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

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!

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/

 

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

New York State Government Site Helps Families. Know What to Look for in a Nursing Home

If you manage a nursing home, you’ll want to be aware of the New York Government site nursinghomes.nyhealth.gov. At this site, families can find great information to help them find a nursing home for their senior family members.

There is a map, showing the NY state and a search feature people can use to find nursing homes and facilities by specific types of care that they offer in their area. They also can specify the distance from a zip code that they would like to find this facility.

One of the features we recommend nursing homes review is Questions to Ask when Choosing a Nursing Home. It is ideal to have answers prepared for each of these questions, so that families can receive the information that they are seeking. Reading this section may help some nursing homes discover exactly the specific areas that concern families when they choose a nursing home, and which questions they are being guided to ask when reviewing facilities.

There are many sections for question topics, including Health Care Decisions, Residents’ Rights, Safety, Cleanliness, Food, Medical/Nursing Care and Dementia Units/Alzheimer Units to name several. Questions can be found here: http://www.health.ny.gov/facilities/nursing/select_nh/

Take for example, their questions about Staffing:

  • How many staff work on the unit my loved one will live in, on each shift?
  • How do you ensure that staff really know the resident they are assigned to?

These are all excellent questions to ask about how staffing is managed at your facility. If you have any staffing needs, let Meridian Nurse Recruiters be a helpful resource to you. We offer nurse and healthcare recruiting for Temporary & Permanent Staffing, Short & Long Term Coverage, Direct Hire Services, Temp to Perm Staffing and 24/7 Staffing. Meridian can act as your HR department – without the burden of maintaining one. Visit our site to learn more: http://www.meridiannurse.com/, then give us a call.

Sources: http://nursinghomes.nyhealth.gov/,

Nurse-led Primary Care

Did you know that nurse-led primary care is critical to the success of Obamacare? Read one critic’s opinion of the plan, and just how important nurses are to today’s healthcare: http://www.philly.com/philly/blogs/fieldclinic/Nurse-Led-Primary-Care-is-the-Real-Key-to-Obamacares-Success.html

5 Regrets

A nurse shares the top 5 regrets that people make from their deathbeds. Most of all, people wished they lived their lives on their own terms – not by someone else’s choices. Nurses are often there for their patients and have serious conversations with them. How do you listen and help your patients during the moments when they need someone to talk to? http://www.karenstan.net/2013/11/11/nurse-reveals-top-5-regrets-people-make-deathbed/

Real Time Nursing Situations

University of Southern Indiana nursing students are preparing to handle real-life nursing situations by working with a simulator. The simulator has a pulse, makes body function sounds and can help them plan for working with patients. If you are a nurse, how did you prepare to work with patients on a unit or in the ER? If you are a nursing student, what has helped you prepare to work with patients? http://www.sfgate.com/news/article/USI-simulator-preps-nursing-students-for-crises-5005972.php

 

 

A nursing professor has created an innovative ostomy resource to help her fellow nurses! Janice Beitz, a professor at the Rutgers School of Nursing-Camden was part of a research team which created an ostomy algorithm. This algorithm is a step-by-step aid that lets nurses assess ostomy patients and their specific needs. This is exciting news and will certainly help many nurses who serve ostomy patients and will help the patients receive excellent care. As a nurse, how have you helped your fellow nurses? Share with us in the comments! http://news.rutgers.edu/news-release/nursing-scholar-helps-develop-new-ostomy-care-resource/20131120#.UpIrxCeDo0k

 

 

In the mood for a good giggle? Take a short break today and enjoy these 10 favorite nursing jokes from Scrubs Magazine! Share your favorite nursing or medical joke with us! http://scrubsmag.com/10-favorite-nursing-jokes/

 

Apps have become popular with nurses. A study done last year showed that 71% of nurses used their Smartphones professionally. Here are 11 popular apps from Apple to use on your iPhone to help patients and make the workday run smoothly! Share your favorite nursing and medical apps with us! http://mobihealthnews.com/22123/apples-top-11-iphone-apps-for-nurses/

 

 

New Graduates – Heed My Advice

Remember when we were all children and our aunts and uncles and grandparents would all ask us, “What do you want to be when you grow up?” Most of the adults followed the question with an ambiguous statement: “You can be anything you want to be.” This is not entirely false, but to a child, this statement sounds like there’s some magic occupation wand that you stand in front of when you’re older; declare you want to be a superhero, and then POOF! You’re a crime fighting cyborg impervious to bullets and rockets.

 

Maybe my ambitions as a child were somewhat different from yours, but the point here is that when we’re told we can be whatever we want to be, the adults conveniently leave out all it takes to achieve our goals, all the hard work involved, and the fact that as we mature, our personalities may lead to different roads in the career path. Very few can say they followed their ambitions as a child and became what we told adults we wanted to be.

 

I’ll spoil my story for you; I’m not a crime fighting cyborg.

 

But, you’ve made it this far, completed all the educational requirements, got your degree and now you’re faced with another challenge: the job interview. YIKES!

 

It can be tough to predict the questions you’ll hear during the job interview, but in the healthcare field, there are a lot of likely questions that are typically geared towards new graduates you can prepare yourself for.

 

  1. Landing the job interview.

Frequently, new graduates experience tremendous difficulty in even being considered for a job. When facilities obtain your resume, they quickly recognize that you’re a new graduate and they’ll put your resume to the side in favor of someone who has experience. It’s prudent to make yourself known on a more proactive level, and maintain persistency. On a weekly basis, plan a route to visit facilities in person to drop off your resume instead of emailing it. Ask the receptionist who you need to speak with at the facility to discuss employment opportunities, and if that person is unavailable, revisit the facility the following week and ask to speak with that person again. You’ll be turned away quite often, but don’t be discouraged; eventually the right people will take notice of your persistency.

 

  1. Facility concerns.

The bottom line is: all facilities are worried about longevity. How long will they be able to retain you as an employee? Usually, healthcare facilities are not open to the idea of accepted a new graduate because of concern about spending valuable resources to train personnel that may result in wasted effort once you’ve been exposed to the true nature of the job and decide that this isn’t what you had expected. Make it known in your interview that you have a ‘never quit’ attitude, that you’re eager to fulfill the employers’ expectations of a model employee, and that you can easily adapt to changes in your environment.

 

  1. What made you decide to pursue healthcare?

This is a question commonly asked, and the most common answer is: “I like helping people.” While this isn’t the wrong answer, there’s probably a better one, or at least a more euphemistic one. As a new graduate, there are hundreds of others with the same credentials giving the same answer for the same position. What makes you stand out? Dig down and find out what really made you want this particular career. There’s something unique to you personally that encouraged this endeavor. Tell the story in as much detail as possible.

 

  1. What do you know about the facility?

Any employer is always impressed when the interviewees knows a bit about the company. Do your homework. Find out how long the facility has been open for, how many beds there are, how many units, and the track record of the facility during state reviews.

 

  1. Educational background.

This isn’t necessarily something that you should spend too much time on, but it’s important to discuss what challenges you experienced in school, and the steps you took to overcome these challenges. This will show your discipline, something every employer wants to see.

 

  1. Make yourself available.

Healthcare is a 24 hour job, and if you lay down the law and limit what shifts you’ll be willing to work, the facility will have no interest in you. At the same time, you don’t want to appear too desperate by telling them you’re available “whenever”. Tell them your preferences, but make it known that you’re anxious to take on the challenges of any hour and that you’re in an ideal position personally to offer flexibility with scheduling.

 

 

The first job you’re offered may not be exactly what you had in mind when you started going to school, but the most important aspect of your professional profile that you’re currently missing is experience. By all means, you shouldn’t jump at the first opportunity either. Make sure you feel comfortable with what you’ve already been exposed to with the facility. Once you’ve gained at least a year of experience, many doors will open up to you and you’ll be well on your way towards following the career path you initially had in mind.

 

Sincerely,

 

Jesse Rose

We are Staffing for Hospitals

Hospital openings for Occupational Therapists and Certified Occupational Therapists…Qualified Candidates will have an opportunity to work with a reputable hospital, while enhancing their career. Pay is very competitive and the possibilities are endless.
Click here to apply http://meridiannurse.com/online.php