The Nursing Home Podcast

Timestamps(00:00:02) Introduction (00:01:01) Healthcare Risk Management Experience (00:02:18) Fair Housing Act Explanation (00:08:15) Prohibition of Disability Discrimination (00:15:57) Understanding Essential Requirements (00:23:15) Rules Around Common Accommodations (00:29:42) Risks & Fair Housing Marketing (00:34:55) Legalities for Assisted Living Services (00:40:17) FSA & Housing Education (00:43:22) Rules Disregard in Senior Living (00:47:41) Risk Tolerance Discussion (00:49:06) Risk Management in Senior Living  So as you mentioned, I did medical malpractice defense for a number of years in New York,and then I moved to Pennsylvania because I was getting married and my husband was fromout of state.And when I moved, I decided to switch hats, and I decided to do healthcare risk management.So I was tasked with starting up a risk management program for FSA.At the time, we started with 12 organizations, nonprofit, faith-based communities, generallyin the Philadelphia area.Since then, we've expanded quite a bit, and we now have 37 sites in six states.And so I give guidance and consultation on risk management issues.So today, we are going to talk about marketing risks, but I'm going to talk about it frommy perspective, you know, from a risk management perspective and a fair housing perspective.Okay.So thanks for that background.So let's get right into it.What is the worst-case scenario if someone says, you know, I'm going to market howeverI want to market?I'm going to say what I want to say, do what I want to do.What have you seen as like a worst-case scenario of someone has done this and this horribleoutcome has happened?Great question.Nothing like the fear factor right from the beginning.So what I'm going to preface that question with is an explanation of why there are risksin this venue, in this area.And so in 1968, Congress enacted the Fair Housing Act, which was what I like to callthe third leg of the stool for civil rights litigation, legislation rather.And so we had the Civil Rights Act, then the Voting Rights Act. And then in 1968, they passed the Fair Housing Act.And that precluded discrimination in housing choices and lending based upon what we callthe protected class status.So started out with race, religion, national origin, color, gender, which now includesgender identity and sexual orientation, and national origin.In 1988, Congress amended the act to include two additional protected class categories.Familial status, meaning that you are not supposed to be able to discriminate againstfamilies with children.And of course, there is a carve-out for our senior living settings.And the one for purposes of our discussion today, which will be very pivotal, is it sayshandicapped, but it's what we would refer to as disability.So you have now protections under the Fair Housing Act, and we just call it FHA for boththe Amendments Act and the original act for all those protected classes, which actessentially as a floor, not a ceiling.So state and local jurisdictions can also add an additional protected class categories,like, for example, maybe marital status, saying that, you know, you can't discriminateagainst somebody because they're unmarried or, you know, because they cohabitatetogether, for example, or source of income is another one that's fairly common.So I think for a lot of senior living communities, they don't necessarily recognizethat they are covered by this act as a housing provider, because I think for a lot ofcommunities, they say justifiably, well, we're not a housing provider because we do somuch more than that. And you do.However, in the eyes of the government, you are a housing provider and you are subject tothe Fair Housing Act.And so there are lots of risks that come along with that.Now, if you choose as an organization just to decide that you're going to market any wayyou want to and you're not going to pay attention to various marketing risks, includingfair housing risks, what's the worst case scenario?The worst case scenario is that you end up being in litigation, sued by potentially afederal government. So it's now the United States of America versus, you know, seniorliving community, A.B.State. You are in litigation with the government.You are being sued for housing discrimination.Almost always that ends very badly for the community.Almost always winds up in a monetary settlement.Many times there is also a settlement compensation fund where the community has toadvertise in multiple places for people that have been subject to what they've just beenfound by the government to be illegally doing.Let's just say discriminating against those with scooters, for example.And so they would have to advertise for anyone that's been impacted by that to give themmoney. In addition, there's almost always what we call a consent decree that comes withthat. It's sort of, if you're familiar with the world of compliance, it's similar toa CIA or a corporate integrity agreement whereby the government puts you into thisconsent decree.And the consent decree not only sets out the exact amount of money that you're going tohave to pay and how you would advertise to those who have been subject to yourdiscriminatory practices to give them money.But there's also usually quite onerous burdens that are placed on the community,including things like they get to and the government will review your actions for aperiod of time. Usually it's about five years.And so they will oversee and have to approve the policies, put policies in place forwhatever the particular topic is, change contracts, sometimes hire a fair housingofficer to perform acts to training and education for the staff on an ongoing basis.And again, being overseen by the government for a period of time.In addition, I would also say that you don't want to be the poster child for that.So again, I happen to mention scooters.And one of the pivotal cases in the world of, you know, communities that have been suedfor improper restrictions on scooters is a community called Twining Village.And I don't like to use them, you know, but that that case is out there and everybodyknows about it. So you don't want to end up having the reputational damage in our worldof, you know, senior living where it's like, oh, that's the Twining Village case.And so, you know, everybody knows based on that case, you know, some of the policiesthat you have to have in place and the no-nos, the things that you shouldn't be doing.You don't want to become the poster child for that, which can very easily happen.Well, so a couple of questions.Thank you for that. I mean, that's quite an overview.So it were someone to actually go ahead and let me just back up.So you're saying that there's the fair housing law, which puts nursing homes together inthat category. So therefore, they have these discrimination laws like you've outlined.So is this, first of all, is this specific to marketing?Are we talking about someone denies a patient because we don't take we don't want patientswith scooters because patients with scooters are dumb or whatever.Yeah. So I'm speaking broadly about senior living communities.Right. So it's anywhere that a person lives.Okay. So if you are running a short term rehab only, then potentially you are excluded fromthe Fair Housing Act because that's not someone's home.The intention is to treat them for a brief period of time with the intention to dischargethem. However, it does apply clearly.All the case law is very clear on this.It does apply to settings like CCRC, independent living, assisted living, personal care,long term care. So all of those things, you know, adult foster care, it does apply to allthose settings. It is questionable whether it would apply in the context of a short termrehab strictly.Okay. So let's back up.If I don't have if I have a regular store and I sell chocolate and desserts and flowers andwhat else? I can discriminate all I want?No. There are other laws.There are other laws that prohibit you from from doing that, that we're not necessarilyspeaking about today. But again, when it comes to housing, we are under the auspices ofmultifamily housing specifically, which means four or more people in a unit or, you know,four or more units, I should say, not four more people.Then you are subject to the Fair Housing Act.So. Okay.So the Civil Rights Act says that you can't discriminate.Right. Suggested.I understand that. So my point is that you have extra laws when it comes to if you'remanaging or you own a home that has multiple families, say for like you said, four unitsor more. So then you have you have extra focus.So now let's assume someone has an assisted living facility, a long term care facility,really can be an apartment building, too.But we're saying even senior living facilities and they're going to and then theydiscriminate against someone.So does that mean that they refuse admission to someone?Okay. So that's a great question.So discrimination can take multiple forms.It can be just as you said, refusal of admission or refusal to someone, an applicant tobe denied admission.That can be a form of discrimination.It can also be a form of discrimination, which is very common.Probably the most common form of discrimination is the refusal to grant what we call areasonable accommodation for disability.And that's where the scooters would come in, for example.So if I was disabled and I had a mobility impairment and I required a scooter to enableme to get around and to meet what we call the essential requirements of tenancy.And you, as the provider, refuse to allow me to have that scooter or, for example, thatservice animal, like you have a no pet policy and I wanted to come in with a serviceanimal. Well, that's not a pet, that's a service animal.That's for my disability. That's a reasonable accommodation.So you can refuse and then you could again potentially be sued for that.But in addition to also refusing to admit somebody, which is a form of discrimination,there are a multitude of other forms of discrimination under the act.And it can be I come in and I'm able bodied when I come in.And after I'm a resident at your community for some period of time, I now becomedisabled. And again, I've asked for reasonable accommodation, whatever that may be.And you now refuse to give me that reasonable accommodation or you are discriminatingagainst me and saying, because let's say I had a let's say I had a fall.I lived in independent living and I had a fall.And you say, well, now you're not independent anymore.And so you need to move to assisted living because you had a fall.You can't from a legal standpoint, from a fair housing standpoint, they'd have to be waymore to it than just forcing me to move up through the continuum for something like whatI just described. And then additionally, I would also say that, you know, there areagain, just treating that it's essentially under the Fair Housing Act, we don't want totreat anyone worse, which is the more common thing to do.We also can't treat anyone better because of their protected class status.So if so, again, we serve primarily faith based communities.So if I had a community that was, for example, a Quaker community and they said, becausewe are a Quaker community, we want to give preferential treatment in admission to Quakers.You don't have to meet the same kinds of financial requirements as we require from everybodyelse. You can't do that either.Right. So, again, it's admission, but it's also discriminating against somebody oncethey're there.OK, so there's also what's the line?And I guess this is where the gray area comes in between providing reasonableaccommodations in this type of living setting versus we have a noscooter policy, let's say, because of a certain maybe safety concern that we have due toour building. Or maybe we don't allow service animals, even though it's not a pet, becausewe have residents with advanced dementia and they view service animals as monsters.They're going to eat them up or any other sort of reason, assuming that it's trueor even if it's not true.I mean, you get a good attorney to make something up, but the reasonable accommodationsversus actual practical reasons why that it's not discrimination, but there's anactual ramification of being, you know, let's see your example.Someone was in an independent living and suffered from a fall and now can no longerambulate safely in that setting.And they want to say, OK, now you have to move on.You know, CCRCs, you have to move on to the assisted living.Like, I don't want to go to the assisted living.Well, over here, you can't take a shower.You can't, you know, prepare your food.You physically can't do any more.We're not discriminating because we don't like people who fall, people who are old orpeople who are weak.We're just saying that we feel that this is not appropriate.So is that where, and obviously the other side is that, no, I'm fine.It's just because I fell.Don't tell me I need to move on.Let me get some therapy.Let me go to the doctor.Let me let this thing heal and I want to stay where I am.So is that where, is that why people like you have jobs?Right.So, yeah, perhaps that's why people like me have jobs.But what I would say to you is, you know, there are parameters around certain things.So let's talk a little bit about that.So, again, when we talk about disability, we, there is a requirement under the law thatsays that in order to live someplace, whether that's just in the community at large, youknow, an apartment building or in a senior living setting, the tenant or the residenthas to meet what we call the essential requirements of tenancy, no matter what.Disability, no disability, you still have to meet the essential requirements of tenancy.So what are those?First and foremost is paying your rent and fees on time.Number two is keeping your unit in a safe, clean and sanitary condition.Now, you know, I think that reasonable people may differ as to what's safe, clean andsanitary. Right.Also obeying the reasonable community rules.Okay. Unless, of course, there has to be an exception made because of the reasonableaccommodation because of somebody's disability.But again, generally speaking, you should have a set of reasonable community rules becausepeople have to obey those rules.You also cannot have excessive damage to the unit.Okay. Normal wear and tear is okay.If I scrape the walls because of my scooter, that's okay.But if I decide to, you know, take a hammer and make holes in the walls, that's not normalwear and tear. Also not unduly disturbing the peace and tranquility of others.Okay. And the last one, which is very important, is not being a direct threat to thehealth and safety of others.Now, in my opinion, and this is not in the law, this is not in the essential requirementsof tenancy. When you are in a senior living community, I feel that it is reasonable tosay you cannot be a direct threat, a direct threat.That's very important language.Not speculative, a real direct threat to your own health and safety.Okay. So, but that's not been tested in the courts yet.That's Christina's theory.But I think it's a good one.And so.Hold on, let me talk about that for a second.If someone's, and they're a threat to themselves, and certainly if they're a threat tothemselves, even if they're not, if they're trying to physically harm themselves, they'retrying to slit their wrists, they're trying to jump out a window, they're trying to, Idon't know, whatever, anything else that's unsafe.And the facility has done everything that they can to prevent, stop, intervene, assist.So there's a question, there are those who say that, no, you cannot, let's say, Section12, you cannot send them out to the hospital because that would be discrimination.Is that even a possibility?Well, no, under the scenario that you just described, you're not evicting them.You're not getting them out permanently.You're just sending them out.So I would say, no, that's reasonable.But there have been situations, I like the examples that you use because they are extremeexamples. And I would argue, if I was a provider, that there is no reasonable accommodationthat will diminish that threat.But that's always going to be a question because tying in with meeting the essentialrequirements of tenancy, which everyone has to do no matter what, that's where thereasonable accommodations come in.So if I have a disability and I ask for a reasonable accommodation or you become awarethat I need a reasonable accommodation, then it should be granted because the reasonableaccommodation is generally what's going to help me meet those essential requirements oftenancy. Now, going back just to the example that you used.Someone who's suicidal or homicidal, even.The, you know, I could say I can't handle, I don't have, I'm not equipped to handlepsychiatric issues and I certainly can't, you know, protect my other residents from thishomicidal individual or I can't protect them from themselves because there's so manyways that they could attempt suicide.And so they are not meeting the essential requirements of tenancy because they are adirect threat. There have been occasions and there have been some cases.Where in circumstances like that, the courts have said, well, and it's not specific tosenior living, it's just general housing.Well, you should try a reasonable accommodation first.So, for example, if you send that person out, you know, to be involuntarily, you know,incapacitated in a psych facility for a period of time.And let's say that they have been given medication that would, you know, presumablycontrol their behaviors.Then the resident or the tenant in this case would be able to say, well, my reasonableaccommodation and I should be allowed to stay because I can remain on this medicationregimen and then my behaviors are controlled.But I know of a case from a number of years ago, multifamily housing out in Connecticut,and an individual had psychiatric issues and actually went after the landlord with a bigbutcher knife and threw him down to the ground and started to stab him.That gentleman was arrested and then the landlord sent notice, you know, you're herebyevicted. You know, after he got out of jail, after he spent some time in jail and cameback, he realized that he couldn't come back to the apartment because he had beenevicted and he sued and he said, you're discriminating against me.And the court in that case actually said, well, you have to try.Let him have his reasonable accommodation.And, you know, but I think that's not, in my view, that wouldn't be a reasonableaccommodation. It's not reasonable to allow someone who has, you know, extremebehaviors like that, you know, again, that's a direct threat that we can't keep otherpeople safe or that even that resident, we can't keep them safe.So that's the extreme example.But, you know, most cases are not as extreme and most cases you're going to have to trythe reasonable accommodation and sometimes multiple reasonable accommodations beforeyou would say you're violating the terms of the resident contract or the lease or theagreement, whatever it is that we have.And now you're going to have to leave or move up to a higher level of care.You're going to have to try a few different reasonable accommodations to be safe beforeyou can generally do that or you'll risk potentially a fair housing claim.Well, that's very messed up, just to realize that for everybody, because to see thatsomeone who physically attempted to murder their landlord was jailed for it and nowevicted, reasonable accommodation, that sounds crazy.But I agree with you on that.I wholeheartedly agree.I think that's fair.But I just felt like I, you know, I had to, you know, kind of raise that to say it's notnecessarily a slam dunk.But generally speaking, yeah, when somebody is a direct threat and it's not speculative,it's not fear that something might happen, it's something did happen.Right. So I want to be clear about something.When it comes to reasonable accommodations, as a provider, you can and should haverules. You don't have to make it willy-nilly, but you are allowed to have reasonable rulessurrounding common accommodations, reasonable accommodations.So, for example, let's use the scooters again.It would be probably very high risk if you just said we don't allow scooters.But it's OK if you said we allow scooters, but we have these rules.A rule, I always encourage my communities to have reasonable rules.A rule might be that you have to sit with therapy and review the rules of the communityto use a scooter first.You know, get educated on it and then sign off that you're agreeing, you understand allyour questions have been answered and you agree to abide by the rules.And those rules might be things like you can only drive your scooter as fast as anon-disabled person can walk.You don't have the right to drive your scooter around like Speed Racer.Right. It may say you have to have a horn and lights if you're going to drive outside.You have to obey the rules of the road on campus.You have to have a flag.You can't park and block fire exits.You can't block mailboxes.If you're going to drive into the dining room, you have to have room.And I want to touch on something that you mentioned a few moments ago, saying mycommunity is older and it's not equipped for these big SUV scooters that people havenow. Under the ADA, which also sometimes can tie in with the Fair Housing Act, thereare also construction requirements.So the ADA went into effect in March of 1991.So did those construction requirements.So if you have construction that occurred after March of 1991 or if your building isolder than that, but you've done any kind of a renovation on your building and the termrenovation is pretty flimsy and loose.It could be even like redecorating can be considered a renovation.You then have to comply with the dictates of the ADA in terms of the physicalrequirements. Like so, for example, it talks about thresholds.You can't have, you know, a big where someone can't come up on the scooter, you know,because of the thresholds or, you know, with their walker, that's an issue.Thresholds, grab bars, lowering cabinets in handicap accessible units.A certain number of your units should be made handicap accessible.That depends on how many units you have.It's a percentage.And simple things like aisles wide enough for people to use their scooters.And arguably in our setting, you know, knowing that many, many people do have mobilityimpairments, it's even more important, you know, to make sure that your community hasabided by the rules and the Department of Justice, you know, and lots of fair housinggroups. And HUD also has put in a tremendous amount of money to talk about people'sfair housing rights and to make sure that providers and architects and contractors areaware of what the physical requirements are for spacing and things like that andthresholds. And they've spent a tremendous amount of money talking about that andmaking sure that people are aware.So it becomes very challenging in these days.Every month a case will come out at least once a month on, you know, again, the ownerof multi-family housing, the owner of senior housing, a municipality, you know, manydifferent types for failing to construct their buildings in accordance with therequirements of the ADA.So you have to be careful about that.But there are reasonable rules.So have them about service animals.You know, you can have about scooters, you know, any other kinds of reasonableaccommodations. You should have, you know, rules around the private duty aides.They're another reasonable accommodation that you should have rules about.Got it. Sometimes we see this, the application of these rules, you know, don't seem soreasonable. I know a particular construction project that was not required to have anelevator, but was required to have handicapped accessible bathrooms on the secondfloor. Go figure.Right. Right.I don't know how, you know, somebody who's disabled, you know, then they would have tohave the right amount of housing on the first floor, you know, handicapped accessible.It wasn't a housing project per se.But, you know, we do see things like that sometimes, but that doesn't negate the rules.But if we can focus the conversation from a marketing standpoint.OK.We want to, you know, we titled this the do's and don'ts of nursing home marketing.So I know that there are things that we cannot say.For example, the nursing homes can't say that they're dementia units because there arelaws. This has nothing to do with Fair Housing, but this is the Department of PublicHealth. They haven't clearly defined a lot of regulations for what's qualified as adementia unit. And there's a whole process to go through.So you can call it memory here.You can call it a lot of other things.They can't call it by that name.I've actually walked in one of the nursing homes I was managing, at least in Massachusetts.I worked with the gentleman whose name is Dr.Paul Rea, and he's the one who wrote the regulations for what's called a dementia unit.And we were thinking of maybe turning one of our units, our memory, our unit thoughanyway was a dementia unit, to just make it an official one.And the cost and just the work that it would take, not just money, but also theinconvenience and the downtime that it would take to get it in compliance just didn'tmake sense. And we changed the wording in our marketing materials and we had the sameresult. So instead, we just decided, you know, it was a company decision, you know,should we do it, should we not do it, so how extensive it was didn't make sense.So question for you is what is the absolute, give me a great example of someone that didsomething horrific in their marketing or something that someone can do like really badin their marketing. And like, I guess I'm a worst case scenario person.And what happened as a result or what could happen as a result?So let me give you some examples of things that are risks in marketing when it comes tofair housing. And I've jotted a few of these down so that, you know, I cover everything.So the first one that I would talk about is models, models or people in your marketingmaterials, photographs of individuals, right?That can be problematic because, for example, we talked about the protected class of race,right? So if you only have photographs, they want to see, the government wants to seediversity. So if you have, you know, all Caucasian individuals, that could be a risk foryou because where are the people of color?You're not allowed to discriminate based on someone's color.What if everybody in your marketing materials is running, jogging, biking, doing yoga?Where are all the people that are on scooters, in wheelchairs, with walkers?So models can be potentially problematic.Another issue would be problematic language in your materials.Another one could be potentially, I know a lot of times marketing, especially in the CCRCsetting, will do what's called a targeting marketing campaign, right?So they want it, they're targeting to a particular income level.All right. And they're sending the materials out to that, to the people in a particulargeographic area that meet those income requirements.Well, there have been cases where that's been considered to be a discriminatory practice.Why? Because you're only sending all your marketing material specifically to potentiallyjust white people.Okay. And you're excluding and you may not have any discriminatory intent with that, butthat's the way it comes out.And in the Supreme Court has decided that in fair housing, there is something calleddisparate impact.It doesn't have to be that you purposely discriminate against somebody, but there is anactual disparate impact.So that's an area that you want to be careful about.Lack of an improper, lack of the fair housing logo, it's the little house, or having thelogo, but it's minuscule.You can't see it. If you have the logo and you should have the logo, the fair housinglogo, it's put out by the government.If you have one for leading age and you have one for, you know, whatever local societiesyou belong to and they're all of a certain font and your fair housing is teeny tiny inthe bottom, that's problematic.There is no requirement, by the way, on font, which makes it a little bit more complicated.But you want to make sure that it's the same size as everything else.Exclusionary practices for admission.Again, we don't let people in with scooters or we don't let people in with serviceanimals. Problematic applications, asking lots of, again, this is for independent living,not for nursing or, you know, assisted living or personal care.Asking medical questions, if you're not a type A community, that can be potentiallyproblematic. Asking intrusive questions, asking them to undergo a physical exam.If you don't have, you know, a guarantee of moving through the continuum of care, thatcan be highly problematic.Improper. Oh, I mentioned the improper request of physical exams.Steering, which is a term of art in the fair housing world.Steering means that I come in and I either and government, by the way, and so do fairhousing groups, send testers in to ask these questions and try if they think there'sdiscrimination going on, they will send somebody in who pretends to be an applicant oris looking for housing for their loved one and ask the questions to see what the answersare. Steering means that I come in and I say, hey, you know, my mom is looking forindependent living.She uses a scooter.She needs some help with her medication management.You know, she sometimes gets a little bit confused.And, you know, if you were to say to me, well, you know, she might feel a lot morecomfortable if she goes over into assisted living.That might be a better place for her.We don't really like those kinds of people in independent living.We don't want to look like a nursing home.That's steering. And that is illegal under the Fair Housing Act.Discriminatory denial of reasonable accommodations.And again, being aware of the state and local laws that expand upon the protected classesand making sure that you are not, again, discriminating against additional protectedclasses that your local jurisdiction or state may have in place.So those are a whole series of marketing risks that I would tell you you have to becareful of. Got it.So let's say I have an assisted living and I am targeting a certain group because this isthe group that actually needs the service, can afford the service, will maybe want theservice. Is there no legal way to target that group?If I'm going to put people, let's say, let's see an example of models or even, you know,language. If I'm going to put words on there or pictures or other things that don'tresonate with them, then they're obviously much less likely to, you know, to respond.It doesn't mean that these are the only people that are marketing to.I may have a separate brochure and a separate marketing plan for, you know, for adifferent ethnic group or a different protected class.But right now I want to focus on these people.You know, an open invitation is no invitation.Come over to my house any night you want for a barbecue.That means you're not invited. I'm not even telling you my address.But if I say Tuesdays at 4 p.m.having a barbecue, you know, please bring over, bring over your family.Here's my address. Then you're invited.Right. So the point is, people will resonate to marketing material if they will act on itresonates with them. So if it's, you know, if it's tailored to them, then it'll work.Can I? Is there no legal way to do that?There, you know, well, first of all, I want to be clear.I'm not giving legal advice here.I'm giving you advice from a risk management standpoint.And so, you know, listen, everything that we do is associated with a risk benefit analysis.Right. So I want to be clear about that.So a community can make a determination.What is their risk tolerance?If they really want to market and target towards a particular, you know, group because oftheir income. And it turns out that that they feel like we could be accused ofdiscriminatory behavior because it's going to go to, you know, all white people.That is a question.If you still want to market to that group, I'm not here to say you can't do it or youshouldn't do it. I'm just saying, be aware that that's a risk.Right. So anything that you market on could be a risk.But if you think that the benefit of targeting a particular group of people is going to,you know, bring in the people that you want or that you think would benefit from yourservices, then that would be your assessment of and that would be a risk tolerance toyour community. Right.Got it. Who are the discrimination police that are going to bring this case in front of,you know, they're going to get, you know, secret people coming in undercover and askingfor service.So the DOJ has testers that work for them in the Civil Rights Division.Now, who brings it to their attention so that someone would want to come down?Yeah. So I'm going to tell you, there are a lot of fair housing advocacy groups outthere. There are a lot of law school clinics that also have fair housing, you know,clinic that are staffed by law students.The government gives money.They're like quasi-public, private, public government entities.They get money from the government in recognition of their work and they get money fromthe government to do that.So they are there to enforce fair housing rights.Usually the way it would work is if I am an individual, many times this is how ithappens. I'm an individual.I go, I apply for residency at a particular community.I feel that I've been discriminated against for whatever reason that, you know, mydisability, my religion, the color of my skin, whatever it is.I go to a fair housing group and I make a complaint.If they, they will then investigate my complaint.If they feel that there is some validity to that, they will do their own research.They will start their own investigation.They will have testers.They will go out. They then turn it over usually to HUD.With their findings, if they feel that there is what we call a pattern or a practice ofdiscrimination, they will send it to HUD.If HUD, the Housing and Urban Development Office of the government, feels that it risesto a certain level and they think that there is a discriminatory pattern and practice goingon, then that gets referred over to the Department of Justice.So the lawsuit can either be me, Wildrick versus ABC Senior Living.If I feel that I've been discriminated against individually, I can sue you instate court or federal court.If it's a fair housing group, then a lot of times, you know, that fair housing groupwill bring it on my behalf.So it would be Wildrick and the Fair Housing Alliance versus if it goes to HUD, itwould be, you know, HUD, Housing and Urban Development v.the housing community.And again, in the worst case scenario, it rises up to the level of the DOJ, theDepartment of Justice, and they will bring the claim and it will then be the UnitedStates of America. It will be in federal court and it will be brought against you.So there are they are essentially what you're referring to as the police.They are the enforcers.They are bringing them. But private claims can be brought by individuals or by privatehousing groups. And there are loads of them out there or the government can do it.Well, so now on a professional standpoint, where do you come in the business thatyou're involved in? Which piece of this?Are you the police? Are you the defendants?Are you just educating people to stay away from the cops?Right. So my job as the risk manager for FSA, for the communities that we work with, webring we do lots of education.We do lots of fair housing education, both for marketing and admission staff, as well asstaff within the community that is responsible to move people through that continuum ofcare. So we do loads of education for them.We also come in many times and we do education for the residents themselves.We have meetings with residents.Sometimes residents, for example, may say, you know, things that we feel areinappropriate, like why is so and so in the dining room?She's in a wheelchair and and she's totally out of it.And I don't want to look at that when I'm eating and, you know, or asking questions.Why is this person living in independent living?This person doesn't belong here.She's not like the rest of us.She should go into assisted living.You know, we have a problem with it.We're here to educate the residents on their rights as residents, as well as, you know,what the Fair Housing Act says and why we're not going to share any details andinformation with them about other residents and what we're doing with them and forthem as far as reasonable accommodations or any any other way that we're working withthem. So we like to educate the residents.We also work specifically with marketing teams.We help them with, again, do's and don'ts in their marketing materials, language thatthey should have on all of their websites, on their brochures, on anything that they'redoing. We help them with information on, you know, things to share and not share duringtours. So, you know, we're here and we develop all kinds of templates for policiesand procedures and things of that nature.We also work with the risk management committees to review all of the marketingmaterials and the website before they actually go live and before anything's printed tomake sure that everything is, you know, on the up and up, both from a fair housingstandpoint and a general risk management standpoint.We don't want people over promising that, you know, it's all about for us settingrealistic expectations.So we're here at FSA to help our communities understand what it is, understand therisks, and also develop policies, procedures, rules, guidance.So we talk about rules and we have templates for rules for service animals, rules forscooters, rules for private duty aid, hold homeless agreements, indemnificationagreements when somebody does want to hire a private aide to make sure that theyunderstand that we're not responsible for, you know, what they do or what they doincorrectly or what they fail to do.So those are all things that we do at FSA in our risk management program to assist theorganizations that we work with.Fascinating.We've gone a little bit later because you're sharing, you're dropping all the jewelsthere. But the question for, is there anything, it may not be necessarily fair housingrelated, but if there are residents in a senior living setting that completelydisregards all discriminatory laws and regulations, to have some people that justdon't care anymore and they'll say things to the staff about their religion, aboutthe color of their skin, about the country that they come from, about their accent, andthey'll, they have nothing to lose.Is there any recourse, and you can educate them, but they don't care.Is there any recourse that providers can do to help really prevent their staff, notprotect their staff, or the residents from each other, when you have residents thatcompletely ignore all the rules that we're discussing?Well, that would be a topic for an entire other podcast.But what I will say is what you're describing for your employees is a hostile workenvironment. And even if you cannot stop the resident from saying, you know, thebigoted, you know, racist kinds of things that you're describing, you cannot, as aprovider, throw your hands up and say, oops, sorry.You know, in one particular case that was, it's a fairly recent case that was broughtfor a hostile work environment.The CNA was being, you know, spoken to in that manner that you just said, and alsosexually harassed, groped, touched, you know.And the administrator in that case, the language that she used was, put your big girlpanties on and deal with it.OK. And they got hit with a massive verdict.So you don't want to do that.But so, again, there are things that you should and can do to mitigate the harm thatcomes to employees. So, you know, for example, you might want to switch staffingpatterns around. You might, if it's somebody that is, you know, touching inappropriately,then you might want to use, you know, a male caregiver or you might send that person inwith a second caregiver at all times.Or you might, again, like in the case of the CNA that I was just talking about, she hasto be moved to a different wing away from that resident.And that's when the administrator said that to her.So, again, you want to look, there's all different things that you can do.But what you shouldn't do is to basically throw your hands up and say, there's nothingthat I can do about that.No, of course not. No, the question is not about the staff, but the question is, is thereanything that can be done to, I guess, to encourage or force the people who live inthat setting not to engage in those practices?Well, other than what you just described, you know, like the education, and obviouslyit's going to depend on the, you know, on the competency of that individual.If that individual has intellectual disabilities and or dementia, right, right.But if they don't have those things, then, you know, and they're not abiding by therules, then there may have to be, you know, after you've spoken to them, anddocumentation is key, you have to be documenting everything you're doing, everyeffort you're making, every conversation that you've had.And if that resident is refusing, then there may have to be a discharge in that casebecause you're not able to care for them anymore.Got it. Got it.Fascinating.If people want to learn more about the topics that we're discussing or learn moreabout you and your company, where's a good resource, where's a good place to send themto?Our website, FSAinfo.org, is a good place, and it has, you know, a number of theresources that we have on there.We, you know, we provide a lot of different services in addition to risk management.Awesome.Okay.FSA, what is it, FSAinfo?Yeah, FSAinfo.org.Okay.We'll include that in the show notes.I'm going to take a little peek.All right.Any final thoughts before we let you go for today?Again, I think it's really important that you recognize and discuss, you know, whatyour risk tolerance is because the message that I want you to take is, yeah, there area lot of fair housing rules and the advocacy groups really, you know, they take a verystrong position pro-tenant, pro-resident.You know, myself, you know, representing providers and on the, you know, trying tokeep providers out of trouble, I might take a more restrictive view of it, but it'sreally be aware of what the risks are and then make informed decisions about your riskbenefit analysis and what your risk tolerance is.Sometimes it might be better to decline admission to somebody, you know, and risk afair housing claim than to take somebody in that, you know, is not appropriate andit's going to struggle in a particular level of care, you know, and it's going to, youknow, be really a massive burden to you.You might choose to take the risk of potentially a discrimination fair housing claimthan to take somebody in that, you know, is going to be incredibly problematic andpotentially present you with a negligence action.Got it.Got it.Okay.I'm just going to, wait, you just want to unmute.I know you didn't, I'm sorry.I'm looking at the wrong place here.That's my bad.But there's just one comment here from Hannah.It says, thank you, Christina, for sharing your expertise as a marketing professional.Christina living in organizations is very interested in to think through the risks,which is definitely true.And there's something that you brought to us.Thank you very much, Christina, for joining us today and for sharing everything that youshared over here on the show.It definitely has been very informative just about, like you said, knowing the risks, whento take them, when not to take them.Right.Okay.You're welcome.Thank you for having me.

Sara Well spent 12 years as a critical care trauma nurse on the acute side. She watched again and again as her facility's money was put into much less pressing issues than staffing and saw how it impacted not just care and quality outcomes but overall revenue.She saw how archaic many of the systems in place for staffing were, and with her tech background realized that this comprehensive issue was a scalable solution with a huge addressable market. Nurses are often perceived as a cost rather than a revenue driver. They have been historically under-appreciated despite how much their presence and work directly impacts the length of stay which is not always covered by insurance.The flaws already present in the healthcare conveyor belt were exacerbated by the arrival of the pandemic. An estimated 500,000 nurses were lost to COVID fatigue, switching to other less taxing professions. At the same time many new travel nursing and outsource labor companies began to pop up, luring staff away from their traditional in-house positions with the promise of higher pay. These companies then sold the nurses back to the same types of facilities they came from at a much higher cost. Though facilities were able to get staff quickly and easily, it was not cheap and cost them the integrity of their in-house teams.Dropstat seeks to re-empower healthcare organizations, working with them to update and automate safe staffing processes, and give total transparent insight into their labor costs.They see the most important relationship as the triad between patient, provider, and the organization that brings them together.Dropstat uses machine learning and AI to predict a facility's staffing needs 60 days in advance.  are able trace increased costs of standard labor and premium labor costs whether its agency or overtime bonuses. With this data they create patterns and recommendations and feed them back to the client.When asked about the problem of staff leaving for a $2-3 raise Sara had some powerful insight to share. She states that just like those serving in the military, healthcare workers see death and loss on a sometimes daily basis. But while the military has instigated an entire culture of comradery and airtight family dynamics within groups, the same is often not present in healthcare.  Sara concludes that if a facility is able to culture hack and ensure with authenticity that nurses feel loved, valued, connected, appreciated, that they are the key to aiding the aging population, they won't have to worry about losing staff because of pay. FOLLOW SARA AND DROPSTATWebsiteLinkedIn RELATED EPISODESEp. 94: Innovative Solutions to the Staffing Shortage in HealthcareEp. 71: Combating Staff Turnover & Burnout In Nursing HomesEp. 42: Healthcare Workers Need Self-Care During Covid-19

After returning from military service, Eric Alvarez got his start in academia before moving to healthcare and delving into startups. It was this time working with students that led him to the idea of Grapefruit Health. By the year 2026 healthcare will be short by 3.2 million healthcare workers. Eric states that many of the current solutions for this problem greatly reduce performance and output while driving up costs. The year 2030 was always slated to be the year that our clinical aging workforce would max out, with baby boomers retiring at a much higher ratio than newcomers entering the profession. Many clinicians have either transitioned to part time or moved on to a gig economy platform. We have heard from various perspectives on the healthcare staffing shortage on this podcast and Grapefruit Health brings a new solution to address this monumental problem. They have created the world's first and only healthcare workforce composed solely of clinical students. Healthcare facilities often run programs to employ students, but this calls for a training preceptor and ultimately leads to an unproductive workflow. Grapefruit Health employees on the other hand provide assistance with remote, low acuity, high volume, repetitive telephonic tasks.These include medication adherence, senior isolation and loneliness outreach calls, and post discharge follow up calls. All of these tasks are clinical in nature but do not require licensure.About 10% of these telephonic tasks need a pharmacist interaction, in which case the employee will do a warm transfer to a pharmacist. This cuts down time greatly for short staffed pharmacy teams who would otherwise have to make all these repetitive calls themselves. Grapefruit Health offers their services at $5 per interaction and doesn't charge for unsuccessful interactions such as when a call goes through to voicemail or a patient hangs up. Typically their client organizations have a program that's failing and are looking to supplement it or outsource it. After understanding the situation and what tasks and roles need to be filled, Grapefruit Health can build scripts and employ students and train them for the job in just six weeks.Eric states that students are eager to learn with their clinical education fresh in their mind. Grapefruit Health leaves their employees with great skills and experience and even full time opportunities with the client organizations they worked with once they graduate. FOLLOW ERIC AND GRAPEFRUIT HEALTHWebsiteLinkedIn RELATED EPISODESEp. 89: Take Full Ownership of Your RecruitmentEp. 85: 5 Strategies You Can Implement Today to Boost Your Recruitment Success RateEp. 79: Smart Hiring for Nursing Homes

Erica has had 30 years of experience as a nursing home administrator and specializes in regulatory compliance. Her nonprofit senior living campus is so excellent at staffing retention that they have managed successfully to never bring in outside agencies. In today's senior care facilities, where administrators constantly struggle to keep staff from leaving, this is an incredible achievement. Erica outlines some of the means by which she and her leadership team have made it happen. Firstly, they have made sure to be visible in the local community. They are involved with two chambers of commerce, hold lots of events, and have great working relationships with the local high-schools.High-school seniors who have completed one year as nursing assistants and want to stay on, will receive 75% tuition reimbursement towards starting a nursing degree at community college. They also hold raffles for those applying and bonuses to current employees for referring someone. For current employees, there is a career ladder in place throughout all departments and excellent tenure. Staff can work to advance themselves and see results for their hard work rather than feeling stuck in a static position. There are also many amenities provided including an excellent break room, and regular socials that help to create a great work atmosphere. Above all, Erica holds that having a work family, all pulling together towards the same mission statement, is essential. Right from the interview she assigns new hires a mentor in their department. By being present at the interview, that person will also be able to decide on behalf of their department whether they want to move forward with hiring. She maintains a strong philosophy of servant leadership and strives to let all her staff know that she cares for and appreciates them.  FOLLOW ERICALinkedIn RELATED EPISODESEp. 88: Hire and Retain the Best CNAsEp. 77: CNAs: Make Them Want To StayEp. 71: Combating Staff Turnover & Burnout In Nursing Homes

Sam Gopinathan only got started in his field after the 2008 recession when he was forced to leave his job as a mechanical engineer. But Sam didn't get into his current field by chance.  After a life-changing experience of helping to provide relief to a community devastated by a natural disaster, he learned that establishing a connection is a fundamental foundation of caring for others.  He decided to work in home health care because it aligned with his professional goals and personal values. Every day he goes to work he is helping someone with their life.  Sam states that long-term care insurance is the only product that will definitively cover the costs of care when one needs it.  Medicare will only pay for the medical side of things. It covers high acuity events, but not the nursing home stays that many people will need afterward. Unless someone has less than $2,000 in assets, they won't qualify for Medicaid coverage and will instead pay for the latter privately.  So how much care is provided by home healthcare? Sam explains that New Wave Home Care offers a minimum of 4 hours of care and a maximum of 24 hours. They help out with basic necessities like showering, meal preparation, and any other tasks that someone might not be able to complete physically.Having the right amount of care early on can save expenses down the line, such as those that will occur if someone is injured.In regards to payment, Sam states that 80-85% of clients pay via private funds, with 15% of clients using long-term care insurance. Depending on what policy someone has, they can get almost 100% off care expenses.Lastly, Sam examines the benefits of a professional long-term caregiver over a private caregiver such as a family member, friend, or trusted employee. By seeking out help privately, someone can be risking a lot.If you are employing someone privately, you are their employer on all records which can lead to a lot of trouble with lawsuits. It is also difficult to do background checks on a potential caregiver.  In theory, a family member or spouse would be the best solution. Still, the emotional burdens often become a problem made even more complicated if the caregiver is a similar age. With their assurance of expertise and knowledge, and ability to do complex background checks, agencies are the best option.  FOLLOW SAM AND NEW WAVE HOME CAREWebsiteLinkedInRELATED EPISODESEp. 87: Dementia Education; WhyEp. 60: The Best Healthcare Happens At HomeEp. 27: Should I Purchase Long Term Care Insurance?

Lindsay Mclaughlin is an expert multitasker! Managing to juggle running a successful full-time venture, teaching others to do the same, and being a working mom, she wears many hats.Her high-poweredness can be seen in the fact that she recorded this episode with us only a few days after the birth of her new baby! Despite going into nursing school, Lindsay knew for a long time that she wanted to be self employed before her thirties.Developing and running residential assisted living homes allows her to combine her background and skill-set with her long-time ambitions of entrepreneurship. But what are residential assisted living homes and how do they differ from traditional, larger assisted living facilities?Lindsay states that even though she prefers to build most of her homes from the ground up, the buildings themselves look and feel like cozy residential homes. Instead of hundreds of residents, most residential assisted living homes usually only have 8-10 beds, and no more than two-dozen. Rather than a host of amenities, clubs, and excursions to fill residents' schedules, the homes offer a cozy, close environment where residents can gather in the common area, get to know each other, and feel like they are living in a real house with a found family. Though they can't provide care to higher acuity patients, such as those who need feeding tubes, residential assisted living homes can take on most patients and provide them with more focused and hands-on care.Lindsay says that the set up of these homes is also very encouraging to the families who may be nervous and reluctant to send their loved one to a large, traditional facility.The smaller setup allows for a more direct line of communication that families can use to receive more personal news and updates. They are also more inclined to feel better about sending their loved one to somewhere that feels like a home. To sum it all up, Lindsay states that anyone looking to get into this sector of the senior care industry has to know what they want realistically before entering the business. The job can be hands-on and emotionally taxing, but it also allows an owner to build a space from the ground up, set their own culture, and run their own show, even if they do not have a large budget going into it.For those interested in this growing field, Lindsay is holding a 2023 flagship event where she gives attendees hands-on experience in running a residential assisted living home. FOLLOW LINDSAYWebsiteLinkedIn RELATED EPISODESEp. 79: Buying Your First Nursing HomeEp. 60: The Best Healthcare Happens At HomeEp. 54: What Is The Green House Model?

Nebras Hayek's incredible career in marketing throughout multiple industries is the result of her high-powered mindset and can-do attitude.  Though she has worked in a number of interesting places, Nebras got into healthcare marketing partly through the connections she made while hosting events for various healthcare related groups.In addition to her intensive day job, she is also an active military combat engineer in North Carolina, a position which on top of everything else demonstrates her love for challenges.  Nebras started out at Gentell as a regional manager covering only a few states but rapidly ascended to assistant vice president of the company, covering all 49 states.  Her significant experience in senior care has shown that progress is best made through building authentic connections and establishing dependability and trust with others in the industry.  Senior care faces a lot of current challenges. While the largest issue may be staffing, census is still a very high priority problem for many facilities.So what can a nursing home do to fix its census?Nebras advises that before judging that a nursing home is struggling, you need to go in, find out what's actually going on, and only target that specific issue rather than making a lot of large irreversible changes.She states that some major points to be examined and evaluated are the facility's current Medical Director and the actions of its Admission Directors.Medical Directors are supposed to be representatives and advocates for their facility. They should be ready to fix the problems they encounter or delegate the process of fixing.It is important to check in regularly with Admission Directors and find out what they are doing. Ask what challenges they are facing, who they are marketing to, and what's happening with referrals.  Lastly, when asked about the relevance of social media for both facility and vendors in senior care, Nebras states that, for both of these parties, the more recognition and familiarity the better. This is best done through authentic video content which is more informative than pictures. FOLLOW NEBRASEmailLinkedIn RELATED EPISODESEp. 79: Smart Hiring for Nursing HomesEp. 69: Should Nursing Homes Be On TikTok?Ep. 62: Social Media Marketing for Nursing Homes

Having served as assistant administrator at a small facility with extensive experience in the senior care industry, Avi Richman understands the extreme challenges facilities face these days in staffingThere is a constant fight over employees and many states cap admissions when a facility is only operating at very low levels of staff. Many facilities attempt to address the problem of staffing through working on their public appearance to prospective employees.Avi states that this method often won't work because it's almost impossible for most facilities to scale the idea of what they want their vibe and company culture to feel like. The only situation in which this would work would be if the facility concerned was small, and standalone.Avi gives an example of such a facility that deepened their company culture by creating an employee counsel that served as a legitimate decision making body.But is there a sole strategy that will contribute with certainty to the success of staffing endeavors? Avi asserts that facilities need to focus their time and energy on making sure the processes they plan are executed smoothly and to completion from start to finish. It is easy to say that this will happen but very difficult in reality, the only way it will work is if the process is monitored and nurtured 24/7. FOLLOW AVI AND VITA HEALTHCARE GROUPWebsiteLinkedIn RELATED EPISODESEp. 85: 5 Strategies You Can Implement Today to Boost Your Recruitment Success RateEp. 79: Smart Hiring for Nursing HomesEp. 77: CNAs: Make Them Want To Stay

During her research into health disparities at John Hopkins, Athena witnessed the difficulties that aspiring healthcare workers who were underprivileged and financially insecure had in starting their career. Single parents who were already working paycheck to paycheck could not afford to put themself through a CNA training program. There is also the issue of overcomplication and outdatedness present in CNA training school sign-ups. Websites are hard to reach or do not even exist. Application documents are difficult to fill out and obtain. Many of the people coming up against these problems are truly passionate about helping others and often already have experience and understanding of what they will face. On the other side of the equation, facilities search high and low for CNAs to hire on.In the post pandemic world, many CNAs have turned to other careers and it is often a struggle to find qualified CNAs who will stay on for more than a few weeks. Athena's company Dreambound addresses both of these problems simultaneously. Dreambound works with 150 schools and training programs in multiple states. If there's a school that's currently not on the platform all they have to do is sign up on the website and start getting students.Instead of a complicated application process, prospective students have only to fill out one universal application which will be directed to any of the schools on the platform. For facilities, Dreambound provides a system by which they can choose students to sponsor who will come and work for them afterwards. Athena also states that many schools are looking for clinical sites for their training. By taking this position, a facility will attract a lot more graduating CNAs who will have already trained there and decide to stay on out of the closeness and convenience. FOLLOW ATHENA AND DREAMBOUNDWebsiteLinkedIn RELATED EPISODESEp. 78: CNAs Care About Company CultureEp. 73: Make Your Staff WANT To Stay!Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes

As a clinical psychologist with over twelve years of experience in the senior living space, Dr. Jennifer Stelter has a lot of experience with dementia. Dr. Jennifer is critical of the idea that pharmacological methods are the only way to address mental health conditions and she strives to provide knowledge of non-pharmacological tools and coping skills that can be used firstly. Together with her business partner Jessica Ryan, biologist, and aromatherapy educator, she created the dementia connection model which employs these types of tools for addressing dementia onset. Dr. Jennifer states that while dementia training should be part of any clinical psychology studies, it is instead left all down to nursing homes. Since most dementia training is just regulatory compliance, it will often be carried out without much real thought or planning and will not be effective. When there is a lack of education in this area staff will not know how to empathize and interact with residents with dementia which leaves them more inclined to become overwhelmed and quit.  In order for a dementia training to be effective, it must be engaging and ideally use sensory based exercises to put employees and caregivers in the position of those with dementia. Exercises that push people to think on their feet are also very important because this is an essential skill when caring for people with dementia. In a post pandemic world, these trainings should be up to date, after all there is evidence that COVID-19 can be a factor of dementia onset. Dr. Jennifer and Jessica will be opening their Dementia Connection Institute which provides in-person and virtual CE seminars and presentations, and staff trainings in all the tools and strategies of their model to staff and caregivers. FOLLOW DR. JENNIFER, AND JESSICA, & THEIR PRESENT AND  UPCOMING DEVELOPMENTSDr. Jennifer's LinkedInJessica's LinkedInThe Dementia Connection Institute  RELATED EPISODESEp. 84: Understanding Our Nursing Home ResidentsEp. 72: Are We Treating Our Seniors Worse Than Horses?Ep. 70: Memory: It's All In Your Head

Having worked on the front lines with hundreds of nursing homes to develop effective infection control strategies, Dr. Buffy got a firsthand look at the way in which these facilities were targeted during the height of the pandemic.She was moved by the stories she heard and problems she observed, to write her best selling novel Broken which highlights the difficulties faced by nursing homes in implementing infection control. Most of these difficulties stem predictably from staffing and budget challenges. All nursing homes are required to have at least a part time infection preventionist on staff, but many take on the role while also holding other positions and with little training or hands on experience. Dr. Buffy's company, IPCWell, helps in these common situations by working with facilities to teach and support their infection preventionist in developing efficient and effective methods that will function inside a facility's means and budget. However, a considerable amount of difficulty is also brought about by the barrage of continuously changing rules and regulations.Responsible regulations are always needed for the functioning of any industry. However, Dr. Buffy states that their sheer volume is crippling for senior care and makes it nearly impossible for facilities to operate inside. This came to a head in 2020 when, instead of helping nursing homes suffering from no PPE and with overworked staff who were risking their lives, the government invested $80,000,000 in targeted infection control surveys. In an effort to show that this money was being put to use, even the smallest action not following regulations word for word was cited. Dr. Buffy states that instead of punishing nursing homes, this funding and attention should be put towards helping them and advocating for them. The last chapter of Broken  explains how anyone who has a relative in a nursing home can advocate for their facility.  FOLLOW DR. BUFFYTo purchase BrokenTo follow her on LinkedInTo visit the IPCWell website RELATED EPISODESEp. 71: Combating Staff Turnover & Burnout In Nursing HomesEp. 38: Administrator Vs The SurveyorEp. 33: Infection Control - Out of the Binder

It's time for a mindset shift. Recruitment needs to be as important as census and marketing. You can even use some of the same resources and people to promote your recruitment activities. Go out to your local supermarket and stop anyone with scrubs and offer them an interview. Find out where else they're hanging out and develop a presence there on or offline. Improve the interview process. Treat them like royalty and make them feel like they arrived home. Have a user-friendly application process, and please, go easy on the paper. Nobody loves filling out tens of pages of the same information over and over again. Ensure your rates are competitive. Need some help? Reach out to Quality Recruit and see how we can help you with this --> shmuel@qualityrecruit.com  Related Episodes:Ep. 76 - Employee LiabilitiesEp. 73 - Make Your Staff Want to Stay!Ep. 71 - Combating Staff Turnover & Burnout In Nursing Homes

Jennifer has been a practicing physiotherapist for 14 years, and shares about her experiences and what she has learned in this space, as a podcaster, author, and speaker.She served as her dad's caregiver for many years while he was housebound and through this experience can empathize and understand the struggles of residents and their families.Most times, going into long term care is no one's choice and therefore its essential for residents to feel independent and at-home.Jennifer approaches every interaction with residents with the understanding that she is in their home and in their space as opposed to them being in her space because she is the therapist.As a physiotherapist her job is to assess patients mobility, balance, and strength and she strives to enable and empower their independence while also minimizing their fall risk. She advises physicians to try and tailor their sessions and treatments to the resident and their goals rather than rushing through and only thinking about the problem, not the person. In order for an at-home environment to be established, residents must feel trust and rapport with their physicians and caregivers. This rapport can only be gained if caregivers and physicians stay present with residents and remember that their role is to guide and inform, not to be authoritative and make decisions against the resident's desires. Jennifer states that compassion and empathy only takes moments and even small gestures can go a long way towards making residents feel comfortable in their surroundings.  FOLLOW JENNIFERRead Her Book - Communication is Care: 9 Empowering Strategies to Guide Patient HealingHer Podcast - The Healthcare Provider Happy HourHer LinkedIn RELATED EPISODESEp. 72: Are We Treating Our Seniors Worse Than Horses?Ep. 56: Phone Calls Help Alleviate Loneliness in Nursing HomesEp. 54: What is the Greenhouse Model? 

After the loss of his grandparent, who received terrible treatment in rehab after surgery, Ryan resolved to address some of the issues in post-acute care by buying a software company already active in that space and using his expertise to build it up. VoiceFriend addresses the problem of inefficient communication faced in facilities where the many different stakeholders, including residents, families, and employees make for a quagmire of related issues. With varying levels of technological proficiency among these stakeholders, there have to be many different methods in place for communicating and conveying information. This type of chaotic system means that information and things said often slip through the cracks or can only be found again after a lengthy search which wastes time and effort. While there are other tools designed to improve this problem, they often only cover a section of facility communication or don't work well with software already in place. Ryan explains that VoiceFriend is not a tool but a system designed to serve as the core communication platform of facilities by which all other means of communication already in place pass through. The software can convey messages over a wide variety of platforms including text, phone, and even Amazon Alexa.Recipients can set their own preferences to reflect how they would like to receive communications. VoiceFriend's simplicity and ease of use are great strengths and by integrating it, a facility can dramatically streamline its communication and enhance processes already in place.  FOLLOW RYAN AND VOICEFRIENDWebsiteLinkedIn RELATED EPISODESEp. 81: Nursing Home Communication Ep. 67:  Can Nursing Homes Be Less Chaotic?Ep. 37: What Should I post on Linkedin?

Jana has represented many healthcare clients and serves as the outside general counsel for a large healthcare entity. The False Claims Act was created to address fraud being perpetrated against the government. To free up government time and resources, private individuals referred to as relators were permitted to bring those suits. Relators have to be an original source with inside information. In healthcare-related cases, they are often disgruntled, former employees or family members. Jana has handled many false claims cases and asserts that the most important first step in making sure that a facility is aware and compliant with the regulations under the False Claims Act is to install a Comprehensive Corporate Compliance Program.This type of program can be drawn up by a lawyer and details all the regulations that a particular facility will need to follow and what they can do to follow them to avoid causing claims to be made against them.Common claims in a healthcare setting often involve billing for services that weren't provided or are insufficient. If an operator or administrator catches wind of this, they should investigate immediately and if a violation is found make a voluntary disclosure to the government and pay any difference that might be owed. In a worse scenario, the government will find out about the violation first and send a Civil Investigative Demand requesting the production of certain documents or an inner view of an employee. In this situation, the facility should act fast to hire experienced counsel and contact the government to negotiate a settlement rather than being taken to court. Fox Rothchild has offices all over the country and can provide all sorts of services to healthcare facilities in the areas of corporate employment, real estate, compliance services for if a facility is involved in litigation or receives a subpoena or Civil Investigative Demand.   LEARN MORE ABOUT JANA AND FOX ROTHCHILD LLPWebsiteLinkedIn RELATED EPISODESEp. 81 - Nursing Home Communication Ep. 76 - Employee Liabilities Ep. 38 - Administrator Vs The Surveyor

Fast and efficient communication is vital in senior care, and may often be the difference between life or death.Even disregarding such dire medical circumstances, a typical facility must constantly interface with numerous parties including residents, their families, employees, and external vendors at all times.Needless to say, without adequate methods in place to streamline all these fractured lines of interaction, accidents are bound to happen. Unfortunately, most senior care facilities still use antiquated means of communication.Terry has spent his whole career modernizing antiquated processes. With Carefeed, he created an all-in-one system that can bring the communication methods of any facility up to speed. The platform provides the most up-to-date technologies for every type of interaction that typically occurs in a facility.Carefeed identifies and addresses all of the outdated, redundant, and faulty communication methods currently in use by a facility, automating and digitizing them. Because of its all-inclusive approach, Carefeed is known as the central place for seamless communication and engagement with residents, family, and staff.FOLLOW TERRY AND CAREFEEDWebsiteLinkedInRELATED EPISODESEp. 69: Should Nursing Homes Be On TikTok?Ep. 66: We Only Notice When IT Stops WorkingEp. 30: Don't You Love All That Admission Paperwork?!

As an occupational therapist with an MBA who has, at one point, been responsible for 120 facilities at one time, Jean is an expert in both the care and business sides of senior care. With his groundbreaking new designs and programs conceived to influence the lives, thought processes and social engagement of residents, he has become recognized as an incredible innovator in the space. Jean's buildings are structured to engage all five senses. Through natural lighting or LED-controlled “Sky Ceilings,” they allow those with memory-related conditions to tell the time. With a design based on the nineteen twenties, thirties, or forties, residents experiencing Retrogenesis and mentally reverting back to their youth can feel at-home in their surroundings. Jean is passionate about the vision of his buildings from a clinical perspective and also understands that this cannot be accomplished without adequate financial backing. He tells investors the true story, that by creating these spaces he is reducing clients' pain and helping them to live longer and healthier lives and that this in-turn makes for significant cash flow. With his penchant for innovation, Jean has been planning and developing various new programs and ideas. Currently he is evolving his informational senior care, Alzheimer's, and dementia focused video platform Okrah.Jean first had the idea for this concept after producing his own documentary on one woman's experience of Alzheimer's and realizing how little media existed around that important topic.FOLLOW JEAN, THE LANTERN GROUP, AND OKRAHLinkedInThe Lantern Group OkrahRELATED EPISODESEp. 75: Flooring; The Biggest DifferenceEp. 72: Are We Treating Our Seniors Worse Than Horses?Ep. 70: Memory: It's All In Your Head

Adam Lewis is the CEO of Apploi, a hiring software company centered around healthcare. With a background in HR, he has spent lots of time working with healthcare companies to identify and remove roadblocks in their job application processes. Two of the largest problems often encountered in healthcare recruiting are: how to attract more candidates into the application funnel and how to successfully move them through said funnel. To start with the latter of these issues, Adam states that out of all industries, healthcare takes the longest amount of time to recruit personnel with the average span being 40 days. This is often the result of an application being too lengthy and complicated. In order to make this process more frictionless, the application should feature fewer questions upfront and be mobile optimized so as to be accessible to nurses, CNAs, and LPNs who will likely be filling it out on their phones. The job postings themselves should also be created with the needs of current healthcare workers in mind. Rather than going by the old method of copying and pasting the needs of a position, employers must be more creative to grab the attention of job seekers in this modern competitive market. Job postings should narrate the experience of company culture, the perks that employees will receive, and the value that they will be regarded with.  FOLLOW ADAM AND APPLOI!WebsiteLinkedIn RELATED EPISODESEp. 77: CNAs: Make Them Want To StayEp. 73: Make Your Staff WANT To Stay!Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes

Jeffrey is the founder and CEO of Cambridge Realty Capital, a real estate company centered around the nursing and senior care market that has made over 500 transactions in that space.From his own experience, he states that those looking to make their first nursing home real estate deal and become an operator often possess experience in the industry but lack the funds.For this reason, it is essential for first-time deal-makers to find a good investing partner to make the purchase with them.Firstly though, they must be sure to make an economical deal with the seller that is written down in the form of a tangible document.This will allow them to show the deal to different parties without being worried about people going behind their back. Maintaining this control is the most important part of making a deal.  Next is the question of loans and finding a good lender to work with.HUD Loans, supplied by the Department of Housing and Urban Development, are an excellent resource but require the assistance of a HUD Lender who can interface with the department.Lastly Jeffrey states the market is very lucrative and for those experienced in the administrative side of senior care, it's always a good time to break into the business. FOLLOW JEFFREY AND CAMBRIDGE REALTY CAPITALWebsiteLinkedIn RELATED EPISODESEp. 52: Investors Focusing on the Senior Care Space - LinkedIn Best PracticesEp. 40: Did The Coronavirus Make Nursing Homes Rich?Ep. 39: Administrators Speak Up; Time For a Change!

Quanisah Bernard is a talented and experienced CNA and, with more than fourteen years of the profession under her belt, has a deep knowledge of the ins and outs of CNA culture.After graduating from high-school in 2006 she started working at a nursing home in the dietary department. Soon after, she took a month-long CNA class which kicked off her journey as a CNA. Since Quanisah had entered her first facility right after high-school she felt as though it was a second family. Rather than treating her as a cog in the machine the administrators noticed her talent and proceeded to foster her skills and give her some chances to shine and be recognized. It was only when the management changed and became less focused on providing this important acknowledgement and care to their employees that Quanisah decided to leave. Though she had begun to think about the lack of a good salary, she states that it was this particular shift in company culture that forced her hand. Though at this time, when senior care facilities are under intense pressure, it is difficult for them to pay employees a higher salary, it is important that they follow through with all financially related promises. Quanisah states that even though the assurance of a raise or bonus may reflect well on a facility, not following through will cause CNAs to leave and let their colleagues know not to work there either. Lastly, she explains that getting involved with colleges would be a great way to find and attract potential future CNAs who will be looking to apply for internships and positions at facilities.   RELATED EPISODES Ep. 77: CNAs: Make Them Want To StayEp. 73: Make Your Staff WANT To Stay!Ep. 71: Combating Staff Turnover & Burnout In Nursing Homes

Together with running her own CNA education program and separate home-care company, Aishling has a lot of experience with the types of people who become CNAs and the career paths they hope to lead. The difficulty of the tasks that the average CNA faces everyday cannot be minimized and many take on this job without even realizing how grueling it really is physically and emotionally. Aishling states that in order to weed out candidates that are prepared from those who might be a better fit at the nearby Target, employers must be upfront and transparent about the reality of what will be expected as well as required workload. The new expectations of staff used to a more modern, gig-economy influenced style of scheduling must also be taken into account. Communication should be established to determine what times staff will be able to work and put together a schedule that they will realistically be able to work with. Finally, employers should seek to mentor and foster the capabilities of CNAs. Work with them to establish a career path then support them on their way towards their ultimate goal. LEARN MORE ABOUT  AISHLING!Aishling Care Academy WebsiteAishling Home Care WebsiteRELATED EPISODESEpisode 73: Make Your Staff WANT To Stay!Episode 71: Combating Staff Turnover & Burnout In Nursing HomesEpsiode 42: Healthcare Workers Need Self-Care During Covid-19

As a long-term care employment litigator, Richard has represented nursing homes and senior care facilities across the country. Litigations can come in a plethora of different forms, yet they all share the same effect of draining resources and time as well as disrupting workflow.Richard states that in order to decrease the likelihood of litigations or at least maintain more control over the process once they play out, employers need to put in place several key protections and strategies. Firstly, good systems of documenting incidents need to be implemented. Since nursing homes often do not possess robust HR offices, documentation responsibilities must be shared between a number of inter-culturally aware, qualified personnel. These systems must be as up-to-date, easy to access, and user-friendly as possible to ensure that important information, such as signed employee arbitration agreements and incident reports, are easy to find and access. Training that clearly outlines policies around expected behavior and what is considered harassment must also take place regularly and be presented in an engaging way. Lastly, to maintain more control in court, eliminate the threat of a jury, and minimize the chance of a class or collective action, employers should seek out an arbitration program.Contact RichardLinkedIn Rscharlat@foxrothchild.comRelated EpisodesSolving the Staffing Challenge in Nursing Homes Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark Kaszirer

Originally in construction, Motty shifted his focus completely to flooring after realizing the room for innovation, and how little was known about the trade even by flooring professionals. Many operators don't even realize that their floors do not meet the requirements of statewide health regulations. Motty explains that under the requirements of OSHPD, which sets the building standards for senior care in California, facilities may only use carpet or VCT (vinyl) for flooring. Carpet is not very stable and often a hazard in nursing homes. This leaves VCT which requires a lot of care and cleaning as it becomes worn very easily. Having built facilities from scratch Motty knows that flooring is always the biggest issue and makes the biggest difference in every project. He states that floors have a dramatic effect on a space and a nice clean floor can bring a building to life. This is why it is essential to fit a facility with a durable, long-lasting floor rather than one that is less expensive and will need to be continuously redone and replaced. After years of researching and tweaking other products, Motty engineered his own type of vinyl that is more durable than regular VCT and will remain unblemished by bleach and disinfectant. Motty states that when looking to remodel facility floors, operators should do a lot of research, know the difference between commercial and residential flooring, and understand that price is not necessarily the best indicator of quality. FOLLOW MOTTY AND HIS COMPANY RITZ FLOORING, INC.WebsiteLinkedIn RELATED EPISODESEp. 61: Real Time Fall PreventionEp. 23: Keep the House and Still Get the Care You Deserve Ep. 11: Follow the Scent 

With his company Comprehensive A/R Solutions, Israel has seen all the ways that inattention to a billing team can wreak havoc on a facility. In a difficult industry, nursing home operators must maximize every penny they receive. Despite this necessity, facilities typically have a lot of bad debt left on the table, often totaling to hundreds of dollars of uncollected receivables. Rather than spending time and effort searching for ways to receive reimbursement for this bad debt, operators should instead focus on decreasing it as much as possible. Due to typical billing cycles and the fact that operators do not have time to manage A/R, billing is often only done reactively and problems encountered only after the window where they could have been resolved. In order to ensure that there is no money left on the table, operators need to conduct A/R proactively rather than reactively. This can be accomplished firstly by making sure one's billing team isn't understaffed. With all the nitty gritty work that it involves, A/R is certainly not something that can be done by a receptionist between shifts. It is also essential that the team center around an expert experienced in A/R and the ever changing trends of insurance and medicaid. This person should work proactively by planning and implementing processes to identify and mitigate these changes. They should also be assigned to watch every patient's payer source from the point of admission to discharge to detect any changes or inconsistencies before they become a real problem. FOLLOW  ISRAELWebsite Email: israelr@comphcs.comToll Free Phone Number: (877) 942-4558 RELATED EPISODES Ep. 30: Don't You Love All That Admission Paperwork?!Ep. 26: Consistent Leadership in Nursing HomesEp. 8: Megadata in Nursing Homes with Shalom Reinman

Izzy has explored these discoveries with his company GBC Facility Services, which provides full janitorial services for healthcare and other facilities.  With mass burnout and not much money, nursing home staff are rapidly leaving their professions for better paying, less stressful opportunities.  In order to keep staff, senior care employers need to shift their mindset from one of hierarchy and chain of command to one of servant leadership, where everyone feels valued and cared for.  To implement servant leadership in their company employers should follow a plan similar to the one detailed below:  First, a connection meeting should be held around 2-3 months after a new employee is hired to discuss how they would like to be treated. Next, a weekly one-on-one should happen once a week to recap their work and give them recognition.  The plan should also contain coaching during the game to create an ongoing dialog, discussing a personal development strategy with the employee to find out and acknowledge their career goals, and lastly performance reviews to discuss how they can improve.  Even if this sort of plan for conducting servant leadership may be too time-consuming for busy senior care facilities, just a five-minute weekly conversation with nursing staff will make a huge difference. FOLLOW IZZY AND GBC FACILITY SERVICESWebsiteLinkedIn RELATED EPISODESEp. 71: Combating Staff Turnover & Burnout In Nursing HomesEp. 51: Solving the Staffing Challenge in Nursing HomesEp. 35: Support Your Nursing Home Staff During Coronavirus Outbreaks

Nancy's podcast Glowing Older examines the intersection of wellness and senior care. With 25 years in the hospitality, health, and wellness industries, she has deep knowledge of the mental and physical benefits wellness can provide. Wellness not only signifies keeping people healthy but also providing them with a good standard of living. While senior care possesses the goal of keeping patients alive and healthy, it is also a very institutionalized setting, often reducing patients to numbers and diagnoses. This inevitable dehumanization is due in large part to our society's stigma of its elderly population. Many commonly held assumptions about seniors are flawed and overlook their innate intelligence and valuable life experience. This ageism must be addressed and some fundamental shifts made in the way we perceive seniors in order for action to be taken to introduce more wellness into senior living. LEARN MORE ABOUT NANCY AND GLOWING OLDER!Glowing Older PodcastLinkedIn RELATED EPISODESEp. 56: Phone Calls Help Alleviate Loneliness in Nursing HomesEp. 54: What Is The Green House Model?Ep.  11: Follow the Scent with Tuli Kraus

Before becoming a serial entrepreneur, Pritma served as a registered nurse for 18 years. This first-hand experience allows her to understand what nurses want and need from employers.  As a nurse, Pritma would sometimes work double shifts that added up to 20 hours a day because of shortages.  In this time of COVID-19, facilities are often understaffed. Nurses are high in-demand and are constantly receiving competing offers of larger salaries and bigger paychecks.  As a result, nurses have become less concerned with money and more with how well they will be cared for by potential employers.   Facilities who want to attract and retain nurses must put more effort into supporting their staff, helping them develop career pathways and supporting their career progression.  Pritma states that this support doesn't have to cost a lot of money and can be as simple as sitting down to get to know staff and learn where they want to end up on their career journey.  Another idea is the mental health toolkit provided by the American Nurses Association, which is designed to help nurses regulate and monitor their mental health during this stressful time.  In order to recruit nursing staff at all though, it is first necessary to possess an efficient employment method.   Apploi is a unique software which assists with all areas of the employment process and separates truly perfect candidates from the rest of the crowd.  LEARN MORE ABOUT PRITMA AND APPLOI!WebsiteLinkedIn RELATED EPISODESEp. 42: Healthcare Workers Need Self-Care During Covid-19Ep. 39: Administrators Speak Up; Time For a Change!Ep. 17: Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark Kaszirer

As a geriatric social worker and memory coach who's been in the field for twenty years, Rena, knows a lot about memory and particularly how it declines.  She provides a distinction between normal memory loss and abnormal memory loss which impedes daily functioning and is associated with conditions such as dementia and Alzheimer's.  While genetics are often assumed to be the largest predictor of abnormal memory loss, they are in fact, only about one-third of the problem.  Lifestyle, including exercise, diet, sleep, focus, and cognitive stimulation, is a much larger factor in determining whether these types of conditions will develop. Physical exercise prompts Neurogenesis. This is the process by which new brain cells are created. Sugar and other junk food impede this process, therefore it is essential to maintain a healthy diet and drink lots of water.  Sleep is also another huge factor, as is our ability to focus, which we should strive to maintain by refraining from multitasking.  Lastly, cognitive stimulation, including new learning and social stimulation ensures that new brain cells will continue to develop.  Just like any skill, memory can be trained through exercises, techniques, and practice. This is Rena's area of expertise, and the first step to remembering anything is believing that you can. LEARN MORE ABOUT RENA! WebsiteRemembershipLinkedIn RELATED EPISODES Ep. 59: Advanced Planning and Detailed ConversationsEp. 55: Fighting Loneliness With Laughter YogaEp. 42: Healthcare Workers Need Self-Care During Covid-19

Despite starting off as a nurse and clinical liaison, Steve's side gig of marketing and content creation soon grew into a full-service agency, Craft Media, of which he remains president. Though senior care facilities serve an older clientele, they are really marketing to younger relatives, decision-makers and placement workers in hospitals, and potential employees. Steve explains that all of these groups will likely be present on social media and will be influenced by the quality of a nursing home's social media presence.In addition, the content will be published online about nursing homes whether they like it or not.  Failing to maintain their brand through a digital presence will ensure that it is not created by them but by consumers, whose spiteful comments may do great damage to their reputation.So where does TikTok fit into all of this?Steve states that, at present, TikTok echoes Instagram's early days, full of young experimenters and rapidly expanding to eventually become a solid segment of the social media landscape. By maintaining a consistent presence on this platform while it is still early days, nursing homes will have a huge advantage in the long run.FOLLOW STEVE AND CRAFT MEDIA!WebsiteLinkedInRELATED EPISODESEp. 65: Content Marketing In Senior CareEp. 62: Social Media Marketing for Nursing HomesEp. 12: LinkedIn Content Marketing with Shaneé Moret

As the founder of MNT Associates and an experienced long-term care dietitian, Esther Gutman hires, trains, and provides dietitians to long-term care facilities. Dietary is often disregarded as glorified catering when, in fact, it is one of the most prominent facets of a facility. It is the one area of service that every resident and every family member can understand and look forward to. For this reason, Esther always tries to bring excellent standards to the kitchen. In order to fully comprehend the reality of what staff must deal with, dietitians should spend time in the kitchen. This will allow them to make informed orders that staff will be able to carry out. Esther states that personality and attitude are 75% of a dietitian's success and they should seek to be team players and establish rapport with staff, especially CNAs.Obtaining weights may be one of the biggest problems that dietitians face. Rather than dealing with it on their own, they should hold team meetings around weights so everyone can understand the complex issue.  LEARN MORE ABOUT ESTHER AND MEDICAL NUTRITION THERAPY ASSOCIATES!  LinkedIn Website  RELATED EPISODESEp. 49: Better Care Coordination; Real Patient ChoiceEp. 17: Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark KaszirerEP. 2: Recruitment and Staffing in Long Term Care with Alvin Kahn

Tzvi Schwartz, certified EOS Implementer, explains that if a leader must motivate employees it means that they don't have a clear vision, their employees don't share their core values, or their employees aren't in the right seat.The concept of a vision refers to who a company is and where exactly it is going every day.This doesn't have to be a grand, altruistic plan. In fact, it will be obvious if a company's vision is contrived or insincere and they will inevitably attract employees who do not align with their true mission or culture.  Despite how good people look on paper, they will not be a good fit, if their core values are not congruent with those of their workplace.If employees remain uninspired despite a clear communication of company vision, it means that they are not the right people.Finally, Tzvi states that if people aren't placed in the right position, or seat, at their company they will do poorly.Simply moving an employee to a different position may increase their productivity significantly. FOLLOW TZVI!LinkedInEmailPhone: (917) 538-8676Read Traction!  RELATED EPISODESEp. 35: Support Your Nursing Home Staff During Coronavirus OutbreaksEp. 17: Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark Kaszirer Ep. 16: Selling Your Nursing Home in Today's Complex Marketing Climate with Joe Goldberg 

Nathan Berger, Chief Technology Officer of DigaCore, explains that most outsiders to the trade, such as nursing home operators, are often confused about what “IT” actually does and doesn't do.  IT covers the internet and computer infrastructures. Without the help of an IT company, nursing home technology systems will likely be designed poorly and operators will lose  lots of valuable time supervising repairs.  Unlike many other IT companies, DigaCore offers its services at a flat-rate model which means that there is no extra, by-the-hour cost for repairs. Their whole business model centers around installing things right the first time or at least fixing them as quickly, efficiently, and permanently as possible. DigaCore also understands that Nursing Homes usually do not have large budgets to work with and focuses on bringing cost-effective technology to clients.LEARN MORE ABOUT NATHAN AND DIGACORE!Digacore.comLinkedInBasic Buying GuideRELATED EPISODESEp. 65: Content Marketing In Senior CareEp. 39: Administrators Speak Up; Time For a Change!Ep. 16: Selling Your Nursing Home in Today's Complex Marketing Climate with Joe Goldberg

Yitz Rubin, Director of Business Development at Renewal Rehab, is relatively new to the healthcare industry. Having been in sales for ten years he has done his fair share of outbound marketing. These traditional sales techniques such as cold calling and mail and email blasts work by the principal that if something is done persistently enough you will begin to see results. This method differs wildly from content marketing which involves creating valuable content that will establish a relationship with a desired audience and retain their attention on its own. Chicago's healthcare market is unique from many others in its practices of relationship building and maintaining which are built upon a foundation of mutual trust. This means that the ancillary companies in the field often don't hire any sales or marketing departments. While this dynamic is extremely beneficial and has allowed such companies to breach the hundred million range, it only extends as far as the Chicago area. It is Yitz's hope with his Spotlight series to reach beyond this geographical barrier and break into the billion range.  LEARN MORE ABOUT YITZ, THE SNF SPOTLIGHT SERIES, AND RENEWAL REHAB!RenewalRehab.comSNFspotlight.comLinkedInCall Yitz: 312-838-0077 RELATED EPISODESEp. 62: Social Media Marketing for Nursing HomesEp. 52: Investors Focusing On The Senior Care Space - LinkedIn Best PracticesEp. 45: Make the Phone Ring With Google Ads

Shmuel: What about the fact that this vaccine was developed so quickly? Shouldn't we be concerned that it was developed too quickly? Katherine: No. This is a different type of vaccine. It's an mRNA vaccine which can be developed efficiently in a much shorter time frame. Shmuel: When they started working on a vaccine, did they know it would take this quickly? Katherine: It's not earth shattering news. In the research community at least this was already known. Shmuel: Should we be concerned about long term side effects? Katherine: There's always a risk of a long term side effect and that's something can develop later on. But based on the research that was done, we're not expecting serious side effects. Shmuel: Can someone get vaccine even once vaccinated? Katherine: You can't get Covid from the vaccine and it's really unlikely that you'll get it once fully vaccinate but it's still possible. Shmuel: Have you seen seniors in the nursing homes suffer from social isolation? Katherine: It's really hard for the seniors and the staff are doing all sorts of innovative things to keep the residents connected to the world. FaceTime. Outdoor visits. Window visits. But at the end of the day it's not the same as pre-Covid.   You Can HelpIf you have any extra tablets at home, bring them to your local nursing home. Call them up and ask what you can bring them.  RELATED EPISODESEp. 58 The COVID Vaccine Trial From A Participant's PerspectiveEp. 57 Should I Get the Covid Vaccine?Ep. 56 Phone Calls Help Alleviate Loneliness in Nursing HomesEp. 55 Fighting Loneliness With Laughter Yoga

Why did I start this podcast? It's actually pretty simple. I started the podcast to find the answers to basic questions that weren't showing up in the Google results. I was only finding flowery and jargon-filled content but nothing that spoke to me in a practical way telling me what to do.The Nursing Home Podcast was created to fill this void.I've received so many beautiful messages from owners, administrators, and those working in nursing homes telling me how they listen to the show on their commute to work or share pieces with their coworkers.This makes it all worth it :)Google is apparently noticing this as well as we are rating really well organically as well! ( Just Google nursing home podcasts and you'll see...)Shameless PlugIf you service this industry and would like to be featured or sponsor an episode - reach out to me.Shmuel@snfmarketing.com Message me LinkedIn 

So let's say it as it is. Social media marketing is not magic. You don't just press a few buttons, get some engagement and your business soars through the roof. It's not that simple. A good content strategy does give you a fantastic way to provide value and engage with your target audience. It will encourage them to take the next step you'd like them to take. This can mean applying for a job, coming for a tour, writing a nice review, or whatever you're focusing on at the time. Know The TurfFacebookFacebook is great to potential residents, their adult children/decision-makers and even some of your staff in more rural areas. But Facebook is pay to play and without boosting (paying) your content you will likely see little traction.Facebook is great for posting jobs - especially for nurses and CNAs. Generally, they're on Facebook and will notice those posts.Facebook is for residents and their adult decisions maker children.  Staff of rural communities will be there as well. InstagramInstagram is great for displaying company culture. Some facilities have 0ne employee who takes over the account for the day to give a glimpse into what it's like to be a part of the team to attract new staff to the team. TwitterTwitter? Not really. Maybe for the CEO or for a large brand to influence government policy and regulations. But for hiring purposes as well as census building it probably won't do too much. Final WordsDon't focus on the shiny things. Stay focused on what's working and double down on it. Follow Wendy! LinkedInSparkrMarketing.comNever Miss an Episode!Join our email list here and be notified when we release new content. RELATED EPISODES47 - Senior Care is Waking Up! with Brian Wallace37 - What Should I post on Linkedin? with Moe Rabi12 - LinkedIn Content Marketing with Shaneé Moret

Caleb York is the Channel Development Manager for VirtueSense and joined the company as a result of witnessing the ineffectiveness of other fall-prevention technologies during his time working at the University of Michigan Health System.While other industries have successfully become more automated and as technologically advanced, healthcare continues to lag behind. Most senior care facilities find it extremely difficult to purchase vital technologies with the potential to save lives because they are already struggling just to stay afloat. Though fall prevention technologies such as pressure pads and bed alarms are used in many senior care facilities, these are often loud, disrupting, and have been known to give just as many false as they do legitimate alarms. While more advanced fall-prevention technology systems such as camera-based monitoring do exist, these are only designed to be used as a means to determine how falls typically occur. VirtueSense utilizes an infrared depth sensor piloted by an AI and is trained with over 1.5 million hours of patient data. It's able to recognize bodily mechanical errors that typically result in falls and prevent them on the spot. Once the AI observes that a patient is likely to fall, it sends an alert, via an app, containing their room number to a nurse who can then catch the patient before it is too late. Rather than only helping to clean up falls, this advanced system predicts and prevents such adverse accidents before they can happen. LEARN MORE ABOUT CALEB AND VIRTUESENSE!LinkedIn: https://www.linkedin.com/in/caleb-york-524584155/ Website: https://virtusense.ai/ RELATED EPISODES52 - Investors Focusing on the Senior Care Space - LinkedIn Best Practices51 - Solving the Staffing Challenge in Nursing Homes49 - Better Care Coordination; Real Patient Choice34 - Detect Coronavirus 2 Weeks Before Fevers Surface!

Remember the good old days with the town doctor came to your house when you weren't feeling right? Didn't think so. But there was a time when that was the norm. The advances of medicine have moved that experience to the doctors practice we're all his tools are available to him.Well what if you could get the best of both worlds? The top quality physicians providing excellent care in the home setting. Now with Heal, this has become a reality. Heal doctors serve as clients' primary care physicians while also remaining much more available and accessible than regular PCPs. Heal doctors also provide quality over quantity, with average initial appointments ranging 90 minutes in length.Heal doctors are able to physically observe the actual environments and living spaces of their patients, they are able to provide much more realistic and accurate diagnoses and treatment plans.  LEARN MORE ABOUT HEAL AND NICK!Website: https://heal.com/about/LinkedIn: https://www.linkedin.com/in/nickdesaiheal/ 

As a certified Alzheimer's disease specialist and expert in contested files with a masters in social work, Stephanie has had significant experience in the types of situations that can occur when people haven't prepared for getting old. These situations might include everything from self-serving relatives attempting to wheedle funds by invoking healthcare proxy and power of attorney documents to family disagreements regarding who should care of an older relative.Stephanie states that people don't usually start planning for aging until they have had children. Even then, these plans are often limited to nonspecific, generalized legal documents that designate only the most basic physical care preferences and fail to take into account the individual's identity at large. Her guide outlines the correct stages that should be taken to approach aging including questions that should be initiated in families and documents that should be created such as a living will. The latter can serve as a place to specify how the senior's money should be distributed for their care and to whom. Finally, In order to recognize a resident or patient by their unique identity rather than their diagnosis, senior care facilities can personalize that person's surroundings by introducing sensory components such as music, scents, or pictures that possess meaning and familiarity for them.FOLLOW STEPHANIE!Book: https://stephanieerickson.ca/book/Website: https://stephanieerickson.ca/YouTube: https://www.youtube.com/channel/UC6zKUK52FgZ3G7Lrm4Mg7WQLinkedIn: https://www.linkedin.com/in/stephanie-erickson-1722229/  

Having worked in biotechnology and pharmaceutical manufacturing for the last decade, Andrew is no stranger to the type of studies that have been employed to test the recent surge of COVID-19 vaccines.After deciding to volunteer in one of these studies, Andrew filled out a survey expressing his interest and was contacted a few months later by a representative from AstraZeneca. On the day of his appointment at the pharmaceutical company, Andrew received a regular medical exam before being given the first shot of the study.The injection was either the active vaccine or a placebo and this knowledge will be withheld from Andrew until the completion of the study two years from now, or if he decides at any time to opt-out. The placebo is included in the study to discourage participants from altering their day to day behavior as they might if they knew for sure it was the actual vaccine they were receiving.Andrew states that he has not experienced any side effects other than the regular muscle ache usually present after a flu shot. Furthermore, the AstraZeneca vaccine was approved in the U.K. just this week and the first doses are set to be administered on Monday.RELATED EPISODEEPISODE 57 - Should I get the Covid Vaccine? 

Learn more about Doctor G at AskDoctorG.com 

Research shows that talking is crucial to brain development, mental health, and well-being.Talking has been shown to feed and enhance the working, short term memory, which is the first type to decline in Seniors. Improvement of the working memory will, in turn, feed the long-term memory and overall health.Phone buddies are trained, empathic, passionate volunteers of all ages who are connected to a senior to call once or twice a week for at least half an hour. It has also been shown that listening helps build empathy and talking helps to improve our mood so the benefits are reciprocal to both parties.Friendly Voices also provides prepaid phones with unlimited minutes to all phone buddies who request them.LEARN MORE ABOUT LAURA AND FRIENDLY VOICES!FriendlyVoices.orgLinkedinRELATED EPISODESEpisode 55 - Fighting Loneliness With Laughter YogaEpisode 48 - The Loneliness PandemicEpisode 13 - Bringing the Caring Back to Healthcare with Dovid Weiss

Alok Mahadevia, who goes by Loki, discovered laughter yoga in 2012 after feeling extremely lonely upon moving to the United States from India. His subsequent experience led him to discover how beneficial this practice was for seniors, those coping with chronic problems or terminal illness, and anyone else simply feeling isolated.Founded in the late 90's by Madan Kataria, laughter yoga incorporates voluntary, group-based laughter, and ancient Pranayama breathing techniques. Studies have shown that laughter, both real and forced, has numerous physiological and psychological benefits including acting as a natural painkiller, boosting endorphin and serotonin levels, and decreasing cortisone (stress) levels.Though one must laugh for an average of 10-15 minutes a day in order to feel these helpful effects, most adults hardly even brush that number.Loki has led laughter workshops in a number of places including the corporate sector and senior care facilities but when COVID-19 struck he had to think up a new method for his practice. He launched Laugh With Loki through Zoom and his virtual laugh yoga sessions have been attended by more than 700 people from over 16 countries.Loki hopes to start collaborating with nursing homes to bring his virtual workshops to residents who, with the difficulties of COVID-19, are more than in need of a good laugh.FOLLOW LAUGH WITH LOKI!Instagram: https://www.instagram.com/laughwithloki/Facebook: https://www.facebook.com/harshlokilaughs/RELATED EPISODES:EPISODE 48:  The Loneliness PandamicEPISODE 24: Adult Care; Where Does it Fit Into the Continuum?

Susan Ryan, senior director of the Green House project, delves into the negative stigma that faces seniors. With 40+ years of experience in the senior care field, Ryan has witnessed first hand the problems of both nursing homes and home care.   With decreased independence,  institutional living environments, coupled with a culture of ageist beliefs, elderly residents often feel disempowered and diminished. Those who partake in homecare may also become extremely isolated and lonely. The Green House Model designs nursing facilities to look and feel like real homes. These pods or units contain around 10-12 rooms each equipped with a private bathroom. A kitchen and courtyard provide residents with independence as they will be able to cook and venture outside should they choose to. Staff are dynamic and serve a variety of functions, thereby developing stronger relationships with residents. Susan explains that in order to make their innovative project work, the Green House team has to:Keep development costs downConsider the best routes to fund and financeDevelop a balanced payer mix of Medicaid, Medicare, and private pay residentsCombine staffing of the various departments.These homes are flourishing amidst the crisis of COVID-19 as a result of their small size and restricted admission. LEARN MORE ABOUT THE GREENHOUSE PROJECT!The Elevate Eldercare Podcastwww.TheGreenHouseProject.org RELATED EPISODES EPISODE 13: Bringing the Caring Back to Healthcare EPISODE 1: Here's Why I Started The Nursing Home PodcastEPISODE 28: First - Put Your Own Mask On

Freda Mowad is the CEO of Quality Rehab Management, QRM, and as a speech and language pathologist who has worked in the rehab industry for 20+ years,  has a lot of experience to bring to the table.Despite its importance, rehab predominantly stands apart from the rest of a nursing facility and often administrators don't completely understand its complexities. For this reason, facilities often outsource the entire rehab team to third party vendors. It can create an internal rift between the rehab team and the rest of the team.Freda highly recommends the integration of in-house rehab but warns that attempting it alone has its own risks. Administrators don't have the time or expertise required to manage the billing and oversee the productivity of rehab programs. They also typically lack the clinical expertise necessary to ensure therapists are complying with the rules and regulations and keeping up to date with current practices. Seeking out an in-house rehab management corporation such as QRM will alleviate these risks and also other challenges the rehab department may encounter,  such as staffing and communication.FIND OUT MORE ABOUT QRM!QRMhealth.com  Related EpisodesTeletherapy During Covid-19What is PDPM and How Will it Affect You? With Marc Zimmet of Zimmet Healthcare

LinkedIn isn't just another social media platform.When done correctly, it can potentially provide a staggering number of views and engagement every week as well as a space equipped for all sorts of transactions. LinkedIn has great potential to help the senior care industry by amplifying innovations geared towards the 60+ market and connecting such startups with Venture Capital Firms.Despite the power and reach of this platform, only 1% of users regularly post content and consequently reap rewards of up to billions of views per week. Judi provides some tips to help business owners and professionals gain a place in this minute but incredibly influential sector. These include:Sharing the spotlight with othersShowing up as a leader not just as a professionalCommenting to start conversations FOLLOW JUDI!JudiFox.comJudi on LinkedInThe Judi Fox Show Related EpisodesEp. 12 - LinkedIn Marketing with Shanee MoretEp. 37 - Why Should I Post on LinkedIn - Moe Rabi

Tony Braswell is a veteran in this space and has been in the Nursing Home staffing industry for 29 years. Most of that time was spent on the excruciatingly slow task of calling up nurses one at a time trying to get them to come to work. This tedious process needed to be faster. Much faster.A brainwave hit Braswell one day when his son purchased just a single bottle of ketchup from Amazon. He realized that with the scope and advancement of modern technology, nursing home staffing could be automated and accomplished much more quickly and efficiently.The Gale App's method of flexible scheduling is key in a country already short 1,000,000 nurses and losing more every day from burnout. The strict schedules, bi-weekly paydays, and exhausting last minute double-shifts of the past don't work anymore.It's time for facilities to adapt to the changing demands of the senior care industry. Over 20,088 nurses have already signed on with the Gale App, and, as the U.S. is rapidly developing into a gig-economy, the technology is set to become a serious contender in the nursing staffing sphere.LEARN MORE!Learn more about the Gale App and Tony Braswell at https://www.usegale.com/! 

In today's episode we meet Eric Harter, president of Rapid CPAP, who goes into detail on how to correct and prevent breathing and respiratory problems in short-term patients. It is a frustrating reality that many patients referred to Nursing Homes from hospitals will often suffer these issues in the very first days of adjustment. This may be the result of details about additional health constraints being left out of a patient's report.This unfortunate pattern is particularly prevalent in this new world of COVID, where many nursing home are really struggling to keep a healthy census.Eric explains how implementing a program to address these problems will not only succeed in decreasing the rate of short-term patient returns but also demonstrate a nursing home's proactivity and show hospitals that they are a good place to refer patients. Rapid CPAP programs include telehealth experts and respiratory therapists who educate nursing staff on correct procedures for respiratory equipment and write recommendations for patient care and measure outcomes of treatment.  Follow Eric!LinkedInhttps://www.rapidcpap.com/Keep an eye out for Eric's new podcast! The Hey Can Someone Please Call Respiratory Podcast

The case managers in the hospitals need to know what level of care is available in the community that will be appropriate for the patient they are trying to discharge.  A nursing home is not always the best solution for a hospital discharge. There can be other community-based options that are better for the patient. It's like Expedia for travel. Before Expedia, you'd have to make dozens of calls to hotels, flights, and rental car companies to make the arrangements for a trip. That's where the current landscape looks like for hospital case managers. They don't have that one resource, the Expedia if you will, to streamline all this information in one place. With CareAvailibility - you can literally insert the needs of a particular patient, check off all the boxes and the system will spit out the best solution for them. --------------------------------------------------------------------------Learn more about Care Availability - www. CareAvailability.com Follow Michael on LinkedIn 

In this episode, we meet the founder and CEO of Oasis Day Center, Israel Lavrinoff. Israel is a young and energetic entrepreneur who's clearly identified his passion. Let's stop waiting for our seniors to die! Let's give them the qualify of life they deserve for as long as possible.  After all we are all going to die someday, so let's live life to the fullest. Israel best describes the role of his center as 'monitoring the social blood pressure' of the participants. Learn more about Israel and his work at OasisDayCenter.com

Normal humans make decisions based on the recommendations of their friends and social circle. They will make serious financial and health decisions based on their peers opinions regardless of their level of expertise. This leaves the opportunity for providers share actual valuable content to your target audience and you'll become that trusted peer that they'll turn to for help and guidance If you create real content that people actually want to see and share, you'll cultivate a following that trusts you. Additionally, you may start getting some earned media attention which will further grow your trust points online. Even if that doesn't happen, but a quick Google search will reveal your Google reviews AND your own content. Take the opportunity to control that experience. Follow Brian!NowSourcing - NowSourcing is an award winning nationally recognized infographic design agency. Founded in 2006.Linkedin  - check out Brian on LInkedIn for all his latest content.