Month: October 2012

Q. How do you manage the ABN notice when a resident refuses therapy for three days?

A. CMS has clarified that an Expedited Review notice is not required when Medicare ends due to therapy refusals. If the resident is going to remain in the facility, give them the SNFABN (or Denial Letter), whichever you are using. This only needs to be given on or before the last covered day of Medicare. When a resident is refusing therapy, don’t forget to discuss and evaluate the reason for refusal. It’s important to be sure that the resident elects to end Medicare and that the refusals are not because we didn’t accommodate their choice for therapy scheduling. (Reference: www.aanac.org)

The passion that leads a person to start a business (think Ensign Group) … that thing you would do (therapy) regardless of monetary compensation (and I realize that for some, money itself — or the pursuit of it — is that passion) … that thing that makes your heart beat fast … is the work you should be doing. The work you do that fulfills you and gives — rather than depletes — energy is the ultimate goal. Yes, goal. It’s the “continuing” that matters, not what you accomplish “one day,” but what you do every single day.

Do you need intermittent goals, milestones, and — for lack of a better term — work breakdown structures to focus your energy and provide that sense of completion that is so gratifying and stress-reducing? Absolutely! But the true value of work is in its continuity. One of the greatest human fears is the fear of dying (fear of falling is also very high and can sometimes lead to dying, but I digress). The opposite of dying is continuing. Therefore, continuing to be productive is one of the healthiest things you can do for yourself. Successful people will tell you that the key to winning is simply to persist. It is the same for productivity; arguably, to be productive is to win.

You don’t have to be brilliant, wealthy, high-profile or well-connected to follow your passion. Everyone should do it. If your energy goes up when you go to work, you’re in the right place. If your energy goes down on the way to work, you are wasting your time, which means you are wasting your life. Time is the only real resource. You can always make more money, but you can never make more time. You don’t have to suffer a massive or public failure to wind up in a pool of stagnation. I’m reminded of the parable of the frogs: The ones thrown into a boiling pot of water jumped out immediately; the ones put into cool water that was slowly heated up over time boiled to death.

Pay attention to your passion. Work is where we spend the majority of our time. Work is what defines our lifestyle. It is critical to align your work with your passion — even if your passion changes. It takes courage to change, especially as we age and become secure in many aspects of our lives. But pay attention to the temperature of the pot you are sitting in. If you can change, you won’t die (metaphorically speaking), and what you risk is living the full blaze of your passion.

by Jon Anderson, Therapy Resource

As a rehab-providing entity, we must consider our future clientele and how they tend to make health decisions. Undoubtedly, we will face a different mindset than that of the patients whom we are currently treating. Whereas the current pre-baby-boomer generation does not like to exercise or maintain healthy habits, the baby boomers take a much different approach to self-care. These boomers, born between 1946 and 1964, soon will dominate the healthcare arena. As such, we will need to adapt our current way of doing business in our skilled setting to the changes ahead.

There are 76 million baby boomers who are partly responsible for the huge economic growth of the 1990s. According to the National Association of Area Agencies on Aging, these seniors control more than 70 percent of the country’s disposable income. Baby boomers are upbeat about their future, and they expect to live better and longer lives than the previous generation. The U.S. Census Bureau predicts that boomers will turn 65 years of age at the rate of 10,000 per day for the next decade. These Americans will live longer and healthier lives than any older generation in history, according to Donna Shalala, the President of the University of Miami and a former U.S. Secretary of Health and Human Services during the Clinton administration.

How will these changes affect us in the skilled nursing and rehab industry? Most boomers are confident about their financial futures and their ability to afford long-term care. Many in this generation also feel confident that they will be able to maintain their health for a longer period of time. They enjoy physical activity. A new breed of seniors-only fitness centers has emerged, catering to this specific demographic. This upcoming generation of seniors chooses to avoid the young gym crowds, with loud music and a frantic and noisy atmosphere, in favor of a more mature and gentler approach. These new senior centers have easy-to-use hydraulic equipment and softer music and are far less intimidating. According to the U.S. Health Club Industry, the number of boomers running in marathons has doubled over the past few years. These seniors have new living goals and are looking for more professional help in various medical areas. They are seeking osteoporosis consultations; advice on exercising, reducing cholesterol and alleviating joint pain; and information on gaining better overall strength, flexibility and balance. They want to have a better quality of life in their golden years.

Meanwhile, according to the U.S. Preventative Services Task Force (USPSTF),seniors 65 years of age and older are at great risk for falls. One in three of all non-institutionalized seniors will fall in any one-year period. This is significant. The leading cause of loss of independence and death as a result of a disability is a fall. The number of potential patients due to falls will only increase due to boomers living longer and being more active.

These facts lead to the question: How can boomers and Ensign benefit one another? As a healthcare leader, the Ensign organization has already branched out into various healthcare-related industries with good success. It would seem logical that Ensign should take advantage of this huge opportunity to cater to these seniors’ healthcare needs by creating an outpatient program emphasizing fitness and utilizing our rehab expertise. By demonstrating a professional approach to seniors, we can create a buzz in the community and establish a natural client of the future, while also potentially generating new revenue.

As therapists, we are responsible for creating a vision for the future of our rehab departments. With the constant changes to Medicare and an uncertain healthcare insurance future, we need to be thinking about how we can continue to provide needed services that can attract potential customers. By offering free community health screens, tips on nutrition and exercise, as well as advice on healthy lifestyles, we can become familiar to our community at large. By allowing potential patients to see our facility, who we are and what we provide, we increase the chances that those who need future total knee replacements will request to receive their skilled rehab services at our facility.

The beginning of this journey should start with a simple outpatient program. Determining what it takes to get an outpatient license is the first step. Usually a few simple modifications to any inpatient rehab department is all that is required. An inquiry to the local or county licensing agency will begin the process. Most modifications can be facilitated without a large investment. We are not asking each facility to establish an independent outpatient facility that could cost hundreds of thousands of dollars to start up. We are talking about taking what you already have, making some required changes and establishing an afternoon outpatient program. Do not be afraid to fail your initial inspection, as this will just provide you with the exact insight as to what needs further modification in your facility. Once you are licensed, all that is required is some basic equipment and some knowledge.

We have a natural referral source: ourselves. How many of your patients have inquired about coming back to your facility for their outpatient care? We would just be allowing them to return to a staff and a system with which they are already familiar. You can even be selective as to whom you let return as an outpatient. This allows you to become familiar with the system and grow at a comfortable pace. There is no limit to how many potential patients could be referred or contracted once you are established. A good program should be able to accept at least one new patient per day.

Another source of potential patients for a Skilled Nursing and Rehab Facility is an Assisted Living Facility. Some, even within our own company, have assisted living facilities attached or within close proximity to their skilled facilities. How many potential patients are within an arm’s length? Establishing a protocol that would allow screens, consultations and instructional programs to a high-risk group, such as seniors in an assisted-living facility, could prove to be beneficial for all parties involved. We should be excited about solidifying relationships with assisted living facilities in our community by being a valuable source of prevention and rehabilitation expertise. This could naturally lead to an easy referral from assisted living clientele that are already familiar with their local Ensign facility.

Website design is also an easy way to attract potential patients. Boomers are becoming much more computer-savvy and can “Google” or “Bing” as easy as looking at a phonebook. Websites that are facility-specific with pictures of the actual facilities and actual staff give seniors a chance to get a look at “the old folk’s home down the street.” A “virtual” tour can be just as valuable as an actual facility tour. We just need a chance to break them of their outdated thinking as to what we are as an Ensign building and as a skilled rehab facility.

The growth potential of Ensign and of outpatient services is limitless. By working to meet seniors’ needs in areas related to more than just inpatient services, we ensure that Ensign can continue to be a viable and growing company for many years to come.

by Peter Jens Brandt, DOR, Premier Care Center, Palm Springs, CA