The Danegeld…

A furore normannorum libera nos, domine...

A furore normannorum libera nos, domine…

Good morning, ProviderNation.

Don’t I feel like an international man of mystery? Got a call from the Royal Danish Consulate yesterday. (You can’t believe how disappointed I was to learn it’s really a diplomatic outpost, not a donut shop.) Anyway, it seems that the fine folks of Denmark are eyeing the long term and post-acute care market here in the U.S.

Last month, Copenhagen hosted the Alzheimer’s Association International conference (it’s coming to D.C. next year), and it seems that the Danes are serious about exporting some of their person-centered design ideas (specifically, bathrooms and kitchens for nursing centers and assisted living buildings), according to one of my new best friends over there.

Contrary to what you may have read, the Danes aren’t all a melancholy bunch. But they are serious as Swedes about patient-centered care. Even as its population ages rapidly, the country is already demonstrating new models of care. Apparently, the House of Glücksburg thinks they can export their goods here.

In any case, things are early. But there are already signs that long term care is becoming a global business.

Speaking of paying the Danegeld, hats off to the fine folks at the Saint Paul Health Center near Denver. They passed the hat, through a crowd-funding Web page, to help send resident Nick (and his mom and aides) on a grand bus tour so he could dip his toes in the Pacific Ocean. You can read about the results here, but wow. Seriously, wow.

And while, we’re all feeling good, a hearty mazel tov to the fine folks at Mainstreet. The senior housing developer once again made the top 500 in Inc.’s list of fastest-growing entrepreneurial businesses. “Mainstreet’s No. 347 rank is based on a three-year revenue growth of 1,352 percent and 2013 revenue of $106.3 million,” the company says in a news release. “This is the fourth year Inc. magazine has recognized Mainstreet’s growth.” Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.

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Training Pays Off

Stan Szpytek

Stan Szpytek

Good morning, ProviderNation.

It is not uncommon to see negative news coverage when disaster strikes at or near a long term care community. The isolated challenges and opportunities for improvement during an adverse event seem to be the “low hanging fruit” for those looking to criticize the operation of health care facilities that suddenly face a crisis or disaster in the midst of their daily commitment of caring for our nation’s elderly and frail with compassion and dignity.Well, I say it’s time for some positive news.

While this local incident itself was somewhat minor in scope (an electrical fire in a SNF that required complete evacuation of a single facility), I believe the narrative provided by one AHCA state affiliate’s director of quality and regulatory services is worth sharing. The comments are directed to the emergency preparedness bureau chief at the state’s Department of Health Services (DHS) summarizing an event that underscores the true benefits of training and preparing LTC facilities to properly manage emergency situations:

Hello Teresa,

I just wanted to share a great success story with you. Yesterday in the early morning, one of our inner facility nursing homes had smoke filling the building. There are 30- to 50-year-old wiring and circuits there, and one arched in the conduit underground. The fire department deemed the building unsafe, and the facility had to be evacuated. There were 84 residents. This facility has many sister facilities here, and they reached out to them. DHS was notified. They set up their Emergency Operation Center (EOC) and donned their Incident Command System (ICS) vests!!!

Yes, this facility had attended the training (Disaster Planning and Nursing Home Incident Command System- NHICS) and were prepared.

Over 50 people arrived to help, and other facilities brought vans, and all residents were safely evacuated starting at 9:00 am and completed by 11:42 am. All families were notified, and the brand new administrator said he watched with great humility and admiration as everything hummed along. Because all the facilities receiving these residents have the same electronic record systems, transfers and transitions went well. Staff was dispersed to the other facilities to care for their residents and will continue to do so until they can return home. Every resident left with their meds and charts.

The facility may be cleared by the fire department today, and they are bringing in a huge generator to run the building until an electrical wiring issue can be addressed. They expect to be able to return residents by Monday at the latest.

I couldn’t be more proud to see something like this actually happen so successfully. I know this is only one facility, but when we evaluate how well this went, there is hope that we really will be “Disaster Ready” as we already are on our way. This facility has promised to tell their story at our state’s conference in October.

One nurse returning to get her car late yesterday evening told the DON, “This is why I love to working here!!!”

We are committed to continue to have more successes whenever the need arises.

Disaster Ready” is the name that this state affiliate created to “brand” its disaster planning and emergency management resource program. Through grant funding received from the Hospital Preparedness Program, this state, along with many others, is focusing on preparedness through the development and implementation of comprehensive training programs.

So, after reading this success story, you should ask yourself one simple question: “Is our facility Disaster Ready?”

Stan Szpytek is the president of Fire and Life Safety and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. For more information, visit or email Szpytek at


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A Tale Of Two Summits

CEO of It's Never Too Late

CEO of It’s Never Too Late

Good afternoon, ProviderNation.

What a crazy world we live in, and a very crazy time to live in it! Bouncing between coasts over the last two weeks has been a fascinating, reflective journey. The 2,841 miles that separate northern California from Washington, D.C., can feel more like the distance between the earth and the sun, depending on your perspective. Here’s mine.

I had the pleasure of being invited to two separate events put together by two organizations over the past two weeks. Invited may be a bit generous; our company—It’s Never 2 Late—was a sponsor at both events.

Exhibit A was the What’s Next Boomer Business Summit: Brilliantly choreographed by Mary Furlong, it brings together, in the same venue, venture capitalists, leaders in the field of aging, and start-up companies—big ideas looking for big money.

Fascinating conversations, trends popping up left and right, smart people who have been around for awhile, such as Laurie Orlov of Aging In Place Technology Watch and Steve Moran of Senior Housing Forum, mingling with fresh new faces that have fresh new ideas, like Katy Fike from Aging 2.0.—bright-eyed entrepreneurs looking to change lives, including their own, while dissecting aging issues and offering technology solutions.

One week later, flashing across the country, I was invited to attend the 2014 Dementia Thought Leader’s Summit, sponsored by the Dementia Action Alliance. This event was also exceptionally choreographed, this time a joint effort between Karen Love and Jackie Pinkowitz.

It included a fascinating group of policymakers, senior living operators, dementia experts, and, most poignantly, people living with dementia. It was an eclectic group of passionate people trying to get their arms around a complex and challenging problem.

It was an interesting juxtaposition, looking at these two events from the inside out, and from the outside in. My first thoughts were about the striking differences between the two groups. On the one hand was the investment event that included dozens of entrepreneurs looking for capital to drive the development of the widgets they hope can profitably change the paradigm for older adults across the spectrum, while, on the other hand and one week later, policy folks and thought leaders were demanding Senate hearings, White House conferences, and additional funding to educate the public to the painful reality of the dementia tsunami coming our way.

Many were seeking solutions both for the individuals themselves and for their loved ones and/or professional caregivers providing support. Hearing Michael Ellenbogen, a 56-year-old successful banking executive diagnosed five years ago, give a hands-on testimonial as to what it feels like to have a judge, who won’t even physically see him, take away all of his rights to manage his own finances, was powerful.

Dementia Summit participants developed five goals to improve person-centered dementia care.

Dementia Summit participants developed five goals to improve person-centered dementia care.

From a personal standpoint, that’s not a remote person who is 95 years old living in a nursing home. That’s me—Michael and I are about the same age. It reminded me how I felt three decades ago when Magic Johnson dramatically proclaimed he had HIV. That experience resonated with me as a young adult and completely changed my perspective. Michael’s words resonated in the same vein with me that day. When people see the world of dementia as “their” problem, they will start to own the solution, and change will happen. I live and work every day trying to help people with dementia. Thank you, Michael, for making it personal for me, and I apologize for not seeing it on my own.

The Fourth of July kicked in, and with a nice couple of days off (and a couple of Heinekens along the way), I started reflecting a bit on the realities of the separate events, and also what a cool country we live in. It really is not so much that the people at the events are that different; they just have different perspectives as to how to solve problems.

And those perspectives are shaped by their own life experiences. If you’re an entrepreneur, you are consumed with finding a niche for your product. If you’re a gerontologist or a policymaker, you will look for solutions within the current framework we live in, oftentimes with governmental help.

It isn’t that entrepreneurs are greedy, heartless people, nor is it that the policy folks all are dismissive of business—it’s creatively looking at ways to deal with a crisis of epic proportions and both sides acknowledging the other side is vital and relevant.

Our company is a great example of that. It’s been our honor to develop a technology experience that completely changes the lives of people living with dementia; we benefit thousands of lives a day with our content and engagement experiences delivered across the U.S. The idea was not thought up through the government; we saw a niche and for 15 years have tried to fill it.

However, if not for a multitude of external grants and governmental and foundation funding during our formative years in the early 2000s, we would not have survived as a company and be thriving today.

And along the way, dementia experts such as Juliet Holt from Brookdale and Kathleen Curry from EMA have continued to push us to make our product better, which in turn benefits more and more people. There’s not one unilateral solution—we all can feed on each other.

By the end of the July 4th weekend, as I swatted mosquitoes and watched a cool fireworks display in Wisconsin, it hit me how unique this all is. Our country allows, even encourages, the intersection of policy and profit to help make people’s lives better and solve problems.

We don’t always agree on the ideal solution, but passion on both sides will get us to a different place as we try to deal with the painful realities of dementia. I can see why people want to live in this glorious country. I’m glad I do.

Today’s guest blog is written by Jack York, founder of It’s Never Too Late. He can be reached at

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The Annals of Oops (Bastille Day Edition)….


Allons enfants de la Patrie (d’Fournisseur), Le jour de gloire est arrivé.

In the annals of oops, there are career-enders, Hall-of-Fame makers, kitsch oops, the off-with-your-head oops and the oops that wake us, screaming, from our sleep. The fine folks at CMS, not to be outdone, have discovered a widespread hospital oops, affecting the Medicare benefits of people in at least three states.*

It appears that certain auditors goofed while performing their Recovery Audit Contractor (RAC) duties, and, well, hospitals started changing patients from “inpatient” to, um, not-inpatient. When the hospital staff tried to convince the auditors to give this another thought, they were given the old Major Major treatment. Result: automatic denial of skilled nursing benefits for patients in Utah, California, and Arizona, and maybe elsewhere.

Last week, CMS did their best to get everyone to remain calm. The agency issued a “Technical Director Letter” to the contractors, telling them, in polite bureaucratese, to straighten up and fly right. No later than Wednesday, contractors will have to post on their Web site that the old rules are, um, inoperative.

“Once the MACs post the information, [skilled nursing] providers that have received this edit in error may adjust their affected claims or contact their MAC in order to have their claims adjusted,” CMS Associate Regional Administrator Barbie Robinson says in a letter to the fine folks at AHCA/NCAL.

Now, it is notorious that the providers and auditors view each other much like the sans-culottes viewed Louis. And CMS is doing its level best to play Tom Paine in this little costume drama. But providers can perhaps be forgiven if they allow themselves a wintry, Madame DeFarge-esque smile: They saw this Bastille Day coming for a long time.

“I believe that CMS is struggling with the unintended consequences of RAC hospital audits, the new hospital two-midnight and rebilling regulations, and the hospital provider confusion that much of this has unintentionally caused,” one long term and post-acute care advocate has said. “And now this confusion on the part of both hospitals and MACs is indirectly hitting us.”

Meanwhile, more pleasant news from the Revolution. The fine folks at AHCA/NCAL have announced their new class for their own Legion d’honneur. Every year, the groups recognize the best and the brightest of their profession, “the men and women who give freely of themselves in caring for individuals in long term and post-acute care centers, ID/DD residences, as well as assisted living communities.”

This year’s honorees are:

  • Hero of the Year — Intellectual and Developmental Disabilities: Alicia Durham, Eureka, CA, who volunteers at Butler Valley Inc., Carole Sund Center.
  • Not for Profit Program of the Year: St. Benedicts Health Center and Benedict Court, Dickinson, ND.
  • Volunteer of the Year — Adult: Ruth-Ann Harrod, Wesley, ME, who volunteers at Maine Veterans’ Home.
  • Volunteer of the Year — Group: Amory High School Health Class, Amory, MS, which volunteers at Golden Living Center, Amory.
  • Volunteer of the Year — Young Adult:Bailey Austin Combs, Amburgey, KY, who volunteers at Knott County Health & Rehabilitation Center.

Vive le republique (and all that).

*Your humble correspondent isn’t above an oops of his own: In an earlier draft of this scintillating post, I neglected to add the extra “n” in “annals.”  I offer the mote in my own eye: with Muphry’s Law, c’est la vie.

Bill Myers est rédacteur principal d’Magazine Fournisseur. Email à . Suivre sur Twitter, @ProviderMyers.

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CMS on Backlog: ‘How Did Things Ever Get So Far?’


CMS says it will hire non-binding mediators to try to tackle its monstrous Medicare audit appeals backlog.

CMS says it will hire non-binding mediators to try to tackle its monstrous Medicare audit appeals backlog.

Good morning, ProviderNation. “How did things ever get so far?” the fine folks at CMS are wondering. The agency is launching an experiment it’s calling the Settlement Conference Facilitation Pilot, hoping against hope that it will help CMS deal with its monstrous audit appeals backlog.

You’ll recall that, in February, the Obama administration called a great big timeout because it was overwhelmed with administrative Medicare appeals from auditors. The People weren’t exactly thrilled with things.

Now, the administration will hire Medicare appeals officers they’re calling “facilitators.” Their mission, (should they choose to accept it) will be to mediate disputes between auditors and providers and, in CMS’ quaint words, “to discuss the potential of a mutually agreeable resolution for claims.” The facilitator won’t be able to rule on the merits of any claim. If he or she can get folks to set aside their feudin’ and a-fussin’, why, then, there will be the peace.

If not, of course, people are free to make their own offers to administrative law judges.

While we’re talking about the fine folks at CMS (and we’re epically mixing metaphors), the agency also says it’s giving a rethink to policies and payments for end-stage renal disease. Under the proposal, contractors and providers wouldn’t get a Medicare market basket update, but they’d get a slight wage-index bump. So you got that going for you, which is nice.

Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.



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AMDA Commanded, And It Stood Fast…

JAMA says the heart risks of anti-pneumonia drug azithromycin are worth it.

AMDA has scored a clean sweep with its recommendations for pain management.

Good morning, ProviderNation. Let’s go to press.

The fine folks at AMDA (formerly known as the American Medical Directors Association) have gotten themselves a clean sweep: AMDA submitted 22 suggested pain management guidelines for long term and post-acute caregivers to the National Quality Measures Clearinghouse and, well, AMDA spake, and it was done. AMDA is taking a victory lap, of course, but they think it may well be the beginning of a beautiful friendship.

“This is one of AMDA’s first steps in defining quality in the post-acute and long term care setting,” AMDA quality honcho Matthew Wayne says. “Our Quality Committee will now look to translate these implementation measures, where applicable, into physician quality measures.”

Meanwhile, researchers in Leeds, the United Kingdom, are thinking that mice may have the best laid schemes o’ Men (and o’ Women) trying to stave off Alzheimer’s disease. The humble mouse, you see, is “peculiarly resistant” to those beta-amyloid diseases such as Alzheimer’s, Parkinson’s, and Creutzfeld Jackob Diseases. Researchers are hoping that they can learn a thing or two from the rodents about stopping those nasty proteins before they start.

“We have to take a completely different tack: Instead of targeting the cause of the disease, we need to disrupt the plaque-building process,” University of Leeds researcher Sheena Radford says. “We already knew that mice were not prone to the build-up of some of these plaques. This study, for the first time, observed the building happening and saw the differences between the mice proteins and their almost identical human equivalents.”

Finally, we turn to the Centennial State to meet the new boss: The Colorado Health Care Association says it has hired Doug Farmer to be its new president and CEO. Farmer had been the top policy leader at Kansas’ Sunflower Foundation.

Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.

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Lockdown! Will Your Team Be Ready On A Moment’s Notice?

Stan Szpytek

Stan Szpytek

Good morning, ProviderNation.

• A shooting at a high school down the street from your health care facility
• A felony stop in front of your assisted living community that leads to a police foot chase on your property
• A bank robbery at the corner that turns into a hostage situation
• A train derailment one-quarter of a mile away, where tank cars are emitting toxic fumes
• A peaceful protest that turns violent at a government building near your community
• A report of a person with a gun in your parking lot

If there is an emergent reason to lock down your facility on a moment’s notice due to some type of peril occurring on or near your property, will your team be ready to meet the challenge?
When it comes to assessing potential threats and perils that can impact a long term care facility or senior care community, you must expand your field of vision to account for incidences that can occur nearby and may not be directly related to your operations.

Establishing an “all hazards” emergency management plan and training all staff on all shifts on proper lockdown procedures is a critical step in helping to ensure the safety of residents, staff, and visitors during an emergency where the facility needs to be secured.

A first step in ensuring a successful outcome when the order is received or given to lock down a facility includes clear command and control through the use of the Nursing Home Incident Command System (NHICS).

Having an “All Hazards” Emergency Operations Plan (EOP) in place that utilizes NHICS will help in the immediate decision-making process that will be required at the time of an unexpected adverse event. It will be imperative for the person in charge, known as the Incident Commander, to recognize the potential security threat (see above examples) and take immediate action to lock down and secure the facility. Hesitating during the initial stages of a rapidly evolving incident may put the facility at risk if it is not secured as quickly as possible.

While it is typical to rely on the facility’s maintenance technician to address day-to-day issues pertaining to the physical plant and infrastructure, an emergency lockdown will require the efforts of all staff on duty at the time of the incident.

A common mistake is assuming the maintenance team is responsible for facility lockdown. Of course, most long term care facilities do not have a maintenance technician on duty around the clock and cannot always rely on their immediate availability. Therefore, it is essential for all staff members to understand the specific procedures required to lock down the facility in an expedited manner when an emergency occurs.

This will involve regular training on lockdown procedures to help ensure that the whole team is aware of the steps needed to secure the facility. Specific issues involving access control systems; delayed-egress locking arrangements; securing windows; and closing window coverings, such as blinds and curtains, to restrict vision in or out of the facility must be comprehensively addressed in written procedures and training protocols. Additionally, practicing facility lockdown with drills and exercises will help ensure an appropriate response during a real-world event.

It should be acknowledged that “lockdown” can mean different things depending on the type of incidence at hand. There are lockdowns to keep unauthorized people out of your building during a crisis or emergency, and there are lockdowns to keep people inside of your building. In the case of a potential hazardous materials incident involving the train derailment a quarter of a mile away from the facility, a “lockdown” may be initiated to prevent building occupants from walking outside into a hazardous environment.

Regardless of the reason, your facility needs to be prepared to initiate a lockdown as quickly as possible when such action is warranted. Training all staff on the physical characteristics of the building and the specific procedures necessary to initiate a lockdown is a critical factor in safeguarding the occupants of your health care or assisted living community during rapidly evolving events that may threaten the safety and security of your residents.

Stan Szpytek is the president of Fire and Life Safety (FLS) and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. He is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. For more information, visit or e-mail Szpytek at

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