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FINAL FAREWELLS HomeRx’s unique service ensures less rehospitalization

NEW ERA IN HEALTHCARE A Brilliant Idea

GARY PARKS ON GOLDEN CARE FOR A GOLDEN AGE

The Future of LTC Insurance

BRIGHT SPACES

Architect John Baumgarten on Facility Lighting


Upfront Healthcare // November 2016

PENNED

Where are you? Here What time is it? Now Who are you? This moment. -Dan Millman, Peaceful Warrior My daughter is away at her first year at Penn State. Time flies. I have seen her go from a baby to a toddler, pre-schooler to a middle schooler, and high schooler to a college freshman. As all parents know, seeing your child grow up is like a series of broken hearts, falling in love with one person only to have them leave as a new person. Each tiny love affair you cherish, knowing you will never be able to return to it. Throughout those years I was focused on every moment that I could spend with her and enjoy who she was. Each step of the way I supported her either as a very talented gymnast, or student or just a person who cared for her family and friends. If you focus on others you find the most fulfillment. Living is giving: time, money and of oneself. Executive Director Joseph Kubulak editor-in-chief Becca Blau assistant editor Andrea Frazer creative Rebecca Grunwald Joy Hoberman advertising Britt Goldberger publisher GCNY Marketing MAIN OFFICE: 1449 37th Street | Suite 507 Brooklyn, New York | 11218

January 2017

In the business that we are in we see how incredibly fragile life is as well. Even with people we know, I am sure we all have experienced how life can change in a split moment. But business is just as simple. Despite the fast-paced, highproductivity business we work in, we constantly keep in mind that we are here for each other. It’s easy to forget; we all have responsibilities and timelines, and people to deal with. It seems overwhelming—until you hear your daughter’s voice over the phone from college telling you she loves you, and the world stops and you realize once again what you are here for and how straightforward this all is. It is simple. Do more for others and be kind. Everyday I address business here at SpecialtyRx. The owners, Mr. Berkowitz, Mr. Zupnick, and myself, realize that our business is about you and your residents. We realize that it is all about this moment. We think about where we came from and what happened yesterday. We know where all the projects need to take us tomorrow, but we know that all stops when we get a call from you. We hope you know how important you are to us. We hope you realize that regardless how busy we may seem, we care about this moment and about you and the right now. This is the kind of attitude that all three of us strive for in our company. We will always push toward that perfect moment. Because life is simple. God bless you and enjoy this issue! Joe Kubulak V.P. of Operations and Business Development, SpecialtyRx


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CONTENTS

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Industry Currents The 5 Most Expensive Medicare Drugs pg 6 Are Diabetes and Dementia Linked? pg 8

10 14 19 Light Therapy

Exercise for Seniors

Healthy at Home

Daylighting Strategies for Long-Term Care Facilities

Keeping the LongTerm Care Community Healthy and Fit

Home Rx Makes Sending Residents Home A Painless Process

24 Midas Touch The Man on a Golden Mission

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LTC Insurance’s Shifting Future Insurance broker Eliezer Zupnick on the ACA, insurance vouchers, and how Trump’s campaign promises affect the future of LTC


Upfront Healthcare // November 2016

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Discover how our five CareCores™ commitments empower you to care, lighten your daily workload, and ensure you always have the goods you need for your facility to do great things.


Upfront Healthcare // November 2016

TRAJECTORY

The 5 Most Expensive Medicare Drugs The rising costs of prescription drugs have been a hot topic recently, but surprisingly, the five most expensive drugs covered by Medicare have one thing in common: none of them had price increases higher than 5% in the last year.

1. In 2015, Medicare spent $162,371 per patient on H.P. Acthar, an increase of 5% since the previous year. Acthar has been around since the 1950’s and is used to treat several

indications, including multiple sclerosis relapse. 2. The price for the second most expensive Medicare prescription, Remodulin, remained unchanged from the prior year. Remodulin treats pulmonary arterial hypertension, and costs an average of $144,070 per patient in 2015. 3. Tyvaso, an inhaled solution for pulmonary arterial hypertension treatment, came in right behind on the list of Medicare’s most expensive drugs. Tyvaso increased 5% since last year, costing Medicare $107,489 per patient.

4. Provenge, the most expensive cancer treatment on a perpatient basis, increased 4% since last year, costing Medicare $95,290 per patient for advanced prostate cancer immunotherapy. 5. The average cost for the fifth most expensive medication, Harvoni, actually went down 1%, costing Medicare $92,847 per patient. The hepatitis C drug is on the top of the list when it comes to total spending, costing Medicare over $7 billion in 2015. â—?


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UP TO DATE

Can common heartburn medications lead to stroke? New study questions the cardiovascular safety of drugs like Nexium, Prevacid, Prilosec, and Protonix In a study of 245,000 Danish adults, scientist have found that the risk of ischemic stroke was increased by an average of 21% with the use of Proton Pump Inhibitors (PPIs). PPIs work by reducing the amount of acid produced in the stomach, thereby lessening the acid back-up in the esophagus, which is what causes painful heartburn. Ischemic stroke is the most common form of stroke, particularly for older adults. It is caused by blood clots obstructing blood flow to the brain. Researchers have found a correlation between PPIs and vascular impairment, which led to this study. Per Dr. Thomas Sehested of the Danish Heart Foundation in Copenhagen, Denmark, “PPIs have been associated with unhealthy vascular function, including

heart attacks, kidney disease and dementia. We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.” Dr. Sehested recently presented these findings at the American Heart Association’s Scientific Sessions, held in New Orleans, LA in November 2016. Researchers suggest using caution when using and dosing the drugs, some of which are over the counter. Since elderly patients are already at an increased risk for stroke, it is best to avoid keeping them on

PPIs for extended periods. “We know that from prior studies that a lot of individuals are using PPIs for a much longer time than indicated, which is especially true for elderly patients,” says Dr. Sehasted. The more frequently used it is, the more of a problem it may be. The study did not show any increased stroke risk with the lowest doses of PPIs. At the highest dose for PPI’s, researchers found that stroke risk increased 33% for Prilosec and Prevacid patients, 50% for Nexium patients and 79% for Protonix patients. ●


Upfront Healthcare // November 2016

NOTEWORTHY

Are Diabetes & Dementia Linked? Lower blood sugar levels may help prevent dementia in residents. People with higher blood sugar levels were found to be linked with a higher risk for dementia. A recent study showed that patients without diabetes had an 18% higher risk of dementia if their glucose averaged 115 milligrams per deciliter (mg/dl) compared to those with an average of 110 mg/dl. In diabetics with generally higher glucose levels, the risk of dementia was 40% higher if their glucose averaged 190 mg/dl, compared to those with an average glucose level of 160 mg/dl. According to Paul K. Crane, an author of the study, “The most interesting finding was that every incrementally higher glucose level was

associated with a higher risk of dementia in people who did not have diabetes. There was no threshold value for lower glucose values where risk leveled off.� Another study included nearly 350,000 type 2 diabetics, and found that controlling blood sugar levels may help prevent dementia in patients with diabetes. The study found that patients with poor blood sugar control had a 50% higher risk of hospital admittance for future dementia, compared to those with good blood sugar control. �


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RECREATION

News and World Report Releases Best Nursing Homes for 2016-17 More than 15,000 nursing homes in each state and in 100 metropolitan areas were evaluated, and this year just over 2,000 nursing homes were chosen as designated U.S. News Best Nursing Homes. U.S. News also released its new Nursing Home Finder tool for people searching for a home for themselves or a loved one. The tool allows people to search by location, Medicare and Medicaid coverage, facility size, and star rating. It also offers comprehensive information about staffing, safety, care, and health inspections for each nursing home. Until now, U.S. News has depended on Centers for Medicare & Medicaid Services (CMS) to put together the list of best nursing homes. CMS puts together a rating of

one to five stars for nursing homes depending on three factors: state-conducted health inspections, nurse staffing and medical quality measures. Effective for 2016-17, U.S. News elected a modification to the CMS ratings approach. The new system involves: 1. The evaluation of a nursing home’s performance over time, by averaging monthly data over a year. 2. More emphasis on strong performance in medical quality measures by capping overall star

ratings of homes with a low rating in this domain. 3. Ensuring that highly rated homes provided more than the required minimum of rehabilitation therapy to residents who were classified as having received high levels of rehabilitative services. About 13% of U.S. nursing homes – a bit over 2,000 nursing homes in total – were chosen as U.S. News Best Nursing Homes. This number reflects a 41% decrease from last year, largely due to the CMS modifications. ●


Upfront Healthcare // November 2016

THER light


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RAPY

Architect John Baumgarten brings thirty years of experience arranging space and light in healthcare facilities.


Upfront Healthcare // November 2016

SEEING THE LIGHT DAYLIGHT STRATEGIES BY J O H N W. B AU M G A R T E N

John Baumgarten, R.A., AIA, LEED AP, is president and founder of the firm of John W. Baumgarten Architect, P.C., an award-winning, full-service architectural firm serving proprietary and not-for-profit health care 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. Mr. Baumgarten has over 30 years of experience working in the field of Health Care Architecture. One of his greatest assets is the ability to see “the total project” and to integrate program, budget, infrastructure and aesthetics to produce a unified and cohesive design that is approvable, buildable and beautiful. Learn more at JWBArch.com.

The health benefits of natural and “simulated” daylight have been much discussed and debated. However, it is generally agreed upon by both laymen and experts alike that daylight can improve a person’s mood and outlook which, in healthcare facilities, can contribute to better patient outcomes. Numerous studies also indicate that the presence of daylight can lead to lower rates of employee turnover and absences.

It is much easier to plan a day-lighting strategy for a new building when decisions which optimize daylight are made up front. These include building orientation, the type and location of facade fenestration and shading elements. There is always a push-pull between the positive benefits of more daylight and the negative impacts of increased glare and heat gain. Passive facade elements

such as light shelves or eyebrows allow light to bounce off them and be reflected toward the ceiling of space where the light, now diffused, is indirectly and evenly diffused across a room without glare. Engineered glazing with high reflectivity and low-e characteristics reduce ultraviolet radiation penetration into a space, thereby reducing heat gain. Active devices such as semi-opaque


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interior shades allow diffused daylight to enter while also reducing heat gain. Such shading systems can also be automated to “track the sun” as part of a computerized building management system.

considerations in the selection and placement of interior (artificial) lighting. Too much glare can agitate and even confuse residents of long term care facilities, especially in a dementia setting.

Interior finishes and furnishings also play a key role in any daylighting strategy with lighter colors and smoother textures helping to increase the reflection of light deeper into a space.

Indirect and semi-indirect light fixtures are designed to “bounce” light off wall and ceiling surfaces, diffusing light just like exterior light shelves do with natural daylight. Suspended and/or baffled light fixtures generally have a more residential look than direct down lighting resulting in a more homelike environment.

PHOTO: JOHN W. BAUMGARTEN ARCHITECT W ITH ICON INTERIORS

BROOKSIDE HE ALTHCARE & REHABILITATION CENTER.

The reduction of glare and the diffusion of light are also important

Where low ceiling heights prevent the use of indirect suspended fixtures, parabolic style units with a dense open grid lens can provide improved light diffusion. Lamp selection and energy efficiency are also key factors in any lighting scheme. In the past, designers had to choose between the warmth of incandescent bulbs and the longer life and greater energy efficiency of fluorescent lamps. This is no longer the case with today’s warmer compact LEDs, providing the best of both worlds. ●


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WAYS TO GET SENIORS EXERCISING AND HAVE FUN WHILE THEY’RE AT IT!

BY A N D R E A F R A Z E R

As a Nursing Home Administrator, keeping seniors active and safe is of utmost priority. While you will not be planning any Sunday hikes for your residents, there is no reason you can’t plan a hike to the rec room for gardening or yoga. From mental to physical health, exercise is a key ingredient in keeping your residents balanced. But let’s face it – no one likes to be lectured about getting in shape. Like a spoonful of sugar, here are seven ways to help that fitness medicine go down sweetly. (In fact, some of these tips are so fun, it won’t be surprising if residents come back again and again for extra doses!)

GARDENING “No occupation is so delightful to me as the culture of the earth, and no culture comparable to that of the garden.” – Thomas Jefferson Turns out our third president might have been

on to something. According to the CDC (Center for Disease Control and Prevention), moderate movement for two and a half hours per week can greatly reduce the risk for weight gain, Type 2 diabetes, depression, heart disease, stroke, high blood pressure, bone breakage and more. For those who are in nursing homes or rehabs for these issues, the same time spend can greatly speed up the healing process. In-room planters and herb gardens in the main lobby can go a long way in lifting spirits. Just the activity of wheeling oneself from their bed to the plant can keep circulation going. The gardens are not only an excuse for moderate lifting and stretching, they smell wonderful, are great conversation pieces and provide a healthy level of accountability to people who often feel a loss of purpose due to disability or illness.

CHAIR AEROBICS No longer just a series of stretching in a lone room, many NHA’s are bringing walkers and wheelchairs together to exercise. “My mom had horrible spinal stenosis, but just getting up and moving a little bit each day really improved her quality of life,” says Los Angeles resident Ria Snoek. From videos to live instructors, sedentary jazzercise – combined with music – can greatly aid seniors in their healing.


Upfront Healthcare // November 2016

TALK TO THEM With so many residents, it can be easy to feel overwhelmed with the tasks of getting so many people on the road to recovery. It is essential to slow down just enough to find out what they love. People are more motivated to exercise if they have a goal, so knowing what your residents hold near and dear to their hearts can be crucial in encouraging them to move. It’s one thing for an NHA to nudge Mr. Greenberg to do a loop around the facility with his walker. It’s another if Mr. Greenberg is reminded that walking will strengthen his legs enough so that he can get back to his grandkid’s ball games again. (And with that kind of encouragement, don’t be surprised if he takes two loops!)

MAKE BEACH BALLS YOUR FRIEND No matter what age, nothing is more fun than throwing a colorful beach ball back and forth. It’s a great cardiovascular activity. In addition, you can make a game out of it. “Whichever team keeps the ball in the air the longest gets an ice cream!” can be your rallying cry. Some rehab and nursing centers have weekly “volleyball games” where up to six chairs are placed on each side of a low net. If your residents are room bound, beach balls can still be used for stretching.


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YOGA It might sound cliché, but it bears mentioning again: Yoga has incredible benefits for seniors. Whether done sitting down or getting on a mat, yoga not only increases balance and provides physical strength training, it also has mental benefits. Focusing on a specific move gets one’s mind off a negative thought. In addition, the serotonin released during the movement helps rewire the brain, allowing seniors to heal quicker than they might without it.

THERAPY ANIMALS It’s true – Fido or Fi Fi are worth their weight in stray fur. While petting an animal is not exactly akin to a 1000 calorie workout, the emotional benefits are equally as impressive. Stress levels drop, allowing residents to see their healing from a new perspective. Knowing that their favorite four-legged friend will be in the common area is sometimes all the motivation someone needs to wheel themselves down the hall for some good old fashioned pet therapy.

INSPIRATIONAL MOVIES Sure, movies and popcorn are not exactly known for their strength building effects, but often an inspiring story is always a springboard for new ideas. Movies like About Schmidt and St. Vincent are both tales about men who could have lived grumpy old lives. Instead, their ordinary existences were jumpstarted by adventures and people that transformed their stories forever. It’s hard to walk away from these films and not feel the effects of a life full of purpose. Such feel-good films are often motivation to get us

Be the Product of the Product! We know that getting seniors to move isn’t always easy – especially when they are recovering from physical illness. For that reason, may we suggest that you incorporate exercise into your own routine? It will not only strengthen you mentally and physically, but it will also give your residents motivation when they see the positive effects it has on you. Nothing sells a product like a sales person that truly loves the product they are pitching. Here’s to your own health care and inspiring the seniors who rely on you go get well!

feeling differently about our own lives. Why wouldn’t the same be true of the seniors in your facility? NHA’s who have weekly movie nights often report higher morale among their members also – this goodwill being transferred into other activities throughout the facility. ●


SEND YOUR HEART HOME.

Entrust your residents into the compassionate company of HDA and our team of family-minded caregivers. It’s your greatest show of love. And they know it. 718.422.4700 | HDACare.com


BRINGING HEALTHY HOME HomeRx Makes Sending Residents Home A Painless Process


Upfront Healthcare // November 2016

EFFORTLESS HOME MEDICATION BY B E C C A B L AU

Gwen Albright, 73, has fourteen pills embedded into her morning oatmeal, with another nineteen medications waiting for her throughout the day: capsules, liquids, and topical creams. Lisa, Gwen’s daughter and caretaker, admits that two months ago, she was “completely overwhelmed. Every time a symptom started—pain in her joints or loss of appetite—I’d call [Gwen’s general practitioner] and he’d tell us to discontinue this, start that. My husband and I would spend hours picking out little pale caplets for weeks, only to find out we’d been administering the wrong ones. It was a nightmare.”

After undergoing a knee cap surgery that April, Gwen was sent to a local rehabilitation center to recover and was discharged three months later. After a couple short weeks home, however, Gwen’s family doctor found that an infection started to develop, and recommended emergency rehospitalization. The hospital’s new rehab program included HomeRx, a retail medication program that delivers full-service pharmacy scripting and refill services directly to residents’ homes. “Everything is simple now,” gushes Lisa, who says she feels like her job is safer and easier ever since September. “No more hassles with insurance, no more waiting in line at the pharmacy, no more worrying about what to take when.” HomeRx’s innovative blister-

packaged meds are delivered every weekend directly to Gwen’s home via courier service. The color-coded, bold packaging is compliance-filled automatically according to the doctor’s prescription updates, eliminating dosage confusion—the prime reason for Gwen’s infection. The user-friendly packaging comes with illustrations of each medicine, so if Gwen’s doctor recommends that she holds back on a specific pill for that week because of adverse side effects, Lisa can easily identify and eliminate it from that week’s bedtime ritual. THE WOMAN BEHIND IT ALL

Servicing multiple New Jerseyand New York-based long-term care facilities, HomeRx has had a stream of successes ever since it


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“It’s approaching a patient who is taking fifteen medications per day, and bringing that number down to one.”


Upfront Healthcare // November 2016

support to maintain the wellness and decrease hospital readmission,” she explains. Ms. Rich’s diverse medical background affords her a uniquely broad perspective of the many different environments in which a patient may find himself. As HomeRx’s quality assurance director, Ms. Rich lets her experience guide her to spot gaps and adapt HomeRx to problem-solve for facilities and residents. For example, HomeRx works directly with insurance companies to ensure that residents get approved for medications before their discharge from a rehab center, Specialty Home Rx Meds’s foolproof blister packs so that residents can take a pre-filled compliant blister package home with them. first began filling prescriptions with “If a patient is denied, we’ll work its conspicuous blister packaging relentlessly with the insurance until and home delivery. “The families we get approval,” says Ms. Rich. and caretakers are relieved because it consistently lessens their responsibilities,” says April Rich, RN.

Ms. Rich has twenty years of combined hospital, pharmaceutical and nursing home experience under her belt. She has been at the helm of HomeRx for four years, and describes HomeRx’s mission statement succinctly. “By creating a safe discharge with more supportive medication administration regimen, you provide residents with additional

HOW THEY STANDS OUT

For residents returning home after hospitalization and/or a facility stay, HomeRx continues the same level of care and medication consistency they learned to trust. Refills for all prescriptions are delivered right to the patient’s door, eliminating waiting lines, forgotten refills, and dosage confusions.

HomeRx is offered to every patient being discharged in affiliated nursing homes, but its efficacy truly shines with residents with complex medical history and towers of pill bottles. “It’s approaching a patient who is taking fifteen medications per day, and bringing that number down to one,” says Ms. Rich. Because geriatric residents with diabetes take an average of seven medications a day, sometimes going up to more than thirty a day, HomeRx vastly simplifies complicated meds. The blister packaging will even include vitamins and over-thecounter medications if recommended by the patient’s doctor, like a Tylenol for morning back pain. Liquids and injections come packaged separately. HomeRx professionals are available round the clock to take questions, monitor refills, and follow up to ensure medications are working for them. Advance automatic refills, shipment tracking and a dedicated pharmaceutical courier service ensure the patient’s or caretaker’s total peace of mind. “One of the most common challenges that I deal with as a social worker is when patients get insurance cuts and they are still frail or weak to go home,” says Jane Altshul, Social Services Director at Alaris Health in Union City, New Jersey. “There is a lot of coordination work with home health agency, pharmacy, and doctor’s office. HomeRx creates an open line of communication between me, the nurses and the patients about


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their medications. All medications are clarified and any changes in medications are promptly updated - all ready for when the patient goes home from our facility. They check in with our residents after discharge, too, to make sure they understand their medications and know how to take them.” “As Director of Nursing, one of my main concerns is discharging a patient safely and keeping them from getting

readmitted to the hospital,” says Anita Westerheim, at Alaris Health in Kearny, New Jersey. “Before HomeRx, I spent too much time fielding phone calls from discharged residents who didn’t get their prescriptions from their doctor or medications from local pharmacy. Now these calls have been eliminated because they coordinate all the patients’ medications with the nursing staff and the doctor’s office before discharge from facility. They are excellent in coordination, logistics and follow-up, and frankly, I wish there were more companies like them.” BENEFITS FOR ALL

HomeRx’s account representatives are in constant contact with rehab facilities’ nurses, social workers, and pharmacists, serving as a point of contact for both facilities and residents. Once the resident’s information and prescription are sent to HomeRx, their professionals do the rest of the work. The pace at which HomeRx works ensures that, even on same-day discharges, the patient goes home with his or her medication—or it’s sent to the patient’s home within a few hours.

SELLING IT

HomeRx is also utilized by nursing homes who want to present the program to local hospital. “Local rehab centers maintain better admissions when they can prove that they have a safe and controlled discharge program. Medication compliance promotes wellness,” explains Mrs. Rich. “These rehab centers can take on residents with more complicated diagnoses and get higher reimbursement rates.” HomeRx provides a vital service to the highest-risk population, which encourages physicians to send patients to a nursing home with a green-lit discharge plan. “It’s this simple: decreased confusion leads to medication compliance and adherence, which decreases hospitalization. Doctors feel more confident sending patients to a nursing home where they get more support once sent home.” As HomeRx’ expands its service offering to more counties and states, home medication safety awareness continues to grow. The success of HomeRx has not only made geriatric living easier, it has brought the supervision and safety of a medical center home. When asked if how HomeRx has made a difference, Lisa thinks and says, “My mother worries less about living and more about living right. I’d say there’s a big difference there.” ●


THE MAN ON A GOLDEN MISSION

MIDAS TOUCH “What is the biggest mistake any nursing home administrator can make when it comes to maintaining a peaceful relationship between staff and residents?� I asked Gary Parks, a mental conditioning coach practicing in the Tri-state area. Parks works with many nursing homes and other healthcare facilities on having their staff connect with residents in a productive and diplomatic way.

B Y A LY S S A B R E E


Upfront Healthcare // November 2016

According to Parks, the main reason that residents and their families get anxious is due to their sudden lack of control in a situation that they find dictated by medical professionals. This anxiety can quickly lead to conflict between the residents, their families, and the staff. Instead of getting defensive when residents and their families react emotionally to a particular situation, the staff should be trained to address the concerns of the residents in a way that allows them to feel in control. The staff should also be reminded constantly never to take the emotional reactions of their residents personally.

Janet, a 50-year-old lawyer from the Bronx, recently put her mother in a long-term care facility in Staten Island. During the process of moving her mother in, she noticed that the doctor had prescribed a number of new medications after his initial check up. Janet was worried that the combination of a new environment, and potential side effects from the new medications would cause her mother’s health to deteriorate. When her mother’s nurse, Meredith, came in, Janet asked about the new medications in her mother’s care plan. Meredith had just been scolded

at the last night’s staff meeting for running late on her rounds. Worried about getting caught up in a lengthy conversation, she responded with a curt, “This is what the doctor ordered. If you have any questions, take it up with him.” Janet began to feel any semblance of control over her mother’s care slipping away. She demanded, “Well then, I need you to immediately terminate any new medications until I speak with the doctor.” Meredith was provoked by Janet’s tone and general attitude, and


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decided to reclaim her authority in the situation. “We will follow the care plan that the doctor decided on,” she said sternly. “That is the policy of this home that you signed for and agreed to when you admitted your mother here.” “I would never have brought my mother here had I known that they employed nurses like you,” said Janet. “You can tell your administrator to expect a letter from my law firm. Maybe then I’ll get some answers as to why my mother is being over medicated.”

According to Parks, there are several problems with the way this confrontation took place. The first issue is administrative. When your staff is surrounded by negativity on a constant basis, they will begin to internalize that attitude. Parks has pinpointed a particularly common problem with healthcare institutions, which are problem-based meetings. There is often a focus on what is going wrong, and how it can be fixed, and little to no discussion about

what is going well and how the staff can be thanked. In the example above, Meredith was scolded at the last meeting for not keeping her shifts running on schedule. Her anxiety at being told that she wasn’t doing a good job led her to be curt with Janet. The second issue that Parks tackles is staff appreciation. In order to avoid a resentful attitude, management must focus on providing emotional compensation for their employees. In order to truly show the staff that their work is valued, there needs to be a consistent reminder that they are making a difference in people’s lives every day. It is not enough to simply have an employee of the month. Every meeting should end with a segment on what the staff is doing well. As Parks explained, “Teaching staff how to communicate effectively isn’t just how to put out the fire prior; it’s how set it up so that the fire doesn’t start in the first place.” The first step in establishing a positive relationship between your staff and their residents is to ensure your staff feels appreciated enough to care about their residents. Meredith may have had a problem keeping her rounds on schedule, but if she had also been told that she was doing a fantastic job connecting with residents, she would have had more patience in her response to Janet. Meredith should see both her schedule, as well as her connection with residents, as important parts of her job that are being noticed by the management.

NEVER TAKE THE EMOTIONAL REACTIONS OF YOUR RESIDENTS PERSONALLY.


Draw up a plan to emotionally compensate your staff members.


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Allowing clients to speak is the best way for staff to help them feel the most in-control of their situation. More than just hearing what they say, staff should take the time to listen to the concerns of the residents. If a patient feels frustrated or scared, they will often complain or even lash out as a way of trying to take back control. According to Parks, this is a normal response that just needs to be met with reassurance. So what should have been done differently with Janet and Meredith? Don’t take things personally! Staff members need to recognize that the patient and/or family member is feeling uncertain about what will happen. Staying calm and composed will de-escalate an anxious patient’s antagonism. Meredith immediately felt defensive when Janet took on a demanding tone. She made a decision to reclaim her authority as a nurse in her response. Instead, Meredith should have kept her cool in response to Janet’s command. She might have responded with a question, such as “Are there any specific medications that concern you?” and proceeded to listen the answer patiently. Instead, Meredith didn’t bother finding out what was bothering Janet, who felt like she wasn’t being given a platform to share her concerns. Meredith’s biggest mistake was taking Janet’s attempt to control the situation personally. She felt attacked when Janet made a demand, instead of seeing Janet’s commanding tone as a psychological response to the situation she was in. Parks says that staff should be

trained to maintain eye contact while their patient or the family member is talking, and allow them to finish what they say before answering. This gives a semblance of certainty to the client in a situation where the staff member seems to be in charge of what happens to them. Allowing residents and their family members to speak freely will allow them to feel in control of what happens to them, and effectively decrease their anxiety. One of the main responsibilities of the staff should be to listen to anxious residents and provide them with answers to their questions and concerns. Staying on top of her schedule may have seemed important, but Meredith should have taken a moment to consider priorities. Janet was understandably anxious about admitting her mother to a nursing home for the first time. She needed her concerns to be heard in order to feel a sense of control in the situation, and to feel like her worries about the medication’s side effects were being taken seriously. Janet felt anxious about being brushed off by Meredith, because she wanted to feel like she wouldn’t lose charge of her mother’s care. Gary Parks recommends that nursing home administrators draw up a plan to emotionally compensate their staff, beginning with a revolution of staff meetings. If negative issues are discussed along with motivational and complimentary comments, the staff will keep their priorities in line, which will promote peaceful relationships between the staff, the residents, and their families. ● To implement the Midas Touch program in your Long Term Care Facility contact us at MidasTouchCare.com or call 929.277.6983

Are Your Staff and Residents Seeing Eye to Eye? Gary dispenses practical wisdom to ascertain that you, your staff, and your residents are all on the same page: Keep your staff motivated on a daily basis by eliminating problem-based meetings and focusing on staff appreciation. Maintain a positive atmosphere in your nursing home by having your staff constantly reminded of the purpose and value that they bring to their residents and families. Make sure that your staff is trained not to take things personally. Gary Parks works with nursing homes to help train nursing home personnel to avoid taking offense from irate residents.


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LTC INSURANCE’S SHIFTING FUTURE

Insurance broker Eliezer Zupnick on the ACA, insurance vouchers and how Trump’s campaign promises affect the future of LTC


Upfront Healthcare // November 2016

INSURANCE UNDER THE TRUMP ADMINISTRATION BY A LY S S A B R E E

The Affordable Care Act introduced a heap of new responsibilities for health insurance brokers. I spoke with Eliezer Zupnick, president of Zupnick Associates, a company that has been rapidly updating their services to keep up with the changes over the past few years. What sort of insurance services do you provide? We are a full-service insurance

agency. We focus mostly on employee benefits, and since the ACA came into effect, services such as group health insurance for large businesses. Large companies may scramble to ensure that they are keeping up with maintenance of the plans. For example, if our client has an employee who rejects health insurance coverage, we need to prove that our client offered coverage and the employee voluntarily rejected the offer. Our benefits administration system allows the employee to do this online so that we

can quickly send in this information in time for the deadline. We have been working hard to help nursing home administrators offer health insurance to their employees without breaking the bank. Oftentimes, particularly with the nursing home industry, employees are part-time or for some other reason not eligible to be offered health insurance. In these cases, we help employers offer more basic coverage in order to remain competitive on the labor market. Do you think Trump will follow


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through with his campaign promise to scrap the ACA? Trump’s presidential campaign promised to dismantle the ACA, but once the campaign was over, Trump began mentioning that he would keep some parts and scrap others. In general, it is extremely uncertain what the outcome of a repeal would be or whether it would happen at all. Since Trump still hasn’t proposed a replacement plan for the ACA, there is no immediate prediction of a largescale repeal. What can we see happening if Trump follows through on his proposition of revoking parts of the ACA? Well that depends on which parts he revokes! First there’s the overall insurance mandate. The prediction is that the employer mandate would stay, and the individual mandate would go away. During his campaign, Trump promised to repeal the individual mandate, but it still remains to be seen whether or not he will follow through with that promise.

Republican party at large have been discussing is opening state lines for insurance. The benefit of this change is that with more competition in the market, premiums will be driven down. However, the actual cost of healthcare is different in New York and Pennsylvania, with New York doctors charging more for services than Pennsylvania doctors. If Trump manages to work through this issue and open state lines, we will see a significantly more affordable rate for health insurance than we have until now. What are your thoughts on Paul Ryan’s proposed voucher system? How would nursing homes be affected by such a change? In some ways the voucher system would be better, because it moves towards private insurance and allows for more competition and for drug price negotiation. On the other hand,

We cannot yet predict the practical effects of Trump’s insurance plan.

We also have the healthcare system’s current policy, which does not allow an individual or business to purchase insurance from any other state than the one they are located in. For example, the state of Pennsylvania might have a low cost available for health insurance, but someone living in NY would not have access to that policy. One of the plans that Trump and the

it can hurt the industry, since the current system allows for higher reimbursements for some services. Private insurance companies will try to negotiate services that they deem unnecessary, which could potentially hurt healthcare institutions such as nursing homes. Trump has shifted away from campaign promises that he’s made, and the general prediction is that he

will keep the ticket items that have been largely helpful for the citizens. At this point I would not be concerned, because it seems that he will keep the Medicare system, but it still remains to be seen. What are your thoughts on the provision in the recent 21st Century Cures Act that frees up funds for drug makers and medical providers? Can this affect the insurance for nursing homes? Obama passed the 21st Century Cures Act on Biden’s initiative. It mostly focuses on cancer research, and as you mentioned, it also allows funding for medications, and drugapproval processes. The FDA will allow medications to pass with easier testing. If this causes medications to be released without proper scrutiny, the subsequent lawsuits can cause higher premiums for healthcare institutions such as nursing homes. I wouldn’t see this as a major immediate concern right now. Things are still in motion, and we will have to see what develops. Any last words? Since Trump has not yet announced his official health insurance plan, we cannot predict the practical effects of it. As of now, most of the policies don’t seem to be immediately changing. Here at Zupnick Associates we are continuing to offer ACA services such as group health insurance plans and employee benefits. We are also ready to update our services as any federal changes are made. ●


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Upfront Healthcare // November 2016

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Upfront Healthcare Issue 2  

Enjoy the second issue of Upfront Healthcare, published by Specialty Rx, keeps LTC professionals updated and informed about the fast-paced h...

Upfront Healthcare Issue 2  

Enjoy the second issue of Upfront Healthcare, published by Specialty Rx, keeps LTC professionals updated and informed about the fast-paced h...

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