Upfront Healthcare Magazine Issue 4

Page 1


Quarterly for LTC Professionals


With Usher Eisen of Visualize Healthcare on keeping up with LTC Compliance PAGE 16

ABOVE AND BEYOND How to offer enviable customer service to your residents PAGE 22


Close the door on the recreation of yesteryear: keep up with today’s seniors PAGE 30


The people who are crazy enough to think they can change the world are the ones who do. -Steve Jobs

Genius is the ability to reduce the complicated to the simple. -C W Ceran

This issue’s cover story is about compliance. We are an industry that is more regulated than most. There are rules for everything. It is to a point where compliance can make things complicated. But we have to do everything in our power as a pharmacy vendor to assist our facilities in maintaining order and of course regulations. However, I propose that there is a simpler approach. What if compliance and the regulations that surrounded it, were simplified to just “doing the right thing?” There is a word that embodies both of our professions, as well as the majority of businesses: service.

Executive Director Joseph Kubulak editor-in-chief Becca Blau assistant editor Mayer Silver creative Rebecca Lieberman Joy Hoberman advertising Britt Goldberger publisher GCNY Marketing MAIN OFFICE: 1449 37th Street | Suite 507 Brooklyn, New York | 11218

October 2018

Good business as well as being successful in general, is a factor of this service. The more we think of others before ourselves, the more successful we will become. It needs to be a selfless service. This means giving without any expectation of return. This is not about my business against yours. It is not about position in the company or industry. It is doing the right thing when it comes to someone else’s needs. We all have labels for ourselves, don’t we? We are husband or wife, daddy or daughter, owner, CEO, COO or VP. But isn’t that limiting in what we are capable of? And why let more rules or labels get in the way as to what we are put on this earth for? My name is Joe. And I along with the two great gentlemen who own this company, Specialty RX, are here to do the best we simply know how to do, be the best selves that we can be and offer you the best service we personally can. To me that is simply genius. And crazy enough to think we can change the complexion of compliance. God bless you!

Joe Kubulak V.P. of Operations and Business Development, SpecialtyRx


06 10 16 22 28 30 34

Industry Currents Travel nurses, getting mathy with healthcare and more tidbits

Designing for Better Outcomes How to get patients in and out as fast as possible

Get Clear on Compliance How to pay attention to exhaustive government regulations

Taking Customer Care to a Whole New Level Stay on top of the game with hotel-like concierges

Care, Expanded SpecialtyRx’s expansion gives their mission statement, Long Term Care Partner, wings

Go Boldly Beyond Bingo Design activities for residents that bring spark to their day-and life

Senior Health is all the Talk Social activity, even via the Internet, keeps the elderly happy and healthy

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November 2018

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Unlock the Magic of Predictive Analytics

Travel Nurses: A Great Way to Fill those Hard-to-Fill Positions

Hospitals and healthcare organizations are starting to take advantage of travel nurses, a pool of highly qualified candidates who have been carefully screened, possess proper certifications, training, and competencies required to get the job done well. Travel nurses are typically adaptable, adventurous, willing to roll up their sleeves, and prepared to take on jobs where they are needed most. These temporary hires are employed through a healthcare staffing agency for a

predetermined amount of time (usually 13 weeks). Since the conventional hiring process can be costly in terms of time, money, and resources, partnering with a reputable travel nurse staffing agency could be the cost-effective answer to your organization’s staffing crunch. According to a study published in the Journal of Nursing Administration, the employment of travel nurses did not detract from patients’ overall satisfaction with nurses. The research supports the fact that patient satisfaction is not driven by whether the nurse is a regular employee of the facility or a travel nurse, but

If you don’t already know, Predictive Analytics is the branch of advanced analytics that uses techniques such as data mining, statistics, modeling, machine learning and AI to bring together different business processes such as management and information technology to find patterns in historical and transactional data to identify risks and opportunities that help predict the future. Mouthful? It’s less “magic crystal ball” and more “using a ton of data to figure out what’s most likely to happen.”

whether the nurse is providing adequate care to the patient and whether the number of nurses providing care is in line with the number of patients needing care. Travel nurse assignments can be planned and budgeted in advance, so shifts can be scheduled ahead of time, which is ideal for an employee’s planned leave of absence or sabbatical, or to fill seasonal positions. For facilities that need to fill a highly skilled position that may take some time to find the right long-term candidate, a travel nurse can fill the position during the hiring and onboarding process, eliminating the nightmare of vacant positions.

The Predictive Analytics craze has recently hit the Healthcare industry. Many organizations are taking notice of the hidden value

in their data. But one area that remains largely untapped is using predictive analytics to forecast staffing needs. And with the impending rise in staffing demand (see Three Big Reasons Driving the Huge Demand for Healthcare Services article in this issue), Predictive Analytics could be your organization’s savior. One of the ways your organization can use predictive models is by using time series analysis to create, validate, and refine historical organizational data to adjust staff schedules within 60 days in advance of a shift. This can help improve staffing issues by accurately scheduling specific staff to meet anticipated patient

demand weeks ahead of time. This is not to say that predictive analytics is flawless. Like all great tools, its performance is as accurate as the data put into it. You’ll need experts to routinely monitor the model. You’ll need functional leaders to make sure that the model is being applied as intended. You’ll need to use it in combination with extensive knowledge of staffing strategies. Above all, don’t expect it to solve all your organizational issues. Bottom line, it’s a tool. It won’t replace the need for the right people who know how to use it the right way.

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November 2018




340B: Lowering prices, raising concerns? The latest initiative out of the President’s office focused on lowering prescription drug prices has also stirred up some concern among hospital advocates. The administration’s report noted that the 340B discount drug program was fueling overall drug price increases: “The additional billions of dollars in discounted sales and the crosssubsidization necessary may have created additional pressure on manufacturers to increase list price.” As the report claims, the 340B program covered more than $16 billion in drug sales in 2016—a 400% increase from 2009. The Trump administration is

HIRING recommending several changes in 340B policy, including: • Updating the requirements governing covered entities that contract with pharmacies or registering offsite outpatient facilities • Revisiting current mechanisms for preventing duplicate discounts • Bolstering claims standards to prevent duplicate discounts in Medicaid and other programs Analysts have posited that many of these changes will require legislative action. Congress discussed possible adjustments to 340B during the Senate Health, Education, Labor, and Pensions (HELP) Committee hearing on May 15. Existing Senate bills targeting 340B include legislation that would implement a moratorium on allowing additional hospitals and hospital outpatient departments to participate. In addition, stricter eligibility criteria would be enforced for hospital outpatient sites.

On the other side of the table, hospital

advocates claim that “Efforts to alter the Congressional intent of the law or otherwise

dramatically narrow the 340B Program will ultimately decrease access to affordable quality health care for vulnerable populations.” Hospitals in the program are still reeling from the effects of the cuts implemented at the beginning of the year, when Medicare payment for drugs acquired through the 340B program dropped from ASP +6% to ASP -22.5%. The policy is designed to reduce Medicare beneficiaries’ out of pocket drug costs, by a margin of $3.2 billion over the next 10 years.

And so the 340B discussion is going in a 360° circle. Hospital advocates filed a challenge that was initially rejected by a federal judge in December, but is now under review and may be revived by a federal appellate panel. A bipartisan group of nearly 200 members of the House of Representatives has co-sponsored legislation to reverse the cuts, stating that “340B is critical for safety-net providers that care for patients with the greatest needs and fewest resources.” It is also possible that the administration will act on its own to implement other provisions of a new drug price strategy. Such strategy is under consideration amid the administration’s recent proposal to delay penalizing drug manufacturers that knowingly and intentionally exceed 340B ceiling prices until July 2019.

What drives the huge demand for caregivers? The debates surrounding healthcare policy notwithstanding, the fact of the matter is that demand for healthcare services is growing—exponentially. This country’s appetite for services promises increased demand for healthcare workers: nurses, physicians, allied health professionals, technologists, coders, leaders and support personnel.

While growth is usually considered good news for any industry, it can quickly turn into bad news for your organization if you don’t have the infrastructure in place to support such growth. Knowing the reasons driving the rise in demand will help you anticipate and plan for adjustments that will enable you to grow with the industry, not flounder under it.

Big Driver #1: An Aging Population By far, the greatest driver of demand is the aging US

population. According to the US Census Bureau, the number of people over 65 years old will double from 43 million (2012) to 84 million by 2050. This mushrooming population is Medicare eligible, typically suffer from multiple chronic conditions, and will experience three times as many hospital days than the general population. This translates to a significant increase in demand for qualified workers.

Big Driver #2: 1.26M Job Openings/Year The US Bureau of Labor Statistics published its projected annual job openings for 2016-2026, citing an expected 624,000 job openings per year for practitioners and technical occupations, and 204,000 for RN jobs. This is fueled by the increase in healthcare utilization, overall growth in US jobs, and the wave of retirement among BabyBoomer healthcare practitioners.

Big Driver #3: The Retirement Wave Retirement of healthcare workers in general, and nurses and physicians, is expected to have the greatest impact on the future supply of healthcare professionals. According to the American Association of Medical Colleges, more than one-third of today’s active physicians turn 65

within the next ten years, which may lead to a shortage of more than 100,000 physicians through 2030. The retirement wave not only exacerbates the shortage of practitioners, but also means the loss of experienced and specialty healthcare practitioners, resulting in hard-to-fill vacancies in the healthcare workforce. Don’t allow shifting trends to take your organization’s health for a ride. Jump into the driver’s seat and set a strategic hiring plan in place for the coming decade.

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November 2018

DESIGNING FOR BETTER OUTCOMES Your LTC facility building should get patients out as fast as possible. Here’s how.


In the wake of the “Impact Act” of 2014, senior care organizations have been adapting to the required implementation of new assessment and quality measures to facilitate coordinated care and improve patient outcomes. At the same time, the shift from a fee-for-service payment system to a value based payment system tied to outcomes has added another layer of complexity. A new formula has emerged: new payment systems = new systems of care. As an architect specializing in postacute care (PAC) design, I see the formula a little differently: new payment systems = new systems of care = new

architectural solutions. It’s understandable that a PAC Administrator who is fighting the daily “Battle of the Bundle” might not be focusing on their building’s physical plant. However, in doing so they are missing an important opportunity because the right design choices can result in better patient outcomes and a better bottom line. Of course, design can make a much bigger impact when you are talking about a new “ground-up” building. But there are a number of renovation approaches that can also make a difference.

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November 2018


There are dozens of evidencebased studies that positively link patient physiologies to natural light and access to the outdoors. Designing from scratch gives an architect the ability to locate the building on its site, to take maximum advantage of sunlight and views and to incorporate daylight harvesting systems into the

facade design. New footprints can also include all-season solariums to allow patients to connect with the outdoors year-round. Good design can also improve infection control and reduce rehospitalizations. The most basic step to achieving this goal is to create as many private rooms as the project budget can handle. Private rooms = better infection control. Private rooms with private

showers also provide greater fall protection as residents do not have to traverse large central tub rooms with wet floors and gaps in grab bar protection. Installing overhead lift systems in a bank of patient rooms may also reduce the likelihood of falls during two-person transfers. Combine a robust air ventilation system featuring rapid air changes with a high percentage of private rooms and you have the backbone of

Interestingly enough almost all of these design approaches which make your building more post-acute and more resilient also position it

very good infection control system. Overlay a telemetry system in a suite of your more “acute” rooms and you might prevent a condition from becoming a rehospitalization.

to be more competitive (also more energy efficient). Your customers

Learning from the past, new HVAC system designs can avoid legionella-prone cooling towers and domestic water systems can include water/purification treatment

have choices. They want private rooms, private showers, access to

technology, natural light, and access to the outdoors and systems which promote their health. By giving your customers what they want, you give

systems. If your building is sick, how can your patients get healthy? MAKE IT RESILI ENT

It goes without saying that the opportunities to improve a facilities’ resiliency are significantly greater with new construction. You can configure a new Essential Electrical System (EES) to power as much of the building as your budget can support and you can locate all essential systems and equipment above the 500 year floodplain. It is also relatively cost effective to add remote connections for drive-up trailer-based boiler and mechanical plants. Non-essential areas below the floodplain can be dry-flood proofed in conjunction with the use of resilient materials

the insurance companies what they and what everyone wants…. better outcomes. Additionally, your

“new” private rooms in the building. RISING WITH THE SUN

Adding daylight harvesting systems to existing buildings is in most cases, only marginally impactful since you are “stuck” with the building’s orientation towards the sun. However, installing new indirect diffuse LED light fixtures that can simulate daylight will be an

improvement over existing direct fluorescent fixtures and will help to reduce your electric bill. If there is available land and zoning permits, a solarium winter-garden could also



“Good design can also improve infection control and reduce rehospitalizations.”

and finishes. In the PAC world, a “bounce-back ” is a negative term. However, when it comes to

resiliency, you want your building to bounce back quickly from a severe weather event.

more energy efficient building will have lower relative operating costs. Of course, in building renovations, the design team does not have as much flexibility to implement PAC

upgrades as in new construction. Our first approach is to look for an opportunity to building an addition. A new addition of private rooms is the most bang for the buck. In backfilling the new private rooms

from existing semi-privates, you immediately double the amount of

be added at a reasonable cost. BREAT HE IT IN

It is possible to increase the volume of outside air in existing patient rooms. Headroom and vertical shaft space are always the issues. On the bright side, fresh air ductwork tends to be much smaller than ducts carrying conditioned (hot or cold) air. Pure fresh air ducts are delivering air at the same temperature as the rooms being served (room neutral air) and as

Upfront Healthcare

November 2018

such do not need to be insulated. In some cases you literally need to think outside the box. On one of our recent alterations we ran new ductwork on the outside of the building and created an architectural treatment that blended into a planned re-cladding of the building’s facade. Supplementary fresh air systems are paired with variable refrigerant flow (VRF) systems to provide more heating & cooling. These systems involve the installation of electrical conduit and refrigerant piping and do not impact headroom. The VRFs electrical loads may dictate a need to upgrade

the main electrical service. Other PAC upgrades in existing buildings are more modest, widening doorways, lowering staff stations to ADA height, replanning/ consolidating overlapping functions to increase on-unit charting/office space and enlarging the central admissions and social services suites to handle a higher volume of admissions and discharges. In summary, a well-designed new building or alteration/addition can make a significant contribution to the “Health” of your organization and its bottom line while helping to improve patient outcomes. ●

John Baumgarten, R.A., AIA, LEED AP, is president and founder of the firm of John W. Baumgarten Architect, P.C., an award-winning, fullservice architectural firm serving proprietary and notfor-profit healthcare and senior care organizations. JWB specializes in the master planning of complex phased nursing home modernization projects, providing an integrated approach to architecture, interiors and engineering. Learn more at JWBArch.com.

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November 2018


Who can possibly keep up with the rules and regulations covering the long-term care (LTC) industry today? The answer is simple: The LTC business that wants to be around tomorrow. There is no question that trying to fully comply with state and federal regulations over services and residents’ care feels like walking through a minefield. It’s easy, and, frankly, common, for an LTC facility to inadvertently misstep. We’re not talking malfeasance; we’re talking innocent mistakes. Sometimes it comes from not knowing that a regulation has changed or a

Rigorous attention to policies, procedures and systems for ensuring compliance with state and federal regulations is crucial for success, let alone survival, in an industry constantly under scrutiny.

new one has been added. Sometimes it’s because you misinterpreted a regulation. (They aren’t always black and white.) Here’s one example. Did you know that among the regulatory changes in the November 2017 updated guidelines from the Centers for Medicare and Medicaid (CMS) is one that shifts your responsibility to ensure residents get eyeglasses and hearing aids? According to interpretive guidance on this change, you no longer are responsible for providing these devices. You still need to help provide these services and secure payment for them, and transport residents to medical appointments. But it’s no longer up to you to make sure individuals get


these aids.


Now, as a practical matter, you’re going to continue doing what you’ve always done: provide eye exams and hearing tests, and make sure your residents get the devices they need, because you want your residents to have a high level of functioning, independence and safety. But in the odd regulatory world LTC facilities operate in, it’s entirely possible that this small change may cause regulators to pay even more attention to, and beef up enforcement of, vision and hearing services you provide – just to make sure you are complying with the latest regulatory tweak. There were big changes to the pharmacy services portion of the CMS guidelines last fall, too. There is more emphasis on ensuring patient care is individualized, and that medications are prescribed and administered appropriately. For example, in the case of psychotropics, you must first try behavioral intervention. If that doesn’t work and you turn to medication, you must have a plan to gradually reduce the dosage and you cannot renew the order after 14 days. COMPLIANCE: NOT AN OPTION

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Often, something slips through the cracks during the Herculean effort to provide great care

to residents who have many and often complex needs while keeping the facility running well 24/7. It’s understandable. But it’s no defense. You can’t negotiate an F-Tag. You either stay on top of regulations, and adjust your policies, practices and procedures, or you potentially risk it all. You could lose your reputation and competitiveness. You could be denied reimbursement. You could face criminal charges and hefty fines and financial penalties. You could even be expelled from Medicare and Medicaid entirely. So, what’s a well-meaning, wellrun LTC facility to do? Make compliance part of your culture, says Usher Eisen, CEO and founder of Visualize Healthcare of Brooklyn, New York. Visualize Healthcare provides comprehensive on-site optometry services to residents in LTC facilities in New York state. (It plans to expand into neighboring states.) Mr. Eisen offers this advice on how to build and maintain a culture of compliance: •

Develop visible and clear compliance programs that include strong support for

ongoing staff education •

Define and delegate responsibilities for compliance

Keep policies and procedures up to date and easy for staff to understand

Recognize that past practices won’t ensure compliance. It’s a new day and it calls for an aggressive approach to validate compliance in every corner of your operation.

Partner with vendors and healthcare providers who understand and embrace compliance throughout their organizations. Ask them how strong their compliance programs are, and how they will strengthen your services and operation.

Saba Ansari, director of compliance for SpecialtyRx, agrees that making compliance second nature is essential for the health of patients and residents, and the business. SpecialtyRx, based in Ridgefield Park, New Jersey, is a full-service pharmacy provider for subacute and LTC facilities in the United States.

“Trying to comply with state & federal regulations feels like walking through a minefield.”

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November 2018


She advises facilities to have regularly scheduled compliance meetings to identify potential issues, and to conduct internal audits of the daily workflow, using the state operations manual as your guide. “Do what the CMS surveyor would do. Look at what they look at,” she suggests. “For example, observe how your staff administers medications. Look at the carts and see if there are any expired medications.”

These websites have great tools and information on compliance:

“You don’t need to run through everything in the manual. Just focus on what have been issues or that you think might be,” she adds.

American Health Care Association (includes links to its state associations)

Both Mr. Eisen and Ms. Ansari recommend turning to consultants for help where you need it. Long-term care consultants can help with audits and development as well as staff training and education. Look for consultants that know your state regulations as well as federal. Pharmacy consultants have experience with survey requirements, especially the recent updates to guidelines on pharmacy services. They can help keep medication carts in proper order.

www.ahcancal.org American Society of Consultant Pharmacists www.ascp.com Centers for Medicare and Medicaid Services (CMS) www.cms.gov CMS website for information on the State Operations Manual, including a link to download the manual https://cmscompliancegroup. com/tag/state-operationsmanual/ National Association of Long Term Care Administrative Boards www.nabweb.org Office of Inspector General, U.S. Department of Health and Human Services www.oig.hhs.gov Office of the Medicaid Inspector General, New York State www.omig.ny.gov

Niche consultants such as Visualize Healthcare and SpecialtyRx have experience with survey requirements, especially the recent updates to guidelines. They also offer tracking and reporting services that ensure you are on top of each patient and resident’s care and will flag potential compliance issues. For example, Visualize Healthcare’s Accutrack scheduling software tracks and reports on residents’ eyecare appointments and services so that you know who was seen when and for what, the outcome of the appointment, and the schedule for follow-up appointments. Facilities can get an overview of vision services for every resident, going back 10 years via email or phone. Mr. Eisen says one of the most common compliance-related problems when it comes to eyecare in LTC facilities is a lack of follow up on the optometrist’s recommendations. “It happens because staff is buried in work, not because they don’t care. Most facilities just don’t have the resources or staff to catch every follow up, and most don’t have a tracking system, other than a manual one,” he explains. If follow up is not timely, you are out of compliance, he notes, and you could be cited by the state during its next survey, under the broader care requirements.

SpecialtyRx also helps clients from drifting into noncompliance. It offers custom reports that identify potential problems, pulling from its database of patient profiles and medication orders. For example, it can run a list of all residents receiving antibiotics or antipsychotic medication, including how long they have been on them, and highlight any conflict with what current regulations say is the correct use and number of days usage. A REAL-WORLD VIEW OF LTC

Mr. Eisen understands the pressure and the fishbowl environment in which LTC providers operate. That comes from

having worked in the healthcare industry all his professional life and coming from a family that operates LTC facilities. “I’m passionate about good care. If you do something, do it right, especially when it comes to the elderly, the sick and the frail. I’ve walked the hallways of hundreds of facilities throughout the state, I’ve seen what it’s like for administrators, staff and residents,” he says. Mr. Eisen also clearly sees the environment in which LTC facilities, and other healthcare providers, operate. “There are so many ways we can

get ‘caught’ if we make any misstep, unintended or otherwise. The pressure is tremendous, and the consequences of noncompliance are severe,” he says. Mr. Eisen notes that federal spending on oversight of the LTC industry has increased significantly. Over the past 10 years, more than $2.1 billion has been spent to investigate and litigate violations. “Noncompliance can knock you out, even if you are providing great care. That’s the reality in healthcare today. So, make sure internally you’re on top of it, and partner with those who know compliance is critical to your future,” he says. ●

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November 2018


The Grand Healthcare System offers a hotel-like concierge service as part of its devotion to providing the best in customer service. BY J OA N T H A R P

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November 2018

The Grand Healthcare System, a New York regional healthcare provider, positions itself as a luxury facility for rehabilitation and recovery. It takes great pride in offering excellent and seamless customer service, which includes a concierge service at each of its 14 facilities. Just as you find at a hotel, the concierge service at The Grand strives to meet every need of its residents (or guests, as they are known) to make the stay as comfortable as possible. Jay Lawrence, director of business development for The Grand, is charged with overseeing the entire customer experience. Upfront Healthcare asked him how the concierge service works, why it matters and what tips he has for improving customer service.

Concierge services are staples in the hotel industry but fairly new in the LTC industry. Why did you launch this service? As a brand, we consider ourselves top shelf. We want to lead in everything we offer. We want to provide a ubiquitous and consistent customer experience, and the concierge service is part of that. It fits with who we are and it’s a way to differentiate ourselves. Concierge services are growing, not just within LTC facilities. I recently read an article that talks about the increase in companies

specializing in offering these services, such as private home services to help people in their daily lives. In addition, increasingly the public expects and appreciates attention to the customer experience – whether in restaurants, online ordering, or nursing homes. Consumer expectations about technology are also changing. Baby Boomers are generally comfortable with technology. It’s part of their lives. As that group starts to age and has more need for medical services such as rehab, they come to places like ours expecting access to technology like iPads and applications like Skype. So we offer these services. As the world changes around us, we want to be in lockstep with people’s expectations because superior customer service is paramount to our brand.

How does the concierge service work? What do you offer your guests? The service is spearheaded by an individual, a concierge, at each facility but it’s really a team effort. The concierge is the point person who navigates the internal process for the guest and pulls in others where they are needed. The goal is to make sure every guest is comfortable right from the moment they come through our doors. They should never feel like they’re alone or lost.

They should always feel like they have a pair of hands ready to help them. When the guest arrives, the concierge makes sure everything on the checklist gets done. Did the guest receive a gift bag? Were all introductions to staff made? Are all the necessary items in the guest’s room? Do they have their schedule and a calendar of events? Do they understand how to operate the TV and the iPad? Do they have any special culinary preferences? Are their meetings we need to set up for them? Later in the day, the concierge comes back to see if the guest has any questions, and to make sure that any scheduled visits by doctors or staff happened and in a timely manner.

Tell me more about how your guests benefit from this added level of service. How does it help them? People often come to us after being in a hospital, where it often is difficult to get someone to stop for a second and talk to you about what’s next. It’s usually hard to navigate the hospital process. We did not want to in any way mirror that confusion and tension. We know our guests will have some level of stress or anxiety when they arrive – it’s natural – and we want from the start to make it easier for them. Knowing that there is someone

“I think businesses in general often forget the importance of listening.”

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November 2018

here quarterbacking their experience is a real delight for our guests. That there is one person who is the point person for their every need. They’re embraced by us, figuratively and literally, as soon as they arrive. We want to get our guests through our system effortlessly, get them better, and, if possible, get them home and back into the community as quickly as possible.

Are there benefits for staff, too? I think they’re proud to be part of an organization that holds

customer service in high esteem and takes it to this level. And they know their input really matters. A lot of what we do is to judge on the fly what each guest needs and will make them more comfortable. The staff’s conversations with guests and their families are crucial to understanding this.

What lessons are here for other LTC facilities? In our industry it’s so easy to get caught up in the daily tasks and paperwork, and forget that the folks that come through our doors are

why we exist. They need to be taken care of in a way that reflects what it means to be in healthcare, to be charged with taking care of a person at that moment in time, to have that life in your hands, until they are ready to go on to the next step. I think businesses in general often forget the importance of listening, communicating, and providing great customer service. Take the time to hear what people are saying and recalibrate what you’re doing so that you truly are meeting each person’s needs. It will take you a long way toward success. ●

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ALEXA, WHAT’S FOR DINNER? The New Jewish Home in New York City is experimenting with a virtual concierge. Called “Connect the Dots”, it is a voice-enabled concierge service based on Amazon’s Echo Show smart speaker and display, and its Alexa virtual assistant. Residents can ask the system to contact staff, find out about amenities and services, and play music, games and news. In addition, residents can call up historical audio clips. “Connect the Dots” was developed by Brooklynbased Soundmind. The system currently is in place at the company’s Sarah Neuman campus in Westchester. It is

available to residents at no charge. Residents’ families can plug in, too. If they have an Amazon Alexa virtual assistant device at home, they can ask it for information about their family member at the New Jewish Home, such as upcoming doctor appointments. It’s a bonus for staff, too. Staff at several of the Neuman campus use the system to keep residents entertained while their meals are being prepared. The New Jewish Home serves 12,000 older adults in their homes, on campuses, and in senior housing complexes in New York City, with services in rehabilitation, long-term care, senior housing and home health.

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Care, Expanded A Worthy Mission to Fulfill



November 2018

For SpecialtyRx, fulfillment is much more than a buzzword in our company nomenclature. The essence of the term inspires our 5 CareCores, informs our lifelong relationship model and underscores our commitment to be “Your Long Term Care Partner.”

And now it describes our most recent move forward, part of our decade-long journey to transform drug care and delivering excellence to each of our valued partners. Our recent acquisition of two successful pharmacies is a strategic step in our mission to expand nationwide, bringing our signature model of seamlessly meeting

pharmacy needs to all corners of the country. Both Citywide Pharmacy in Brooklyn, NY and InspireRx which serves Ohio, Pennsylvania and Kentucky share our company values and vision for care servicing. Each is an esteemed business member of their respective communities with a pristine reputation for excellence. With these two new partners, SpecialtyRx will continue to ensure that the facilities we work with and the long-term care patients they serve receive the most costeffective medication and reliable service possible. Expansion such as this recent one allows us to further streamline our processes and discover additional ways to innovate in our sector. The more

we grow, the more we stick to our roots. SpecialtyRx remains driven to facilitate faster fulfillment nationwide, uphold a rigorous standard of precision, and cultivate enhanced teamwork. And so, we look forward to the exciting opportunities these two new locations present and the ongoing fulfillment of our mission. ●

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November 2018

Painting. Board games. Movie night. Fitness class. Musical performances. Flower arranging. Challah baking. Ice cream socials. Religious services. A visit from a mini horse. These are just some of the activities residents can participate in during a typical week at the 510-bed Boro Park Center for Rehabilitation and Healthcare in Brooklyn, New York.

Go Boldly Beyond Bingo Residents thrive best when you match activities to their interests and age group, and offer lots of variety. BY J OA N T H A R P

And at Brooklyn’s 200bed Sheepshead Nursing and Rehabilitation Center, residents can choose from a wide range of activities, including yoga, a visit from a therapy dog, and community-wide art projects that entice everyone to participate. What, no bingo? Yes, there’s bingo. But both facilities go far beyond the traditional bingo and birthday parties. Each use a person-centered approach to designing recreational activities, just as they do with all the services and care they provide. They take the time to understand the interests and activities of residents before they entered the facility, and find ways to incorporate, if not replicate, them. Plenty of studies confirm the importance of providing many and diverse activities at LTC facilities. Done thoughtfully and with the individual in mind, you can provide residents with meaning, pleasure, more competence and better social connection.

Rachel Klein, recreation director at Boro Park Center, says she strives to make it feel like home. “When it feels more like home, your residents feel better. You help do that by understanding and offering activities that really reflect their interests and lives before they came to your facility,” she comments. “ Sound tough to do? Think you don’t have the budget? It’s often not a lack of resources that prevents a facility from offering a rich program of activities, but a lack of information and understanding about residents and what they like to do. (And sometimes you must reignite the creative spark.)

At Sheepshead, Christine Gorman, director of therapeutic recreation, and her staff like to combine activities to make the experience much richer and more meaningful. She mentions Charlotte, an 86-yearold resident, who enjoys yoga and art. Staff blended those interests to create an art therapy for Charlotte that begins and ends with a meditation, as is the practice in yoga classes. Charlotte loves it. VARIETY: THAT SPICE OF LIFE

Shake it up, Ms. Klein says. Be creative. “Don’t keep doing what you’ve always done. Some facilities’ activities haven’t changed in years: it’s bingo, bingo, bingo. Today’s 65-year-old isn’t always interested in bingo. Or crochet. They like paint nights, jewelry making, ceramics and up-and-coming crafts,” she says.


Boro Park Center’s activities are so popular that many former residents come back just to join in the fun.” They ask me, ‘When’s Music with Michael?’”, she says with a laugh. Both facilities

Upfront Healthcare

November 2018 33

are meticulous about getting feedback from residents after they participate in an activity. That’s how Ms. Klein found out, to her surprise, that many at Boro Park Center prefer exuberant Zumba (a dance fitness program) over sedate yoga. At Sheepshead, recreation staff check in with residents twice a day. If a resident has stopped attending an activity, they try to find out why. “Sometimes you’ll find out that they stopped going to bowling because they are feeling less flexible. Then you can adjust their therapy to make it easier for them to do what they had been enjoying,” she comments. Ms. Gorman also encourages her staff to come up with ideas on how to make an event more interesting and engaging. After each event she asks them how it could be improved.


Boro Park Center originally was built to serve the local Jewish community and it still does. Activities reflect that: there are weekly Shabbat services and regular talks by a rabbi. In addition, there is a Shul (synagogue) on site. It also offers Christian services. A growing population of Chinese residents in the neighborhood prompted Boro Park Center to dedicate two floors to serve this community. Activities tap into their cultural practices and interests: tai chi, calligraphy, mahjong, origami and Chinese opera. Chinesespeaking staff interpret for any activities led by staff who don’t speak Chinese. “It’s important to offer activities

that are meaningful to each culture,” says Ms. Klein. “It’s part of making it feel like home. We educate ourselves on all of the cultures represented in our facility to determine what activities are appropriate for each culture and age group.” Sheepshead, too, offers Jewish religious services as well as Christian. THINK ENGAGEMENT, NOT

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“We believe strongly in using different tools and modalities for creative expression to meet client’s needs, improve their self-esteem and self-expression, and increase their quality of life,” says Ms. Gorman “People want to feel good, to grow, to learn new things, no matter who they are or where they are.” ●

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Upfront Healthcare


November 2018

You may groan about how much time the younger gen spends on their phones, but they may be onto something. Especially in an age when large, extended families living in close proximity are on the decline, social interaction—even occurring in untraditional ways—is proving to be good for seniors. Studies show that people who have outside interests and converse regularly with others have lower blood pressure and heart rates, fewer colds, and suffer less from depression. Perhaps even more noteworthy is the belief that social wellbeing

Internet in a chat room. Chat rooms are websites or parts of websites where people meet to dialogue in real time with others in the “room.” Most are free but require that users register to create a username and password. You can search for a chat room based on your interests—stamp collecting, Elvis Presley sightings or French literature, to name a few— or join one designed expressly for seniors. Though it’s true that many of the chat rooms meant for seniors exist for those in their golden years to find love and romance, not all serve that purpose, and

Seniors can make new connections via the Internet in a chat room.

Chatter: Senior Health is All the Talk


is associated with lower levels of interleukin-6, an inflammatory factor found in age-related disorders such as osteoporosis, cardiovascular disease, Alzheimer’s, rheumatoid arthritis and some cancers. So it seems that a little chitchat might be just what the doctor ordered. Seniors who have watched their social network dwindle due to decreased mobility or relocation can make new connections via the

plenty have members who simply want friendship and stimulating conversation. SeniorChatters, SeniorSite and Buzz50 are three popular chat rooms where seniors enjoy meeting people from all over the world, sharing anecdotes, and discussing timely topics in a safe environment. And if you think you’re not tech savvy enough, it’s simple: You simply type what you want to say in the message box, and it’s instantly

visible to others in your clique. Before you start typing away, keep in mind these tips for minding your chat room manners: - The first time you log in, greet everyone and introduce yourself. - Be as polite in the virtual world as you are in the physical one. Give other chatterers the chance to answer your comments or questions. - Don’t type in ALL CAPS—it’s akin to shouting. - Joining a chat room and not participating in the conversation is called “lurking.” If you feel shy, it’s completely acceptable to say that you’re new and would like to watch for a little while. - When you leave the room, let others know. Part of the beauty of chat rooms is that most are always open. At any time of day or night, you can find others to share meaningful talk and build relationships. The other beautiful part is that you can show up with bad breath, in your robe, and with your hair looking like Albert Einstein... However, be aware that on a few senior online chat rooms, like 321Chat, you can be seen as well as heard. Whether you drop in from time to time, or spend hours debating pithy subjects, join a conversation today and make a cyber-friend or two for your health. ●

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