need to slow down. Your residents were once farm boys storming unfamiliar lands, fighting for the ideas that keep our Nation free. But now it is our turn to fight for them. Happy Veteran’s Day to you and yours.

For more information, contact Patriot Angels, (844) 757-3047.

What is Patriot Angels?

Founded in 2012, Patriot Angels has grown into one of the leaders in our industry. In 2022, we accounted for 16.4% of all Aid and Attendance approvals across the Country. At the time of writing, our company has assisted over 17,500 Veterans/ Veteran spouses with obtaining benefits. However, Patriot Angels is not just a product to be sold. Patriot Angels is a mission to uphold the

https://www.argentum.org/argentum-statement-on-senate-veterans-affairs-committee-hearing-examining-veterans-access-to-long-term-care/ 2022 Annual VA Benefits Report

YOUR TRUSTED SENIOR LIVING RESOURCE | 17

Q: What placement services does MedBest offer?

ASK A RECRUITER by j u l i e r u p e n s k i ,

MedBest Recruiting, Founder and CEO

Q: What are the benefits of hiring an interim for a vacant role?

A: Interims are seasoned long-term care professionals with a deep knowledge of and experience in the senior living industry. They bring strategic and operational expertise when the predecessor has resigned, retired, left suddenly, or needs an extended break. However, they are often brought aboard for other reasons besides filling vacant positions including crisis management, strategic planning, project work, specialized skill sets, fresh ideas, and new solutions, etc.

Q: Does it cost anything to interview the interim candidate before deciding to use one?

A: It does not cost anything to interview interims and you’re not obligated to use them if you talk to them. We know that it takes an interview for you to determine if there’s a good fit. However,

remember that interims have a very short shelf life of availability, and the interview just gets the ball rolling. If you interview an interim and feel there’s a match, speed is the name of the game. If you don’t hire them quickly, another senior living organization will.

Q: How can an executive search firm save me time and money?

A: Are you putting everything aside to focus on recruiting? If so, you know that executive talent acquisition can be time consuming and resource intensive. Each hour you spend takes you away from your usual work and ultimately, productivity suffers. Senior Living executive recruiters can streamline the recruiting process for you by tapping into their network of highly qualified candidates, handling candidate screenings, reference checks, background checks, initial interviews, and salary negotiations allowing organizations to focus on their core responsibilities.

Q: How can we ensure a candidate won’t accept a counteroffer?

A: First, you need to understand the candidate’s current situation and motivation to leave their employer. If pay is the only reason, your candidate may be tempted to accept a counteroffer. However, if not, we advise that you stay in touch often and highlight the positive aspects of the new position and get them ready to make a change.

At MedBest, our team takes several proactive approaches during the hiring process to minimize the likelihood of a counteroffer. We work as consultants throughout the whole process supporting candidates. We are trained on how to navigate counters and sniff them out early in the process. We know how to get a candidate through a rough resignation. We support their salary needs and remain close to them every step of the way.

A: MedBest Recruiting offers both perm and interim talent solutions for the full continuum of senior living including Assisted Living, Independent Living, Life Plan Communities / CCRC, Skilled Nursing Facilities & Memory Care Facilities. Once you partner with MedBest for an executive search, you will have access to a large and vast network of industry

executives, both active and passive candidates. Because MedBest’s leadership is directly from the industry, we’re connected to the best executive talent in the US. MedBest is an award-winning national Executive Search Firm exclusive to the Senior Living Industry. For more than two decades, we have connected senior living organizations with exceptional senior living executive talent for both permanent and interim roles.

The MedBest Interim Solutions Division was named one of the Top 10 Interim Service Providers

by ManageHR Magazine 2023. In 2021, MedBest was honored as one of American’s top companies

by Inc.5000 and Tampa Bay Business Journal (TBBJ) named MedBest as a Fast 50 Company in Tampa.

julie rupenski Julie Rupenski is the Founder & CEO of MedBest Recruiting. Since opening its doors in 2001, Julie has grown MedBest into an award winning, multimillion-dollar national firm, garnering impressive awards including INC 5000 2021 and Tampa Bay Fast 50 2021! Julie was also named as one of the “Top 100 Women Leaders in Tampa 2022″ by Women We Admire.

MedBest has gained national recognition due to Julie’s industry expertise and high level of success. Julie has an in-depth knowledge of the senior living industry. She previously worked in operations for both senior housing and senior living prior to founding MedBest. Today, Julie and her industry-savvy team of recruiters, make it their mission to place exceptional industry executives in senior living positions where they have the greatest impact.

Senior Living Executives Placing Senior Living Executives ~ Exclusive to the Senior Living Industry

Ask a Recruiter

~ Permanent & Interim Talent Solutions

~ Senior Search Consultants Are Former Industry Executives ~ Assign Recruiter & Research Team to Every Search ~ Network of Highly Qualified Executive Talent

727.526.1294 • info@medbest.com • www.medbest.com 18 |

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

YOUR TRUSTED SENIOR LIVING RESOURCE | 19

Champion Willie Enchill, Regional

s h aw n m cg r eg o r ,

m ba , m c f b d , m c f e , c d m Area Executive Chef, Healthcare Services Group, Inc.

When someone thinks of senior living, they likely consider the accommodations, the services offered, and the activities available to the residents. What may often be overlooked is the incredible work of the food service professionals who endeavor to enrich the lives of their residents through dining services that not only provide sound nutrition but also outstanding meals that rival high quality restaurants.

For the past several years, the Florida Senior Living Association (FSLA) has highlighted these culinary accomplishments through its Chefs Competition at its annual conference. I have had the pleasure and the privilege of supervising this event since its inception, which has become a must-attend event like no other. As a trained chef with decades of experience, I cannot stress enough the importance of quality dining services in senior living communities, and this competition has elevated the recognition this work truly deserves.

Each year, FSLA invites a handful of chefs from its member communities to participate in the live competition, which offers the opportunity for communities to show off their chef and their dining programs as an entity. With the experience level of chefs who

20 |

participate continuing to grow with each passing year, the competition has become more and more fierce.

Over the years, the competition has evolved to its current iteration — a single dish which the chefs must create with their own personal flourish. Standard ingredients and equipment are provided to each participant, who are also encouraged to bring their own extra ingredients to make their dish shine.

It is nothing short of fascinating to see the vast difference in the results presented by each of the chefs as they serve their results to a panel of professional judges.

What I personally enjoy is the engagement, support and enthusiasm shared by the members of the organization these chefs represent. As each chef works on their creation, their colleagues gather to cheer them on in front of hundreds of enthusiastic audience members. This event encourages full participation from spectators unlike any other professional development opportunity.

As we move forward after the pandemic, I believe food has become more important than ever before for many reasons.

During COVID, our senior living communities struggled to provide a safe and engaging environment

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

for their residents to enjoy their meals. For long periods of time, the camaraderie of sharing meals was lost, highlighting the importance of not only excellent food but also the benefit of breaking bread together.

Supply chain issues, staffing shortages and other challenges added to the struggle, and many of these challenges still exist today.

However, quitting has never been and never will be an option. As an industry, we have risen to the challenges and our food service divisions are once again flourishing.

It will always be important to serve our residents and their families, as well as our staff and their families, through our dining programs. And the best way to accomplish this is engaging and empowering our chefs and their teams.

If I have learned anything from participating in the annual Chefs Competition, I have learned just how critical this engagement and empowerment truly is. When your chef has this support, the positive results will be transferred back to your facility, its residents, families, and staff.

We hope you and your chef join us in the years ahead.

Executive Chef, Health Care Services Group Willie Enchill recalled his culinary passion beginning around the age of 9 as he watched his mother and aunties cooking and wondered how it was possible to make the dishes he saw. Enchill attended Le Cordon Bleu in London in 1997 where he developed his passion for mixing bold flavors, specializing in mixing traditional French cuisine with his palette for African & British fusion.

He has now found his home in senior living, making dishes simple enough to be understood yet unique enough to be marketable. This is what makes him such an asset to the communities he serves.

“Having elevated dining is important because it bridges the gap between family, residents and clients,” explained Enchill. “It’s also critical to give residents an experience which is both memorable and consistent.”

Regardless of who is in the kitchen, a resident should not be able to tell the difference between chefs, which requires great consistency and accuracy, both in taste and texture.

Enchill explained how these factors enliven residents, often causing them to share stories about their

own dining experiences or their favorite meals.

the judges smiling after trying his delicious dish.

“If we can make a memorable experience by mimicking something from a resident’s history or home, we can improve the physical, mental and emotional health of our residents,” he said. “Residents especially look forward to their meals because meals are often where they have the most control.”

Runner Up Bagens Nerelus, Food

The FSLA Chefs Competition was not Enchill’s first time competing, as evidenced by the complexity of his dish’s presentation. He recalled winning the People’s Choice award at a recent senior living chef competition in Maryland, and has given live cooking demos for FOX News. He said the FSLA’s Chefs Competition is unique due to the interaction with the audience and he enjoyed hearing their live feedback.

Enchill was inspired to include palm leaves and coconuts in his dish’s presentation when he landed at the Palm Beach airport for the annual conference, leading him to infuse his dish with coconut hickory smoke. Using a torch and glass case to infuse his Chicken Scapariello, he left the audience in awe and

Service Supervisor, Grand Villa of Boynton Beach Bagens Nerelua has had a passion for cooking ever since he was a child. Growing up in Haiti as the eldest of five children, Nerelus has always been interested in trying new recipes but his favorite is a tried and true classic — chicken Parmesan.

At 37, Nerelus has been a chef for 16 years and has worked at Grand Villa of Boynton Beach for 6 years. He appreciates how Grand Villa feels like a home with the relationships between the residents and staff members, and he knows he is making a difference in people’s lives through his cooking. Whenever he is not at Grand Villa, he maintains the same passion through his catering business for small events and parties…so keep this winner in mind for your next gathering.

Bagens explained his participation and winning at FSLA’s 2023 Chef Competition as an exciting opportunity to showcase his cooking skills. He states he was truly grateful for the opportunity to compete, and we are just as grateful to him for his dedication to the industry.

Chicken Scapariello INGREDIENTS

PREPARATIONS

1½ pounds fingerling potatoes, halved lengthwise 6 tablespoons extra-virgin olive oil, divided Kosher salt, freshly ground pepper 3 links sweet Italian sausage 6 skin-on, boneless chicken thighs 2 large onions, 6 garlic cloves, finely grated 1 cup dry white wine 1 cup low-sodium chicken broth ½ cup chopped hot, sweet, pickled Peppadew peppers in brine ¼ cup white wine vinegar 1 cup heavy cream

Step 1: Arrange racks in upper and lower thirds of oven; preheat to 450°. Toss potatoes with 3 Tbsp. oil on a rimmed baking sheet; season with salt and pepper. Arrange cut side down and roast on lower rack until tender and cut sides are browned, 20-30 minutes; set aside.

Step 2: Meanwhile, heat remaining 3 Tbsp. oil in a large skillet over medium-high. Cook sausages, turning occasionally, until browned on all sides, 6-8 minutes (they will not be fully cooked). Transfer to a plate.

Step 3: Season chicken on both sides with salt and pepper. Cook in same skillet, turning occasionally, until golden brown on both sides, 8-10 minutes (they will also be undercooked). Transfer to plate with sausage.

Step 4: Cook onions, pepper, and garlic in same skillet over medium-high heat, stirring occasionally and scraping bottom of pan, until tender and beginning to brown, or 12 minutes. Add wine and cook, stirring occasionally, until reduced and you can no longer smell the alcohol, about 8 minutes. Add broth, peppers, vinegar, and rosemary and bring to a boil; cook until slightly reduced, about 5 minutes.

Step 5: Nestle chicken into onion mixture, then transfer skillet to upper rack of the oven and roast chicken for 10 minutes. Add sausages to skillet, pushing them into onion mixture, and continue to roast until chicken is cooked through and a thermometer inserted into the thickest part of thigh registers 165°, about 5-10 minutes.

Step 6: Top with parsley oil and garnish; infuse with hickory smoke. Serve with roasted potatoes alongside.

YOUR TRUSTED SENIOR LIVING RESOURCE | 21

Are you

-

for the storm? by k r i s t i n q u i r k

Preparation for Hurricane Season: Everyday Our state is especially vulnerable to tropical storms and hurricanes, which means it is vital for your community to have an emergency plan in place. Before hurricane season even starts, creating your plan is essential for having a safe hurricane season. As members of FSLA, we can help ensure your community, residents and employees are safe.

FSLA understands the importance of safety, proper planning and communication, and our members can rely on us to be a resource when faced with a disaster.

Our relationship with AHCA allows us to track down information and answers to any questions you may have as well as provide your community with advice and instructions.

To understand the measures your community must take to ensure safety and avoid great liability, FSLA attended the Pre-Hurricane Season Association Meeting at AHCA. These are the points our team gathered that from the meeting: Hurricane Season Checklist: • Verify your comprehensive emergency management plan (CEMP), including your emergency environmental control plan (ECCP) and other plans.

• Make sure your contact info in AHCA’s HFRS is up to date, and you have all necessary log-in information.

• Know your mandatory evacuation zones and comply with evacuation orders. Unsure? FloridaDisaster.org allows you to search by address.

• Verify your evacuation location(s).

• Future plans are vital. Don’t wait until a storm is being tracked to start yours.

• All facilities are required to have generators, and they should be tested and retested.

• Make sure you have the required amount of fuel for your generator, and double check your fuel contracts.

• •

Focus on your residents and staff.

We understand turnovers and ownership changes happen, but you should still be prepared, and have instructions set in place.

- FLSA recommends having training/retraining in place, so all new and existing staff know what to do when faced with a hurricane.

• Understand the types of residents and staff your community has.

- This will help when ensuring you have enough supplies on site and that your supplies are specific to your community.

• Reach out to your county emergency management office.

- Tell the county emergency management office that your community is an assisted living facility (not a nursing home).

Tell the county emergency management office what types of residents/individuals are in your community.

- Get contact information, including cell phones, so you can reach appropriate persons immediately.

• Reach out to transportation companies and get contracts in place for potential evacuations.

• Staff members should know who is in charge when faced with hurricanes, crises and emergencies.

• Staff members who are in charge should: - Be in contact with FSLA and AHCA. - Know your CEMP. - Know who to reach out to: county emergency management first, then the state and/or FSLA. When Evacuating: • If your community evacuates, you must reach out to your local AHCA field office.

- Your community will need to be examined, especially if there’s damage, before you return.

• Recap: Know what the mandatory evacuation zones are.

• Recap: Verify your evacuation location.

• ACHA will investigate failing to evacuate or not implementing emergency management plans!

- As a member of FSLA, we can help prevent you from having any of these issues with AHCA. Post-Hurricane Wrap Up: • Continue coordination and communication post disaster.

• Understand lessons learned from previous storms: - What worked?

- What did not work?

- What can we do differently this time to improve our plan?

Communication. Collaboration. Coordination = KEY! FSLA cares about the safety of your community, residents, and staff. For us to communicate with you when faced with a disaster, we have to have your emergency contact information.

Please provide your emergency contacts (cell phone) to Kristin Quirk, our Director of Membership & Partners.

You can reach her at membership@floridaseniorliving. org or 850-708-4972.

Advice from FSLA: 1. Send FSLA your emergency contact information.

2. Take another look at your plans, and practice them with your staff members.

3. Do not just have plan A and plan B in place. Have plans C and D just in case – the more options the better.

4. Re-test generators! Test! Test! Test!

5. Ask an FSLA team member about updates from AHCA. 6. Stay Alert! Keep a lookout for any hurricane updates and hurricane preparation updates from FSLA. We want your community to feel prepared for hurricane season. FSLA is your trusted senior living resource, and we are always here to help!

kristin quirk, ms

Director of Membership & Partnership Florida Senior Living Association

YOUR TRUSTED SENIOR LIVING RESOURCE | 23

regularly in order to maximize them. The best way to address this is to have the right menu management tools and processes in place. Doing regular reviews of your menu and menu inputs - things such as order guide, standardized recipes, production records - will let you see opportunities to make appropriate adjustments. The key though is to not just shop around for the best price, but find the right mix of price and quality to avoid wild swings in quality and satisfaction.

Another thing that restaurateurs do is know the value of menu engineering. Understanding the value of menu items from a satisfaction and cost perspective will maximize your ability to manage your menu composition. Having the right systems in place will allow for this to be an easy and successful endeavor.

2. Install Systems for Inventory & Waste Management by a a r o n f i s h Operators across all sectors of senior living (and food service in general) have been battling inflation and expense management for quite some time. Being in the service industry and knowing that what we provide is a service of people serving people, labor has been a large factor in this conversation.

But what operators are also fighting is the increases and struggles that come with managing their second highest expense - food costs. It’s important to know that while the decades-high growth rates in food costs are in the past, average food prices are still well above pre-pandemic levels. As of June 2023, the Producer Price Index for All Foods remained more than 24% above its February 2020 reading per the National Restaurant Association. Add to this that many senior living operators do a poor job of waste management, and you have some serious opportunities to have a bloated food expense line. But the good news is that with the right focus on key areas and processes, you can reign that all in and keep your food costs in check for the most part. This is why you should think like a restaurateur.

Their job is to maximize their profits on food, and that comes with a different mindset than you typically see in senior living. To create this mindset, here are four areas of opportunity that every operator should focus on in order to get the most for their food dollar:

1. Understand Your Menu Composition

Many times when senior living operators develop their menus, it is typically a bi-annual process. We do a big shift in menus seasonally, and then we let it go until the next menu rollout is due. While this is not inherently a bad thing, it can cause some reactive management and complacency in food cost management. Restaurateurs do not think this way. They are evaluating their menus 24 |

Speaking of having the right systems in place, it’s important that you have regular processes to manage both your food inventories and your production and service food waste. Restaurants invest in the right systems and value knowing all of the inputs and outputs of their kitchens.

When looking at waste, senior living operators typically are not very good at waste management. As a whole, the industry sees anywhere between 18%-20% food waste versus 7%-9% for commercial operators. Better production processes (avoiding bulk production when possible), better tracking tools and specific waste management initiatives will all create a lower waste percentage.

Inventories are also a big opportunity for senior living operators. First and foremost, if you don’t do a monthly inventory, start now. This is food cost management at its simplest and easiest to find opportunities and issues. Also, simply adding weekly stock counts (a common practice in restaurants) of your top 15-20 cost items or largest movers can add up to 10% to your bottom line annually. Creating a consistent system and training multiple employees on how to take these inventories will allow for a successful inventory process for your operation.

The other thing to remember with data is that you have to understand G I G O - Garbage In, Garbage Out. If you are not collecting your data consistently or accurately, the trends that you get will not be reflective of what is actually happening in your various food service outlets. So having the right data will not only help you with managing food costs, it won’t be a waste of valuable employee time.

4. Educate & Engage Your Employees

Employees are the key to any foodservice operator’s success. But to create a culture of employee engagement, you have to give your employees the WHY. They are the

BOLDLY DEFINING THE FUTURE OF SENIOR LIVING

part of their daily routines. Showing value for them will help them to value it for you.

Hiring and onboarding successfully is critical, and you have to develop the journey with the end in mind.

Creating learning touch points, developing training partners, and having knowledge and skills checks are all key components. You also have to create a connection with the data. If you show them how the data not just benefits the company but how it can also impact them, you will see employee buy-in quickly grow and become a normal

These are all items that will initially feel like more work. But once you set the stage with the process and then create and show the value of it all to the team, you will see the benefits and return on investment of your time and dollars. These will create better employees, increase resident satisfaction, and allow you to be surgical in your approach to managing food costs. To learn more about these key drivers, you can email the Trestle Hospitality Concepts team at info@trestlehc.com

aaron fish

Founder & CEO, Trestle Hospitality

FOOD & BEVERAGE EXECUTIVE CONSULTANT TO THE SENIOR LIVING INDUSTRY

3. Follow Your Data Trends

Creating within your food service culture a data-driven operation is key to being successful with managing your food costs. Whether you are capturing it or not, your kitchens and dining rooms are creating multiple data points every meal that you can use to maximize your operation. The best restaurateurs know their data, and use it daily to make decisions on all aspects of food cost management, We recommend finding the right software that can meet your needs, but at a minimum, manually capturing data from purchasing, production records, your point of sale, inventories, and waste logs will give you a great start and insights on what the trends are in your operation.

ones that are daily creating the food and experience in your community. But how do we do this? It starts with training RELENTLESSLY.

Consulting Executive Kitchen & Dining Design Corporate Training & Education Operational Audits F&B Program Development Concept & Menu Development Marketing & Brand Awareness info@trestlehc.com 682.593.2034

2023

www.trestlehospitalityconcepts.com

Industry Partner of the Year

YOUR TRUSTED SENIOR LIVING RESOURCE | 25

boot ca

mp

FOR NEW AND CURRENT ALF EMPLOYEES

CNA

CNA TRAINING

Training includes an online program with course materials, clinical test skills preparation, and paid Prometric test.

Each facility may have four (4) learners enrolled at one time.

THREE LEARNING TRACKS AVAILABLE by m e r e d i t h va n va l k e n b u r g h

TEAL TRACK

for Experienced Staff

SILVER TRACK

CORAL TRACK

for All ALF Staff

for Newer Staff

Online Learning Management System

Google Classroom Setting

Weekend “Boot Camp” training for 8-16 learners.

75-Hour Online Training Course

2-7 Week Online Training Course

•

•

• • •

CNA overview: Basic nursing skills, Client Rights, Communication, Legal and ethical behaviors, and Spiritual and Cultural Issues Online coaching for test prep CNA Practice Written Exams CNA Clinical Skills Review

• •

• • •

CNA Prometric material overview Basic nursing skills, Client Rights, Communication, Legal and ethical behaviors, and Spiritual and Cultural Issues Online coaching for test prep CNA Practice Written Exams CNA Clinical Skills Review

Ready to Learn?

SIGN UP NOW

flseniorlivinginstitute.org/cna-training

Requirements

Summer is one of my favorite times of the year, not only because I enjoy the season but also because FSLA hosts our annual conference each summer.

We work throughout the entire year to plan the best possible event, searching for the right mix of speakers, classes and extra details to ensure a successful conference for our member communities and industry partners.

Training Map

This year’s conference was additionally beneficial because for the first time, we hosted a CNA Bootcamp at no cost to either the communities or the participants.

This bootcamp, led by Dr. Lori Barnes, APRN, is the first of many FSLA and the Florida Senior Living Institute (FSLI) are planning to offer around the state.

•

Over the course of two days, participants were instructed

• • •

•

• • • •

Dedicated Classroom for up to 16 Weekend Learners.

Two Dedicated Testing Rooms on Monday and Tuesday Qualify Testing Rooms for In-Facility Testing (IFT) with assistance from FSLI. WI-FI connection for written computer testing.

Community qualifies for program at least four weeks prior to Boot Camp.

Students must register in Prometric for CNA exam three weeks prior to Boot Camp.

Students review and study online in the weeks prior to Boot Camp.

Students receive textbooks 1 week prior to Boot Camp.

Students complete Boot Camp on a Saturday and Sunday.

8 Max Learners for Written and Clinical Skills Exam on the next Monday and Tuesday.

flseniorlivinginstitute.org | (850) 755-6583 | meredith@floridaseniorliving.org

about the materials on the written exam and took part in live demonstrations of the 22 required clinical skills. Each student received a textbook, online access to hone their knowledge, and test taking strategies for the written exam and the clinical test.

This means students can learn in a group environment and then take the exams locally at their convenience.

This first group of students was extremely motivated. Every step of the way, they would interact with the clinical skill demonstrations, ask questions to gain better understanding of the Prometric exam, and take detailed notes to ensure their future success with the material.

These educational bootcamps enable participants to strengthen technical knowledge together, encourage group problem-solving skills, and promote engagement in visual learning.

Our summer students came from communities in the Boca Raton area, highlighting the benefit of having a local bootcamp for community staff to attend.

And because most senior living communities are located in areas with a higher population density, increasing the probability that a Prometric testing site is nearby.

Based on this model, we are now scheduling weekend bootcamps in communities around the state. The learning module will take place on Saturday and Sunday from 9am-2pm with lunch provided. Dr. Barnes will provide the instruction, lead the demonstrations, and facilitate the educational overview. Students will attend both days and prepare to challenge the CNA exam, armed with the best passing strategies and knowledge.

We are currently looking for communities with an interest in having their staff members attend and that would be willing to host the weekend training.

The required space is minimal and will not create any disruption for the host community, its residents or its staff members.

If you are interested in hosting a weekend bootcamp in your community, please contact me for more information at: meredith@ floridaseniorliving.org or 850755-6583.

m e r e d i t h va n va l k e n b u r g h Project Director Florida Senior Living Institute

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THE

WHAT IFS by j i m m i e fay g r i f f i n j i m m i e fay g r i f f i n

Accounting & Membership Manager Florida Senior Living Association

Throughout our lives, it’s common for us to make decisions based not on a current need, but on something that might happen in the future. This is what drives our decision making when we purchase insurance, extended warranties, and other protection plans. We’re thinking, “what if this happens,” or “what if that breaks,” and we take proactive action to prevent or correct something that isn’t even on the horizon yet. It’s not a bad idea to consider the “what ifs” when you’re making decisions because it forces you to think about things that might go wrong and how you can keep them from negatively affecting you.

When I was working in a senior living community, I remember a gentleman who told me about why he chose to move out of his home of 20 years, even though he was still quite capable of tending to his own affairs. He told me he made his decision based on his own series of “what ifs” and how they might affect his future quality of life. For example, what if he reached a point when he couldn’t take his medications on time and correctly without realizing it? What

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if he fell and was unable to get timely help? What if he waited too long to make the decision to move and his daughter had to make the hard choices? He told me everyone should plan for the “what ifs” in all aspects of their lives, and I completely agree with him.

The “what ifs” can affect us professionally as well. What if your community doesn’t have the proper information about emergency evacuation requirements? What if your staff members are behind on your training? What if a surveyor shows up and you can’t find the right documentation for something you know you already have taken care of?

Fortunately, that’s where the Florida Senior Living Association can help our members. We work hard to provide the best information and protection possible from potential “what if” situations.

Our dedicated and experienced team can help you save money, prevent potential frivolous lawsuits, and meet the needs and desires of your residents and staff members, among other things.

When I first started working in an assisted living community, I dealt with day-to-day issues. But no matter how hard we tried, we could never imagine every single challenge that was ahead for us. Who could have predicted the pandemic and the countless ways it affected our industry? We probably dealt with about 15 “what ifs” an hour in 2020 and even that might be a conservative estimate.

Now that I work with FSLA, I am proud of our team’s ability to help our members deal with whatever the day throws at them while continuing to prepare for tomorrow.

Senior living is a challenging industry, and it’s so important for senior living professionals to work together toward a common goal – providing the best care possible for elderly residents who need that special place to call home. Helping our members provide that care while handling the “what ifs” is the primary goal of our association.

Your membership offers your community our expertise and assistance in preparing for and maybe even preventing those “what ifs” from every happening.

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Reducing Risk Through Proactive

MANAGEMENT by k e l ly m . s m i t h , p h d , c l s s b b , c p h q

Senior living settings are purposefully designed to provide services in the least restrictive and most homelike environment while promoting high quality care and quality of life for older adults.

Given the requirements for adverse event reporting, Florida’s Agency for Health Care Administration recommends that senior living providers have an internal risk management/quality assurance program that includes a written plan for identifying and correcting deficiencies in care including but not limited to resident assessments and care plans, staff training and qualifications, incident reporting and investigations, as well as resident rights and grievances. It is a fine balance but a necessary one.

Why is this relevant? A recent actuarial analysis of paid claims for general and professional insurance liability suggests an expected increase in claim frequency, claim severity, and loss rates over the next year for senior living providers including independent living, assisted living, and memory care facilities1. While nursing homes were excluded from the analysis, the report indicates claims associated with resident falls, skin/wound injuries, elopements or missing residents and resident abuse were among the highest losses in 2022 for senior living providers who took part in the survey. Absent legislation to protect senior living providers from similar claims, proactive prevention of issues in high-risk areas can save providers money and reduce the risk of potential premium hikes.

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Proactive improvement begins with the implementation of a comprehensive, quality management system that is datadriven and incorporates a systemsbased approach to quality. The use of objective data promotes decision making based upon fact rather than intuition or opinions of the leadership team. Regardless of whether your organization has a complex data/analytics system or is using Excel® to track key performance indicators (KPIs), reliable and accurate data collection is the fundamental first step toward proactive analysis. To begin, providers should consider creating a data collection plan which outlines KPIs that are important and vital to the organization’s success for tracking. Repeatable, concrete, and measurable terms for each KPI should be included in the data collection plan to ensure consistent and reliable measurement. For example, data on resident falls that is extracted from an electronic health record which is input during the regular course of resident care will produce similar results assuming training is equivalent for staff.

The frequency of data collection for each KPI should be defined using regularly scheduled intervals of time based upon availability and practical process application within the care setting (e.g., weekly, monthly, quarterly). The data collection plan should also include the source of the data or where it will be extracted from and the name of the team member

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responsible for collecting the data.

Information related to how the data will be maintained, tracked, trended, and reported is also vital to promote accountability and transparency within operations.

While understanding internal performance is important, using comparative data offers crucial insight on an organization’s performance. Comparisons may be made to other facilities within a corporate chain but should also encompass data from outside of the organization. Assessment of performance compared to industry averages produces key information on where a facility is excelling or falling behind. It can also inform whether a particular strategy or project was effective that has been implemented. Providers may choose to benchmark against state or national averages; however, comparisons within individual markets are equally important to identify any strategic advantages and/or challenges. Bottom lineperformance benchmarks should be set from a variety of different angles to gain a complete picture of performance and to set appropriate goals. Stratification for comparisons based on operating factors such as bed size, resident acuity, or services can also be beneficial.

Once data is collected, KPI performance should be evaluated against chosen internal and external performance benchmarks.

This process should be conducted individually for each KPI to determine whether performance

is adequate and/or if there is an opportunity for improvement. Performance for vital KPIs that meet or exceed benchmark or comparison performance should continue to be monitored assuming it is important overall operations. If a KPIs performance is lacking, a performance improvement plan may need to be initiated.

Given the complex nature of resident care, performance improvement plans should always be developed using an interdisciplinary team approach and deploy evidence-based quality improvement tools. Common methods include the PDSA (Plan Do Study Act) or the DMAIC (Define Measure Analyze Improvement Control) process as a framework with inclusion of tools such as root causes analyses, the 5 Whys, fishbone diagrams, and the failure modes and effects analysis. Regardless of the chosen method and tool, analyses should be conducted systematically with decisions supported by data. Using an interdisciplinary approach and encouraging participation in PIPs of team members to provide expertise will not only enhance improvement efforts but it will also promote engagement among your staff.

Utilizing systematic processes to evaluate high risk areas such as falls, skin/wound injuries, and elopements supports evidence based decision making, facilitates identification of gaps in knowledge, and produces high quality outcomes. As projections for general and professional liability claims increase, senior living providers need to adopt proactive practices to ensure quality and reduce risk. Development of a comprehensive, data-driven quality management system can help by promoting risk avoidance and resident safety while cultivating a culture of continuous improvement among your team. For more information about designing a comprehensive quality management system, reach out to us at info@q3hc.com.

Are you struggling with the ongoing labor shortage Paychex HR can help with h finding and keeping top employees.

Contact me to learn how Paula Melley pmelley@paychex.com com 561.757.0245

OliverWyman & Marsh (2023). 2022 General and Professional Liability Benchmark Report for Senior Living and Long-Term Care Providers. Accessed via: 2022 General and Professional Liability Benchmark Report | Marsh

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k e l ly m . s m i t h , p h d , c l s s b b , c p h q

Owner Q3 Healthcare Company

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Understanding Florida’s Assisted Living Staffing Requirements by m o n i c a w i l s o n Over the past few years, many of our conversations about staffing in senior living have focused on staff shortages, which we are still experiencing in some areas. I have observed an uptick in questions about minimum staffing standards and what that really looks like.

Minimum Staff Hours Per Week In Florida, minimum staffing requirements include a minimum number of staff hours per week based on the community census rather than specific staffing ratios. This allows communities to distribute staff hours throughout the week during the busiest service times when staff are most needed.

There is a chart listing the minimum number of hours per week in Chapter 59A-36, F.A.C. Typically, the hours worked by staff members who regularly interact with residents as part of their daily jobs may be counted toward minimum staffing hour requirements. Staff time for those employees whose

duties are exclusively building or grounds maintenance, clerical or food preparation may not be counted toward meeting this requirement.

Notwithstanding the minimum staff hours per week, communities are required to have sufficient staff coverage to meet the needs of the residents.

Administrators and managers’ time may be counted when they are actively involved in day-today operations, including making decisions and providing supervision for all aspects of resident care.

Their time must be included on the community’s staffing schedule to be counted.

The Agency for Health Care Administration (AHCA) may require staffing above the defined minimum staff hours per week if the agency determines that adequate supervision and care is not being provided to residents, resident care standards are not being met, or that the community is failing to meet the terms of their contracts with residents.

These are the requirements for calculating the minimum number of staff hours per week. However, the minimum staff hours per week provision can be misleading, as it does not account for all the staffing standards that must be met. While these minimum hours per week provide communities flexibility and account for the diverse populations served under Florida’s assisted living licensure category, they were written many years ago when resident acuity levels were not what we typically see today in our senior living communities.

Additional Staffing Standards The actual number of staff members or staff hours needed requires communities to consider the needs of the residents, the contracted care and services in accordance with residency agreements, any service plans that exist, the ability to adjust to changing service needs, and the ability to meet residents’ unscheduled needs.

Communities certainly do not want to find themselves in a situation where AHCA is identifying staffing deficiencies before the community recognizes the problem. There are plenty of early warning signs for community managers to identify and respond to. Long wait times for care, missed services, errors, resident and family complaints, the inability to respond timely to unscheduled needs, and high staff turnover are just a few of the signs that suggest a need to review staff distribution hours.

Customer surveys, quality assurance tools and time studies can provide pertinent information about necessary adjustments to staffing and/or the type of residents each community accepts based on its ability to recruit and retain staff in critical positions.

monica wilson, ms ICEBridge, LLC

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YOUR TRUSTED SENIOR LIVING RESOURCE | 33

ADRD TRAINING:

What Florida’s New Laws Require by ja s o n h a n d

During the 2023 Florida Legislative Session, the Legislature passed and the Governor signed into law a bill that specifically addresses Alzheimer’s Disease and Related Disorders (ADRD) training. HB 299 (2023) took effect on July 1, and we understand many of our members have valid questions about the implementation of this new law.

Hearing your concerns, FSLA asked the Department of Elder Affairs (DOEA) for additional information; the following is the response to our inquiries: •

•

•

The DOEA will manage all ADRD training applications, review, and approval/revisions.

USF is no longer serving as the training contractor.

The DOEA website is launching an update with additional information about changes to ADRD training requirements.

The updated DOEA website will also include the new 1-hour training content outlined in the bill, which is not yet available.

In light of the delayed access to

ja s o n h a n d

VP of Public Policy & Legal Affairs Florida Senior Living Association

approved training materials, FSLA has communicated its concerns to the Agency for Healthcare Administration (AHCA). It is our understanding that AHCA will not implement the ADRD training requirement into their monitoring process or surveys until the content is available. The DOEA and AHCA will work together to ensure all licensed facilities are notified when the content is available.

FSLA will continue to monitor DOEA’s activities, and once the training content is available on the website, we will request additional meetings as needed to discuss proper implementation of the new law. We will keep you informed as additional information becomes available.

Bill Summary:

Training Table:

Elder Affairs:

The new ADRD training requirements can be confusing.

FSLA’s core training partner, Monica Wilson with ICE Bridge Training, has developed a summary of the bill and a training table for FSLA members. Contact FSLA for a copy of the bill summary and training table.

On July 3, 2023, AHCA published Emergency Rules 59AER23-1 and 59AER23-2, which implement requirements from SB 252, Protection from Discrimination Based on Health Care Choices. The intent of the Legislature in enacting this legislation is that Floridians can be free from: (1) mandated facial coverings; (2) mandates of any kind relating to COVID-19 vaccines; and (3) discrimination based on such vaccination status.

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View more information here:

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Pay Attention to The Details: SB 252 (2023), in part, creates s.

408.824, F.S., and requires ALFs to establish facial covering policies and procedures by August 1, 2023, and to also make sure the policies are accessible from either: (1) the ALF’s website, or: (2) conspicuously displayed in its lobby. When deciding where to place the policies, please also double-check (and update as needed) your visitation policy as required by SB 988 (2022).

SB 988 (2022) requires ALF visitation policies to address the ALF’s visitor infection control policies and procedures, including personal protective equipment. The two things ALFs must to be mindful of as it relates to SB 252 (2023) are: (1) ensuring the visitation policy requirements comply with the new emergency rules; and (2) understanding that although SB 252 (2023) allows an ALF to choose whether its facial coverings policy is accessible on its website or in its lobby, the visitation statutory requirements from SB 988 (2022) requires an ALF’s visitation policies and procedures to be easily accessible from the home page of the ALF’s website.

To implement this intent, CS/SB 252 provides the following: COVID-19 Vaccination, Recovery & Testing Status ALFs may not discharge or refuse to hire a person; deprive or attempt to deprive a person of employment opportunities; adversely affect a person’s status as an employee or as an applicant for employment; or otherwise discriminate against a person based on knowledge or belief of the person’s status relating to COVID-19 vaccination, post infection recovery, or failure to take a COVID-19 test. For matters relating to non-COVID-19 vaccines, the business entity shall provide for exemptions and reasonable accommodations for religious and medical reasons in accordance with federal law.

Face Masks

By August 1, 2023, ALFs shall establish facial covering policies and procedures for their respective health care settings, if the ALF requires any individual to wear a facial covering for any reason.

Such policies and procedures must comply with AHCA rules and must be accessible from the home page of the ALF’s website or conspicuously displayed in the lobby of its health care service setting or settings. ALFs may not

require any person to wear facial covering for any reason unless the requirement is in accordance with AHCA rules and the businesses policies and procedures for facial coverings. ALFs in violation thereof are subject to disciplinary action.

AHCA has adopted emergency rules 59AER23-1 (which contains definitions) and 59AER23-2 (which contains standards for the appropriate use of facial coverings for infection control). A quick summary follows: Health care providers may choose to require a patient to wear a facial covering only when the patient is in a common area (e.g., areas where patients are not treated, diagnosed or examined) and is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission.

Health care providers may choose to require a visitor to wear a facial covering only when the visitor is: • Exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission; • In sterile areas of the health care setting or an area where sterile procedures are being performed; • In an in-patient or clinical room with a patient who is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission; or • Visiting a patient whose treating health care practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner which is known to increase risk of transmission of an infection from employees without signs or symptoms of infection to a patient and whose treating practitioner has determined that the use of facial coverings is necessary for the patient’s safety.

Opt-Out Requirements are as follows: • Health care providers who choose to require a facial covering for any patient must include in the policy a provision for the opting-out of wearing a facial covering. Such policy must be in accordance with the Florida Patient Bill of Rights and Responsibilities, section 381.026, F.S. (e.g., generally covering rights to dignity, information, access to health care, experimental research and knowledge).

• Health care providers who choose to require a facial covering for any visitor must include in the policy a provision for the opting-out of wearing a facial covering if an alternative method of infection control or infectious disease prevention is available.

• Health care practitioners and health care providers must allow an employee to opt out of facial covering requirements unless an employee is: • Conducting sterile procedures; • Working in a sterile area; • Working with a patient whose treating health care practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner which is known to increase risk of transmission of an infection from employees without signs or symptoms of infection to a patient and whose treating practitioner has determined that the use of facial coverings is necessary for the patient’s safety; • With a patient on droplet or airborne isolation; or • Engaging in non-clinical potentially hazardous activities that require facial coverings to prevent physical injury or harm in accordance with industry standards.

Please contact Jason Hand, FSLA’s Vice President of Public Policy & Legal Affairs, for more information.

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Navigating Polypharmacy Deprescribing in Senior Living: Embracing for Better Outcomes by m at t d e p e n b r o c k Many senior living (SL) residents take multiple medications to manage their health conditions.

But when it comes to medications, how many is too many? While there is not a specific number of medications that determines when it becomes harmful or dangerous, we do know that taking too many or unnecessary medications, a situation known as ‘polypharmacy’, can put residents at risk and be costly for SL community operators.

Although there’s no standard definition for polypharmacy, current data is concerning. About one-third of older adults use five or more prescription drugs, and in long-term care settings, 65% of residents take more than 10 medications. Polypharmacy has become increasingly prevalent in the last decade, and a variety of factors have contributed to this rise. The growing availability of new drug options, the trend towards early treatment of chronic diseases, the involvement of multiple prescribers, and the impact of direct-to-consumer drug advertising all play significant roles in exacerbating the problem.

Polypharmacy has a wide range of adverse consequences for residents and added financial burden for operators. The health risks associated with polypharmacy include adverse drug reactions, drug interactions, falls, hospitalizations, longer hospital stays, and higher rates of frailty and cognitive decline.

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For operators, polypharmacy can have a significant impact on the bottom line. It leads to increased labor costs due to the need for additional hours dedicated to administering, documenting, and monitoring complex medication regimens. These extra demands add further strain to current staffing challenges. Higher hospitalization rates associated with polypharmacy reduce lengths of stay, increase labor hours required to readmit residents, and contribute to instability in occupancy rates.

Addressing polypharmacy in SL communities can be challenging, but there are effective strategies that can ease the burden: Understand the Purpose for Each Medication: Medication administration staff should be confident of the purpose for each medication a resident receives.

If unsure, ask the physician to document the reason in the medical record. If a medication is no longer needed or its purpose is unclear, ask the physician if it is appropriate to stop the drug.

Know Common Medication Side Effects: Staff should be familiar with the common side effects of each medication being administered. When residents report new complaints, reviewing their complete medication list can help identify potential drug-related side effects. This is essential in preventing a ‘prescribing cascade’ where a new medication is added

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to counter the side effects of another medication.

Engage Residents and Families: Regular communication with residents and their families about their medications is crucial.

Ensuring they understand the purpose, intended effects, potential side effects, and when to report concerns to the physician promotes better medication management.

Collaborate with Pharmacists: Pharmacists are valuable resources in medication management for older adults. Involving them as part of the care team from the outset is beneficial. Pharmacists can actively identify opportunities for deprescribing through discussions with staff, residents, and their families.

when necessary. LTC pharmacies can help provide data and analytics on medication use and pharmacists’ clinical interventions that are helpful in identifying inappropriate prescribing patterns and opportunities for deprescribing.

Leverage Technology: An LTC pharmacy’s ability to seamlessly integrate with the community’s electronic health record (EHR) gives the pharmacist a 360-degree view of a resident’s medication profile across all prescribers. This visibility helps identify medication-

related risks early and narrow in on opportunities to deprescribe in situations such as duplicate therapies and use of high-risk medications.

Increasing awareness of the risks of polypharmacy and embracing a culture of deprescribing offers numerous benefits for SL communities, including improved health outcomes, reduced financial burdens, and enhanced quality of life for residents. By navigating the complexities of polypharmacy through deprescribing and

collaborating with senior care pharmacists and leveraging the technology and resources of their LTC pharmacy partners, operators can pave the way for a healthier future for their residents.

m at t d e p e n b r o c k Business Development Leader Guardian Pharmacy of Florida

Through its seven local pharmacies, Guardian’s pharmacies provide outstanding client service and resident care to long-term care communities, including assisted living and skilled nursing, group home, behavioral health and to organizations that serve individuals with intellectual and developmental disabilities across the entire state.

Embrace Deprescribing: Reducing or discontinuing unnecessary medications under a physician’s supervision is an important strategy to address polypharmacy. Deprescribing can lead to cost savings, prevent medication errors, and improve residents’ well-being. However, individual resident needs, especially for those with multiple health conditions, must be carefully considered.

Partner with an LTC Pharmacy: Establish a partnership with a long-term care (LTC) pharmacy that reviews each medication before dispensing for safety, compatibility and appropriateness and intervenes

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monica wilson, ms ICEBridge, LLC

Have a question about assisted living operations?

Ask Monica: Monica@icebridgetraining.com Monica Wilson is registered with the Florida Agency for Health Care Administration (AHCA) as an Assisted Living Core training provider and with the Florida Department of Elder Affairs as an Alzheimer’s disease and related disorders training provider.

She is an experienced administrator, trainer, facilitator, and educator with a passion for older adults, technology and connecting people and processes.

The physician completing our employee physicals is telling us we do not need an annual statement that the person is free from Tuberculosis (TB). What is the requirement?

Chapter 59A-36, F.A.C. requires evidence of a negative TB examination documented on an annual basis for all employees.

The health care practitioner determines how to conduct the examination. This is the case even though the Centers for Disease Control and Prevention (CDC) guidance states annual TB testing is not recommended unless there is a known exposure or an ongoing transmission at the community.

If our Food Service Supervisor holds a food manager certificate, are any other staff members also required to hold this certificate?

Assisted living communities licensed for 11 or more residents are required to comply with the Food Hygiene Code – Chapter 64E-11, F.A.C. This rule states that if an assisted living community has three or more employees who are engaged at the same time in the storage, preparation, display, or serving of food, there must be at least one certified manager present at all times when these activities are taking place.

Additionally, assisted living communities that serve highly susceptible populations should ensure an employee who holds the credential be present at all times when food service activities are taking place, regardless of whether there are three employees conduting food services at one time.

A “highly susceptible population” is defined in Chapter 64E-11, F.A.C. as a group of persons who are more likely than other populations to experience foodborne disease because they are immunocompromised, institutionalized older adults, preschool age children in custodial care or elementary school age children.

FSLA Education: Right at Your Fingertips!

We are committed to offering excellent education opportunities. You can access ALF Core Training, Professional Development, Continuing Education, Webinars, Cocktails and Conversations, Upcoming Events and more on our Education page!

GAIN PEACE OF MIND WITH MEDICATION SAFETY INSIGHTS. Guardian pharmacists have always put resident safety first. But don’t take our word for it. You’ll gain visibility and peace of mind with data-driven insights into the clinical decisions and interventions our pharmacists make every day to safeguard residents from medication harm with Clinical Intervention—the newest member of our GuardianShield suite of services, engineered to help senior living communities drive their clinical and financial outcomes.

Does your pharmacy deliver more than medicine? Advanced technologies, local expertise, and personal support... that’s the Guardian difference.

floridaseniorliving.org/education

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Tampa 727.366.6766 Jacksonville 904.345.4304 Orlando 863.670.7554 Southwest Florida 727.366.6766 Daytona 386.944.6201

Learn more at: guardianpharmacy.com/guardianshield 38 |

Northwest Florida 850.718.7651

Southeast Florida 561.756.3909 YOUR TRUSTED SENIOR LIVING RESOURCE | 39

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