Enhancing Staff Engagement, Education, and Satisfaction in Assisted Living and Skilled Nursing Facilities

By: Sharon Stiegler, RN IP RAC-CT ALA, Regional Director for Advanced Health Institute 

The heart of every assisted living and skilled nursing facility is its staff. Engaged, educated, and satisfied healthcare workers create a positive environment for residents and improve overall care quality. With workforce shortages and burnout on the rise, facilities must adopt innovative strategies to enhance staff well-being and professional growth. Here’s how: 

1. Prioritize Continuing Education and Professional Development 

Investing in staff education boosts confidence and job satisfaction while improving patient outcomes. According to a 2023 study published in The Journal of Nursing Administration, organizations that offer structured learning opportunities see a 15% increase in staff retention rates (Smith & Turner, 2023). 

Actionable Steps: 

• Provide tuition reimbursement or scholarships for certifications in geriatric nursing and infection prevention. 

• Host in-service training and workshops with interactive case studies. 

• Implement mentorship programs where seasoned nurses support new hires. 

2. Foster a Culture of Recognition and Appreciation 

Employees who feel valued are more likely to stay engaged. A Gallup survey found that organizations with strong recognition programs experience a 21% increase in productivity (Gallup Workplace Report, 2022). 

Ways to Recognize Staff: 

• Implement “Employee of the Month” programs with meaningful rewards. 

• Celebrate small and large achievements, from resident success stories to work anniversaries. 

• Encourage peer-to-peer recognition through internal newsletters or meetings. 

3. Enhance Work-Life Balance and Mental Health Support 

Burnout and stress are major contributors to high turnover in healthcare settings. A report from the American Nurses Association emphasized that facilities prioritizing mental health support saw a 30% decrease in staff absenteeism (ANA, 2023). 

Strategies to Promote Work-Life Balance: 

• Offer flexible scheduling options to accommodate personal needs. 

• Provide access to counseling and employee wellness programs. 

• Encourage breaks and time-off policies to prevent exhaustion. 

4. Strengthen Team Communication and Collaboration 

When staff members feel heard and empowered, they are more engaged. Studies show that facilities with open communication channels experience 25% higher job satisfaction rates (Healthcare Leadership Review, 2022). 

Communication Enhancements: 

• Hold regular staff meetings with an open forum for feedback. 

• Utilize digital platforms for real-time collaboration. 

• Encourage leadership to have an open-door policy. 

5. Leverage Technology to Reduce Workload 

Technology can streamline tasks and reduce administrative burden, allowing staff to focus on patient care. Implementing electronic health records (EHRs) and AI-assisted scheduling has been shown to improve efficiency by 40% in long-term care facilities (Journal of Health Informatics, 2023). 

Technology Implementation Ideas: 

• Adopt automated medication management systems. 

• Utilize mobile apps for instant staff communication. 

• Invest in AI-driven tools for efficient documentation. 

Final Thoughts: Building a Thriving Workforce 

By prioritizing staff engagement, education, and well-being, assisted living and skilled nursing facilities can cultivate a committed, motivated workforce. As healthcare continues to evolve, investing in staff development and satisfaction is not just beneficial—it’s essential. 

“When healthcare professionals feel supported, valued, and equipped, they deliver the best care possible.” (National Institute for Healthcare Excellence, 2023) 

Let’s work together to create workplaces that nurture both our caregivers and the residents they serve. 

Nurse Leadership and Conflict Resolution: A Mindfulness and Yoga Perspective

By: Evangelina "Jazzy" Palacios, BSN, RN 

As a nurse leader who integrates yoga and mindfulness into daily practice, I have witnessed firsthand the transformative impact these disciplines have on managing workplace conflicts. The high-pressure environment of healthcare often gives rise to interpersonal tensions, communication breakdowns, and ethical dilemmas. By embracing mindfulness and yoga, nurse leaders can navigate these challenges with clarity, compassion, and resilience. 

The Role of Mindfulness in Conflict Resolution 

Mindfulness, the practice of being fully present and engaged in the current moment without judgment, enhances self-awareness and emotional regulation. Research indicates that mindfulness is significantly associated with integrative conflict resolution styles among nurse managers. This approach fosters collaborative problem-solving and mutual understanding, essential components in resolving disputes effectively.

Implementing Mindfulness Strategies 

• Mindful Breathing: In moments of tension, focusing on the breath can ground emotions and reduce reactive responses.

• Present-Moment Awareness: Encouraging team members to engage fully in discussions promotes active listening and reduces misunderstandings.

• Non-Judgmental Observation: Approaching conflicts without preconceived notions allows for unbiased assessment and fair solutions. 

Integrating Yoga into Leadership Practices 

Yoga, with its emphasis on physical postures, breath control, and meditation, complements mindfulness by promoting physical and mental well-being. Regular yoga practice has been shown to reduce stress and burnout among healthcare professionals, thereby enhancing their capacity to manage conflicts.

Yoga Practices to Enhance Leadership 

• Asanas (Physical Postures): Incorporating poses that release tension can prepare the body and mind for calm and focused interactions.

• Pranayama (Breath Control): Techniques such as deep diaphragmatic breathing can alleviate anxiety, fostering a composed demeanor during conflicts.

• Meditation: Regular meditation enhances self-awareness and patience, key attributes in effective leadership and conflict resolution. 

Cultivating a Mindful and Cohesive Team Environment 

As nurse leaders, modeling mindfulness and yoga practices can inspire team members to adopt similar approaches, leading to a more harmonious workplace. Educational programs focusing on authentic leadership and mindfulness have demonstrated positive effects on managerial competencies, further supporting the integration of these practices in leadership development.

Strategies for Team Implementation 

• Mindfulness Workshops: Organizing sessions that teach mindfulness techniques can equip staff with tools to handle stress and interpersonal challenges. 

• Group Yoga Sessions: Facilitating regular yoga classes fosters team bonding and collective well-being. 

• Open Communication Channels: Encouraging transparent and empathetic communication nurtures trust and reduces the potential for conflicts. 

Integrating mindfulness and yoga into nurse leadership practices offers a holistic approach to conflict resolution. By fostering self-awareness, emotional regulation, and a culture of open communication, nurse leaders can effectively navigate workplace conflicts, leading to improved team dynamics and enhanced patient care. 

References 

1. Assi, M. D., Eshah, N. F., & Rayan, A. (2022). The Relationship Between Mindfulness and Conflict Resolution Styles Among Nurse Managers: A Cross-Sectional Study. SAGE Open Nursing. https://pubmed.ncbi.nlm.nih.gov/36467312/ 

1. Al-Ghabeesh, S. H., Abu-Snieneh, H., Abu-Snieneh, A., & Abu-Snieneh, A. (2023). Effect of Authentic Leadership and Mindfulness Educational Program on Nurse Managers' Managerial Competencies. BMC Nursing, 22, Article 63. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-024-01976-z 

1. Alexander, G. K., Rollins, K., Walker, D., Wong, L., & Pennings, J. (2015). Mindfulness-Based Yoga as an Intervention to Manage Stress and Burnout in Nurses: A Systematic Review. Holistic Nursing Practice, 29(5), 231-241. https://journals.sagepub.com/doi/full/10.1177/0898010120921587 

Empathy in Action: The Heart of Healthcare

By: Taylor Brown, RN, Client and Operations Specialist for Advanced Health Institute 

In the fast-paced world of healthcare, it’s easy to get caught up in the technical aspects of our work—medications, diagnoses, care plans, and administrative duties. But at the heart of our profession is something that transcends all these critical elements: empathy. It’s the foundation upon which we build trust with our patients, families, and teams.

As healthcare professionals, we are often the first people patients turn to during their most vulnerable moments. Whether it’s delivering difficult news, guiding them through recovery, or supporting families, our role extends far beyond clinical care. Empathy is the bridge that connects our technical knowledge with the human element of our profession, allowing us to provide care that truly heals—physically and emotionally.

Why Empathy Matters

Studies show that when healthcare providers practice empathy, patient outcomes improve significantly. Patients who feel heard and understood are more likely to follow through with treatment plans, communicate openly, and experience better overall satisfaction with their care. But empathy isn’t just beneficial for patients; it’s also a crucial element of a supportive, collaborative team culture. When we lead with compassion, we create an environment where colleagues feel valued and understood, which can reduce burnout and enhance team performance.

Practical Ways to Cultivate Empathy

• Active Listening: It sounds simple, but truly listening to our patients and colleagues can make all the difference. Give them your full attention—set aside distractions and focus on understanding their needs, fears, and concerns.

• Mindfulness in Care: Slow down, even for just a few moments, to connect with the person in front of you. A smile, a kind word, or taking a few extra minutes to explain something can go a long way in making patients feel supported.

• Self-Care: Empathy starts with caring for yourself. In a profession where we constantly give to others, it’s important to replenish our emotional reserves. Take time for your mental and physical well-being, so you can offer your best self to those in your care.

A Healthcare Culture of Compassion

We strive to integrate empathy into every aspect of our work. From leadership to front-line care, we believe that compassionate communication fosters trust, resilience, and healing. As we look ahead to the future of healthcare, let’s remember that it’s the human connection that often makes the greatest impact. No matter how advanced our technology or treatments become, the power of empathy will always be at the core of exceptional care.

Work-Life Balance for Healthcare Professionals: A Vital Necessity

Healthcare professionals often face long hours, emotional strain, and physical exhaustion, making work-life balance difficult to achieve. This balance is essential for maintaining their well-being and ensuring high-quality resident care.

The Impact of Imbalance

Work-life imbalance is common in healthcare, leading to higher rates of burnout. The demanding nature of the profession can cause physical and mental fatigue, lower job satisfaction, and even affect resident outcomes.

Strategies for Achieving Balance

1. Set Clear Boundaries: Establish boundaries between work and personal life. When at home, it’s important to disconnect from work-related stress.

2. Practice Self-Care: Self-care is crucial. Healthcare workers should prioritize exercise, sleep, and mental well-being through activities like meditation or hobbies.

3. Time Management: Efficiently managing time with tools like to-do lists or apps can prevent feeling overwhelmed. Scheduling regular breaks is also important.

4. Seek Support Systems: Surrounding oneself with a support network of friends, family, or colleagues helps manage stress and creates a positive environment.

5. Leverage Flexibility: Whenever possible, advocate for flexible scheduling options like telemedicine or part-time work to better manage personal and professional life.

The Role of Employers

Healthcare employers should provide adequate resources, time off, and manageable workloads to support their staff’s well-being, improving both job satisfaction and resident care.

Work-life balance is essential for healthcare professionals, enhancing both personal well-being and resident care. By setting boundaries, practicing self-care, and seeking support, professionals can maintain a healthier, sustainable career.

The Importance of Vaccinations: Protecting Our Health and Our Communities

Vaccinations are one of the most critical tools we have in modern healthcare. From eradicating smallpox to drastically reducing cases of polio, vaccines have been instrumental in saving lives and preventing the spread of deadly diseases. Yet, despite their proven success, the importance of vaccinations remains a topic of public discussion. In this blog, we’ll revisit the vital role vaccines play in both individual and community health.

Why Vaccines Matter

At their core, vaccines train the immune system to recognize and fight off harmful pathogens without causing illness. This protective immunity is crucial for preventing the onset of severe diseases such as measles, influenza, hepatitis, and now COVID-19. Vaccines significantly reduce the chances of contracting these infections and can lessen the severity of symptoms if a person does get sick.

For healthcare professionals, ensuring that patients understand the safety and necessity of vaccines is paramount. Vaccinations help keep preventable diseases at bay, which in turn reduces the strain on our healthcare system, lowers healthcare costs, and protects vulnerable populations such as the elderly, newborns, and those with compromised immune systems.

Herd Immunity: A Community Effort

When a significant portion of the population is vaccinated, it creates what is known as "herd immunity." This form of protection helps to prevent the spread of disease within a community, especially safeguarding individuals who cannot receive certain vaccines due to medical reasons. Herd immunity can effectively stop the chain of transmission, reducing outbreaks and limiting the spread of infectious diseases.

Without widespread vaccination, highly contagious diseases can return quickly, as seen with the resurgence of measles in certain parts of the world. It’s crucial to remember that diseases eradicated in some countries may still exist in others, and international travel can reintroduce them if immunity levels drop.

Looking to the Future

Vaccines are not only essential for controlling diseases we’ve already encountered but also for addressing new and emerging health threats. Research into new vaccines continues to evolve, offering hope for protecting future generations from diseases that currently have no cure or prevention.

As we move forward in the fight against infectious diseases, let’s continue to advocate for vaccinations. They are not just an individual choice; they are a collective responsibility that saves lives, protects communities, and ensures a healthier future for all.

Press: Transforming Long-Term Care with Technology (Eldercare Review Article)

AHI’s very own Christopher Blomquist contributed an excellent article for Eldercare Review. Christopher is AHI’s Regional Director for Skilled Nursing Services & VP of Clinical AI Strategy at DOVAXIS.

“AI systems have the potential to serve as personal assistants to streamline the process of gathering and organizing essential health information. This technology could empower individuals to make informed decisions quickly by providing instant access to all relevant data they need to provide safe and effective care.”

Read More: Transforming Long-Term Care with Technology (eldercarereview.com)

Addressing Violence Towards Healthcare Workers in Assisted Living Settings

by Heidi LaMeyer, RN, LALD, Regional Director at AHI

Violence against healthcare workers has been on the rise, particularly in assisted living settings where staff often work alone or with minimal support. This trend has severe implications for both the physical and mental well-being of healthcare professionals and the quality of care they provide. This post explores recent data on this issue, strategies for coping, and methods for ensuring safety and self-defense.

Current Trends and Statistics

Recent reports indicate a significant increase in workplace violence experienced by healthcare workers. The National Nurses United (NNU) survey found that 81.6% of nurses experienced at least one type of workplace violence in the past year, with nearly half reporting an increase in such incidents. Factors contributing to this rise include patient frustration, mental health issues, and the aftermath of the COVID-19 pandemic​ (National Nurses United)​​ (AAMC)​.

Strategies for Coping and Safety

Training and Education: Providing regular training on de-escalation techniques and self-defense can equip staff to handle violent situations effectively. Programs like the Behavioral Escalation Support Team (BEST) at UC Davis Medical Center have shown success in calming aggressive patients through trained mental health care providers​ (AAMC)​.

Safety Protocols: Implementing strict safety protocols, such as flagging systems for aggressive patients and controlling access to certain areas, can help protect staff. For example, Boston Medical Center uses electronic records to flag patients with a history of aggression, allowing staff to take preventive measures​ (AAMC)​.

Support Systems: Ensuring that there is always a mechanism for staff to call for help, such as panic buttons or quick-response security teams, can enhance safety. The Occupational Safety and Health Administration (OSHA) emphasizes the importance of management leadership and employee participation in hazard identification and control​ (CDC Blogs)​.

Environmental Design: Modifying the physical environment to minimize risk, such as securing furniture that could be used as weapons and ensuring clear escape routes, can reduce the likelihood of harm during violent episodes​ (World Health Organization (WHO))​.

Self-Defense and Mental Health Support

Self-Defense Training: Offering self-defense courses tailored to healthcare settings can empower workers to protect themselves without escalating the situation.

Mental Health Resources: Providing access to counseling and mental health support for workers who experience violence can mitigate long-term psychological impacts. Organizations should prioritize the mental well-being of their staff, recognizing that violence can lead to burnout and decreased job satisfaction​ (World Health Organization (WHO))​.

Legislative Support: Advocating for stronger legal protections and support for healthcare workers is crucial. The proposed Safety from Violence for Healthcare Employees Act aims to increase penalties for assaults on healthcare workers, providing a safer working environment​ (AAMC)​.

Conclusion

Violence in healthcare settings, particularly in assisted living facilities, is a pressing issue that requires a multifaceted approach. By implementing comprehensive training, strict safety protocols, robust support systems, and advocating for legislative changes, we can create a safer environment for healthcare workers. It is essential to prioritize the physical and mental well-being of these professionals to ensure they can continue to provide high-quality care.

For more detailed information, you can refer to the original reports and articles from the National Nurses United, CDC, and other sources mentioned in this post.

New Requirements for Facility Assessment in Long-Term Care Facilities: What Leaders Need to Know

The Centers for Medicare & Medicaid Services (CMS) have implemented new regulations under §483.71, Facility Assessment, as part of the final rule on Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting. These changes, effective August 8, 2024, bring significant updates that long-term care leaders must understand and integrate into their operational strategies.

Key Changes in Facility Assessment Requirements

Comprehensive Evaluation of Resident Population.

The new regulations mandate a thorough evaluation of the resident population, including:

• Resident Count and Capacity: Detailed accounting of the number of residents and the facility’s capacity.

• Care Needs: Assessment of the types of diseases, conditions, physical and cognitive limitations, and overall acuity. This evaluation must be evidence-based and data-driven.

• Staff Competencies: Determining the skills and competencies required to meet the care needs of the resident population.

• Physical Environment and Equipment: Identifying necessary physical space, equipment, and other resources.

• Cultural and Religious Considerations: Including activities and food services tailored to the diverse needs of residents.

Annual and As-Needed Updates

Facilities must conduct and document these assessments at least annually and whenever there is a significant change in the resident population or other circumstances that could affect the assessment. This ensures that the assessment remains current and reflective of the actual needs and resources required.

Active Involvement and Input

To ensure a complete and accurate assessment, the facility must involve key personnel in the assessment process:

• Leadership and Management: Including members of the governing body, medical director, administrator, and director of nursing.

• Direct Care Staff: Such as RNs, LPNs/LVNs, and nursing assistants.

• Resident and Family Input: Soliciting feedback from residents and their families to inform the assessment.

Utilizing the Facility Assessment

The facility assessment should directly inform various operational aspects:

• Staffing Decisions: Ensuring sufficient staffing levels and appropriate competencies to meet residents’ needs.

• Resource Allocation: Identifying and planning for necessary physical, technological, and service resources.

• Contingency Planning: Preparing for events that could impact resident care without activating the emergency plan, such as staffing shortages.

Compliance and Survey Procedures

Surveyors will continue to assess compliance with staffing requirements. Even if a facility meets the assessment requirements, it may still be cited for noncompliance if resident needs are unmet due to insufficient staffing. Therefore, it is crucial that the facility assessment accurately reflects and addresses staffing and resource needs.

Preparing for the New Requirements

As leaders in long-term care, it is imperative to take the following steps to ensure compliance with the new facility assessment requirements:

1. Review and Update Policies: Ensure all facility policies align with the new regulations.

2. Conduct Thorough Assessments: Implement a detailed and data-driven approach to evaluating resident needs and resources.

3. Engage Key Stakeholders: Involve leadership, staff, residents, and families in the assessment process.

4. Regularly Update Assessments: Maintain an ongoing process for updating the facility assessment as required.

5. Train Staff: Educate staff on the new requirements and their role in the assessment process.

By proactively adapting to these changes, long-term care facilities can ensure they provide high-quality care that meets the needs of their residents while maintaining compliance with CMS regulations.

Resources for Further Information

For more detailed information, visit the CMS website and review the updated State Operations Manual (SOM), Appendix PP.

By staying informed and prepared, long-term care leaders can navigate these regulatory changes effectively, ensuring continued excellence in resident care.

Key Focus Areas for a Nursing Home Administrator

Running a nursing home requires balancing multiple priorities to ensure the well-being of residents, the satisfaction of staff, and the efficiency of operations.

Resident Care and Quality of Life

The primary responsibility of a nursing home administrator is to ensure that residents receive quality care that enhances their well-being. This involves:

• Personalized Care Plans: Developing individualized care plans that cater to the specific needs of each resident.

• Health and Safety: Implementing health and safety protocols to prevent infections and ensure a safe environment.

• Engagement and Activities: Providing a variety of activities and social opportunities to keep residents engaged and active.

Staff Management and Development

Well-trained and motivated staff are essential for delivering high-quality care. Administrators should prioritize:

• Recruitment and Retention: Attracting and retaining skilled nursing staff and support personnel.

• Training and Development: Offering ongoing training to keep staff up to date on best practices and regulatory requirements.

• Work Environment: Creating a positive and supportive work environment to reduce turnover and improve job satisfaction.

Regulatory Compliance

Nursing homes must adhere to strict regulations and standards. Administrators must ensure compliance with all local, state, and federal requirements by:

• Staying Informed: Keeping up to date with changes in laws and regulations that affect nursing home operations.

• Documentation and Reporting: Maintaining accurate records and submitting required reports to regulatory authorities.

• Inspection Readiness: Preparing for and managing inspections and audits to ensure the facility meets all regulatory requirements.

Financial Management

Effective financial management is crucial for the sustainability of a nursing home. Administrators should focus on:

• Budgeting: Developing and managing budgets to ensure financial stability and the ability to invest in quality improvements.

• Cost Control: Implementing cost-control measures without compromising the quality of care.

• Revenue Management: Ensuring accurate billing and maximizing revenue through efficient management of insurance claims and payments.

Community and Family Relations

Building strong relationships with residents' families and the local community is essential for the reputation and success of a nursing home. Administrators should:

• Communication: Maintain open and transparent communication with residents’ families about care plans, changes, and any concerns.

• Family Involvement: Encourage family involvement in residents' lives and care plans.

• Community Outreach: Engage with the local community through events, partnerships, and volunteer programs.

A successful nursing home administrator must balance the needs of residents, staff, regulatory requirements, and financial realities. By focusing on these key areas, administrators can create a supportive, safe, and high-quality environment for all residents.

Trauma-Informed Leadership for Dietary Staff

by Mistin M Warkenthien, CDM, CFPP, CFPM 

In the dynamic world of long-term care facilities, dietary staff are essential in promoting the health and well-being of residents. However, these teams often grapple with challenges like managerial turnover and insufficient guidance, sometimes leaving them to manage on their own. Such circumstances can lead to what we might call 'managerial trauma,' affecting staff morale and eroding the effectiveness of team management.

As consultants, we've encountered numerous dietary crews facing these very issues. Our experiences have reinforced the value of trauma-informed leadership—a strategy that pivots from punitive oversight to fostering a culture of support and understanding. Grounded in principles like safety, trustworthiness, choice, collaboration, and empowerment, this leadership style acknowledges and mitigates the impact of stress and trauma on staff.

The Role of Supportive Leadership

Emphasizing supportive leadership in the kitchen is crucial. This approach is not merely about being agreeable; it's about genuinely understanding the challenges staff face and addressing them with empathy and respect. Such leadership has consistently proven effective, enhancing job satisfaction, reducing turnover, and ensuring the delivery of high-quality meals to residents. It demonstrates that understanding and respecting staff is fundamental to maintaining a high-functioning care home.

Implementing Kind Leadership: Our Approach

Through our consulting work, we've applied several key strategies to promote kind leadership:

• Engage in Open Communication: Encouraging leaders to regularly engage with their team, fostering a culture where staff feel comfortable sharing their experiences and challenges.

• Provide Training and Support: Identifying areas where the team needs additional support and offering targeted training and guidance to address these gaps.

• Recognize and Appreciate Efforts: Showing appreciation for the hard work and dedication of the staff, making them feel valued and motivated.

• Foster a Positive Work Environment: Creating an enjoyable and positive workplace that encourages team cohesion and individual satisfaction.

• Establish Clear and Fair Expectations: Setting understandable, transparent expectations and policies, while also being mindful of the team's past experiences with autonomous operation due to leadership voids.

Witnessing Transformation Across Environments

Our approach, grounded in trauma-informed leadership practices, has yielded positive outcomes in practically every environment we've encountered. By addressing and healing from managerial trauma, teams become more cohesive, the quality of service improves, and the overall atmosphere of facilities becomes more positive. This transformation underscores the effectiveness of balancing kindness with accountability and high standards.

Embracing Change with AHI's Support

At AHI, we deeply value the principles of trauma-informed leadership and understand the transformative impact it can have on long-term care facilities, especially within the dietary department. Our firsthand experiences across various environments have shown us the effectiveness of this approach in healing managerial trauma and fostering a positive, productive workplace culture.

We're committed to supporting facilities in embracing this change, offering a range of services tailored to the unique needs of each environment.

Our Services Include:

• Interim Leadership: Providing experienced leaders who can step in temporarily to stabilize and guide your team through transitions, implementing trauma-informed practices along the way.

• Support Leadership: Offering ongoing leadership support to help your existing managers adopt and refine trauma-informed leadership skills, ensuring they can effectively lead and nurture their teams.

• Culture Change: Assisting in the transformation of your workplace culture to one that is rooted in the principles of trauma-informed care, fostering an environment of safety, trust, and empowerment.

• Remote Morale Support: Offering remote support to boost team morale, address challenges, and provide guidance on maintaining a positive and supportive work environment.

At AHI, we walk the walk. Our approach is not just about providing interim solutions; it's about instilling lasting changes that enhance the well-being and satisfaction of staff, which in turn, improves the quality of care for residents. We've witnessed the positive impact of thoughtful leadership on staff morale and performance, and we're here to help you achieve these outcomes in your facility.

Let's Partner for Positive Change

If you're ready to transform your dietary department—or any area of your long-term care facility—into a more supportive, effective, and compassionate workplace, AHI is here to help. Together, we can create environments where staff thrive, residents receive the best possible care, and the entire community benefits.

Contact us today to learn how we can support your journey towards implementing trauma-informed leadership and fostering a culture of care that reflects the values and excellence of your facility.

Nebulizer use in the Long-Term Care Setting

To use a nebulizer or not to use a nebulizer, that is the question! 

The recent past- 

During Covid, Long Term Care (LTC) clinical staff often switched residents from a nebulizer treatment to a metered-dose inhaler with a dedicated spacer. The rationale being that we would be reducing infectious respiratory aerosols. Now we are past the Covid Pandemic yet many of our residents remain on inhalers when they might be better served with a nebulizer treatment.  

Why the switch- 

The recommendation for the switch came from various sources but one source could be found on the MN Dept of Health website which has since been retired. The recommendations from the website included considerations to minimize transmission risk from nebulizers. This included the suggestion of utilizing a metered-dose inhaler with a dedicated spacer to reduce residents and staff exposure to infection. The document also included identification of Aerosol Generating Procedures or AGPs and considerations to minimize transmission risks.  

So where are we now- 

In a nutshell, residents with Asthma and COPD are less likely to tolerate inhalers. In fact, an inhaler often triggers coughing which can increase the risk for exposure to respiratory infections. It is imperative that we assess each resident individually and provide the best treatment possible. During the peak of Covid facilities often resorted understandably to removing almost all the nebulizer treatments which was not the intention of CDC or the Mn Dept of Health.  

What do we do now- 

If SARS or Covid infection is not suspected in a resident presenting for care (based on symptom and exposure history) the health care professional should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis).  

For a resident with suspected or confirmed COVID staff should wear all PPE as indicated per the CDC guidance. And as always we close the door while administering the treatment not only for privacy but also for containment.  

Facilities should determine if they have any Aerosol Generating Procedures and have a policy that guides the staff when performing these procedures. An example would be open suctioning of airways, CPR and manual ventilation and CPAP/BIPAP. Guiding staff on what PPE should be utilized is key.  A reference tool for this can be found at cdc.gov Respiratory Virus Toolkit. 

In summary- 

Please consider reviewing the residents within your care that are at risk, such as those with Asthma and COPD and assure that an individualized assessment is updated. It is important that if the resident would benefit from a nebulizer treatment regime that they be allowed to have a nebulizer treatment. If there is a concern with a SARS or Covid infection, we will utilize Transmission Based Precautions which is what we are already doing.  We are back to a new normal. I hope this clears up some of the confusion and removes the barriers to providing nebulizer treatments for those in need. 

Lynn Fossen RN, VP | Advanced Health Institute 

From Bland to Grand: The Purée Revolution

by Mistin M Warkenthien, CDM, CFPP, CFPM 

Food is more than just fuel for our bodies; it's a source of joy, comfort, and connection. In long-term care environments, where individuals may rely on puréed diets for extended periods, the quality and flavor of these meals take on an even greater significance. Serving flavorful, carefully prepared puréed dishes can profoundly impact residents' quality of life, offering not just nutritional sustenance but also emotional and psychological benefits. I remember in high school, being silly with friends, when I decided to try baby food. How many of you have ventured into the baby food aisle as adults, curious about the taste? Let me tell you, it's like eating flavored water, with the faintest hint of what it's supposed to be—and it's awful! This experience made me wonder, why are we serving such bland fare to our elders or anyone in need of a puréed diet? Puréed food can and should be as delicate, flavorful, and gourmet as any other type of cuisine. After all, TMD stands for texture modified diet, not taste modified diet. We must not overlook the potential of puréed foods to be rich and satisfying, just like any other meal.

The Importance of Flavorful Purée Food:

Eating is one of life's greatest pleasures and a fundamental experience that should bring joy to everyone, including those on a purée diet. Ensuring that purée food is both flavorful and nutritious is not just about meeting dietary needs; it's about respecting the dignity of every diner. The joy of eating well extends beyond the palate, touching on mental and emotional well-being. Here are the key benefits of making puréed food flavorful:

• Dignity: High-quality meals respect the dignity of all diners, regardless of their dietary restrictions.

• Enjoyment: Flavorful food enhances the enjoyment of eating, making meals something to look forward to.

• Well-being: A tasty meal can brighten the day and positively impact mental and emotional health.

• Comfort: Good food offers comfort, reminding individuals of the joy of eating and the pleasures it can bring.

• Sense of Normalcy: Flavorful dishes help maintain a sense of normalcy and inclusion in social settings.

• Connection: Meals prepared with care can express love and foster a deeper sense of connection between the diner and the caregiver.

• Better Nutrition: When food is appetizing, individuals are more likely to consume the necessary nutrients for their health.

Basic Principles of Making Tasty Purée Food:

Creating tasty purée food that delights everyone involves a careful balance of flavors to ensure that the puréed version mirrors the dish being served to the rest of the diners. It's essential that a puréed lasagna, for instance, retains the rich, layered flavors that make the original so beloved. This means adding the same herbs and spices used in the traditional recipe and being mindful not to dilute these flavors with excessive liquid. The goal is to maintain the integrity of the dish's taste, ensuring that each purée offers a true reflection of its namesake. A key strategy in achieving this is to use complementary liquids judiciously. Adding compatible liquids — such as using milk or butter in potatoes, chicken broth for chicken dishes, or beef broth for beef-based meals — enhances the natural flavors without overwhelming them. This approach helps in keeping the essence of the original dish intact, making the purée as enjoyable as its solid counterpart. Moreover, thickening liquids to a pudding thick (IDDSI 4) level before blending gives them a cohesive consistency, making the food easier for the blender to process to the desired texture. By carefully managing the consistency, we ensure that the purée is appealing and safe for those on a TMD. Attention to seasoning is paramount, as it brings out the depth and complexity of flavors in puréed foods. Just like in traditional cooking, the right amount of seasoning can elevate a dish from good to great. It's vital to taste and adjust the seasoning, accordingly, striving for a balance that resonates with the original dish's flavor profile.

Puréed Taco Plate:

Transform the vibrant flavors of tacos into a smooth, delightful purée with this innovative recipe. By carefully combining seasoned ground meat, beans, and vegetables, we create a puréed version that encapsulates the essence of a taco night in a format suitable for all dietary needs.

Ingredients:

·  1 lb ground beef or turkey

·  1 can (15 oz) black beans, rinsed and drained

·  1 cup of your favorite salsa

·  2 teaspoons taco seasoning

·  Water or broth as needed

·  Powdered or Gel Thickener

 Instructions:

1.  Prepare a thickened liquid of your choice with the thickener according to directions on the container. We suggest beef broth or tomato juice.

2.  Cook the meat until it is browned. Drain all excess grease and liquid.

3.  Add taco seasoning, salsa, and beans and stir. Let simmer until heated through.

4.  Add all ingredients to a blender blend to a smooth consistency.

5.  Prepare puréed avocado, sour cream, and tomato as toppings.

6.  Plate the purée in a circle to mimic a taco shell, and add the toppings using a pastry bottle for precision.

Tips for Attractive Presentation:

A notable study by Rush University found that individuals on a puréed diet consumed 500 more calories when their food was shaped into simple geometric forms, compared to when it was presented without any distinct shape. This underscores the importance of presentation in encouraging better dietary intake and ensuring that puréed meals are both nourishing and enjoyable.

• Color Contrast: Bright and vibrant purées can significantly enhance the visual appeal of a dish. Utilizing color contrast not only makes the plate more attractive but also stimulates the diner's appetite and interest in the meal.

• Creative Plating: Inspired by the findings from Rush University, shaping puréed food into simple geometric shapes can be both an art and a science. Tools like pastry bags, molds, or squeeze bottles allow for precision and creativity in plating, making meals visually engaging and more likely to be consumed in larger quantities.

• Serving Ware: The choice of dishware plays a crucial role in presentation. Selecting plates that contrast with the purée's color can frame the meal beautifully, enhancing its overall appeal.

Our journey through the world of puréed food reaffirms that texture-modified diets do not have to compromise on taste, nutrition, or visual appeal. From the simple act of enhancing flavors with thoughtful seasoning and the careful selection of liquids, to the artful presentation of dishes that appeal to the senses, we've explored how puréed food can be both a culinary delight and a nutritious necessity.

The Puréed Taco Plate, along with the insights on presentation and serving, illustrates that with a bit of creativity and care, meals can transcend their texture, offering joy and satisfaction to all who partake. The study from Rush University underscores this, showing that the appearance of food significantly impacts consumption and enjoyment, even in its puréed form.

As we conclude, remember that preparing puréed food is an opportunity to express love and care through culinary creativity. Whether you're cooking for someone on a texture-modified diet or simply exploring the vast landscape of culinary textures, the principles of flavor, nutrition, and presentation remain the same. Embrace the challenge, experiment with new recipes, and celebrate the joy of eating in all its forms.

Together, let's continue to break the boundaries of traditional purée perceptions, proving that every dish, regardless of its texture, can be a gourmet experience worth savoring.

Contact Us to learn more about how AHI’s Certified Dietary Manager Consultant Support can help your facility!

Elevating Safety Standards in U.S. Skilled Nursing and Assisted Living Facilities

By Sharon Stiegler, RN RAC-CT ALA IP, Advanced Health Institute Regional Director  

In the ever-evolving landscape of healthcare, the safety and well-being of residents in skilled nursing and assisted living facilities across the United States remains a top priority. The Centers for Medicare & Medicaid Services (CMS) has set forth regulations aimed at enhancing life safety, emergency preparedness, and infection control measures. These steps are designed not only to protect those who call these facilities home but also the dedicated staff who support them daily. 

Recent audits by the US Department of Health and Human Services Office of the Inspector General, including unannounced comprehensive checks at selected facilities, have highlighted a common theme: there's room for improvement in adhering to these critical safety standards. Findings showed notable deficiencies in areas such as fire safety, emergency response plans, and infection prevention, signaling a need for facilities nationwide to bolster their safety protocols. 

The essence of these findings is not to critique but to motivate positive change. The challenges identified—ranging from oversight gaps to the need for more consistent staff training—underscore the importance of collective efforts in raising the bar for safety and preparedness. 

To address these gaps, a collaborative approach is recommended. Facilities are encouraged to take proactive steps towards rectifying identified issues, enhancing staff training programs, and engaging in more frequent and thorough safety audits. This is not just about meeting regulatory requirements but about fostering a culture of continuous improvement and readiness. 

The call to action extends beyond individual facilities; it is a nationwide push towards excellence in care and safety. By embracing standardized training, prioritizing regular audits, and committing to swift corrective actions, the collective goal of safeguarding the health and safety of residents and staff becomes more achievable. 

This journey towards enhanced safety and preparedness in skilled nursing and assisted living facilities is a shared responsibility. Together, through diligence and a commitment to excellence, we can ensure that our facilities are not only compliant with regulations but are also sanctuaries of safety and care for all residents and staff. 

Let this be a reminder of the critical role that safety plays in the quality of care provided. It is an opportunity to reflect, reassess, and recommit to making our facilities the best and safest they can be. Let us unite in this endeavor for the betterment of our communities and the nation. 

Heartfelt Leadership: Empowering Healthcare Teams to Thrive

In the fast-paced world of elderly care, the role of leadership extends far beyond the logistical coordination of care and resources. It encompasses a deep responsibility for nurturing the well-being of healthcare teams, especially those working in high-pressure environments such as skilled nursing and assisted living facilities.

In February, when heart health and themes of love take center stage, it is an opportune moment to reflect on the concept of heartfelt leadership—an approach that emphasizes compassion, support, and connection to empower healthcare teams to thrive.

The Importance of Leadership in Elderly Care

Leadership in healthcare, particularly in elderly care, can make or break the quality of care delivered. Nurses, social workers, and caregivers are on the front lines, facing emotionally and physically demanding situations daily. Without strong and compassionate leadership, the strain of caregiving can lead to burnout, disengagement, and high turnover.

In contrast, leaders who prioritize empathy, active listening, and team well-being create a ripple effect of positivity that not only enhances staff satisfaction but also directly impacts the quality of care residents receive. Heartfelt leadership is about leading with empathy and putting people—both residents and staff—at the center of decision-making. It's a style that encourages open communication, emotional intelligence, and genuine concern for the mental and emotional health of healthcare professionals.

When leaders take the time to understand and support their teams, they foster a culture where staff feel valued, motivated, and equipped to provide the highest standard of care.

Leading with Empathy

Empathy is at the core of heartfelt leadership.

For administrators and nurse managers, demonstrating empathy starts with understanding the unique challenges that staff members face in caring for elderly residents. Whether it’s managing complex medical conditions, providing end-of-life care, or simply handling the daily stressors that come with caregiving, leaders must acknowledge these experiences and respond with compassion.

One of the most effective ways to lead with empathy is through active listening. Healthcare professionals often feel unheard or overlooked, particularly when they are dealing with difficult situations. By taking the time to listen to their concerns, leaders show that they care not just about the work being done, but also about the emotional and mental health of their team. Regular check-ins, both formal and informal, can provide valuable opportunities to hear feedback, identify challenges, and offer support.

Creating a Culture of Support

In any healthcare setting, creating a supportive environment is essential for team well-being. Heartfelt leadership involves building a culture where collaboration, mutual respect, and teamwork are emphasized. When leaders foster a supportive work environment, healthcare professionals feel more connected to one another and to the mission of providing quality care for residents.

One way to create this culture is through peer recognition programs, where team members are encouraged to acknowledge and celebrate each other’s successes. Recognition can come in the form of monthly awards, shout-outs during team meetings, or even a simple thank-you note. These small acts of appreciation go a long way in boosting morale and reinforcing the idea that every team member’s contribution is valued.

Another aspect of a supportive work culture is ensuring that staff have access to the resources they need to succeed. This could involve professional development opportunities, such as training on new care techniques, or providing mental health resources to help staff manage stress and avoid burnout. By investing in their team’s growth and well-being, leaders show that they are committed to their success.

Empowering Through Appreciation

A key component of heartfelt leadership is showing appreciation for the hard work and dedication of healthcare professionals. Acknowledging their contributions not only boosts morale but also strengthens their sense of purpose and belonging. Staff who feel appreciated are more likely to stay engaged, be proactive in their roles, and go above and beyond for the residents they care for.

Simple gestures of appreciation—like personalized thank-you notes, public recognition in staff meetings, or even organizing events such as team lunches—can create a lasting impact.

During February, in particular, leaders can incorporate the theme of love and care into these gestures, perhaps by organizing a Valentine’s Day appreciation event for the team. Small tokens of gratitude, like heart-shaped cards or a personalized message, can remind staff that they are valued and respected.

Leading by Example

Finally, heartfelt leadership requires leaders to model the behaviors they wish to see in their teams. This includes maintaining a positive attitude, demonstrating resilience in the face of challenges, and showing respect and kindness to all team members. Leaders who lead by example create a culture where staff feel encouraged to follow suit, resulting in a more harmonious and supportive work environment. Moreover, leaders who prioritize self-care set an important precedent for their teams.

In healthcare, where burnout is common, it is crucial for leaders to practice what they preach when it comes to work-life balance. By taking time to rest, recharge, and focus on their well-being, leaders send a powerful message that self-care is not only acceptable but necessary.

In elderly care, where the stakes are high and the work is emotionally demanding, heartfelt leadership can make a world of difference. By leading with empathy, creating a culture of support, showing appreciation, and modeling positive behavior, administrators and nurse managers can empower their healthcare teams to thrive.

In February, a time when we focus on love and heart health, it’s a fitting reminder that leadership is about more than just managing tasks—it’s about caring for the hearts and minds of those who care for others.

When healthcare professionals feel supported and valued, they are better equipped to provide the compassionate, high-quality care that residents deserve.

Empathetic Care in the Clinical Setting

By Kyle Svee, COO & VP of Strategy

Consistent demonstration of empathy towards residents is among the strongest predictors associated with positive resident outcomes, including resident satisfaction and health-related outcomes. Showing empathy is a critical method of providing individualized care that takes a plethora of unique resident needs into consideration, therefore improving the overall quality of care. There are three primary branches of affective resident empathy: cognitive, behavioral and affective. Cognitive empathy shows interpersonal sensitivity and shows effective verbal and nonverbal communication which allows a staff member to get to know a resident on a deeper level and helps to foster comfort and demonstrates kindness. Behavioral empathy involves staff members demonstrating sensitivity and resident advocacy to help to alleviate pain and improve overall health. Affective empathy is shown by staff members recognizing residents as individual people and not as generalized “customers of the facility.” Nonverbal communication can be related to body positioning, eye contact, and active listening between residents and caregivers. Verbal communication can be added by mirroring resident communication, recognizing resident feelings or moods, and by asking questions to clarify resident wants and needs. Ultimately, demonstrating empathy and effective communication skills empowers healthcare staff to positively impact resident satisfaction. 

Healthcare staff can demonstrate empathetic resident care while listening to residents, providing verbal and nonverbal communication, as well as delivering a high level of individualized advocacy and good quality resident care. Maintaining resident empathy may lead to a syndrome called “compassion fatigue”, which is a type of physical, emotional, and psychological exhaustion that caregivers and healthcare staff often experience while delivering individualized empathetic resident care. Compassion fatigue may result in the caregiver and healthcare staff experiencing withdrawal, irritability, disillusionment, and moodiness. Healthcare staff exhibit a high level of compassion every day while on the job and this can contribute to “burn out.” Prevention of “compassion fatigue” and “burn out” can be alleviated by staff and caregivers providing self-care; developing hobbies, speaking to supportive people who understand their struggles, getting plenty of sleep, reading, exercising, and conducting healthy lifestyle choices. Traumatic events, minus any private health information, may be discussed with a trusted friend, co-worker, or professionals and this can greatly reduce pent up stress and frustrations. 

For some healthcare staff empathy does not always come naturally; however, empathy can be developed like any other skill. Two ways to improve caregiver empathy while on the job include practicing mindfulness or meditation and finding a strong caregiver support system among your co-workers. Mindfulness is demonstrated by making sure that you are aware of what you are doing, where you are, and what you are feeling. This helps lead the person to acceptance. Healthcare facilities can help to alleviate burn out and compassion fatigue by developing a positive workplace environment, consisting of supportive coworkers, and ensuring that staff members take appropriate breaks to recharge and reinvigorate. Demonstration of empathy has tremendous benefits for positive resident care experience and rewarding feelings of accomplishment and caregiving for healthcare workers. For these reasons it is imperative that efforts and methods to maintain consistent expression of empathy towards residents are standardized.

Best Practice Narcotic Control in Assisted Living Settings

By Heidi LaMeyer, RN, LALD - Regional Director of Assisted Living - MN  

Assisted living facilities provide care for elderly or disabled individuals who may require assistance with activities of daily living. One of the most critical aspects of care in these facilities is narcotic control. Narcotics are prescription medications that have a high potential for abuse and addiction and can cause serious harm if misused or mishandled. In this blog post, we will discuss best practice approaches to narcotic control in assisted living settings, including strategies to prevent diversion of these medications. 

Shift to Shift Counts 

One of the best practice approaches to narcotic control in assisted living settings is shift-to-shift counts. At the beginning and end of each shift, staff members should conduct counts of narcotics to ensure accuracy and accountability. Any discrepancies should be immediately reported and investigated. This approach ensures that the facility is aware of the total number of narcotics in their possession at any given time and can help prevent diversion by ensuring that all medications are accounted for. 

Double Signatures and Witness on Administration 

Another best practice approach to narcotic control is double signatures and witness on administration. Whenever possible, narcotics should be administered by two authorized staff members who sign off on the medication administration. This approach ensures that there is a second person to verify that the medication is being given to the correct resident and in the correct dosage. It also helps to prevent diversion by ensuring that the medication is not being misused or diverted by a single staff member. In addition, having a witness present during administration can help to further reduce the risk of diversion. 

Bound Narcotic Logbooks 

Bound narcotic logbooks are another best practice approach to narcotic control in assisted living settings. Staff members should keep a record of all narcotics dispensed, including the resident's name, medication name, dose, and date and time of administration. These logs should be signed by both staff members and witnessed, if possible, to confirm the medication administration. This approach provides a clear record of all medication dispensing and ensures that the facility can track and monitor the use of narcotics. 

Double Lock Storage 

Narcotics should be stored in a secure location accessible only to authorized staff members. One of the best practice approaches to narcotic control in assisted living settings is to use double lock storage. This means that the storage area should have two locks to ensure additional security. Access should be granted only by key or code. 

In conclusion, narcotic control in assisted living settings is essential for the safety and well-being of residents. Best practice approaches to narcotic control include shift to shift counts, double signatures and witness on administration whenever possible, bound narcotic logbooks, and double lock storage. These strategies can help to prevent diversion of narcotics and ensure that residents receive the care they need. It is important to train staff members on these best practice approaches and ensure that they are following them consistently to minimize the risk of diversion. 

Adapting to Change: Navigating the Evolving Role of LPNs in Assisted Living Centers

By Heidi LaMeyer, RN, LALD - Regional Director of Assisted Living - MN

In August 2021, significant changes were introduced to Assisted Living Regulations, which have had a profound impact on the roles and responsibilities of Licensed Practical Nurses (LPNs). These changes have led to a shift in LPNs' ability to conduct certain assessments, specifically every other 90-day assessment, which were previously delegated by Registered Nurses (RNs). This alteration now mandates that all assessment duties fall squarely under the purview of Registered Nurses.   

Adding to the complexity, the guidance on the extent to which LPNs can participate in training and competency for Unlicensed Personnel (ULP) appears to reflect the broader confusion within the industry. This legislative overhaul has spurred a trend where LPNs are finding themselves utilized less frequently within the Assisted Living environment.   

Compounded by the nursing shortage exacerbated by the aftermath of the Covid-19 pandemic, we now find ourselves in a precarious situation concerning resident care. However, before prematurely dismissing the potential contributions of LPNs, it's essential to recognize the range of tasks that LPNs can indeed perform within their defined scope of practice while adhering to the statutes and rules outlined in 144G and 4659. 

In this context, it's imperative to highlight the vital role that LPNs can still play within Assisted Living Centers. While some aspects of their involvement have shifted, LPNs possess a wealth of expertise and competencies that can significantly contribute to maintaining the quality of care for residents. Let's explore some of the various tasks and responsibilities that LPNs can undertake while remaining in compliance with the revised regulations. 

Assessments  

• Resident Assessments Support: While LPNs cannot perform comprehensive assessments, they can contribute by gathering data, documenting condition-related information for formal assessments by RNs and conduct focused health assessments for communication to RNs/providers. 

Medication/ Resource Management 

• Medication Management: In addition to administering medications, LPNs can assist in medication management tasks, such as medication reconciliation, ensuring proper storage of medications, reordering medications, or reaching out to the primary physician to obtain a new physician order, and helping residents with medication adherence. They can also Provide support to unlicensed personnel when questions arise. 

• Resource Management: LPNs can assist in managing and ordering medical supplies, ensuring that the facility is adequately equipped to provide care. 

• Processing Orders from Providers: LPNs can receive and process orders from healthcare providers, such as medication changes or treatments, ensuring they are accurately implemented and documented. 

• Medication Disposition and Destruction: LPNs oversee proper disposal of medications, following guidelines and documenting the process in assisted living settings. 

Narcotic Supply Monitoring and Diversion Concerns: LPNs audit and track narcotic supplies, promptly reporting any discrepancies to prevent diversion, ensuring resident safety in assisted living facilities.  

Treatments 

• Wound Care: LPNs can provide basic wound care, including cleaning, dressing changes, and monitoring healing progress. 

• INR Checks: LPNs can perform International Normalized Ratio (INR) checks for residents on anticoagulant therapy, under the supervision of a registered nurse. 

• Pacemaker Checks: LPNs can assist with basic pacemaker checks and assessments, reporting any abnormalities to the appropriate healthcare professionals. 

• Skin Care Management: LPNs can monitor residents' skin integrity, implement preventive measures, and provide guidance on proper skincare to prevent pressure ulcers. 

Staffing/ Staff Relations 

• Staff Supervision: LPNs can monitor and provide support to Unlicensed Personnel (ULP’s) and other support staff, ensuring that care is delivered effectively and efficiently. 

• Effective Shift Collaboration: LPNs assist RNs in scheduling, staffing, and seamless shift handoffs, ensuring comprehensive care coordination within assisted living.   

•  Performance Evaluations: LPNs can provide input to the RN/nurse on the performance of CNAs and other support staff for performance evaluations. 

Training & Education 

• In-Service Training: LPNs can assist in providing in-service training to ULP’s and other staff members, ensuring that everyone is updated on the latest care protocols and policies. 

• Providing Health Education: LPNs can educate residents and their families about health conditions, medications, and self-care strategies. 

• Assistance with Training and Education: LPNs can assist in providing training to staff, ensuring compliance with approved training materials and the involvement of registered nurses in competency evaluations 

• Health Promotion Initiatives: LPNs can assist in organizing and promoting wellness programs, screenings, and educational events for residents and staff. 

Documentation/ Records  

• Documentation Review: LPNs can review and verify the accuracy of documentation completed by ULP’s ensuring that it aligns with residents' care plans and facility policies. 

• Documenting: LPNs are responsible for maintaining accurate and up-to-date medical records, including residents' health status and care provided. 

• Electronic Health Record Management: LPNs can contribute to maintaining accurate electronic health records, ensuring documentation compliance and easy access to residents' medical information. 

Clinical Support 

• Collaboration: LPNs collaborate with registered nurses, physicians, and other healthcare professionals to ensure comprehensive care for residents. 

• Care Plan Updates: LPNs can assist in updating residents' service plans based on changes in their health status or care needs. 

• Provider Rounding: LPNs can participate in provider rounding, providing necessary information about residents' conditions, and assisting with care coordination during rounds. 

• Pain Management: LPNs can monitor residents' pain levels, administer prescribed pain medications, and provide comfort measures while reporting any changes to registered nurses. 

• Infection Control: LPNs can assist in implementing infection control measures, ensuring proper hand hygiene, isolation precautions, and cleanliness within the facility. 

• Nutritional Support: LPNs can collaborate with dietitians and food services to ensure residents' nutritional needs are met, including monitoring dietary restrictions and preferences. 

• Communication: LPNs play a crucial role in communicating with residents, families, case managers/care coordinators and other healthcare team members, relaying important information about residents' conditions and care plans. 

Risk Management  

• Quality Assurance: LPNs can participate in quality assurance activities, such as audits, assessments, and performance improvement initiatives to maintain high standards of care. 

• Emergency Preparedness: LPNs can be involved in emergency preparedness plans and drills, helping to ensure that staff and residents are well-prepared for various scenarios. 

• Fall Prevention and Safety Measures: LPNs can contribute to fall risk assessments, implement safety protocols, and educate residents and staff about fall prevention strategies. 

Psychosocial Nursing Support 

• Behavioral Health Support: LPNs can provide emotional support to residents with behavioral health concerns, using active listening and communication techniques to promote well-being. 

• Transition of Care: LPNs can facilitate smooth transitions when residents move between different levels of care within the facility or when they are discharged to other healthcare settings. 

• Collaboration with Families: LPNs can work closely with residents' families to ensure open communication, address concerns, and provide updates on their loved ones' health status. 

• End-of-Life Care Support: LPNs can provide emotional and physical support to residents and families during end-of-life care, collaborating with hospice services as needed. 

Remember, LPNs should always adhere to the guidelines outlined in the Nurse Practice Act, facility policies/procedures, and the scope of their practice and regulatory statutes.  They should work in collaboration with registered nurses and other healthcare professionals to ensure comprehensive and safe care for residents in the assisted living facility.

Assisted Living Survey Tips

By Heidi LaMeyer, RN, LALD - Regional Director of Assisted Living - MN

Assisted living facilities must meet certain standards set by the Minnesota Department of Health (MDH) to ensure that they are providing high-quality care. Regular surveys are conducted to assess the facility's compliance with state regulations. As a caregiver or staff member, it is essential to be prepared for these surveys to ensure that they run as smoothly as possible. Here are some tips for making the survey process as efficient as possible: 

• Welcome the survey team and check for identification. This will help ensure the safety and security of your facility. 

• Offer refreshments to the survey team. This simple gesture can help set a positive tone for the visit and make the surveyors feel welcome. 

• Escort the survey team to a quiet work area that is not in resident or nursing space. This ensures that the survey team can work efficiently and without distractions, making their visit more productive. 

• Ensure the Survey Readiness Binder is up-to-date and ready to be handed over to the survey team. This binder contains all the necessary information about the facility's policies, procedures, and resident care, ensuring that the survey team has access to all the necessary information, making their job easier and more efficient. 

• Ensure frontline staff knows where the Survey Readiness Binder is kept and can gather it for the survey team if needed. This ensures that everyone knows where the binder is kept to avoid delays or confusion during the survey process. 

• Inform the onsite team that MDH has entered for the survey. It is essential to keep all staff members informed and updated throughout the survey process, ensuring that everyone is on the same page and can work together to make the survey process as smooth as possible. 

• Assign a team lead who will be in charge of coordinating and managing the survey process. This ensures that everything runs smoothly, and the team can work together to make the survey process as efficient as possible. 

• Ensure there is enough nursing help to maintain day-to-day operations when the MDH survey team is in the building. Adequate staffing ensures that the residents receive the care they need without any interruptions. 

• Be prompt in responses to requests from the surveyors. This helps to ensure that the survey team can complete their work efficiently and helps to build a positive relationship with the surveyors. 

• Be precise with responses and dig deeper to find information that will assist in resolving any questions of the survey team. This ensures that the surveyors have accurate information and can make informed decisions about the facility's compliance with state regulations. 

• Be aware and mindful of the process. Understand the next steps in the survey process, ask questions about progress, and don't be afraid to ask for clarification on what they are looking for. 

• Support your onsite team by holding start of day/end of day stand-up meetings to regroup and support the team. This helps ensure that everyone is on the same page and can work together to make the survey process as efficient as possible. 

• Leadership should remain on site during the survey process. This shows a commitment to the survey process and ensures that leadership is available to answer any questions the survey team may have. 

• During the exit interview, take good notes on the findings. This will help you start your plan of correction right away. 

• Try not to internalize the comments or findings. Stay calm and take deep breaths. Remember that the goal of the survey is to improve the quality of care provided to the residents of the facility. 

In conclusion, by following these tips, you can make the survey process as efficient and smooth as possible. By being prepared, welcoming, and responsive to the survey team, you can demonstrate your commitment to providing high-quality care to the residents of your assisted living facility. 

The Health Care Tsunami

by Lynn Fossen, VP of Strategic Solutions

It is hard to believe, but it has been 3 years since the world went on full tilt due to Covid. During this time health care workers have become ‘health care warriors.’  

The Covid pandemic will go down in history as a time that health care workers truly experienced post-traumatic stress. The average health care worker went through experiences that one cannot easily describe without a profound sense of loss and even some anger. The lack of supplies and ability to cope with the disaster left many feeling shocked that this could transpire now and, in the U.S.

Covid has forever altered our work landscape. The most serious hit from Covid however is the lack of applicants who want to work in health care. Long Term Care was experiencing a staffing crisis prior to Covid. We knew that a storm was coming due to the baby boomers aging while the healthcare workforce was dwindling. The tsunami-effect that Covid has created fast-tracked the staffing crisis to levels that nobody could have anticipated. The young workforce today wants work life balance. The older workers are retiring early. Working in health care, especially Long-Term Care, has become less attractive to the new nurses entering the workforce.  The result has been a 1-2 punch to the gut in the staffing arena. Health care providers are forced to pay bonuses for hiring, filling shifts and higher wages. Many facilities are counting on staffing agencies to fill the bulk of their open positions. The applications simply are not there.  

Today the government intends to mandate staffing levels in nursing homes. All of this points to a belief that by regulating staffing requirements we will suddenly resolve the staffing crisis. This belief is a blind spot in America today. Facilities are reducing beds, and some are being forced to close their doors. The result will be less availability of care especially for the higher acuity needs that nursing homes provide.  

What do we do now? It has never been more important that we as a group of health care providers use our voice at the government level. It is also critical that we look at what we do have control over such as support for the care givers which ultimately impacts morale. Creating a team by building a preceptor/mentor program that is guiding staff at each level of care on a shift by shift basis is key to reducing frustration and burnout. Empowering the preceptor/mentor to solve problems at their level such as resolving issues around supplies, training, and onboarding. Establishing that each morning stand up meeting will be initiated with positivity by giving examples of the facility core values in action will ground the facility with a feel-good moment when it is desperately needed. Examination of workflow will be key. Assuring that no money is being left on the table is a given. The role of the MDS nurse in a nursing home has never been more important than now as this nurse is responsible for capturing the dollars and managing the data. Assuring that the MDS nurse has the authority to hold staff accountable and the ability to make system changes is often overlooked. The MDS nurse role is one that should be elevated and yes, celebrated. 

We are in a health care tsunami, but we will come out of this better and stronger than ever before. The solutions that we are creating are in fact already improving staff morale even in the face of the staffing crisis.  We are in this business because of our passion and mission to do the right thing for the elders in our communities. I would say, never underestimate the abilities of todays LTC Health Care Warriors!

Finding the joy in healthcare again

by Niki Ballingrud, RN, LALD, Regional Manager - Consulting MN

Are the Sunday Scaries taking over your whole weekend?  Do you feel your patience with everyone and everything is wearing thin? Does it seem as though no matter what you do at work it is never enough? For many of us in healthcare these thoughts and feelings are quite real and likely have been for some time now. As COVID continues to rage on and struggles with staffing continue to persist, how do we cope? How do we find the joy in healthcare?  

The definition of joy is easy to find by looking it up in the Webster Dictionary: the emotion evoked by well-being, success, or good fortune or by the prospect of possessing what one desires; a state of happiness or felicity; a source or cause of delight.  

The finding of joy can be a little more difficult than just looking it up. While it would be wonderful if that were the case, we all know that isn’t true and some days, a lot of days, we need to work pretty darn hard to find the joy in healthcare.  

If joy is found in the little things, and the little things add up to be quite impactful, here are some suggestions of little things to help you find the joy in healthcare.  

Intentional reflection at the end of each day to actively seek out a joyful moment, a happy thought, a positive interaction, or fun activity. Seek and you shall find.  

Think about “the why.” Why did you go into nursing, healthcare administration, caregiving etc. Use that why and connect it to your day. What fulfills your why? Write it down and look at it when times are hard.  

Connect with others through simple acts of kindness. Compliment someone on his shoes. Tell someone she has a great laugh. Give a genuine smile and “great to see you today” to someone who needs it. Give joy to get joy.  

Laugh. They say laughter is the best medicine. Laughing releases endorphins and relieves stress. A good laugh just makes you feel better.  Laughter and joy go hand in hand.  

Make a list of the things that bring you joy. Can you find some of them at work? Can you incorporate some of them into your day at work?  

While these small acts of trying to find joy may seem daunting against the adversity we face in healthcare, placing extra emphasis on joy that is found, created, and given can foster a positive environment and can make each day a little bit brighter. Every little bit helps.