How Music Can Benefit the Elderly

by Chris Sloan, ALM – Operations Specialist, AZ

Music is an important part of our everyday lives; it is more than just chords or lyrics.  Music resembles your feelings and can create a sense of calm. To most, the playlist you choose can mimic your current feelings or help you resolve stress.  You can relate to the music.  This is true for the elderly as well.  

Music offers a “workout” for the brain.  Research has shown that music can reduce stress, blood pressure, and pain.  It has been shown to improve sleep, enhance mood, offers mental alertness, and help with memory issues. It has been shown that music offers memory stimulation.  You may not recall your high school algebra class to a tee, but music has been known to arouse a trigger memory to help you recall the tempo or lyrics of your favorite song from that same time.  Why is this?  Because music can offer feelings.   

Music can improve the quality of life for our elderly.  It allows us to share our feelings through music.  Our older loved ones may not be able to go out to a club and hit the dance floor like they once had, but music will allow them to maintain and create relationships or express their feelings.  This is also true for even non-verbal seniors. 

It is easier than you think to bring music to our elderly

• You can include music in their daily exercise routine.  Aiding balance, mobility, and coordination. 

• Playing music during mealtimes helps create a pleasant dining experience.  The better the experience, the more apt the senior will enjoy and eat their entire meal. Promoting better nutrition.  

• You can create playlists to include music from their generation and culture.  Promoting self-esteem, pride, and a connection for all.  

• Introduce your elderly loved ones to today’s technology.  There is vast access to any genre of music on- line.  This is also a great way to help the elderly stay connected to the younger population and share their feelings. 

• You can take your loved ones to a school concert. This is also a great opportunity to include multiple generations, bridging the gap. 

• A sing-along is fun for all!  This can help create a sense of community and belonging. 

Music is a timeless and ageless gift that can significantly enhance the lives of the elderly.  By capitalizing on the plethora of benefits that music offers, this will allow your loved ones to flourish and improve their quality of life.  A win-win for the elderly and those that care for them. So, let the melodies play on and watch as the benefits take effect.

Coffee Perks

by Chris Sloan, ALM – Operations Specialist, AZ 

Coffee, often regarded as the elixir of life, is a beverage cherished by people of all ages. While it's commonly associated with jumpstarting our mornings or providing a midday pick-me-up, coffee offers numerous benefits that can be particularly beneficial for the elderly. Let’s explore a variety of ways in which coffee can positively impact the well-being of older adults. 

Cognitive Health 

One of the most prominent benefits of coffee for the elderly is its potential to boost cognitive function. The caffeine in coffee acts as a natural stimulant, improving alertness and concentration. Studies have suggested that moderate coffee consumption may reduce the risk of cognitive decline and conditions like Alzheimer's disease and dementia. It seems that coffee isn't just good for waking you up; it can help keep your mind sharp too! 

Mood Enhancement 

Older adults often face challenges such as isolation and depression. Coffee, with its ability to enhance mood and stimulate the release of neurotransmitters like dopamine, can be a simple yet effective way to combat feelings of sadness or loneliness. Sharing a cup of coffee with friends or loved ones can also promote social interaction and emotional well-being. 

Antioxidant Power 

Coffee is rich in antioxidants, which help protect cells from damage caused by harmful free radicals. These antioxidants have been linked to a reduced risk of chronic diseases, including certain types of cancer and heart disease. For the elderly, maintaining good health is crucial, and coffee can be a tasty addition to an overall nutritious diet. 

Pain Relief 

Many seniors grapple with chronic pain conditions, such as arthritis. Coffee contains compounds that have been shown to have pain-relieving properties. Some elderly individuals may find that moderate coffee consumption helps alleviate discomfort and improves their overall quality of life. 

Digestive Aid 

Digestive issues become more common as we age. Coffee can act as a gentle stimulant for the digestive system, potentially helping with constipation. However, it's important to consume coffee in moderation, as excessive caffeine intake can have the opposite effect and lead to digestive discomfort. 

Social Connection 

Coffee has long been a social beverage, fostering connections and conversations. For seniors living in retirement communities or assisted living facilities, the coffee corner can be a hub of interaction and companionship. Sharing a cup of coffee with peers can be a simple way to establish friendships and maintain an active social life. 

Energy Boost 

As we age, energy levels can decline. Coffee can provide a much-needed energy boost, allowing older adults to stay active and engaged in daily activities. Whether it's to tackle household chores, pursue hobbies, or enjoy outdoor walks, a cup of coffee can help kickstart the day. 

Conclusion 

Coffee, when consumed in moderation, offers a multitude of benefits for the elderly. From enhancing cognitive function and mood to providing antioxidant protection and aiding digestion, this favorite beverage has the potential to enhance the overall well-being of older adults. However, it's essential to remember that individual responses to coffee can vary, so it's advisable to consult with a healthcare professional before making significant changes to your coffee consumption, especially if you have underlying health conditions. In the right context, coffee can be a delightful and healthful addition to the daily routine of seniors, bringing both physical and social benefits.  

Benefits of Interim Leadership

by Chris Sloan, ALM – Operations Specialist, AZ

Does hiring new leadership for your organization seem daunting? Have the last few leadership hires been quick hires, only to turn out not be a good fit for your organization, leaving you to start the process all over again?  What if you had another option? What if you could tap into a seasoned leader, to allow you the time to vet the perfect fit, to end the revolving cycle?  Let’s look at a few benefits of hiring an interim leader. 

Boost Morale:  Interim leadership has been known to improve staff morale.  The interim leader can provide fresh perspective to the team, which can lead to inspiring creative solutions and foster collaboration. The interim can offer the team support during an otherwise difficult transition. All while offering a non-bias objective to the areas where improvement is needed.  Identifying and supporting these improvements help motivate the team, boosting morale. 

Reduce Turn-Over and Burnout:  With a leadership position vacant, inevitably the duties would be distributed to the team members that are still employed.  The additional responsibility and time that the remaining staff will incur can cause dissatisfaction and burn out among the team.  This extra stress on the remaining team members can lead to more resignations. Having an interim leader added to this mix can offer the team support and take the burden off the current team members.  

Less Pressure on Hiring Managers:  A bad hire can take up to 24 months to rectify the damage.  Costing upwards of 30 times the person’s salary.   With an Interim leader in place, the hiring team can take the time to hire and vet the right person.  Pressure is relieved by knowing there is a qualified leader at the helm, with no strings attached, as the interim leader came into the position knowing there will be an end date once the team finds the perfect fit.  

Business as Usual:  An interim leader can help address the day-to-day concerns and obstacles.  While providing the steadiness and calm that is needed for a smooth transition.  The interim can provide guidance and support while staying within budget. Delivering the best outcome for all involved. 

Smooth Transition: A leadership transition can be a turbulent time in any organization.  Interim leadership can help ensure the operations are running smoothly during the search for a permanent leader; that will be the right fit for the organization.  Once a permanent leader has been found, the interim can provide a wealth of knowledge to the incoming leader.  Thus, setting up the permanent leader and the organization for success. 

Final Thoughts on the Benefits of Interim Leadership 

There are many ways your organization can benefit from interim leadership. Such as improving team morale, reducing burn-out and turnover, relieving pressure on your hiring team, continuing with business as usual, as well as creating the opportunity for a smooth transition during an otherwise turbulent time.   

To receive the highest ROI from this strategy, it is imperative to define your organization’s needs and identify the areas that can benefit the most from this role, while providing you the time to select the best permanent leader for your team. 

The Importance of Socialization Between the Elderly and the Youth

by Chris Sloan, ALM – Operations Specialist, AZ

While you are out in public, have you ever noticed the unspoken draw that young children have towards the elderly? And vice versa?  Just last weekend while out for breakfast, I observed an older gentleman and a toddler waving to each other and playing peek a boo, as if no one else was around. Both of their smiles were so genuine and heartfelt.  Intergenerational socialization is something we all benefit from and should be encouraging. 

For the youth, interaction with the elderly can help with communication skills, empathy, respect, and patience just to name a few.  The younger generations learn to accept their own ageing and decrease the fear of the elderly. The elderly can fill a void that the younger generations may be experiencing, if they do not have grandparents to engage with.  The elderly are not in a hurry, they are there in the moment and draw strength from it.  This is not something that the younger generation often gets to be a part of today. But it is something we all could benefit from, once we learn that this is acceptable.  Who better to learn from than the ones who have already been through more than we could ever imagine.  

For the elderly, interaction with the younger generations help with a decrease of social isolation, create a sense of belonging and self-worth, as well as help build self-esteem.  Being a part of the younger generation’s day-to-day activities help the elderly stay active and alert. The elderly tend to overcome their own ailments when they are involved and serving the youth.  One could say it makes them feel younger, more vibrant. 

Intergenerational socializing helps reduce stress for both the elderly and the younger population.  They both learn to feel as if they have a purpose and are valued. With mental health issues on the rise, anything that could help increase one’s feelings of purpose and value is a win-win for all. 

Many cultures revere the elderly, they are treated with the upmost respect and are valued.  Often times the elderly offer the wisdom of a lifetime of challenges and successes. They offer solace and calm. Knowledge of the past can be brought to the younger generations to learn and grow from.  

Intergenerational socialization is a benefit for all.  The youth help the elderly understand the modern ways. Open their minds to things the elderly could never have imagined that would occur in their lifetime.  They can help them with the digital era, so the elderly population is less isolated, being able to face-time or text your grandchildren is an amazing benefit. The seniors who embrace and accept the digital era benefit tremendously.   

The current elderly population have been through the most life altering changes than any other generation before us. Knowing this we owe them the time and respect to understand that.  We should all desire to learn and respect all that our elderly population has endured. 

In conclusion, the intergenerational socialization of the youth and the elderly is nothing but beneficial for all.  We all can learn and grow from each other at any age.  Knowledge of the past will help us bring success in the future. The bonds that the elderly and youth can establish together are immeasurable.

The Art of Communication

By Melinda Williams, RN Consultant

As we all know, Communication is a vital part of success for any company. Important information is not passed to the correct people without communication. We are all guilty of not communicating to the best of our ability from time to time, and this does cause great concern for many of us. 

Communication has many different types: Verbal, Non-verbal, Written, Listening and Visual. Being clear, respectful, positive and confident in your communication skills will increase how your communication is received. Communication must have a purpose for the audience to be engaged. Communication can be taken in all different directions, if the communication is not clear. Incorporating the following types of communication in everyday life are vital for the listener and the speaker: 

Verbal: Using your voice. The words that you choose can have a big impact on the message that is given and received. Speak intelligently and clearly and try to avoid slang or inappropriate language. 

Non-Verbal: Body Language, facial expressions, posture can all impact the non-verbal signals that are being translated by the listener and/or bystander of the message. 

Written: Words we read via email, paper, text, posts, newspaper, or billboard. Be cautious of the words that are written as they cannot be taken back. Write intelligently and clearly and try to avoid slang or inappropriate language.  

Listening: Being actively engaged when someone is speaking. Listen for content and be able to repeat the message that is sent and then articulate understanding by responding when appropriate. Ask questions if the message is not clear or if you do not understand what is being communicated. 

Visual: Things that we see- including, GIFs, screenshots, video, pie charts, infographics, and slide deck presentations. Evoking emotion by utilizing the senses of visual elements to convey a message and inspire change through emotion. 

We all communicate daily with many individuals and at one time or another, we have all thought to ourselves…. could I have communicated that better?  If so…what could, or should I have done differently to ensure my communication was clear? 

Communication is extremely important to the day-to-day operations in every field. Nurses rely on communication in every form to investigate and discover the needs of our seniors.  Communication can impact the outcome in every situation. Effective communication seems like it should be easy however, communication like everything else requires practice, feedback, and skill.  

Communication can be frustrating when the receiver does not hear the message that we clearly think is being sent. This can lead to miscommunication, frustration, and a poor outcome. Opening oneself to feedback and criticism is a clear way to improve communication message and delivery.   

Working on communication skills to improve the message and accepting feedback is important to building effective communication. Discovering the barriers of communication and why the message was not received or offered effectively is also key to the communication circle. A good team that communicates effectively makes for a less stressful environment.   

Whether you are trying to improve your communication among the team at work or at home, becoming aware of the skills that will deepen the connections to others and build a greater trust and respect to improve as a team will improve problem solving, trust, and over all social and emotional health. 

Tennessee: “Survey Says!”

The Department of Health continues to write a high number of Immediate Jeopardy (IJ) tags in nursing homes. It is critical that facilities become familiar with what constitutes noncompliance. If an IJ is written the impact for facilities is far reaching and can include steep fines, a hold on admissions and of course a negative impact on the 5-star rating. 

Facilities will need to understand what type of situations put them at risk for an IJ. Noncompliance with federal health, safety, and/or quality regulation with evidence that a serious adverse outcome has occurred are key determining factors. An IJ can be cited if a serious adverse outcome is likely to occur. The fact that it did not occur does not minimize the outcome of an IJ.  

Facilities are expected to take immediate action to correct. If State Surveyors find that immediate action was taken the citation may then be written under past non-compliance at a lower level. This is key information to know and understand. Bad things happen, it is how we manage through these situations that counts. If the facility can demonstrate an immediate response that covers what State Surveyors would be looking for if cited, it reduces the risk greatly for the facility.  

Key areas for IJ are as follows:  

#1 Free from Abuse and Neglect 

The facility failed to provide a safe environment and ensure supervision to prevent neglect for one resident who eloped. The resident was left unsupervised at a medical appointment. The resident left the appointment and was missing for over 8 hrs. Elopement was cited several times with several facilities at an IJ level. 

Residents were observed to be unclean and unkempt, had strong urine odors and soiled linens.  

Strong urine odors for 6 residents, dirty meal trays from a meal the prior day, soiled linen on the floor, bare mattresses, strong lingering odors.  

Failed to prevent sexual abuse of 2 residents when a male staff member inappropriately touched the residents. 

#2 Care Plan Timing and Revision 

Failed to revise a care plan for an unplanned weight loss and lost 41.3 lbs in 5 months. 

#3 ADL Care Provided for Dependent Residents 

Failed to provide proper grooming and hygiene services, assist with meals and provide showers and baths.  Failed to provide incontinence care resulting in actual harm.  

#4. CPR 

The facility failed to ensure that there was at least one CPR certified staff member on each shift to perform CPR. 

#5. Free of Accident Hazards/Supervision/Devices 

Several facilities cited in this area with citations around elopement. 

#6. Nutrition/Hydration Status Maintenance 

Failure to prevent weight loss. Failed to implement interventions to prevent further weight loss.  

#7. RN 8 hrs/7 days/wk, Full-time D.O.N. 

Failed to employ an RN acting as a D.O.N. for 18 of 52 wks over 5.5 months. Failed to provide RN coverage for 4 out of 30 days. 

Above are some examples that will help facilities understand what items can lead to an IJ. Note that if after 6 months a facility is not in substantial compliance CMS requires that the facility be terminated from the Medicare /Medicaid program. 

All of this points to the importance of managing risk in our day-to-day operations of our facilities. It is the right thing to do for those in our care.  

If you or your facility need support in understanding how to avoid the pitfalls of an IJ please feel free to reach out to Advanced Health Institute or email me directly at lfossen@ahinstitute.com 

Lynn Fossen R.N. 

VP of Consulting 

A.H.I. 

Caring for Caregivers: Recognizing and Reducing Suicide Risk in Healthcare Workers

Written by Marquita Anderson, RN Consultant

COVID positivity rates may be on the decline, but the incessant stress, anxiety and social disengagement health care workers took on during the pandemic persists. 2020 brought more than the first global pandemic we’ve seen in almost 100 years; it brought expectations that tested the limits of our healthcare system and the workers at it’s foundation.  

As hospitals around the country started filling up, healthcare workers became the first line of defense against the growing shadow that COVID cast over the United States. While corporations were sending their employees home and shutting down their office buildings, healthcare staff were taking longer shifts and fewer breaks. Many slept in their hospitals and went weeks without seeing their families, even as the flow of PPE dried up and the number of patients became overwhelming.  

For months, healthcare workers stepped into a war they didn’t sign up to fight.  

Let’s take a moment to reflect on how COVID has changed the face of healthcare and what we can do to support our community of caregivers going forward.  

More Expensive Than We Can Afford 

While we watch society emerge from two years of darkness and confusion, we can’t forget that many healthcare workers are still feeling the long-term consequences of an event that ravaged their mental fortitude, their industry, and their community.  

According to Mental Health America, which conducted a survey of health care workers’ mental health between June-September 2020, 82% of healthcare workers reported feeling emotionally exhausted during the pandemic and more than half of nurses did not feel like they were receiving enough emotional support. 93% of healthcare workers said they felt stressed and 63% experienced work-related dread. Furthermore, physicians and nurses are two-to-three-times more likely to complete suicide than the general population.  

As a result, a study conducted by Elsevier Health found that 47% of U.S. healthcare workers plan to leave their current role within the next two to three years.  

The cost of our healthcare workers’ mental health is too expensive for us, as a society, to bear. We can’t continue to ask healthcare workers to continue to sacrifice themselves for an indeterminate amount of time without offering the support they need to fully rest and recover.  

What Can Healthcare Workers, Hospitals and Others Do to Protect Themselves?  

Change happens one step at a time. Whether you are a nurse, LPN, doctor, DON or another healthcare worker, there are steps you can take to protect yourself and set your colleagues up for success.  

If you are a hospital, nursing home or residential care facility: 

• Staff appropriately: Leaning on just a few individuals leaves you, and your patients, vulnerable if just one person steps away for the day or gets sick. Instead of staffing the minimum number of people for your facility to run, hire enough people to handle the workload successfully, even if one or two aren’t able to work. Healthcare workers should be able to feel like they can take the day off if needed without it impacting their patients.  

• Invest in training for your staff: For the most part, people will meet expectations that are set for them if those expectations are attainable and understood. Set your staff up for success by investing in training materials and providing them enough time to not only learn their jobs, but to gain confidence in their roles.  

• Advocate for your staff: If you are a manager, DON, or someone else in a leadership role, part of your job is to advocate for those who work for you so they get the resources they need to do their job successfully. Work with them so they can feel empowered to be their best at work and you will see lower turnover, happier staff and as a result, better patient care.  

If you are a nurse, doctor, LPN or other healthcare worker who works directly with patients: 

• Advocate for yourself: Take your vacation time, talk to your coworkers and be a champion for what you need. You are the only one who knows what’s best for you.  

• Stop “shoulding” on yourself: When you need a break, take it. Don’t let guilt make you feel like you should be cleaning the house, cooking, working out, or doing something else productive. The last two and a half years have tested the mental and physical fortitude of every caregiver. Do what you need to do to take care of yourself instead of increasing your stress by thinking about everything you “should” be doing.  

• Take care of yourself: To the best of your ability, make time to get enough sleep, eat well, and try to exercise; even if that means going for a 20-minute walk at the end of the day. 

• Accept help: There are many reasons people turn down therapy, medication or other forms of emotional support. But if you’re struggling with depression, anxiety, suicidal ideation or other forms of psychological distress, it’s okay to get help. You can call the National Suicide Prevention Lifeline at 1-800-273-8255 and the Disaster Distress Helpline at 1-800-985-5990. If you prefer to text, you can text “HOME” to 741741. There are also training courses titled “Care for the Caregiver” that you and your colleagues can complete to learn how to better take care of yourself while serving others.  

Healthcare workers often forget to take care of themselves or fear seeking mental health treatment because they don’t want to be perceived as incompetent or unfit to care for others. But after years of giving your heart, soul and body to the care of your patients, you owe it to yourself and your family to get the help you need.  

The COVID pandemic may have brought new and overwhelming challenges to healthcare workers throughout the country, but those same caregivers have repeatedly proven themselves to be some of the strongest individuals in the world. Now, as the pandemic is entering a new era, is the time to advocate for your recovery and forge a new path in the world of healthcare. Together, we can do anything.

Staffing Crisis Causing You to Utilize Your MDS Nurses as Floor Nurses?

By Robin Stern, RN & WI Regional Director, National Director of MDS

Many do not understand the MDS nurse contribution to the LTC building and see them as an extra nurse who is just sitting at their desk. This can’t be farther from the truth. The MDS nurse is an irreplaceable part of the team. Many nurses have left bedside nursing to go into MDS and may no longer be able to jump on a cart. MDS requires extensive knowledge about Medicare, Medicaid, and managed care. Not understanding these rules can cause the facility to return revenue if the MDS is not supported by required documentation.

The MDS nurse is primarily responsible to gather the resident’s information via the RAI process, which assesses a resident’s behavioral, psychological, clinical, nutritional, and physical strengths and needs to create an individualized care plan that considers the resident holistically. The MDS nurse, then works with nursing, therapy, registered dietician, social services, psych services, and NP/MD, to ensure that all components are compliant with Medicare requirements.

MDS is also the key driver for Medicare payment and many Medicaid reimbursement systems and is especially critical for long-term care providers. Reimbursement is determined by MDS assessments. Small adjustments in the can result in a significant increase (or decrease) in revenue for which the facility is entitled. MDS Coordinators are responsible for ensuring documentation, ARD dates, all required components that are submitted on the MDS are accurate.  These levels ensure the facility is getting accurate, and maximum, reimbursement.

“I think that taking any time away from MDS risks being less thorough. Potentially losing money and coding inaccurate information. You need time to dig for information, talk with staff and residents, transmit, check quality measures, and indicators, ect. MDS is a full-time job that requires full time attention.”  Jenny Leach RN RAC-CT.

Staffing challenges may be very real especially for rural sites, however your MDS coordinator is more than just a nurse and at times solely responsible for your site’s revenue. They are constantly assessing each resident for significant changes and keeping your team on task, updating care plans, driving for improvement in your quality measures and meeting regulatory requirements. This nurse is your rock!

Keeping Seniors Hydrated

By Suzanne Braaten, AHI RN Consultant

Dehydration can lead to many health issues varying from mild to life-threatening complications. According to the National Council on Aging, seniors are more at risk for dehydration due to body composition changes, diminished sense of thirst and appetite, taking certain medications and changes related to body temperature regulation. With the warm summer weather, it is imperative that we all help our seniors stay hydrated as much as possible to reduce their risk for becoming dehydrated.  

Dehydration can easily be spotted by monitoring changes in urine color. The darker the urine color, the more at risk for complications a person is. With older adults, there may be other warning signs that can easily be missed, such as tiredness, irritability, headaches, or cognition changes. Urinary tract infections are frequently seen in seniors and commonly blamed for by urinary incontinence but may actually be the result of not consuming enough fluids. Falls are another indication that a senior may need to increase fluid intake since dehydration can reduce coordination and increase weakness. 

Here are some fun and easy ways to encourage increased fluid intake in seniors: 

• Offer foods such as lettuce, celery, watermelon, soups, berries, tomatoes that are all great summer foods that seniors love. Have soup and salad options daily with lunch and dinner. Serve fluids first with every meal.  

• Educate staff that provide medication passes to offer a full glass of water each time they are giving medications.  

• Have water easily accessible and inviting at various areas of the facility. Plain water can be very dull and unenticing so try adding different fruits or vegetables to change the flavor periodically such as cucumbers, lemons, oranges, berries, etc.  

• Educate residents that alcohol is a diuretic and can cause dehydration. Other options are serving non-alcoholic drinks.  

• Some older adults benefit from nutritional supplements which can also go toward daily fluid intake.  

• Offer reusable water bottles that have water goals listed on them.  

• Get families involved! Encourage family members to provide reminders to drink fluids when they visit or even when they are on the phone with their loved one. Provide them details on the importance of hydration in older adults.  

• Activities:  

• Provide beverages at all activities. Coffee and tea can have dehydration effects as well, so try offering flavored or carbonated water or low sugar sports drinks. 

• For activities outdoors, ensure residents have easy to reach beverages with them and provide reminders regularly to drink their beverage.  

• Offer cold snacks like popsicles, fresh fruit, gelatin desserts, or flavored ice.  

• Create a competition or water consumption goals and assist residents in tracking their fluid consumption for a “prize” over a certain number of days.  

Dehydration can be debilitating to our seniors. Do you have any other creative ways to encourage seniors to drink more fluids? By starting with just a few simple changes in how fluids are offered and encouraged with seniors, you can help them continue to live a more hydrated and healthier life.  

Source 

National Council on Aging. (2021). Hydration for Older Adults. How to Stay Hydrated for Better Health. https://www.ncoa.org/article/how-to-stay-hydrated-for-better-health 

Is Your Site Prepared for Flu Season?

by Robin Stern, RN & WI Regional Director, National Director of MDS

Are you prepared for Flu Season?

• Per CMS all residents must be offered the influenza vaccine and is tracked on the MDS. 

• This is also a good time to offer other vaccinations such as Pneumococcal, COVID, and Shingles;  if previously declined or unavailable upon initial offering.  

• By offering vaccines you can avoid citation and decrease risk for the spread of illness in your facility.  

• Vaccination is recommended by the end of October however Flu season can vary 

• 2 cases of lab confirmed influenza are reported within 72 hours of one another on the same unit, outbreak control measures will need to be implemented.   

 Review and Plan  

• Review your policies and procedures for influenza with clinical team  

• Ensure plans are in place for Flu Shot Clinic / (Standard or high dose) 

• Ensure an Epi pen(s) are available (check expiration date) 

• Obtain and document consent from resident or representative  

• Document reason for declination from resident or representative if applicable  

• Add one time order in EMR for date of clinic and monitoring for side effects 

• Plan for who will document and update EMR and vaccine reporting site if applicable  

• Re-educate staff on influenza prevention and infection control  

• Plan for outbreak with action steps  

• Obtain testing supplies from lab (these do expire) 

• Review antiviral plan with medical director / MD / NPs 

• Obtain baseline labs if needed within the window / calculate creatine clearance for renal dosing (you do not want to have to do this the day of the outbreak) 

• PPE readily available for droplet precautions  

• IP nurse ready for daily surveillance & prepare for co-circulation of Influenza and COVID  

• For residents with adverse events from vaccine you must report to VAERS 

  NEED EXTRA HANDS? AHI IS HAPPY TO HELP!

The Power of Work-Life Balance: Unlocking Success and Satisfaction

Work-life balance is a concept that holds different meanings for everyone.  It includes the ability to maintain harmony between work commitments and personal life, allowing us to engage in activities that bring us joy and fulfillment.  Whether it's spending quality time with loved ones, pursuing hobbies, or simply having time for oneself, work-life balance plays a crucial role in achieving overall satisfaction.  

In this blog post, we will explore the importance of work-life balance, its benefits for both employees and employers, and practical strategies to attain it. 

A Happy Employee, A Happy Workplace: Work-life balance has a significant impact on professional success.  When employees feel they have a healthy balance between their work and personal life, they tend to be more motivated, engaged, and productive.  

When at Work: 

Prioritization and Goal Setting: Learn to prioritize tasks and set realistic goals.  Identify the most important tasks that require immediate attention and determine what can be postponed or delegated.  

Time Efficiency: Make the most of your work hours by utilizing effective time management techniques. Avoid multitasking.  Instead, focus on one task at a time, set deadlines, and break larger tasks into smaller, more manageable steps. 

Embrace Breaks: Regularly taking short breaks throughout the workday can significantly improve productivity and mental well-being. 

When at Home: 

Unplug and Recharge: Once you leave work, make a conscious effort to disconnect from technology. Set boundaries by limiting the use of emails and work-related communication during personal time. Engage in activities that bring you joy. 

Achieving work-life balance is essential.  It benefits both employees and employers by enhancing happiness, productivity, and job satisfaction.  By implementing effective strategies like prioritization, time efficiency, breaks, and unplugging from work, individuals can attain balance between their professional and personal lives.

Providing Balance for your Employees

If you have ever worked in a management position, you know that there are few “perks” that come with the job.  Typically, you are paid a salary of 40 hours a week, and you don’t have to work weekends.  But the truth is the responsibilities that come with the job can be overwhelming.  You often find yourself working way beyond the standard 40-hour work week, taking on extra hours to get the job done.  And if one of your employees calls in sick and you can’t find a replacement, guess who’s left to cover the shift?  That’s right, you!  

As leaders it is crucial for us to provide balance for our employees.  We need to set an example and create an environment where work-life balance is a reality.  Let’s discuss some strategies that can help us achieve this goal. 

Communication 

First and foremost, communication is key.  Encourage open and honest dialogue with your team members.  Let them know that their well-being matters and you’re there to support them.  Regularly check in with them to understand their workload, challenges and any personal issues that may affect their work.   By fostering a culture of open communication, you can address problems early on and find ways to alleviate stress and promote balance. 

Lead by Example 

Next, lead by example.  Show your team that you prioritize work-life balance.  Avoid sending work-related emails or messages during off-hours, unless it’s truly urgent.  Respect your team members’ personal time and encourage them to disconnect when they’re not at work.  When employees see that their leader values and practices work life balance, they will be more apt to as well. 

Flexibility  

Lastly, flexibility is crucial.  Employees have lives outside of work, things come up, life happens.  Allow your employees flexibility in their schedule when needed.  If someone needs to leave early to attend a family event or take care of a personal matter, trust them to manage their time effectively and make up for it later.  Providing flexibility shows that you trust your team and empowers them to take ownership of their work. 

By fostering open communication, leading by example, and offering flexibility, we can create a work environment where our team members feel supported and can achieve a strong work-life balance. 

Ensuring Resident Safety in Minnesota’s Unpredictable Weather

Fall in Minnesota is a very bizarre time for weather.  One day it can be 70 and the next day it is snowing.  The weather here changes so quickly it will be winter before we know it.  One of biggest environmental vulnerabilities in Minnesota are blizzards or freezing temperatures.  With that in mind, how do we ensure that our residents are safe from these hazards? 

In this blog post, we will explore things to keep in mind and steps to take in order to protect residents from these hazards. 

• Review and Update Your Emergency Preparedness Plan: Annually reviewing your emergency preparedness plan is essential to guarantee its effectiveness.  With changing staff and vendors, it's crucial to ensure that all contact information is up to date.  

• Maintain an Up-to-Date Missing Resident Policy: To address any potential risks, it is important to have an updated missing resident policy in place.  

• Conduct Missing Resident Drills: Practicing missing resident drills helps your staff become familiar with the procedures and increases their ability to respond efficiently during emergencies.  

• Perform Elopement Assessments: Every resident should have an elopement assessment done to evaluate their risk. 

• Implement Measures for Elopement Risks: For residents identified as elopement risks, additional precautions should be in place.  Do they need a wander guard or locked unit for safety? 

• Maintain an Updated EMR System with Resident Photos: Each resident's electronic medical record should contain their current photograph.  This visual helps if a resident goes missing. 

• Regularly Verify the Functionality of Wander Guard Systems: Routine checks should be performed to ensure the Wander Guard System is operating correctly.  

• Secure Doors and Windows: Doors leading to the outside should lock to prevent exiting.  Likewise, windows should be properly secured.   

Responding to an Elopement Incident: In the unfortunate event of an elopement remember the following steps: 

• Implement the Facility's Action Plan: Immediately initiate the facility's Missing Resident action plan. 

• Maintain a Detailed Timeline: Keep a timeline of events, documenting actions taken, and any information related to the incident. 

• Notify Appropriate Parties: Contact the local police, the resident's family members, and the resident's physician.  

• Conduct a Comprehensive Assessment: When the resident is found, perform a thorough assessment to evaluate their physical and emotional well-being.  

• Follow up with Appropriate Parties: This includes updating the police on the resident's safe recovery, informing the family members about the situation and the actions taken, and consulting with the resident's physician to address any potential medical concerns or necessary adjustments to their care plan. 

• Conduct a Post-Incident Review: Evaluate the effectiveness of the facility's response, identify any areas for improvement, and implement necessary changes to prevent similar incidents in the future.  

• Provide Support and Education: Offer support to the resident and their family members following an elopement incident. 

• Enhance Security Measures: Use the elopement incident as an opportunity to reassess and strengthen security measures within the nursing home. 

Responding to an elopement incident in a nursing home requires a well-prepared and coordinated effort. By following these steps, nursing homes can improve their response to an elopement.  With a proactive approach and a commitment to resident safety, nursing homes in Minnesota can create a secure environment even in the face of unpredictable weather. 

Navigating Common Immediate Jeopardy Citations in Nursing Homes and Assisted Living Facilities: A Partnership for Success

by Chris Blomquist, RN, BSN, QCP, Regional Director of Skilled Nursing - MN  

As nursing home administrators and directors of nursing, we share the responsibility of providing a safe and healthy environment for our residents. Despite our best efforts, our facilities may sometimes face immediate jeopardy citations, which indicate situations where residents are at risk for serious harm or even death. Understanding the CMS definition of Immediate Jeopardy is essential to our efforts to prevent these situations.  

CMS Definition of Immediate Jeopardy 

Immediate Jeopardy (IJ) is a term used by the Centers for Medicare & Medicaid Services (CMS) to describe a situation in which a provider's noncompliance with CMS requirements has caused or is likely to cause serious injury, harm, impairment, or death to a resident. CMS surveyors use the Core Guidelines in the State Operations Manual Appendix Q to determine and cite Immediate Jeopardy (see link below). Recognizing and addressing IJ situations promptly is crucial in ensuring the safety and well-being of our residents. 

Common IJ citations being issued in 2023 

• Free from Accident Hazards, Adequate Supervision, and Safe Devices (F689): This issue may arise when residents are not properly supervised or when equipment is misused, resulting in accidents and injuries. For example, a resident might be transferred incorrectly using a full-body mechanical lift, causing the lift to tip over and the resident to sustain injuries. 

• Advance Directives (F578): Miscommunication or lack of proper documentation for life-sustaining treatment preferences can lead to potentially life-threatening situations. In one instance, a resident's Provider Orders for Life-Sustaining Treatment (POLST) identified the resident as having an active do-not-resuscitate (DNR) order, but the physician orders indicated the resident should receive CPR. 

• Investigate, Prevent, Correct Alleged Abuse, Neglect, Exploitation, or Mistreatment (F610): Failing to report, investigate, and address accusations of abuse or neglect can place residents at immediate risk. In one case, a facility failed to report and investigate a resident's report of rough handling by a Certified Nursing Assistant (CNA) and later received an additional accusation of sexual abuse from the resident about the CNA. 

Mitigating Risk 

To reduce the likelihood of immediate jeopardy citations, we must prioritize staff training, implement robust policies and procedures, maintain accurate documentation, and conduct regular audits to ensure compliance. Recognizing sentinel events and near misses as opportunities to review and update policies and using them as triggers for additional audits and investigations, can significantly improve overall resident safety. Fostering open communication between staff members, residents, and their families is also crucial in providing high-quality care. 

At Advanced Health Institute, we are dedicated to helping nursing homes and assisted living facilities provide the highest level of care for their residents. Our team of experts can assist in identifying potential risks, implementing best practices, and ensuring regulatory compliance. By partnering together we can audit our records, review policies, develop plans of correction together, and review and assist with writing and investigating vulnerable adult reports. Let's not wait for an immediate jeopardy citation to address these critical issues. Through collaboration with Advanced Health Institute, we can safeguard the well-being of our residents and maintain the highest standards of care.

Culture vs Morale

by Chris Sloan, ALM – Operations Specialist, AZ 

Let’s look back at the places you have worked at throughout your career.  Did the morale of your team members have an impact on the culture of the company? Did the culture of the company have an impact on the morale of the team? Or were they the same thing? 

A company’s culture is a set of values, visions, standards, attitudes, and behaviors to achieve a common goal.  It will reflect both the written and unwritten rules of a particular organization. 

While morale is the employee’s perception of satisfaction, confidence, and outlook of a company.  It will reflect the feelings of the employees. Are they being heard and supported? Are they engaged?  Do they feel their opinions and suggestions matter?  A company’s culture is a reflection of your employee’s morale. The morale at a company will have a direct impact on the company’s culture. 

Creating a company with high morale, to have positive company culture. 

While company merchandise, donuts and pizza are a great treat for your team, it goes beyond that.  Keep in mind if you invest in your team, your team will invest in you! Such things as policies, development, and career growth that will directly impact the employee are important to your team. They want to know that their suggestions and ideas matter. That THEY matter. Your team is yearning for your recognition and praise.  They want to know that their efforts are impactful to the clients and to the company itself. If you ‘hear’ them, they will in turn have a higher rate of satisfaction and belief in the company vision. Creating a positive company culture.  

Communication is key! 

• Have regular 1 on 1’s with your direct staff. Encourage your direct reports to do the same with their team.

• Recognize them, publicly.

• Tell them you appreciate them.

• Have an open-door policy. Better yet, seek them out to ask their opinion.

• Trust in your team. This will lead to their trust in you.

• Admit when something is not working, listen to your team’s feedback.

• Do anonymous employee surveys. Take the results as a learning tool to improve the environment for staff and clients alike.

• Be consistent. If your team knows that their efforts are being recognized on a regular basis, they will continue to strive to achieve more. 

In Conclusion:   

Employee morale is a vital part of your organization’s strengths or weaknesses. It is something that needs to be continuously measured and treated as important as your business strategy.  Creating a healthy and positive culture will boost morale in any organization. Building morale is so much more than pizza and donuts, it needs to be the act of a team mentality. Where everyone feels that their efforts and opinions matter. Where there is room to grow for both the company and the employee. With efforts to strengthen your team morale, you will succeed in having a positive company culture. 

Employee Retention

By Montanna Hanson, AHI RN Consultant

Ask anybody what some of the greatest challenges facing their industry, and staffing needs are sure to be within the top 5. In the current climate, operating with a less-than-desired level of staff has become normal. Changes in the workforce and the COVID-19 pandemic have contributed to this trend.  

Companies can, and should, take this time to assess their policies that apply to employees for potential improvements. Pew Research found that the low pay, feeling disrespected, too few advancement opportunities, and not enough flexibility were among the top reasons that Americans left their jobs in 2021. (KIM PARKER, n.d.) Increasing wages is easier said than done, so improvements should be searched for within communication between employees and supervisors, employee engagement, and flexibility.   

The best interpersonal relationships boast healthy, productive communication as one of their greatest strengths. Similarly, great relationships between leaders and staff embody this quality as well. Staff should feel comfortable bringing concerns, questions, etc. to any supervisor. However, every leader will have to deliver information that staff may disagree with and be frustrated over. The goal is for this information and frustration to not have a permanent impact on the relationship between parties. Management teams should focus on creating a transparent environment that strives to educate and empower staff. If a team member states they are upset about a policy change, initiate a conversation, and ask questions. Why are they upset about the change? How will this change impact their day-to-day role? Consider explaining the reasoning behind the change. Offer more in-depth training on the changes. Look into the need to re-assess workflow and revise standard operating procedure. Ideally, these options could lead to a better prepared, more efficient team with improved employee engagement. At the least, employees will feel respected and valued, making them more likely to reach out in the future.   

The changing policies and guidelines throughout the COVID-19 pandemic had an impact on staff. Employees want to be notified of changes, kept up to date on guidelines, and feel comfortable with the precautions being taken. Now, as the pandemic continues to wind down, and for much of the world is a non-issue, the health care industry remains impacted. To promote compliance with PPE, symptom reporting, etc., staff should be kept up to date with requirements and changes. Ideally, staff would all be updated each time a change is made, but rarely is all staff reached. Consider having a team member discuss current guidelines briefly at your daily meeting. Another option could be to create easy to read signage for the employee break room.  

There continues to be a trend within the workforce from a motivated by money mindset to a motivated by time mentality. The pandemic exacerbated what had previously been a gradual shift, to a drastic change with significant impacts. Workers want more flexibility and greater benefits, as evidenced by the increase in calls for the U.S. to transition to a 4-day work week, even if it means a decrease in pay. Long term care settings operate 24/7, so imagination is required to increase flexibility and accommodations for staff. One option is to consider utilizing an online scheduling system that allows staff to trade shifts independently. After both staff members submit their change requests, managers only need to approve this. This saves time for everybody involved, as well as prevents employee call ins. Supervisors should ask their employees what changes they would like to see and discuss the potential of these changes.  

The difficulties in finding and keeping employees has affected most within the health care system. This can be very discouraging to companies and leaders, in addition to clients. However, there are steps that organizations can take to take on this challenge. With input from team members, opportunities for change can be explored and implemented.

A Fresh Start

By Kim Calahan, RN & Regional Director of Colorado

The beginning of a new year is always a suitable time for reflection, setting new goals, and planning for a successful year. Spending a half day or full day with your leadership team to discuss these things is instrumental to your success. It ensures everyone is aligned with the company and with each other, they understand the plan, and they know their role in helping to make the community you serve be the best it can be. To get things started and to keep things moving forward, make assignments, have completion dates, and track your progress. 

With your team, ask yourselves the following questions: 

Reflection 

1. What went well last year? 

2. What could we have done better? 

3. What were our biggest obstacles? 

4. How did we overcome them? 

5. What did the staff need from us? 

Goals 

1. What are our financial goals this year? 

2. What are our goals for the staff? 

3. What are our goals for the residents? 

4. What are our goals as a leadership team? 

5. What do we need to stop doing? 

Planning/Considerations 

1. What new programs/services do we need to offer? 

2. What needs to happen to get ready for our annual survey?

3. How do we stand out from our competition? 

4. Are all our manuals up-to-date? 

5. How could we communicate better? 

6. Have we done a wage survey recently to ensure we have competitive wages? 

7. How are we attracting potential candidates? 

8. What changes need to be made to attract more candidates? 

9. Are we proactive with informing residents, staff, and families of changes? 

10. Are we using our current EHR software to its fullest? 

11. Are there other outside resources we should be using? 

Meet frequently, make the most of your time together, and know that evaluating and changing the way you do things is necessary. As Picasso once said, “Our goals can only be reached through a vehicle of a plan, in which we must fervently believe, and upon which we must vigorously act. There is no other route to success.” 

Nursing Homes Note

By Lynn Fossen, VP of AHI Consulting

Re: QSO Memo 22-08 NH -Staffing Turnover and Weekend Staffing

Allow me to point out the 1:2 punch from CMS in one of the recent QSO’s for SNF’s. The QSO is making the staffing patterns more visible to the public by requiring facilities to share their weekend nursing hours as well as their staff turnover rate. This information will appear on the Medicare.gov Care Compare website beginning in January of 2022. This data will also impact facility 5-star rating scores starting in July of 2022.

The level of weekend staffing, including RNs, LPNs, and CNAs, is reported over a quarter indicating the number of hours worked per day.

Staff turnover will be reported by looking at the data over the last year. Reporting will include the percentage of RN staff that have left the facility, total nurse staff that have left the facility {comma} and the number of administrators that have left the facility.

It will be imperative that you report the data correctly. Remember to link employee identifiers to ensure accuracy in data submission. To learn more, click on the links within the QSO by visiting:

https://www.cms.gov/files/document/qso-22-08-nh.pdf 

Let us all simply be honest for a moment. I personally cannot help but feel a bit negative regarding the QSO as it was pushed out at a time when we are struggling with staffing in the middle of a pandemic.

We know you are in the middle of managing staffing at a crisis level at your facilities which makes this step an even more jagged pill to swallow.

An interesting side note: CMS has identified that when there is turnover within the LNHA and with leadership in the nursing department there is fallout resulting in reduced quality. What? Wow, wait what? We did not know that, right? Okay, I hear you grumbling and I agree with you! Of course, there is fallout.

The upside is that CMS wants the data on staffing. They will be forced to face the problem with hard facts and hopefully do something to help facilities. We need CMS and our governing body to recognize the needs of long-term care. It is hard to argue with analytical data. To that end, I remain hopeful there is a wake-up call that will lead to the change we have been waiting for regarding care of the elderly.

Day In the Life of a Consultant

In healthcare, there must be teamwork. All departments have their specific responsibilities and when everyone does their part, it is wonderful. The day I’m sharing with you starts out with MDH entering the building of LTC, first thing in the morning. A hot summer morning. Raining with thunder and lightning, which happened to blow one of the LTC electrical circuits.

Maintenance: showed up quickly with extension cords for each unit to utilize with the emergency outlets, needed for tube feedings, electrical beds, fans to provide circulation on each unit and each wing, making sure the facility is within emergency preparedness.

Nursing: had increased anxiety due to MDH being in the building. As the nurse manager, I had to not only see to the requests from MDH, but I also had to encourage staff to manage and prioritize which residents needed electricity; air mattresses, tube feeders, IV medications. Nursing assistants worked together to strategically do cares, frequently rounding to provide residents their needs. Being mindful to turn and reposition those with wounds, monitor diabetics, and monitor frequent fallers.

Therapy: helped with moving residents closer to the emergency outlets, frequent rounding on each unit and rooms since call lights were not working. Therapy came up with a plan to get a resident down the stairs safely in a wheelchair so they could get to their dialysis appointment.

Dietary: quickly came up with a plan to feed the residents, to get the food to each unit because of the elevators not working, and to be mindful of all specific diets and allergies.

Therapeutic & Recreation: was so helpful at being mindful of the residents who have a history of being anxious, helping to distract and assure safety while the electricity was out.

With all this happening, MDH stayed to complete their investigation. Staff was pulled in so many directions, having to conceal their anxiety that usual arises when MDH enters, continuing to follow protocols and policies; keeping up with PPE, nursing doing all their checks before giving medications, making sure to keep HIPPA in mind.

MDH included in their report how impressed they were to see such teamwork from all departments. It was truly a memorable day, to have such chaos but it felt as though we were a well-oiled machine; staff was not complaining or making statements such as “that’s not my resident”. Teamwork makes it all possible.

By Nichelle Hall, AHI Nurse Consultant

The COVID-19 pandemic, then, now and self-care tips

Written by Jessica Harvey, AHI RN Consultant

When the COVID-19 pandemic was declared in March of 2020, very quickly the realization was made that there was not enough personal protective equipment available to effectively protect our healthcare workers as they provided care to our loved ones in hospitals, long term care facilities, assisted living facilities, and other care settings. However, communities pulled together the best they could to support those in the healthcare arena.  Nurses, nursing assistants, EMT’s, paramedics, etc. were touted as heroes of the pandemic, bravely forging ahead, re-using PPE, caring for the sick.  

Fast forward through over a year of this pandemic. There is enough PPE available so that it does not need to be re-used for days on end. There is also a vaccine that reduces the severity of COVID-19 symptoms and overall illness if the disease is caught. Yet, healthcare workers are tired, exhausted, and burnt out. In truth, almost everyone is tired of the pandemic, tired of quarantines, mask wearing, and social distancing. We are all dealing with a level of stress that is unprecedented. With this level of stress and exhaustion, we have gone from supporting each other through the pandemic to arguments over vaccination status and vaccination mandates. 

The hard truth is that we lost a lot of healthcare workers through the pandemic due to illness, exhaustion, early retirement, and career changes. Now, with the addition of vaccine mandates we are losing more staff than the healthcare industry can replace and there does not appear to be a light at the end of the tunnel of workforce shortages. Yet, there are those healthcare workers that will forge on and provide the best care that they can with the resources they have. Please remember, that you cannot continue to pull from a well that is dry, and you cannot expect other staff to do so either. Self-care is as important as it has ever been, if not more so.  

There are many different ways to practice self-care that does not involve taking a vacation or leaving town. There a many simple things that can be done.  

-Take a break when needed. It’s okay to step away for five minutes to take a breath or cry or scream, however you need to decompress quickly and recenter. 

-Go outside during your breaks or lunch, especially when it’s sunny out and soak in the sun. 

-Get an adequate amount of sleep, shoot for 8 hours of solid sleep. 

-Disconnect from electronics and television during days off, the weekends, and/or after work hours. 

-Exercise, for even 30 minutes a day, it will boost your endorphins and give you an outlet to shed your stress. 

-Meditate or practice mindfulness. 

-Learn a deep breathing technique that takes minutes to do but can melt away stress. 

-Connect with loved ones and friends, just a phone call can be beneficial. 

-Schedule a coffee, lunch, happy hour, or dinner date with a friend. 

-Recognize if you need to talk to a professional and reach out, there are many mental health professionals available and many different ways to establish that relationship that don’t involve sitting in someone’s office.