Fun With The Interweb…

A new bill would help skilled nursing centers get connected to the Interweb revolution. (Photo courtesy the good people of WikiMedia Commons.)

A new bill would help skilled nursing centers get connected to the Interweb. (Photo courtesy the good people of WikiMedia Commons.)

Bill Myers

Happy Thanksgiving, ProviderNation. “Life,” as the late, great Kingsley Amis has it,

          … is mainly toil and labor

          Two things see you through:

          Chortling when it hits your neighbor,

          Whinging when it’s you.

So mad props to the fine folks at, who’ve decided to have a little chortle at the new ICD-10 codes. Whatever our differences as a nation, I think we can all agree that this is the kind of thing that the Interweb was invented for.

The Broadband Bill You Should Know About

Speaking of the Interweb, there has been a fascinating—and underreported—development from your Nation’s Capital. Last week, a bill entitled the “Rural Healthcare Connectivity Act of 2015” cleared the Senate Commerce committee without amendment.

In Washingtonese, the bill amends the 1934 Communications Act to allow skilled nursing centers to request, under the Universal Service Fund, “necessary telecommunications and information services to serve persons who reside in rural areas at rates that are reasonably comparable to rates charged for similar services in urban areas.”

In plain language, the bill offers tens of millions of dollars in subsidies so that care centers can get hooked up to high-speed broadband.

 Skilled Nursing Left Out

Here’s the background: If you look at your phone bill, you’ll see that the FCC docks you for what it calls the Universal Service Fund. In days of yore, the fund was used as a way to help pay for phone service in poor and rural neighborhoods that couldn’t otherwise make a business case for Ma Bell. But about five years ago, the FCC did a soup-to-nuts overhaul of the fund and it became a broadband-for-America fund.

As part of that overhaul, the FCC set aside a special Healthcare Connect Fund, with the idea of connecting health providers to high-speed Internet. The commission even promised a $50 million pilot program specifically for nonprofit skilled nursing centers. But in fiscal 2014, when the skilled nursing pilot was supposed to take off, the commission redirected the cash, saying it didn’t have the legal authority for the program, after all.

Enter Sen. John Thune, R-S.D., the champion of rural connectivity, who is shepherding the current bill through Washington.

Anchors Away?

The heavy lifting here has been done by the fine folks at Good Samaritan, who’ve generally been ahead of the tech curve. If their efforts are successful, though, all providers will owe them a big thanks.

And not just by way of helping residents stay atop of Game of Thrones, either. There are two further Universal Service implications for providers.

The first is that elders face what we might call an App Gap.  If new technology is going to serve elders, many are arguing, it must needs be designed by elders, not just for them. Low-cost, high-speed broadband is one of the best labs for that kind of innovation: Think of what some tech-savvy CNA, for instance, might be able to do in her down time, as she wonders how she can help one of her residents enjoy Angry Birds (say) the same way the kids do.

The second is that, in many rural areas, the only high-speed broadband available is through what tech types call “anchor institutions”—schools, libraries, hospitals, &c. Think of the good will that rural providers could engender by being the place where kids go to finish their homework online, or moms and dads look for jobs.

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

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INTERACT Slashes Assisted Living Hospitalizations, Study Finds…

Fairchild sees real promise in INTERACT moving to assisted living.

Fairchild sees real promise in INTERACT moving to assisted living.

Bill Myers

Good morning, ProviderNation. INTERACT, the quality improvement program used to help skilled nursing centers cut down on unnecessary hospitalizations, has shown promise for assisted living, too, a new study finds.

With a grant from the fine folks at CMS, researchers with Brookdale Senior Living, the University of North Texas Health Science Center, Florida Atlantic and the University of South Florida found that drilling a slightly modified INTERACT curriculum into staff at assisted living centers reduced the mean number of hospitalizations, 30-day readmissions, emergency room trips, and observation stays. They also slashed the average total cost for every resident’s by nearly $30 per day while the INTERACT experiment was being run, lead researcher and North Texas professor Thomas J. Fairchild tells me.

Fairchild presented his findings last week at the Gerontological Society of America meeting in Orlando, Fla.

“This is the first time, really, that this had been done in assisted living,” Fairchild says. “The challenge of trying to make this idea work is you are really changing the habits of people. And getting them to do that on a consistent basis and trying to get them to appreciate the value of doing it, even there, it was clearly challenging.”

 Critical Time

His findings come at a critical time for the profession, Brookdale Chief Medical Officer Kevin O’Neil, MD, says. Acuity is intensifying in assisted living centers, and—especially for large places like Brookdale—the “social model” that gave birth to assisted living is evolving into a more integrated model where providers will have to look out for the social and physical needs of their residents. O’Neil likens INTERACT to a kind of preflight checklist.

“I’m really delighted to see that pilot, who’s probably been doing this for years, remembers everything, still going through the discipline checklist,” he says. “For a vulnerable population like this, it’s really important that we employ safeguards.”

O’Neil co-directed the CMS grant and helped lead the research.

Fairchild says the results show genuine promise that the program is scalable, but he’s still “not naïve” about the challenges providers face in assisted living—especially on a scale such as Brookdale’s. “I think the magnitude of it wasn’t fully appreciated. I mean, you’re trying do this at the same time that the environment you’re in is constantly evolving.”

The key to INTERACT, or any quality improvement program, is communication, O’Neil says.

Getting The Message Across (And Through)

“The system has become pretty fragmented. We don’t have…primary care docs going to the hospitals. We have hospitalists. When it comes to skilled nursing, we actually have a specialty emergency called SNFists, and now there’s a number of physicians where they just go to assisted living and home care settings,” he says. “INTERACT is really a comprehensive program that helps keep information from falling through the cracks.”

The difference between INTERACT and airlines, though, is that everyone in an assisted living center—from part-time cafeteria workers to top executives—is trained to run through their INTERACT checklists, O’Neil says.

“We’re not asking them to diagnose,” he says. “But we need their observations.”

‘Saved That Person’s Life’

Just recently, a housekeeper in the Cleveland area noticed that one of her residents seemed “a little off,” O’Neil recalls. The change wasn’t dramatic, but the housekeeper noticed it. It turned out, the resident had a nasty infection, and if things had gone unchecked for just a couple of hours longer, she might have gone into septic shock, O’Neil says.

“It really saved that person’s life,” he says. “What we’ve found is, the more we train our staff to recognize things early and get the appropriate clinical support…we notice a marked diminution of people having to be sent off to the hospital.”

Data Essential

Turnover remains an obstacle, O’Neil says. It’s hard to keep having to train and retrain.

But, whatever quality program providers adopt, Brookdale has learned a lot from Fairchild’s study, O’Neil says.

“I think the reality is, we’ve got to collect this data,” he says. “This is a vulnerable population and I think the reason we got the grant is because CMS recognized that, even if the assisted living population isn’t an at-risk population for hospitalization, it’s a rising risk population. As these systems start looking at geriatric population health management, assisted living is going to be the next big frontier.

“I think we have an opportunity to really make a difference,” he says.

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



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The Heartbreak (And Hard Work) Of Family Caregiving…



Pamela D. Wilson

(Good morning, ProviderNation. November is Alzheimer’s Awareness Month. Today, guest columnist Pamela D. Wilson takes us through the heartbreak and hard work of family caregivers.)

The heartbreak associated with losing a loved one to Alzheimer’s disease is indescribable. One day, an adult child holds the hand of a parent; the parent asks, “Do I know you?” and the child’s heart (no matter what age) breaks into thousands of tiny pieces, never to be repaired. A spouse experiencing a similar moment may feel the sting of rejection or the absence of appreciation after a lifelong marriage of commitment and caring for a husband or wife experiencing memory loss.

How are spouses, children, relatives, and friends of someone with Alzheimer’s disease supposed to be a spouse, a child, a relative, or a friend, when the individual with the diagnosis no longer recognizes them? Does this lack of recognition seduce family members to hold on more tightly with the hope that one day a loved one may show a glimmer of recollection? Do family members feel disconnected and less committed to continue to visit a loved one who no longer remembers or feels connected to them?  Does this lack of recognition of marriage by a spouse with memory loss raise the option for the healthy spouse to pursue a companion or even another lifelong partner?

I am commonly asked by caregivers of persons with dementia or Alzheimer’s disease if their experiences are unusual. I respond that with a diagnosis of memory loss there is no usual, meaning that each journey is unlike another and that there is no crystal ball to predict the future. This uncertainly is the component that results in stress and anxiety for families because many feel they have no control over the situation and delay making a plan for care.

Planning Crucial

The planning component is critical for persons diagnosed with memory loss especially if the memory loss is diagnosed early, if the individual is aware of the diagnosis, and is able to express wishes and desires in writing to family and to a spouse. This is the time to appoint a medical and financial power of attorney, to finalize a living will, and to establish a will or a trust. This is also the time to have “what if” discussions with family. What if the time comes that a husband or wife can no longer provide care at home? What if a care community becomes a necessity? In what type of community would the individual with memory loss choose to live? Are there financial resources to pay for care or is Medicaid a likely payer? What are the wishes for burial or cremation?

These practical questions should be a priority, in addition to the more difficult discussions of creating memories today so that when memory does fail, the family has something tangible by which to remember a loved one: photographs, family recipes, discussion about the family tree, my wishes for what happens when I don’t recognize my wife, brother, sister or children. Denial and delay of these discussions—not talking or thinking about end of life—permits family members to avoid these all important but difficult conversations that result in conflict later as the disease progresses.

My husband wants me to take him skiing and point him in the direction of a steep cliff. I hear other individuals say, “put me somewhere and go on with your life.” Those who love the outdoors desire to go camping and have an adventure from which they don’t return. One might wonder how sincere these statements are and if there truly was a change in situation would the request change to desiring care rather than desiring to quickly end an unpleasant situation.

Have ‘The Talk’ Now

The conversation of what do I want for myself (and my spouse), especially for individuals with memory loss, is important and should be held early before memory loss or a chronic or terminal disease advances, held when logic rather than when emotion or guilt become entrenched and change the conversation. I recommend placing these wishes in writing as children and other family members typically place guilt on a spouse or the responsible caregiver for making decisions they may disagree with yet decisions that represent the wishes of the care receiver. How many times after a loved one passes away do families argue over cremation or burial, service or no service, and last wishes—more often than families might imagine.

If you were the person diagnosed with dementia or Alzheimer’s, what type of life would you wish for your spouse if you knew that there will be a time when the marriage relationship focuses solely on care tasks related to the advancement of the disease? Tasks like incontinence care, feeding, and constant one-on-one companionship. What if your care needs required that your spouse identify others—in home caregivers or a care community—to provide hands-on care because your spouse alone cannot provide the level of care and support that you require? What happens to the marriage when you are no longer able to recognize your spouse or to find the words to carry on a meaningful conversation? A marriage where your spouse grieves your loss as your memory slips away day by day and is isolated in the role of caregiver and lonely because of the responsibility and duty of care?

What would you want for your spouse? The dilemma of a community caring for a spouse with dementia or Alzheimer’s is rarely discussed. Marriage is supposed to be forever. Many spouses in a marriage affected by dementia or Alzheimer’s disease feel guilty if they seek out companionship and loudly hear from others that they should remain dedicated to their marriage regardless of the condition of the spouse diagnosed with memory loss. This, like the prediction of what will happen as the result of a diagnosis of memory loss, is an unusual situation with no usual. There are no right or wrong answers, only actions.

When Love Hurts

Seeking companionship or love outside the marriage isn’t the same thing as abandoning your loved one. I have personally witnessed the challenges of this situation for the caregiver spouse who is committed to a loved one yet emotionally and physically exhausted from being a 24/7 caregiver and having no social life. I have also witnessed the loneliness and isolation of a spouse caring for a loved one with dementia or Alzheimer’s disease, who then becomes as ill as the spouse for whom care is provided.

Research affirms the benefits of continued social activity and connection for caregivers; this includes marital caregivers. How might society address the challenge of the healthy spouse caring for a spouse with a diagnosis of memory loss with no recollection of the marriage? Should the legal profession begin including direction in medical power of attorney or other marital agreements regarding “at the time I need significant care, I wish for my own care x, y, z, and I wish for my spouse a, b, c?”

Just like the concept of a life review to create an ethical will that shares values, blessings, life’s lessons, hopes and dreams, and love and forgiveness, do we need a specialty legal document surrounding marriage and caregiving when there is no spousal recognition or when care requires long term placement that risks elimination of all marital savings and finances?

A Broader Discussion

Alzheimer’s disease appears daily in the press; it is a dreaded diagnosis. Caregiving, while well publicized, is not a subject of awareness until the need arises and one becomes a caregiver. Care relationships are filled with denial and avoidance of planning. Society avoids the subjects of illness and death.

Might we be better prepared for caregiving and aging if there were more discussion of the process of aging in the community; whether in churches, medical offices, or community groups? Might we be better prepared for responding to the challenges that result from caregiving and how these affect family relationships, including marriages, if this was part of a school curriculum or workplace support program? Might these broader discussions—if discussed earlier in life—have a positive impact on daily health and retirement planning so that when caregiving becomes a reality there are fewer crises and more focus on making memories?

Pamela D. Wilson is the author of “The Caregiving Trap: Solutions for Life’s Unexpected Changes.” Follow her on Twitter, @caregivingtrap.


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Ensign Thinks Local, Gets Global…

Ensign's Christensen: Quietly, locally, building an empire...

Ensign’s Christensen: Quietly, locally, building an empire…

Bill Myers

Good morning, ProviderNation. If it’s possible for one of the profession’s largest companies to be aggressive, quietly, the fine folks at The Ensign Group have certainly contrived it.

Already the nation’s eighth largest skilled nursing (and 29th largest assisted living) company, according to Provider’s 2015 rankings, Ensign (NASDAQ: ENSG) has steadily built an empire—not through blockbusters, but through relatively small acquisitions.

Since the beginning of the year, the Mission Viejo, Calif.-based company has announced at least 18 different acquisitions, according to Levin Associates. In August, Ensign crossed the Mississippi for the first time and bought up 15 assisted living communities in Wisconsin. Barely three months later, and Ensign announced that it had acquired a 125-bed center in West Columbia, S.C.

Get Globally, Merge Locally

Ensign leaders say they’re becoming global because they’re thinking locally.

“This really goes back to our belief in local leadership,” President and CEO Christopher Christensen said on an investors’ call last week. “The deal has to make sense, and the state has to make sense, and the facility has to make sense, but we do better when we have somebody who has a local passion for the site.”

Most of the acquisitions this year were of places that weren’t on the market: It was simply a matter of local Ensign leaders seeing an opportunity, Christensen said. “We were able to get them to see that getting these assets into our hands would be better, more stable,” he said of their acquisitions’ executives.

There’s another way Ensign likes to differentiate itself, as well: quality. In 2009—two years after the company went public—more than 40 percent of its buildings were rated One-Star. Today, even as the company has expanded rapidly, nearly 65 percent of Ensign’s buildings are Four- or Five-Star, and less than 5 percent are One-Star.

Value-Based Purchasing—What, We Worry?

That may also be why company executives say they don’t fear payment reform the way some operators do.

“Some form of value-based reimbursement is ultimately better for the patient, and it’s something that we care about,” Executive Vice President Chad Keetch told investors and analysts last week, adding that Ensign is already participating in bundling models for dual eligibles—arguably the biggest risk group out there.

In any case, Keetch says he’s not sure he shares the sky-is-falling sentiment of those who worry over payment reform.

“I don’t really understand the logic there. Everything we see points to a positive reimbursement environment. At the end of the day, there may be some shrinking length of stay, but the providers that are thinking ahead will manage for volume,” he said.

Right or not, Ensign’s presentation had stock analysts practically going full-on wolf during last week’s investors’ call. As if to whet their whistles even more, Ensign had just announced a $15 million stock buy-back ahead of its third-quarter earnings call. That’s usually a sign that a company thinks its stock is undervalued.

Oh, and the company has just opened its first health care resort. Four more are expected next year.

Consulate: Meet The New Bosses


Consulate's new overlords: Mathies (left) and Bryson.

Consulate’s new overlords: Mathies (left) and Bryson.


Speaking of capitalism and all that, mad props to new Consulate Health Care overlords Bill Mathies (CEO) and Chris Bryson (CFO).

Mathies comes over from Sun Healthcare Group, where he’d been chairman and CEO; Bryson was previously COO at Pruitt Health.

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

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Provider Agreements: A Measure Of Devotion….

Provider advocates stand ready to help all those who gave some...

Provider advocates stand ready to help all those who served their country. (Photo courtesy the fine folks at Wikimedia Commons.)

Bill Myers

Washington, D.C.—Good morning, ProviderNation. It’s Veterans’ Day. You can be stoic about it, if you like, or even mournfully hostile to the day’s enterprise, but let us agree that the duty laid upon us by the mighty and humane 16th president—“to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow and his orphan”—is one (subject to the occasional, and ambivalent, toggling between masculine and feminine pronouns) that each generation knows it can neither shirk nor ever discharge fully.

With that in mind, provider advocates can take some cheer in the fact that legislation that would make it easier for them to offer top-quality care to the nation’s vets is slowly working its way to becoming law. Senate bill 2000, the Veterans Access to Long Term Care and Health Services Act, has already had two readings and is now in the Committee on Veterans Affairs.

The bill would make it easier for the Department of Veterans Affairs to sign provider agreements with long term and post-acute care centers without all the baggage of making the care centers full-on government contractors.

Champions In Both Houses

Its champions in the Senate are John Hoeven, the North Dakota Republican, and Joe Machin, D-W.Va.

“North Dakota is a very large state, which can make it a real hardship for our veterans in rural areas to get basic services like physical therapy, diagnostic imaging, and other necessary medical procedures,” Hoeven said, in introducing the bill. “That’s why we’re working very hard to make it easier for our veterans to receive services and extended care near where they live so that they can be close to their family and friends. This is important to our veterans and their families and will help us to better keep our nation’s promise to care for the men and women who have served our country so well.”

A similar bill, could be up for a hearing on the House side as early as next Wednesday. (The champions there are Reps. Jackie Walorski, R-Ind. and Tulsi Gabbard, D-Hawaii. Gabbard is herself a combat vet.)

“As the VA suffers from a crisis of confidence and attempts to reform itself, Congress needs to look at ways to ensure our veterans have access to the care they deserve, especially for those in rural areas where a VA facility is a few hours’ drive away,” Walorski tells me. “I am currently working on legislation that would expand provider agreements to include hospital care and other medical services. Provider agreements are important because they will guarantee those the ability to receive the necessary care in the comfort of their home town, close to friends and family.”

Providers Fit And Ready For Duty

The fine folks at AHCA/NCAL have been pushing for the provider agreements for awhile, and, without resting on any laurels, are feeling rather hopeful that their members will be reporting for duty, stat.

“Once we can enter into the agreements, the number of providers serving veterans will increase in most markets, expanding the options among veterans for nursing center care and home- and community-based services,” says Dana Halvorson, AHCA’s own perpetual motion machine. “It is simply time we get VA provider agreements across the finish line so those most in need can receive quality care close to home. It is the least we can do for those that have served our nation so bravely.”

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

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Technology A ‘Use It Or Lose It’ And A ‘Move It Or Lose It’ Proposition, Study Suggests….

Social technology isn't just a 'use it or lose it' proposition; it's a 'move it or lose it' one, too, Brookdale's O'Neil says.

Social technology isn’t just a ‘use it or lose it’ proposition; it’s a ‘move it or lose it’ one, too, Brookdale’s O’Neil says.

Bill Myers

Good morning, ProviderNation. Elders who embraced modern social technology tended to feel more satisfied with their lives, less lonely, more confident about attaining their goals, and be healthier and more active than their tech-averse peers, a new study by the fine folks at Stanford Center on Longevity has found.

Overall, the more tech-savvy the elders tended to be, the better their mental and physical health, researchers found. But, intriguingly, elders who used new technology for social reasons—to stay in touch with family, connect with friends, etc.—were much better off than those elders who used technology for non-social purposes (crosswords, say), the study finds.

In one way, the findings are almost painfully obvious—give folks tools to attack loneliness, they’ll feel less lonely. In another way, though, the findings are terribly subtle—they suggest that technology isn’t as important as the way it’s used.

‘Isolation Is Toxic’

“I think we know that if you use technology inappropriately, it can be just as socially isolating,” says Kevin O’Neil, chief medical officer at Brookdale Senior Living, whose company spearheaded the Stanford study. “You see these people in restaurants on their iPhones, not talking to each other. That’s no good, either.”

What that means is that care center leaders not only have to be willing to embrace new technologies, but to embrace them with the goal of making folks less isolated, not more.

“We know that social isolation is toxic,” he adds. “There’s just a much higher risk of depression, stroke, even Alzheimer’s disease. I’ve always felt that wellness is not just our bodies—it’s our minds and our hearts and our souls.”

Connected Caregivers

That’s music to the ears of the good people of the National Center for Assisted Living, who think that technology isn’t only a great way to connect elders with friends and families—but to connect elders with their caregivers in fun ways, too.

“This research shows that senior living providers need to be on top of their game on integrating technology–not just from an operational standpoint, but also as part of providing high-class customer experience,” says Rachel Reeves, spokeswoman for NCAL. “It could be a unique way to help bridge the gap between the younger generation that cares for these individuals and the residents.”

O’Neil and his colleagues have pioneered an approach they’ve called Optimum Life. The idea is not just to buy new technologies, but to be open to any innovation—high- or low-tech—that will help people feel less lonely.

Design Barriers

O’Neil also argues that elders, and those who care for them, have to get onto the ground floor of discussions about new technologies. A lot of seniors, for instance, struggle with eyesight. It follows, then, that apps with low-contrast fonts and pastel backgrounds just won’t cut it. Similarly, touchscreens are a lot more friendly to arthritic hands than keyboards, O’Neil says.

“We’ve found that embracing this kind of technology—especially in connecting with grandchildren and families—really makes a difference,” he says.

This is going to be truer as time goes on, not less. One thing O’Neil says he worries about are the one-third of elders in the Stanford study who don’t use any kind of technology.

“It’s one of those things where people are becoming more socially isolated,” he says. “They become disconnected from the outside world. It’s really important that we educate the administration about the clinical importance of these technologies.”

Emerging evidence exits that using technology helps spur cognition, even in elder brains, O’Neil says. But, as important as it may be to use technology to get minds fired up, it’s even more important to use technology to help people connect with one another, he says.

“The old adage is true—‘Use it or lose it,’” O’Neil says. “But it’s also, move it or lose it.”

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

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Florida Atlantic University Offers Life’s Little Hospitalization Book…

Florida Atlantic's Tappen: The newest pamphleteer in the battle against hospitalizations...

Florida Atlantic University’s Tappen: The newest pamphleteer in the battle against unnecessary hospitalizations…

Bill Myers

Good morning, ProviderNation. The fine folks at Florida Atlantic University’s nursing school have done the heavy thinking (and, perhaps, the heavy lifting) for us all. They’ve produced a series of pamphlets, aimed at relatives and friends of those in long term or post-acute care, that they hope will help calm some nerves and keep families from dialing 911.

“Everybody is focused on cutting back on unnecessary hospitalizations,” FAU’s Ruth Tappen tells me. “We realized that we were focusing on everybody but the families and the residents, and the staff consistently told us that families, or sometimes the residents, are really the drivers of this. Very few providers will say ‘no’ when a family member asks to send a relative to the hospital.”

Nearly one out of every four residents are taken to hospitals within the first 30 days of their new lives in care centers, according to CMS data. The stress is awful, of course, but it’s also expensive: about $14.3 billion per year, the federal government estimates.

Easy To Use (But Some Assembly Required)

The FAU pamphlets (in English and Spanish, with Haitian Creole, Chinese, and Tagalog en route) are simple, colorful, and straightforward. Subject headings include, “Reasons to Prefer Being Treated Here,” as well as, “Reasons to Prefer Being Treated in the Hospital.” There’s even a special section for families and friends for those suffering from dementia.

“We tried to use the terminology that they would know—to fill them in on what a nursing home could do. A number of people said, ‘I had no idea that I had any right to be part of this decision.’ That surprised me a little bit,” Tappen says.

The pamphlets are easy to use, but there is still a little assembly required. Tappen says she hopes that care center officials will take care to hand out the pamphlets separately, apart from the massive data dump that occurs on Day One in most care centers.

‘Wonder How No One Thought Of It Sooner’

“Some people give people such a stack of paperwork that it’s really easy to miss,” Tappen says. “You wait a couple of days, so they can read it, if not at their leisure, then when things are little bit calmer.”

Seeing the pamphlets, some providers could be forgiven for having a V8 moment.

“Our members are always looking for good ideas, and this feels so simple that I wonder how no one thought of it sooner,” says Steven Chies, a consultant to Living Services Foundation, a board member of AHCA, and an all-around decent chap. “Look, that first day in a care center is one of the toughest days of any family’s life. And the better we can communicate with families, the better the care we can give. This looks like another great tool to help break down those barriers and let us do what we do best.”

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

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