A Shift From Nursing Homes to Managed Care at Home

Faced with soaring health care costs and shrinking Medicare andMedicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions.

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Todd Heisler/The New York Times

Dr. Fredrick Sherman at Harlem PACE with Edna Blandon. “My spirits would drop if I went to a nursing home,” she said.

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The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

“It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care,” said Jason A. Helgerson, the Medicaid director for New York State. “That meant we were institutionalizing service for people, many of whom didn’t need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it’s a lower cost to taxpayers.”

The recent influx of adult day-care centers and other managed care plans for the frail elderly is being driven by financial constraints as President Obama and Congressional leaders seek hundreds of billions of dollars in savings in Medicare and Medicaid. Nursing homes, which tend to rely heavily on Medicare and Medicaid dollars, are facing enormous financial pressure — Mr. Obama’s proposed budget includes a $56 billion Medicare cut over 10 years achieved by restricting payments to nursing homes and other long-term care providers.

Nationally, the number of nursing homes has declined by nearly 350 in the past six years, according to the American Health Care Association. In New York, the number of nursing homes declined to 634 this January from 649 in October 2007, and the number of beds to 116,514 from 119,691.

Over the next three years, New York State plans to shift 70,000 to 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services and are not in nursing homes into managed care models, Mr. Helgerson said.

The move away from nursing homes was highlighted on Thursday when Cardinal Timothy M. Dolan announced that the Archdiocese of New York, one of the state’s largest providers of nursing home care, is selling two of its seven nursing homes and opening or planning to open seven new adult day-care centers over the next three years.

“Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably,” Cardinal Dolan said in a statement before he opened a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx.

These new adult day-care centers, known around the nation by the acronym PACE — Program of All-Inclusive Care for the Elderly — provide almost all the services a nursing home might, including periodic examinations by doctors and nurses, daytime social activities like sing-alongs and lectures, physical and occupational therapy and two or three daily meals. All the participants are considered eligible for nursing homes because they cannot perform two or more essential activities on their own like bathing, dressing and going to the toilet. But they get to sleep in their own beds at night, often with a home health care aide or relative nearby.

The nonprofit groups that operate them receive a fixed monthly fee for each participant and manage their entire care, including visits to specialists, hospitalizations, home care and even placement in a nursing home. Because Medicare and Medicaid pay set fees instead of paying for specific procedures, center operators are motivated to provide preventive care to avoid costly hospitalizations or nursing home care.

Some elderly people, however, spurn PACE programs because under managed care, they would have to switch their physicians to those at the PACE center or in its network. Most elderly people want to live out their lives at home, a desire evident in interviews in the PACE center the archdiocese opened in 2009 in Harlem, which has a staff of three doctors and is visited regularly by a dentist, a podiatrist and a psychiatrist.

Todd Heisler/The New York Times

Rick Leeds, who teaches yoga and other wellness programs at the ArchCare PACE Center in Harlem, gives a massage to Edna Blandon, who goes to the center three times a week.

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Edna Blandon, 74, a diabetic weakened on her left side by a stroke who relies on a wheelchair, is transported by specialized van to the Harlem PACE center three days a week and appreciates that it provides not only a home care attendant but sends a nurse every two weeks to change pills in her pillbox and load a 14-day supply of insulin into syringes that she will inject.

“My spirits would drop if I went to a nursing home,” she said. “I love the fact that I can go home at night. There’s no place like home. I can sit down, look at the TV and go to bed when I want.”

James Harper, 70, a retired bank employee who spent 10 months at the archdiocese’s Kateri Residence, a nursing home on the Upper West Side, after a stroke paralyzed his right side, enjoys yoga breathing classes and discussions about black history. Yet he gets to spend nights and weekends with his wife, Albertene, and daughter, Traci, both of whom work during the day and are not around to care for him.

“This way I’m around people,” he said.

Dr. Fredrick T. Sherman, the Harlem PACE medical director, said that a 2009 study showed that PACE programs reduce lengths of stays in hospitals and delay assignments to nursing homes.

The archdiocese, whose new centers will serve a total of 1,500 people, receives an average of $4,000 a month from Medicaid for each participant and $3,300 from Medicare. By comparison, said Scott LaRue, the chief executive of ArchCare, the archdiocesan health care network, a month of nursing home care can cost the government $9,000.

Ultimately, the archdiocese hopes that half of its elderly clients will be served in community settings rather than in nursing homes, which currently serve about 90 percent of the archdiocese’s clients. For-profit companies have not yet moved into the managed care market, in part because of uncertainties about reimbursement formulas and the risks of taking on a nursing home population.

The PACE population tends to be younger than that at nursing homes, which raises the question of whether many PACE clients would really need nursing homes without PACE. Dr. Sherman replies to such skepticism by saying that his clients “need that level of service — the question is where they’re going to get it.”

Without PACE, he said, “they’re going to end up in nursing homes.”

Robert Pear and Christopher Reeve contributed reporting.

Local Civil Registry

The power of positive

I recently listened to a Pod cast of the different effects Positive Thinking and Acting can have on the human body.


It’s amazing how easily your mind, body and soul can easily be influenced from a few key words that help you relive and make alive certain emotions that make you feel whole again.


Public speakers have mastered this art and have used their gift to rally crowds to the greater good. History have shown that a true leader (whether we believe in their motive or not) usually wins the minds of many by his/her words.





Encourage Employees to Be Active for Spring

Encourage Employees to Be Active for Spring

As we watch the snow melt away across the Tri-State area one thing is for certain: spring is just around the corner! Now is the perfect time to encourage your employees to increase their physical activity for good health. With warmer weather, most will be more than happy to spend a little time outside and being active has physical, mental and emotional benefits for everyone.

One of the most popular outdoor activities that employees can do on their lunch hour or break is to take a quick walk. To get the most benefits from a walk, you want to keep the pace fast enough as if you were trying to catch a bus or if you were running late for an appointment. If someone hasn’t exercised in awhile, they may want to check with their primary care physician before starting any exercise regimen.

Taking a short 20 to 30 minute walk everyday has many benefits which include:

• Weight loss/weight management

• Reduction or management of daily stress

• Sounder sleep

• Help with digestion and bowels

Try encouraging your hospital or medical facility employees to walk daily for a week, creating a walking challenge. You could offer prizes or incentives for those employees who do walk, such as entry in a raffle. Or there could be group walks at certain times that employees could join that would go to a certain destination such as a local park and back to the hospital.

More and more employers are understanding that a good work/life balance is critical for keeping employees happy. Hospitals and medical facilities are the first on the forefront to know that health is a priority for everyone, and to encourage your employees to be healthy is an excellent goal. With spring just around the corner – now is the perfect time!


3 Tips to Attract Top Notch Employees

3 Tips to Attract Top Notch Employees


In today’s economy every employer knows that many people are looking for a job. But you don’t want to find “just” anyone to fill that position at your hospital or medical facility – you want to get top notch employees. Here are 3 tips to attract top notch employees every time!


Reward Excellence. This sounds very simple, but create an environment where doing an excellent job is noticed and recognized. When employees see that they go the extra mile and it makes a difference to your facility – you are going to discover that more employees will push themselves to do more and more as the group dynamic changes to encourage excellence. A reward can be an “Employee of the Month” plaque, a Thank You from the President of the hospital or anything else you think employees would enjoy.


Encourage Continued Education. Yes, this is a benefit you would need to invest in – but employers who invest in continued education for their employees often discover they have a smarter & more effective workforce. You will also find that your employees are promotable and offer even more transferable skills to grow and advance with your hospital and facility. That is an environment that top notch employees want to work in.


Respect Work Life Balance. One of the biggest challenges many employees face on the job is trying to create a good work life balance – being available to their children for special moments like watching a school play or getting time off for a family vacation. Do what you can as a hospital or medical facility to encourage managers and top executives to create a work environment where work life balance is respected. Most healthcare professionals work 12 hour shifts and some work in very stressful circumstances. It is critical to give them time off to restore and renew themselves and to be with loved ones. They will come back to work more energized, ready to do more for your hospital or medical facility.


Doing these 3 tips will easily create an environment where top notch employees will put your hospital or medical facility at the top of their list when searching for a position!

Is Your Facility Covered for Upcoming School Vacations?

Is Your Facility Covered for Upcoming School Vacations?


Most of us in the Tri-State area have eagerly begun counting the days ‘till Spring arrives. We’re tired of shoveling snow and walking over icy sidewalks to get everywhere. Let Old Man Winter blow his chilly winds someplace else! But before you cross another day off your calendar, its time to ask yourself: is your facility or hospital ready to cover upcoming school vacations?


Both public & private schools from pre-K to grade 12 typically take one week off during the spring. There also may be a short break for the Passover and Easter holidays, depending on the calendar and the school’s preference for scheduling breaks. These spring breaks are peak times for families to plan that fun vacation to visit a theme park such as Disneyworld or to visit Grandma a few states away from home. So more than likely, your hospital or facility will have quite a few employees asking for time off during these school breaks.


Getting time off when an employee wants it is considered one of the top benefits. BusinessWeek.com reports that Gallup reported on how unhappy employees cost companies in the U.S.A. more than $300 billion a year. Keeping your employees happy is one of the best ways to contribute to their productivity levels. And giving them a day or week off when they’ve requested it is a very helpful way to do this.


Your hospital or medical facility needs to be prepared for the upcoming school holidays, such as spring break and the religious holidays. Now is also the ideal time to plan for summer vacation, as schools typically break for three to two and a half months, and many families take a one to two week vacation during this time. Getting coverage plans organized well in advance is the proactive and practical solution, so there is far less stress for everyone working on the unit or the floor.


Those school holidays will be here sooner than you think. Contact Meridian Nurse Recruiters today at 718-255-5830and let us know how we can help with your spring and summer vacation coverage!



What Are You Doing to Avoid “the Revolving Door” of Employee Turnaround?

What Are You Doing to Avoid “the Revolving Door” of Employee Turnaround?


Everyone knows that hiring and finding a job in the medical field is far simpler than in many other industries. But HR Managers and top executives at hospitals and medical facilities “in the know” understand the great value in doing what they can to avoid the “revolving door” of employee turnaround.


While you may not always be able to control an employee’s decision to exit – a spouse can get a job across the country or several states away, an employee can decide they want to be a stay-at-home parent or they could choose to go back to school full-time. But every medical facility should do what they can to prevent losing employees to their competitor’s great offer of a fantastic job that a current employee can’t say “No” to. Fortunately there are some steps you can take right now to help close that revolving door – firmly shut!


Improve Communication at Your Hospital or Medical Facility. A lack of or poor communication is one of the top reasons cited for low employee morale. Employees who don’t feel valued and motivated are going to be tempted by an offer from a competitor. It may take time & effort to improve communication in each department or you may need to implement a few simple practical steps to make things run smoother for everyone – but the most important thing to do is to ask staff “what needs to be better?”


Offer Continuing Education for All Staff. This is a benefit many employees appreciate – and it is actually one that benefits you immensely. A highly trained work force at work in your hospital or medical facility shows that you attract top-notch employees and retain them – it also shows that you care about medical innovations to keep everyone up-to-date. A hospital or medical facility that offers continuing education is one where employees will get excited about what they are doing and also be eager to make both short and long term plans to work with them.


Create a System of Awards and Rewards for Employees. Everyone likes to be appreciated for hard work. Work with each department and create a system of both awards and reward, to show your appreciate for employees on each level. Whether employees receive a plaque, thanks from the hospital’s President or attend a special luncheon or breakfast in their honor, all of these are well worth it to help retain employees.


Finally: Be Open to Feedback. Your employees care about patients and may see things that can be changed to help improve the quality of care for patients – and even the “bottom line” in some circumstances. Maintain an open door policy as much as you can and welcome both positive and negative feedback, with the understanding that there is value in each from employees who care deeply about what they are doing.


Your facility doesn’t have to have a “revolving door” for turnaround, not when you work to retain employees! 

Encourage Employees to Manage Job Stress Before it “Manages” Them

We think everyone knows that healthcare employees work hard. Often they work long hours and under tense situations, sometimes facing critical care patients and concerns. It’s logical to understand that many healthcare employees would face job stress, something that many professionals deal with from time to time.


But as healthcare professionals, it is a delicate balance: it is crucial that they manage their job stress before it “manages” them because they care for patients. Many of the signs related to job stress can wind up affecting your on-the-job performance. As a hospital or medical facility, don’t think you can hope that job stress doesn’t happen in your facility or “wish” it all away. It is far better to be proactive and have a plan than to see top-notch employees become vulnerable to job stress and experience uncomfortable symptoms that put everyone at risk.


According to WebMD, the symptoms of job stress are:


Difficulty sleeping


Trouble concentrating




Losing your temper or “a short fuse”


Stomach aches


Low morale at work or job dissatisfaction


There are some common causes of job stress, some which an employer can help with.


One of them is more responsibility at work. This can come through a promotion – or simply adding more duties onto someone’s already hard working shoulders. This creates a stressful situation for any employee. As a hospital or medical facility if you realize you are in a circumstance where you will need to add additional duties for employees, look for ways you can relieve their stress. This is a valuable contribution you can make to the employees, patients and the entire facility.


Job satisfaction is another concern that often leads to job stress. Admittedly, this is not always under an employee’s control. If you have a healthcare employee who dreams of being an opera singer, you could have a top-notch medical facility and they would still long to be singing arias! But if you feel morale could be slipping in departments, look for ways to raise it. Giving employees feedback and praise about their performance is one of the top ways you can help to relieve job stress. Don’t forget to say “Thank you.”


A working environment with poor communication can often lead to great job stress for just about everyone. If morale is down and most employees seem frustrated and are verbalizing this, this is often a sign that communication skills need to be improved. Yes, this can be a lot of work but it is well worth the effort, to improve each department and the quality of care for your patients. Smoothing out what may be simple misunderstandings between coworkers and departments may increase your facility’s performance in ways you can’t begin to image.


Take the time to think now: what can I do to prevent job stress for my employees this quarter?


Source: http://www.webmd.com/balance/stress-management/tc/managing-job-stress-topic-overview

The Snow is Melting. Are You Prepared for Spring Break and Holiday Coverage?

Its hard to believe as another 2 snowstorms are headed towards the Tri-State area, but the snow is melting, and spring is about 30 days away. That gives HR professionals and managers approximately one month to plan for spring break and holiday coverage.


Most schools take a week off in the spring, coinciding with the Easter holiday. Many schools also take off time in late February for President’s Day, whether it is a long weekend or a full week. Moms and Dads will be eager to take this week off from work to be with their children, whether they go visit family, go to a fun theme park or simply enjoy a staycation at home together. But is your hospital prepared to cover these shifts?


It is important to let employees have time off if they are due this time whenever it is possible. Taking a vacation or time off is often needed for stress release and is especially good for staff morale. One thing that concerns many employees is having a healthy work/life balance – being unable to take a vacation when they would like to have one may cause some employees to question if this is an environment they want to remain in. Though most employees do understand at times it is simply impractical or impossible for an employer to let everyone or too many employees have the exact same shifts off, hospitals can be proactive and work to arrange coverage to allow for some to have this time off.


Now is the time to put a plan in place to prepare for President’s Day weekend/week, Spring Break and all of the spring holidays. Contact Meridian Nurse Recruiters at 718-255-5830 to talk about your spring vacation and holiday needs, we’ll create a successful plan to cover EVERY shift without hassle or stress! http://www.meridiannurse.com/


Hospitals Know Patients Come First Even When Balancing the Budget

According to The New York Times, the for-profit hospital chain health Management Associates set aggressive goals to admit patients based on increasing their bottom line and not on patient care. Physicians were actually coded – like stop lights – at green, yellow and red to show not their quality of care or even their efficiency – but their successful rate of admission – where it did not matter whether the patient was sick or healthy – they were just all admitted for care.

Many hospitals and medical facilities are carefully watching the bottom line, especially with concerns over the changing regulations for health insurance and how this will affect reimbursement. But 99.9% would never consider schemes and scams like the one that Health Management Associates actually put into play for their unsuspecting patients. Hospitals know they care for patients and want them to leave healthier and better, not with emptier wallets.Hospitals and facilities are looking at other ways to lower their costs and improve their bottom line – all while keeping patient care their #1 concern. Sadly, when potential patients hear of hospitals and hospital groups such as Hospital Management Associates and their wrong doings, it can be easy to wonder if their hospitals nearby are efficient and would ever take aggressive measures to cut costs.

How have you shown patients that patient care is your top priority – all while keeping the bottom line in mind? Many hospitals and facilities do face cutbacks but still are dedicated to their patients.

Quite likely the biggest cutbacks your patients will notice are changes in staff. If you decrease your staff, doctors, nurses and other healthcare professionals there may be cause for concern. Patients will worry there will not be someone to care for them when they are ill, or for their loved one when they need that critical care.

If the time comes when you need to consider your bottom line, remember that other cuts affect patient care less. It may be easier to cut back on landscaping for the hospital grounds than to consider decreasing nurses in the E.R. or the maternity ward.


Make Patients and the Public Aware of the Need for a Living Will

There have been some stories recently in the news that focus on the challenging circumstance of what occurs when someone does not leave a living will. They may talk about their wishes with a loved one, or assume that others know what they would like done, but this is not enough. A legal document, a living will must be in place to ensure that what an adult would like to happen during end-of-life or serious circumstances happens as they wish.


Every adult needs a living will. Hospitals know that unexpected circumstances can arise at just about any age. Making your patients aware of the importance and need for living wills will help serve your community more effectively and successfully.


According to MayoClinic.org patients will want to have advanced directives in place. This is not simply a living will, but several other documents to protect patients – and patients should be aware of the importance of each.


Advanced directives give written instructions with your medical care preferences. If you are unable to make decisions regarding your healthcare, these written instructions will offer clarity.


A living will is also a form of an advanced directive and specifically states the types of medical treatments and what kinds of life-sustaining measures you would like to be given – or not to be taken if they are to be considered for your medical treatment.


A medical/healthcare power of attorney will designate a person (called your health care agent/proxy) who can make medical decisions for you if you are not able to do so.


A DNR order (do not resuscitate) is a request to not have CPR (cardiopulmonary resuscitation if the patient’s heart stops or if they stop breathing.


No one likes to think of the unexpected or tragic occurring, but it is helpful to be prepared to best take care of your family and loved ones so they can manage the circumstance well. It also means that your wishes for how this circumstance will be managed will happen. Patients should be aware of the need for advance directives such as living wills and putting them in place.


Source: http://www.mayoclinic.org/living-wills/art-20046303