Pursuing Quality Long-Term Care Podcast

The US Surgeon General referred to the epidemic of loneliness and social isolation in the United States as a public health crisis with profound consequences, and emphasized the need to prioritize social connections. Throughout the COVID-19 pandemic, perhaps no community was more impacted by loneliness and isolation than people living in long-term care. This seclusion led to many emotional, physical, and psychosocial health consequences. 

In this episode, we speak with Dr. Susan Wehry, a nationally recognized keynote speaker and workshop facilitator on depression, dementia, and healthy aging, about the impacts of severe isolation and extreme loneliness many residents have experienced, not just during the pandemic, but before and after. Dr. Whery discusses the value of being heard and ways staff, family members, and friends can work to help combat loneliness in long-term care moving forward.

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As we are finding our way out of the COVID-19 pandemic and Public Health Emergency (PHE) that devastated so many lives – particularly in nursing homes – there is an opportunity to look back at what happened, both the good and the bad, and find the lessons we can learn from to perhaps do better in the future. This is particularly true in evaluating what was happening in long-term care facilities prior to and during the pandemic that affected their response to COVID-19, and the subsequent increase in staffing shortages that many facilities are experiencing.   

In this episode, Consumer Voice Executive Director, Lori Smetanka, talks with David Farrell, a licensed nursing home administrator who has spent his entire career in the long-term care profession, about the long-term care facilities that had better outcomes than their peers, or as David notes, facilities that “weathered the storm of COVID-19 and staffing crises.”

David and his colleagues did a deep dive into those facilities that were outliers or stood out from their peers with regard to COVID-19 infections and staffing shortages, to try to determine what was happening that we could learn from, and hopefully replicate. 

Resource: Sharing Lessons From Successes

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February marked the one-year anniversary of President Biden's announcement of historic nursing home reforms. Creating a minimum staffing standard, which would be the most significant increase in protections for nursing home residents in decades, was central to his plan. In this episode, we are sharing the audio from Consumer Voice’s webinar that was part of the “Dignity for All: Staffing Standards Now!” campaign. This campaign is advocating for a minimum staffing standard in nursing homes.

This discussion highlighted how there is little accountability for how nursing homes spend taxpayer dollars, despite receiving tens of billions of dollars each year in Medicare and Medicaid dollars. In this episode, you will hear Consumer Voice and Ernie Tosh discuss the new report, “Where do the Billions of Dollars Go? A Look at Nursing Home Related Party Transactions.” The report takes an in-depth look at how nursing home owners and operators funnel billions of dollars through companies they own with little to no accountability for how that money is used each year. They also offer examples and solutions to address this industry-wide problem to ensure public dollars are going toward resident care.

Resources: Webinar Slides | Report: Where do the Billions of Dollars Go? A Look at Nursing Home Related Party Transactions | Dignity for All webpage

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February marked the one-year anniversary of President Biden's announcement of historic nursing home reforms. Creating a minimum staffing standard, which would be the most significant increase in protections for nursing home residents in decades, was central to his plan.  In this episode, we are sharing the audio from Consumer Voice’s webinar that was part of the “Dignity for All: Staffing Standards Now!” campaign. This campaign is advocating for a minimum staffing standard in nursing homes.

This discussion highlighted the experiences of long-term care residents as they shared, in their own words, how living in a facility with inadequate staffing affects their quality of life and the quality of care that they receive, and what it would mean for their lives to live in a facility with enough staff.

Resources: Webinar Slides | Dignity for All webpage

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February marked the one-year anniversary of President Biden's announcement of historic nursing home reforms. Creating a minimum staffing standard, which would be the most significant increase in protections for nursing home residents in decades, was central to his plan. In this episode, we are sharing the audio from Consumer Voice’s webinar that was part of the “Dignity for All: Staffing Standards Now!” campaign. This campaign is advocating for a minimum staffing standard in nursing homes.

The implementation of a minimum staffing standard would not only protect nursing home residents it would address the long-standing job quality problems that plague nursing homes. On average, nursing home staff turnover is 52% each year, which is the result of low-wages, poor benefits, inadequate training, and little opportunity for job growth. The burden of providing essential and critical care falls largely on women, a majority of whom are women of color, while they are treated poorly by nursing home owners and operators. In this episode, you will hear a conversation with Consumer Voice and several direct care workers, also members of the Service Employees International Union, who discuss what it is like to work in an understaffed facility and what a minimum staffing standard would mean to direct care staff in nursing homes.

Resources: Webinar Slides | Dignity for All webpage

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This month marks the one-year anniversary of President Biden's announcement of historic nursing home reforms. Creating a minimum staffing standard, which would be the most significant increase in protections for nursing home residents in decades, was central to his plan.

In this episode, we are sharing the audio from Consumer Voice’s webinar earlier this month that launched our “Dignity for All: Staffing Standards Now!” campaign. Through this campaign, Consumer Voice is advocating for a minimum staffing standard in nursing homes. In this episode you will hear about the importance of adequate staffing for residents’ safety and health from Sam Brooks at Consumer Voice, and Toby Edelman, at the Center for Medicare Advocacy. You will also hear from Shelley Jackson, a CNA in Pennsylvania, and Margarite Grootjes, a resident in Ohio, as they share what it is like to live and work in a facility without adequate staffing.

Resources: Webinar Slides | Dignity for All webpage

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Intimacy and sexual expression are basic human rights and are needed throughout our lifespan. Aging does not mean a loss of sexual intimacy, but when an older adult is cognitively impaired, it can be difficult to determine if they are engaged in a healthy sexual relationship. The right to freedom of sexual expression among these populations has proven a sensitive and sometimes controversial topic, particularly when cognitive capacity is in question. By federal law, individuals residing in long-term care are afforded multiple rights, many of which are relevant to sexuality, such as privacy, confidentiality, the right to make independent choices, and the right to choose visitors and meet in a private location.
 
In this episode, we are joined by Patty Ducayet, Texas State Long-Term Care Ombudsman, to explore the complex issues surrounding the ability to consent to sexual activity among long-term care residents and supporting a resident’s right to intimacy and sexual expression. 

Resources

• NORC Issue Page: Sexuality and Intimacy in Long-Term Care Facilities
• Texas Ombudsman Program Webinar PowerPoint on Sexual Expression in Long-Term Care – An Advocate’s Guide
• Sexual Abuse in Nursing Homes: What You Need to Know Note: This podcast episode did not cover sexual abuse. Review this issue brief for more information on sexual abuse in nursing homes.

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Recent CMS data shows that only 46% of nursing home residents are up to date on their COVID-19 vaccinations. That percentage is even lower for nursing home staff, 23.1%. COVID-19 cases and deaths are rising across the country, while at the same time seasonal influenza and RSV cases are also causing hospital beds to be full.

This podcast features Dr. Celine Gounder who discusses the importance of nursing home residents and staff being up to date with their COVID-19 vaccinations. Dr. Gounder addresses questions about the efficacy of boosters and also how frequently nursing home residents and staff should be receiving them.

Dr. Gounder is a Senior Fellow and Editor-at-Large for Public Health at the Kaiser Family Foundation and for Kaiser Health News. She is also a Clinical Associate Professor of Medicine and Infectious Diseases at New York University’s Grossman School of Medicine. She cares for patients on the wards at Bellevue Hospital Center. She served on the Biden-Harris Transition COVID-19 Advisory Board.

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As the result of changing CMS and CDC guidance since the start of the pandemic, residents and families have had a great deal of uncertainty during the holidays surrounding visitation and the requirements for residents who leave their facilities. Jerry Rothkoff, of Rothkoff Law Group, joins us to talk about where visitation is now, almost three years into the pandemic, and how everyone can spend time safely together this holiday season.

Resource: Newsletter by the Rothkoff Law Group: Can Nursing Home Residents Leave the Facility for the Holiday? | Consumer Voice Article on Spending Time with Loved Ones During the Holidays

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For decades the Consumer Voice has designated October as Residents’ Rights Month as a way to honor residents living in long-term care. This month is an opportunity to focus on the commitment to recognize the value of each resident and the importance of treating every resident with dignity and respect. In this episode, join us as we speak about this year’s Residents’ Rights Month theme, Inspiring Unity within Our Community. Lori Smetanka, Executive Director at Consumer Voice, and Jocelyn Bogdan, Senior Policy Specialist at Consumer Voice discuss why having a community is important, how residents can exercise their rights around their community, and examples of ways residents, families, and staff can help build a community for residents living in long-term care.

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Abuse is defined in the federal nursing home regulations as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. It can take many forms including physical abuse, verbal, sexual, mental, emotional, and financial. Even though federal law states that residents of long-term care facilities have the right to be free from abuse, it still does occur and is largely under-reported and inadequately investigated and addressed.

In this episode we are talking with Dr. Laura Mosqueda, a professor of Family Medicine and Geriatrics, and Beverley Laubert, the National Ombudsman Program Coordinator at the Administration for Community Living about abuse of those living in long-term care facilities – an issue that affects thousands of residents of nursing homes, assisted living facilities, and other long-term care settings.

Recent data indicates increased concern about incidences of abuse in long-term care facilities. That, along with the fact that June 15 is designated as World Elder Abuse Awareness Day (WEAAD), made us think it was important and timely to talk about this issue.

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Research has shown that staffing in nursing homes - numbers of staff, skills mix, and training - are critical indicators of quality care and positive resident outcomes. Yet too many nursing homes are understaffed, and the long-term care industry claims it does not have the resources to hire more staff. But is that really true? Listen in for a discussion with David Brevda, Esq., Partner, Senior Justice Law Firm, and Robyn Grant, Director of Public Policy at Consumer Voice about how complex facility practices and resource allocation, combined with a lack of minimum standards, put residents at risk for poor care and bad outcomes; as well as recommendations for addressing these problems.

Resources: Senior Justice Law Firm | David Brevda Bio | Consumer Voice Report: State Nursing Home Staffing Standards

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The most significant nursing home reforms in decades were announced in February 2022. The reforms include the creation of a minimum staffing standard in nursing homes, accountability for poor performing nursing homes, increased transparency around ownership and finances, and support for direct care staff. These reforms are critical and urgently needed to address the inadequate conditions many residents face in their day-to-day lives. 

In this episode we continue our conversation with long-term care residents about the importance of these reforms. We speak with two residents to discuss the problems they face in their day-to-day lives from inadequate staffing, the ways nursing home ownership has impacted their lives throughout the pandemic, as well as what can be done to improve their lives in long-term care.

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In this episode, we take a deeper look at the Biden Administration's nursing home reforms, announced on February 28, 2022. These reforms include the most significant improvements to nursing homes in decades.

We are joined by Sam Brooks and Jocelyn Bogdan of Consumer Voice, who break down the five categories of the reforms including (1) Ensuring taxpayer dollars support nursing homes that provide safe adequate, and dignified care; (2) Enhancing accountability and oversight; (3) Increasing transparency; (4) Creating pathways to good-paying jobs with the free and fair choice to join a union; and (5) Ensuring pandemic and emergency preparedness in nursing homes. These reforms are critical to addressing the inadequate conditions many residents face in their day-to-day lives. 

Resource: Summary of the Biden-Harris Administration Nursing Home Reforms

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On February 28, 2022, the Biden Administration announced it would be implementing new nursing home reforms including the creation of a minimum staffing standard in nursing homes, accountability for poor performing nursing homes, increased transparency around ownership and finances, and support for direct care staff. These reforms are critical and desperately needed to address the inadequate conditions that many residents face in their day-to-day lives.  

In this episode, we speak directly with two long-term care residents, in Texas and Ohio, about the importance of these reforms, the problems they face in their day to day lives from inadequate and untrained staff, and what other improvements they would like to see that would help improve their lives in long-term care.

Resources

• Inadequate Staffing During the COVID-19 Pandemic and Its Catastrophic Effects on Nursing Homes Residents
• Staffing in Nursing Homes
• March Forth Together
• COVID-19 in Long-Term Care Facilities

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The pandemic has renewed concerns about the quality of care that residents receive in some nursing homes, and many family members have reported significant decline in the condition of their loved ones. Neglect and abuse of older adults is a long-standing problem that is under-reported and has not received the necessary attention and response from policymakers, yet it results in needless and preventable suffering and harm.

In this episode with Dr. Laura Mosqueda, a professor of Family Medicine and Geriatrics at the Keck School of Medicine at the University of Southern California, we talk about neglect, which is the failure to provide goods and services to an individual that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Neglect may or may not be intentional. 

Resources

• Consumer Fact Sheet - Nursing Home Neglect: Preventing It and Getting Help
• Video

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On November 12, the Centers for Medicare & Medicaid Services (CMS) issued updated Nursing Home Visitation Guidance. Because of the high rates of vaccination among residents and the new vaccine requirement for staff, as well as the reduced number of new COVID-19 cases each week, visitation is now allowed at all times for all residents, this includes indoor visitation. In this episode, Jocelyn Bogdan from Consumer Voice goes through the updated guidance and talks about what rights residents of nursing homes have.

Resources:

• CMS Revised Nursing Home Visitation Guidance, updated November 12, 2021
• Consumer Voice Summary of the Guidance

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In this episode we are sharing with you a discussion that was held on Facebook Live around residents' rights in nursing homes. Lori Smetanka, Consumer Voice’s Executive Director, and Jocelyn Bogdan, Program and Policy Specialist at Consumer Voice talk about what impact COVID-19 has had on residents and their exercising of rights, they also provided an overview of residents' rights that exist in federal law. 

Resources:

• Residents' Rights Month Resources 2021
• Residents' Rights Fact Sheet
• Limitations on Visitation and Daily Activities Negatively Impact the Lives of Nursing Home Residents: A Survey of Residents
• Limitations on Visitation Continue to Harm Nursing Home Residents: A Survey of Residents' Families
• Avoiding Drugs as Chemical Restraints Consumer Education Campaign
• Know Your Drugs & Know Your Rights Questions to ask your care provider and a list of drugs often used as chemical restraints
• Locate a Long-Term Care Ombudsman

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Before COVID-19, Mary Daniel would head to the long-term care facility where her husband resided every day after work and spend the evening with him. When facilities were locked down in March, family members were not allowed in, and residents were left without many of the essential supports that family members provided. In this episode we will hear Mary’s story about how she advocated to be reunited with her husband, the national movement she founded, and talk about what we all can do to make a difference today. 

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When facilities tell residents and their families that they are "not a good fit" or encourage antipsychotic medications, often families feel pressured and aren't sure how to advocate for their loved ones. In this conversation, we first hear from Kathy, a family member who went through this experience with her mother. We then speak with Tony Chicotel from California Advocates for Nursing Home Reform (CANHR), about steps family members can take, the specific rights nursing home residents have, and how families can work with facilities to ensure their loved one receives quality long-term care.

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In recognition of World Elder Abuse Awareness Day (WEAAD), this webinar from the National Long-Term Care Ombudsman Resource Center (NORC) discussed how to identify and respond to signs of trauma and potential abuse or neglect and support residents as Ombudsman programs resume in-person visits during the COVID-19 pandemic.

Dr. Laura Mosqueda, a national and international expert on elder abuse and neglect, provided tips for Ombudsman programs conducting in-person visits, such as signs of trauma in response to isolation and loss during the pandemic and potential signs of abuse and neglect. She also shared recommendations for supporting residents and available resources. As an accomplished physician and researcher, Dr. Mosqueda has testified in front of Congress and has been invited to the White House several times to discuss elder justice initiatives. She has taken the lead on landmark studies to identify forensic markers of abuse and neglect and serves as a volunteer representative for the California Long-Term Care Ombudsman program.

Attendees also heard from two Ombudsman program representatives as they shared their experience resuming in-person visits and highlighted what they observed upon reentry, how they supported residents, tips for visits, lessons learned, and successful practices.

Resources: PowerPoint | Creating Your COVID-19 Person-Centered Description and COVID-19 Passport

Guests: Dr. Laura Mosqueda, Professor of Family Medicine, Keck School of Medicine of  University of Southern California (USC), Keck School of Medicine of USC operates the National Center on Elder Abuse (NCEA); Karen Jones, Chair, National Association of Local Long-Term Care Ombudsmen (NALLTCO), Executive Director/Program Manager Long-Term Care Ombudsman Services of San Luis Obispo County, California Long-Term Care Ombudsman Program; and Jane Brink, Regional Ombudsman, Minnesota Long-Term Care Ombudsman Program, Member of National Consumer Voice for Quality Long-Term Care Leadership Council, and NALLTCO Board Member

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In this conversation with Consumer Voice learn about how residents, families, and advocates can use guidance from the Centers for Medicare and Medicaid Services (CMS) to facilitate in-person visitation. While the new guidance expands visitation, many residents and families still have questions and concerns. After providing a brief overview of the CMS guidance, we discuss several of the most common issues, including strategies and tips for applying the guidance to help open nursing home doors. This conversation also covers the recent guidance from the Centers for Disease Control and Prevention (CDC) that limits when residents should be quarantined.

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When the needs of residents living with dementia are met, incidences of resident stress are significantly reduced. Practicing person-centered approaches and interventions increase the likelihood that the message being communicated by the resident will be heard and addressed, leading to better outcomes and more satisfaction for the individual. Join our conversation with Dr. Jonathan Evans as we talk about caring for human beings with dementia. 

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On March 13, 2021, it will be one year since the Center for Medicare & Medicaid Services (CMS) issued an order preventing everyone but essential healthcare workers from entering facilities. To date, despite some loosening of visitation restrictions, tens of thousands of residents have still not seen their families and loved ones in person. Chronic short-staffing of nursing homes that plagued facilities before the pandemic has gotten worse, with almost 1 in 5 facilities reporting staff shortages in aides. As a result, the lockdown has resulted in many residents suffering from isolation and neglect. 

In late 2020, The Consumer Voice conducted an informal survey of families that had visited with their loved ones to learn how the lockdown has impacted residents' condition. The overwhelming response was that families met residents who had experienced significant declines in their physical and mental health. In this episode of the Pursuing Quality Long-Term Care podcast, Sam Brooks and Lori Smetanka of Consumer Voice will discuss the survey results and Consumer Voice’s call to safely reopen facilities so that families can provide necessary care and support to residents.

Resources: The Devastating Effect of Lockdowns on Residents of Long-Term Care Facilities During COVID-19: A Survey of Residents’ Families

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In March of 2020, as COVID-19 was spreading through nursing homes at alarming rates, nursing home doors were closed to outside visitors, keeping out families, friends and other members of the community. At the same time, most residents were required to stay in their rooms, doors often shut, having little contact with others. A survey of nursing home residents by Altarum provides a look at the impact of these restrictions on those living in the facilities, and the toll it has taken on their physical and emotional health. This discussion features Anne Montgomery and Sarah Slocum, Co-Directors of Eldercare Improvement at Altarum.

Resources: Altarum Report: Experiences of Nursing Home Residents During the Covid-19 Pandemic Report

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Residents of nursing homes have rights that are guaranteed by the federal Nursing Home Reform Law. The law requires nursing homes to “promote and protect the rights of each resident” and stresses individual dignity and self-determination. A person living in a long-term care facility maintains the same rights as an individual in the larger community. Under the federal Older Americans Act (OAA) every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system. Ombudsman programs help residents, family members, and others understand residents’ rights and support residents in exercising their rights guaranteed by law. Most nursing homes participate in Medicare and Medicaid, and therefore must meet federal requirements, including facility responsibilities and residents’ rights.

Join us for a conversation with Beverley Laubert, Ohio State Long-Term Care Ombudsman, and Patty Ducayet, Texas State Long-Term Care Ombudsman, to discuss resident rights, the role of the Ombudsman program, and how residents can advocate for their rig