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In an April 24 Long-Term Living blog post, PHI Organizational and Executive Coach Sara Joffe and Susan Misiorski, PHI director of coaching and consulting services, identify a key skill to help nursing home leaders manage staff resistance to organizational change.

Active listening, writes Misiorski, will help those who are implementing change to discover the “background story that underlies staff resistance,” allowing them to “address root problems, rather than symptoms, and thereby make change stick.”

Misiorski, drawing from her experience working with dozens of nursing home leaders who faced opposition when they attempted to make changes at their facilities, reports that leaders who have developed their active listening skills have turned “resisters” into “champions for change.”

– by Matthew Ozga

MPRO, Michigan’s Quality Improvement Organization, has produced a video on the benefits of the consistent assignment staffing model that more nursing homes are using to schedule their staff.

The video features interviews with staff and residents from three facilities in Michigan that are using consistent assignment, which helps to strengthen relationships between direct-care workers and consumers and leads to better care and less turnover.

“Without the opportunity to form close relationships and a system that protects the continuity of the relationships, person-centered care and sustainable culture transformation cannot occur,” said PHI Organizational Change Consultant Cean Eppelheimer.

“Being well-known within the community through the practice of consistent assignment is fundamental to quality person-centered eldercare and underlies the development of a more meaningful workplace,” Eppelheimer continued.

According to Advancing Excellence in America’s Nursing Homes, a national campaign aimed at improving the quality of nursing home care, consistent assignment (pdf) means that residents see the same caregivers (registered nurse, licensed practical nurse, or certified nursing assistant) almost every time they are on duty.

“Nursing homes that begin using consistent assignments might have to change the way they manage staffers,” said Mary Jane Koren, MD, chair of the Advancing Excellence in America’s Nursing Homes Campaign and vice president at the Commonwealth Fund.

“After the initial startup, they often find the new way is a better way: They often catch medical problems in the early, treatable stages,” Koren said. “In the end, nursing homes that adopt consistent assignment reduce staff turnover and work to improve other quality measures gain something priceless: They’ll have a facility that fosters strong relationships between caregivers and residents, and offers the highest standard of care.”

– by Deane Beebe

Consumers, workers, and other stakeholders in the Illinois nursing home industry are voicing their opposition to a proposed 18 percent cut to the state Medicaid program.

Details of the potentially devastating round of cuts began to emerge on April 19. According to published reports, Governor Pat Quinn (D) wants to slash Medicaid rolls by 215,000 while lowering Medicaid reimbursement rates for doctors, hospitals, and nursing homes.

Quinn’s plan would save the state $2.7 billion.

A Quick Response

Nursing home stakeholders responded immediately to the threat. The Health Care Council of Illinois (HCCI), an organization representing nursing homes, scheduled a 17-stop protest tour to speak out against the cuts. HCCI held rallies in Rockford and Chicago during the weekend of April 21-22.

If enacted, the drastic Medicaid cuts would cause thousands of elders to be kicked out of their nursing homes, according to HCCI Executive Director Pat Comstock.

“What will happen to some of these residents is that they may not be able to stay here. They may lose their home,” Comstock told WBBM, a Chicago-area television network.

Report Shows Folly of Cuts

On April 25, the Campaign for Better Care and Families USA released a joint report (pdf) documenting the economic toll Quinn’s cuts would take on Illinois.

The report finds that the proposed $2.7 billion worth of cuts to Medicaid would put more than 25,000 jobs at risk and cost the state $3.3 billion in economic activity.

Many of those imperiled jobs would be in the nursing home industry, the report says.

“Cuts could mean jobs lost for [nursing] facilities’ employees, such as aides, nurses, pharmacists, and facility maintenance and management staff,” the report states. “Inadequate staffing lessens the quality of care that facilities are able to provide.”

– by Matthew Ozga

Layoffs of certified nursing assistants are imminent in nursing homes across the country, according to a survey (pdf) published by the Alliance for Quality Nursing Home Care, a nursing home industry association.

More than one-third (36.8 percent) of nursing home directors surveyed said they expect to lay off direct-service staff, such as registered nurses, licensed practical nurses, certified nursing assistants, therapists and other staff, following a reduction in Medicare skilled nursing facility payment rates, which took effect in October 2011.

Approximately the same percentage of respondents (37 percent) said their facilities were indefinitely postponing or canceling the hiring of new direct-service staff.

Nearly three out of four nursing home directors (74.2 percent) plan to respond to the Medicare rate reduction by cutting or freezing wages throughout their facilities. Almost half (47.8 percent) plan to cut or restrict their workers’ benefits.

More than 230 nursing home directors participated in the survey, which was conducted shortly after the cuts took effect last October by Avalere Health.

Layoffs Tied to Rate Cut

Last July, the Centers for Medicare and Medicaid Services (CMS) announced it would cut the Medicare payment rate for skilled nursing facilities by 11.1 percent.

Eldercare advocates immediately criticized the cut, arguing that facilities would have to shed tens of thousands of workers to compensate.

Judging by the survey results, it appears facilities are indeed planning to lay off staff. “In response to the CMS cut, facilities will lay off over 20,000 staff and cancel projects that would have created 20,000-25,000 new jobs,” the survey states.

Fewer Workers, Worse Care

Studies have consistently demonstrated a correlation between staffing levels in nursing homes and the quality of the care provided there.

“This report is disturbing,” said PHI Coaching & Consulting Services Director Susan Misiorski. “Quality nursing home care is dependent upon a well-trained staff of direct-care workers whose personal case load allows the time necessary to provide for physical and emotional needs.

“The layoffs threatened by last year’s Medicare rate cuts threaten to degrade quality of care throughout the country at a time when more people than ever need long-term care due to the increases in our aging population,” Misiorski continued.

– by Matthew Ozga

Legislation proposed in Massachusetts would require that direct-care workers employed by nursing homes and their supervisors, as well as activity directors, be trained in dementia care.

Should the bill pass, the law would apply to all licensed nursing homes in the state regardless of whether the facility markets itself as having specialized dementia-care units.

Facilities that have special dementia care units would — for the first time — be required to adhere to minimum standards to “ensure safety and quality of services,” which would be set by the Massachusetts Department of Public Health in consultation with the Massachusetts Alzheimer’s Association and representatives from the nursing home provider community.

Activity programs geared specifically to people with dementia would also be mandated by the law for facilities that have dementia care units, as well as guidelines for the physical design of the unit.

Under the proposed law, such facilities would be responsible for disclosing to consumers and the state public health department exactly what services their specialized dementia care units provided.

According to a Boston Globe article, a 2005 federal report indicated that 44 states had requirements for “training, staffing, security, and other areas” for facilities that provide dementia care services.

While similar legislation has been proposed for the past seven years, it never passed. These bills were opposed by the industry because they “stipulated specific staffing levels for dementia care units,” according to the article. It notes that the Massachusetts Senior Care Association, an industry group, supports the current legislation since it does not have minimum staffing level provisions.

A provision in the bill, titled An Act Relative to Dementia Patients in Long-Term Care Facilities, states that any regulations promulgated to implement it “may not be used as a basis for higher reimbursement rates” for the licensed homes.

– by Deane Beebe

Just as the Green House Project® announced the completion of the nation’s 100th Green House home in September, Seniors Home & Care Journal published an article concluding that the Green House model’s operations are “comparable in cost to traditional nursing homes as well as nursing homes that are implementing other culture change practices.”

The article, “Financial Implications of The Green House Model,” explains that several published studies have already shown that the Green House Model of licensed nursing homes “provides significant and sustained satisfaction and clinical improvements when compared to traditional nursing homes,” but that questions remain as to the model’s initial and long-term financial viability.

The authors review past studies on the financial performance of the Green House Model and report on two recent studies that look at the 1) costs of Green House administration and organizational staffing, and 2) environmental costs, overall financial performance, and benchmarks of Green House homes.

The first study found that the total estimated personnel costs of the Green House homes and traditional models are “essentially equal.”

While there is an increase in the number of full-time direct employees in the Green House homes compared with traditional facilities, this increase is offset by a reduction in the number of both administrative and support staff (housekeeping, laundry, and food service staff), the authors report.

Shahbazims’ Larger Role Reduces Other Costs

In the Greenhouse model, the certified nurse assistants known as Shahbazim are responsible for the tasks of these support staff in addition to their typical direct-care duties.

The authors attribute the reduction in administrative full-time employees to the increased role of both the nursing staff and the Shahbazim who coordinate care and maintain patient records in the Green House model rather than having unit secretaries or charge nurses do so.

The second study compares the overall costs — including food costs, plant operations, ancillary costs and administrative expenses — of Green House homes to traditional nursing homes. It also compares their capital costs, both per square foot and per unit.

In this study, the authors conclude that the capital costs of the Green House homes are equivalent or less than similar culture change models but higher than traditional facility designs. They note that the increased occupancy and more private-pay days that are associated with the Green House model may offset these capital costs.

Tripling the Number of Green House Homes

The Robert Wood Johnson Foundation, a partner of the Green House Project, announced the organizations’ mutual goal of tripling the number of Green House homes in the next three years.

PHI, also a partner with the Green House Project, has worked with the project to imbed its Coaching Approach^SM in the educational offerings for all Green House staff, including the formal leadership team, nurses, and the self-managed work team of Shahbazim.

– by Deane Beebe