SNF Minimum Staffing Standard Published: Tell CMS How New Mandate will Impact your SNFs and Access to Care

September 11, 2023

On September 1, the Biden Administration officially published for public comment a proposed rule that would mandate minimum staffing levels at skilled nursing facilities. A 60-day comment period began September 6 and will end with all comments due on November 6.

Lutheran Services in America will be submitting comments sharing our concerns about the proposed new requirement and helping you do the same. We are currently analyzing the full rule and what it means for our network, but our initial concerns include the 24/7 RN requirement, only allowing time-limited hardship exemption waivers, and lack of funding for implementing mandated staffing increases.

Since early 2022 when the Administration originally announced their intent to mandate minimum staffing levels, we have heard from many of you that the uniform application of this new requirement, on top of the enduring workforce shortage in direct care, will result in reduced access to long-term care for older adults in rural and underserved communities as providers continue to struggle to fill staffing vacancies. We have worked diligently to ensure that the concerns of our network are heard and incorporated into the new rule, including meetings with key senators, the White House Domestic Policy Council, and CMS Administrator Chiquita Brooks-LaSure.

Our collective voice is powerful, and we look forward to continuing to bring its impact to bear on this rule.

Sarah Dobson is the Senior Director of Public Policy and Advocacy at Lutheran Services in America.

Forward-looking Approaches Toward Health Equity

August 10, 2023

Recently, I had the privilege to speak with Lutheran Services in America members about how they approach achieving health equity in their communities. Recognizing the challenges community members face with housing and food insecurity, lack of transportation, challenges receiving behavioral health care, and loneliness and social isolation (also known as social determinants of health (SDOH)), five members of the Coalition for Better Social Care shared innovative and promising solutions. Thanks to their groundbreaking approaches, more than 11,000 people have been screened for SDOH risks. Their efforts laid the groundwork for reaching more people, identifying their needs, and providing the services and supports that help community members live independently and thrive.

Source: Amanda Krzykowski, LSS Wisconsin

 

Below is a snapshot of the conversation with:

Watch the full conversation.

Source: Amanda Krzykowski, LSS Wisconsin

 

A key insight offered was to integrate screenings for social determinants of health during regular interactions with program participants. While screenings are often conducted during initial interactions, needs can change over time. Updated information can help tailor programs to current needs, use resources more effectively, allow more people to receive services, and better connect people with appropriate services to support their specific needs.

For example:

  • Lutheran Family Services of Nebraska shared that for a variety of factors, older adults were resistant to utilizing their behavioral health services. Staff started meeting residents where they were – in the dining facilities, at group activities – rather than scheduling formal appointments. Using relationship-building questions to initiate conversations, they earned the trust of the older adults which grew into identifying needs and providing appropriate behavioral health services.
  • Genacross Lutheran Services in Toledo, Ohio, suggested integrating facilities staff, who interact frequently with residents, into regular care planning meetings. Now, the facilities staff are key partners in identifying other services and support needed. A request to “just change a light bulb” expanded into a realization the resident had trouble getting out of their chair and might need medical attention.
  • Family Health Centers at NYU Langone is implementing new protocols when residents return home from the hospital (known as transitional care), conducting a targeted SDOH screening to identify the unique needs after hospitalization such as home care, transportation to medical appointments, and meal assistance.

During our conversation, members emphasized that addressing SDOH needs is the pathway to health equity. Lutheran Social Services of Illinois Director Matt Hammoudeh summarized: “Without stable and secure housing and other basic needs met, program participants struggle to focus on health matters such as doctor’s appointments and filling prescriptions.”

Our network excels at innovation in the face of challenging situations. Members of the Coalition for Better Social Care are seeking more reliable sources of funding to provide program sustainability, such as Medicaid reimbursements and contracts with health insurers. The mechanisms for reimbursement are still emerging, such as the Center for Medicare and Medicaid Service’s recently proposed Physician Fee Schedule that includes SDOH reimbursements under Medicare, and new partnerships are needed to scale services. Going forward, we will be convening thought leadership on reimbursement mechanisms and enabling conditions leading to partnerships with health insurers and others.

 

We invite you to join your peers to advance health equity: Susan Newton, Senior Director of Strategic Initiatives at Lutheran Services in America, will guide you to a Collaborative that best fits your strategic direction.

For more information, watch our Strength & Service Series webinar “Swap Shop: Innovative Strategies Across the Network to Address Social Determinants of Health.

Looking for more information on social determinants of health? This easy-to-print graphic details what SDOH are and why they are important. We encourage you to utilize this resource and share it within your respective communities and organizations!

 

Caregivers: Recognizing the Important Role of our Nation’s Hidden Heroes

February 17, 2023

Today we honor millions of people who make an extraordinary difference in the lives of others. Caregiving, both professional and unpaid, is a line of work that has a long and often unrecognized history of providing a better quality of life for older adults, people with disabilities and many others.

Caregivers are heroes—selflessly providing care, often at the expense of their own well-being. It is a rarely talked-about role that is not typically highlighted as a career option to young people, yet is a critical profession caring for the lives of millions of people. There are more than 4 million caregivers who provide direct care in homes and hospitals, and another 55 million people in America who are unpaid caregivers providing care for family or friends.

The role of caregiving is especially important in rural communities where limited resources and isolation for older adults is more acute. For years, our network has leveraged the long-standing commitment of Lutheran social ministries in these communities to expand services for older adults and family caregivers.

As we commemorate National Caregivers Day, it’s important to recognize the complicated journey of caregiving: a role that is incredibly gratifying and simultaneously arduous, especially for those who take on the job alone.

The Personal Challenge of Caregiving

Caring for an older adult has unique challenges and requires significant time, energy and finances from family caregivers. More than 60 percent of family caregivers help older adults with activities of daily living (ADLs), including getting in and out of beds and chairs, bathing, feeding and getting dressed. Nearly all family caregivers also support older adults with instrumental activities of daily living (IADLs), including providing transportation, ordering groceries, performing housework, preparing meals, managing finances and the like. According to the Gallup-Healthways Well-Being Index, most caregivers provide these services to one individual, but 18 percent do so for two or more.

Despite assisting with a number of these tasks, the majority of family caregivers admit they need more instruction, including how to keep their care recipient safe at home, manage their stress and identify eligible supports and services. That is a tall order for one person and many family caregivers often assume their role unexpectedly or suddenly.

That was my experience as well. After my mother suffered a stroke, my family and I were immediately thrust into the role of caregivers. It was incredibly difficult to watch my mother, a top C-suite executive, trailblazer in her industry and the smartest person I knew, no longer able to grab a spoon or remember her birthdate. Like many caregivers, I felt overwhelmed by this “new normal” of helping my mother with daily tasks.

Thankfully, my family and I were not alone—we were helped by countless compassionate caregivers who cared for Mom and brought out her smile again. I felt tremendous hope thanks to the caring conversations and whole-person approach from these caregivers. Each day reminded me of the critical importance of our work at Lutheran Services in America. I am truly honored to raise the visibility of caregiver heroes across our nationwide network who support families like mine and individuals like my mother.

Support Makes All the Difference

I know how much of an enormous task caregiving can be on a single person. If there is one thing caregivers should know is that they do not need to go it alone. Support and resources are available to help tackle these seismic responsibilities. Two-thirds of the Lutheran Services in America network are dedicated to caring for older adults, addressing their critical needs and enabling them to lead their best lives.

Lutheran social ministry organizations have developed new ways to support caregivers during these challenging times. Lutheran Social Service of Minnesota, for example, offers coaching and counseling to help family caregivers not only develop their caregiving skills but also find resources and practice self-care to maintain a healthy and balanced lifestyle. Samaritas in Michigan and Bethany Village in Kansas are leveraging technology to connect loved ones to caregivers living out of state.

Through our Rural Aging Action Network, Lutheran Services in America unites our member organizations to respond to the increasing number of older adults in rural communities who experience social isolation and difficulty accessing services and supports to successfully age at home. Together, we’re using the unique assets in these communities to address key barriers to care that older adults and caregivers face.

Service providers are doing what they can to bring on as many caregivers as possible during a historic workforce staffing crisis. I ask you to join our network in advocating solutions that support the caregiving community and protect access for all.

As one in four families has experienced, caregiving is more than supplying individuals with basic necessities. It restores the dignity and sense of self-worth of our loved ones during the toughest moments of our lives. As we fulfill our commitment to empower our communities, we cannot forget the sacrifice of many of the caregivers who selflessly come along for the journey.

Ashley Washington is Director of Aging Initiatives at Lutheran Services in America.

The Robots are Here

September 28, 2022

This weekend the Washington Post ran an article titled “The robots are here. And they are making your tacos.” It was a story of how fast-food restaurants are addressing workforce shortages by using robots to fry French fries, tortilla chips and tacos. It’s seen as a wave of the future—even though the robots occasionally freak out when encountering tacos requiring a human worker to toss them in the garbage.

While there is increased technology, including robots, in Lutheran social ministry organizations, it’s not as straightforward given the “high touch” nature of our work in caring for people. It also takes capital to invest in technology—capital that is scarcer in the non-profit sector. Yet we know that increased and innovative technology is crucial to our future.

We have partnered with the Consumer Technology Association Foundation (CTAF) over the past few years to enable Lutheran social ministry organizations to innovate. Through our partnership with CTAF, Graceworks Lutheran Services is currently increasing access for low-income older adults to telehealth, cognitive tools and virtual visits with family and friends in its 17 affordable housing communities. Previously, Samaritas provided assisted reality devices to formal and family caregivers caring for older adults diagnosed with dementia so they could receive realistic dementia education and training through an evidence-based program. Bethany Village provided “mobile communication stations” to allow frail older adults to visit with loved ones and healthcare providers, and Lutheran Social Service of Minnesota provided technology for family caregivers in rural communities to access support groups, counseling, companionship programs, and other services during the early days of COVID.

We’ve also worked with technology providers to create solutions that allow our members, including Genacross Lutheran Services and Lutheran Social Services of Northern California, to evaluate the social determinant of health needs of their clients, connect them to services in the community and enable them to live in their home and community. And our CEO Summit and Strength & Service Series feature workforce experts as well as our members as they share their insights, experiences and innovations.

But there’s a long way to go. Join us by sharing your ideas, your innovations, and your experiences. Together we can advance the ability of Lutheran social ministry organizations to expand innovation and automation and enable all people to lead their best lives.

Alligators and Lutheran Social Ministry

September 6, 2022

Last week the Washington Post ran an article titled “His emotional support animal is an alligator…” and it showed a photo of a man with a 70-pound, 5.5-foot alligator. It talked about how the alligator went everywhere with him and had even been approved as an emotional support animal.

I didn’t read on.  I only hoped not to meet the alligator on a plane someday.

Fortunately, Wendy, our Vice President of Marketing and Communications, read the rest of the article. It turns out that Wallygator visits schools and senior living facilities, among other educational venues. And one of the places he’s visited is SpiriTrust Lutheran in Pennsylvania (see photo above).

It reminded me of the extraordinary efforts Lutheran social ministry organizations make to care for people and ensure they live a full and abundant life.  It reminded me of the alpaca that visited Diakon residents and staff during the earliest days of the pandemic and the staff and certified courthouse dog from Lutheran Community Services Northwest that spend time with victims of sexual assault and so many more stories that I could share.

It reminded me that one of the special aspects of Lutheran social ministry is our emphasis on building deep and meaningful relationships with people—not transactional relationships—but relationships that reflect the dignity and value of people. Relationships that consider people’s whole needs and where we strive to remove the barriers that prevent them from leading their best lives. It reminded me how we put people at the center of our work.

It reflects who we are and what’s important to us.  And it makes a meaningful difference in the lives of one in 50 people living in America.

Heritage, Vision and Mission: How Lutheran Services in America is Building a Healthier Future

September 12, 2022

The Lutheran Services in America network has over 150 years of dedicated service in the way of caring for older adults in America. That sustained success is largely due to the Lutheran tradition of empowering people and communities. “What makes us unique is our shared heritage, vision and mission,” said Charlotte Haberaecker, president and CEO of Lutheran Services in America, on the LTC Heroes podcast.

It is that shared sense of duty that makes teamwork possible amongst the 300 health and human services organizations of the Lutheran Services in America network in over 1,400 communities across 45 states. “Our organizations trust each other, collaborate and innovate together,” Haberaecker told Experience Care’s Peter Murphy Lewis, who hosts the podcast.

Needless to say, that sort of reach results in making a positive impact on the trajectory of long-term care in the United States. “We utilize the collective power of our national network with national partners to advance innovation and achieve a healthier, more equitable future for people in America,” she said.

According to Ted Goins, the president and CEO of Lutheran Services Carolinas — a member organization of Lutheran Services in America — this camaraderie is faith-inspired. “We are all friends at Lutheran Services in America,” he said. “It’s just baked into the network, which was created by the Church. That sponsorship has taught us all to work closely together without hesitation.”

Perhaps most remarkable is that the Lutheran Services in America network has been able to maintain the highest standard of care for older adults with diverse needs despite a challenging environment and workforce shortage. “Our network has been caring for people with a broad range of continuum of services, from home community-based services to affordable housing and full senior living facilities,” Haberaecker said. “And we have cared for all of the older adults in our care with dignity, respect, health and independence for well over a century.”

Lutheran Services in America is sincerely dedicated to older adults across America. This means remaining humble, unselfish and well-coordinated across the nation to facilitate the most appropriate care for all our older adults.

The Power of Partnership

September 1, 2022

One of the key areas where Lutheran Services in America brings together our members—along with strategic national partners in philanthropy, academia, healthcare and more—to advance innovative solutions is in enabling older adults to live with dignity, health, meaning, and independence in a place where they call home.

We recently partnered with our member NYU Langone Family Health Centers (formerly Lutheran Family Health Centers), the University of North Carolina at Chapel Hill (UNC), and The Harry & Jeanette Weinberg Foundation to empower older adults in affordable housing—particularly those transitioning from the hospital or post acute care—to remain living independently in their community.

The work builds on a four-year partnership with UNC and The Harry & Jeanette Weinberg Foundation where we worked with seven members in seven states to successfully transition 875 older adults from post-acute care to home, demonstrating improvement in care transition and quality of life.

The current two-year project will expand UNC’s Connect-Home transition care model to strengthen the capacity of staff to identify affordable housing residents most at risk of hospitalization, address gaps in care that lead to increased isolation and emergency room visits and enable older adults to live independently. Genacross Lutheran Services is providing peer support and expertise based on the extensive work they have done to assess and connect their affordable housing residents to services in the community.

Why is this important? According to CMS, 76 percent of 30-day hospital readmissions are preventable.  And we know the transition from hospital to home places older adults at risk.  We also know that when we bring together our members with expertise and funding from partners in academia, philanthropy and healthcare that we can tackle tough challenges and make a meaningful difference in the lives of people.

We look forward to sharing with you the learnings and results of the work and partnership in the future.