One of the biggest areas of concern and risk DONs face nationwide is the difficulty of recruiting and retaining quality, compassionate long-term caregivers. It can be demoralizing to bring in the “perfect” employee, spend weeks training them, and then have them leave for a position at a neighboring home.

CMS also understands the impact of staff instability, and they are focusing on this area from a quality perspective. Because the more familiar our caregivers are with the residents, the better the care will be.

I don’t know about you but I don’t like small appliances that only do one task. Don’t buy me an appliance if it isn’t multi-functional or I'll return it! So why should reports be any different?

As with anything in life, there is good news and bad news about reports. First, the bad news. We have more reports that tell us more about our centers than we sometimes care to know. CASPER, PB&J, Quality Measures, 5-star, wound logs, fall logs, pharmacy, 24 hour, RUGs/PPS/MDS, weight loss, rehospitalizations, infection control...the list just goes on and on!

If your community is a three- or four-star facility, you may well have it in your DNA to make the leap to five-star status. And if you're a one or two star, maybe it was just bad luck that got you demoted—just a bad survey or an unfortunate resident fall. Hope is a great attribute, but it's not a strategy. As Thomas Jefferson said, “I’m a great believer in luck, and I find the harder I work the more I have of it.”

So if you want to achieve a five-star rating, you do have an opportunity to do that! Everyone wants to be a five-star, and it should be a real goal. But how can you get there? The truth is that you and your team have to do a thousand things a day (seriously) really well. But the two most critical areas where you can drive results are staffing adequately for acuity and professionally managing adverse events.

In a recent McKnight’s article, a registered nurse in Canada took to social media to air her frustrations over a relative’s skilled nursing care. As a result, she was found guilty of professional misconduct by a nursing organization. The nurse’s grandfather was a resident at a long-term care center, receiving end-of-life care. The nurse felt the center should have provided a higher level of resident-centered palliative care to improve his end of life.

It’s the most wonderful time of the year...unless you're responsible for ensuring your residents are provided with appropriate staffing during the holidays! Then it might not be so wonderful, right? As an administrator, I remember meeting every morning with the management team and the first question was always, “How is staffing for the weekend?” or, “How is staffing for the holidays?”

These are high-risk times for senior living centers, and there is no way to avoid it. But there may be some ways to encourage caregivers to “show up” for work, or even “volunteer” for extra shifts.

In a report by the OIG, in 10 sample states, inadequate staffing levels were identified as one of the major problems in nursing homes. This problem is nothing new, and it's no secret among assisted living communities. The real secret seems to be how to make sure you have adequate staffing to reduce adverse events and fall-related injuries.

In long-term and post-acute care communities, hiring good nurses is only one step towards success. The challenge is often keeping great caregivers once you have them.

High staff turnover is a frustrating and costly reality for many senior living communities. Not only does it cost you time and money to train and retrain staff as they come and go, but a lack of consistency in nurses and caregivers can make residents and their families — and even other staff — feel uneasy.

For these reasons, keeping your staff from leaving should be a priority. But if you’re already offering them good pay and benefits, what else can you do?

It appears that Medicare/CMS is planning to start a game with our skilled therapy services. What does this mean? Basically it means that you as a person or resident will not be important, but rather you as a diagnosis will drive the care Medicare will pay for.

If you're familiar with DRGs, you will recall the uproar that happened when a patient’s diagnosis was the only driver of hospitalization, care, and payment. This is similar to that payment model.