Take the lead with LeadingAge PA fall education programs

As in previous years, back-to-school time brings with it a full slate of educational events. We have a variety of programming scheduled this fall that we hope you and your staff will find worthwhile.

COOs and human resources professionals will want to join Brandon Williams, Associate at Capozzi Adler, P.C., when he presents a webinar on Recent Developments in Labor Law and National Labor Relations Board on Sept. 29.

If you’re responsible for compliance, then you won’t want to miss our Oct. 5 webinar, CCRC Compliance Issues Arising from Recent Pennsylvania Insurance Department Examinations, presented by Dayna Mancuso and Kimber Latsha from Latsha Davis McKenna, P.C.

Back by popular demand, we will be hosting two active shooter training sessions: Thursday, Oct. 6 at Tel Hai Retirement Community in Honey Brook, and Friday, Oct. 7 at Masonic Village in Sewickley. Prepare & Survive: Armed Intruder and Active Shooter Scenarios in the LTC Environment will be an interactive program presented by Dan Wilder, Director of Professional Services at Sorensen Wilder & Associates.

LeadingAge PA revamps and expands its annual financial issues seminar to offer a two-day conference, Confronting the Challenges of Change, Nov. 16-17 at Masonic Village, Elizabethtown. This conference includes keynote presentations and education sessions showcasing forward-thinking ideas and innovations on topics like technology, reimbursement and contracting, respositioning, financial and organizational benchmarks, and emerging trends.

We also offer several webinars that are free for LeadingAge PA members. For more information and to register for any of our events, visit our Education Calendar at www.leadingagepa.org.


How do we ensure our aging population is served?

By Ron Barth, President & CEO

There’s been no shortage of conversations lately about what defines a good nursing facility versus a bad nursing facility. Everyone has an opinion and a story to tell, but we need to remember the complexity of this issue when conversations get heated.

We represent not-for-profit providers of services for older adults. Not-for-profit nursing facilities on average have fewer deficiencies, higher staffing and generally provide a higher quality of care. Knowing that makes it harder to accept that a minority of nursing facilities in Pennsylvania are chronically bad and should be eliminated, however, it’s not that simple.

We have a crisis on our hands concerning how we will ensure that our aging population will be served. Simplistic solutions will not work. It is not enough to say we should increase regulations or increase fines. Assuring quality and funding services is a multifaceted problem.

The current survey system, which has been in existence for 30 years, is not effective. It focuses on process instead of outcome. The emphasis of the survey is to see if the facility violated any of the thousands of regulations affecting nursing facilities. The fact of the matter is that there is no facility, no matter how well run, that can possibly be in 100 percent compliance with the thousands of regulations 100 percent of the time.

What the survey system does not do is focus on outcomes. Resident outcomes are the most important thing to review when it comes to nursing facilities.

If the survey system focused on outcomes, surveyors could visit each facility not one time a year, but two or three and look at the outcomes of a random selection of residents, do a walk through to make sure the facility is clean, and watch the interaction between the staff and residents. If the surveyors are pleased with what they witnessed, they can move on to the next facility. However, if those same surveyors note resident care problems, then a more intense facility review needs to take place. In other words, spend 80 percent of surveyor resources on the 20 percent of facilities that are the most problematic and 20 percent of the surveyor resources on the other 80 percent.

As the conversation takes place on the state and federal level, it is important to keep staffing and Medicaid funding top of mind. These two issues have a correlation to the quality of care in a facility.

Nothing has a more direct impact on quality of care than a sufficient and well trained staff. In fact, government statistics show that not-for-profit facilities staff significantly higher than for-profit facilities. In fact, not-for-profits staff on average 4.7 hours per day per resident.

Sixty-five percent of residents’ care in nursing facilities is paid for by the Medicaid program. Yet study after study shows that Medicaid pays far less than the actual cost of care. This has to be made up by charging private paying residents more than their fair share, which ironically, forces them to deplete their resources sooner and go on Medicaid.

Medicaid pays an astounding $22-$25 per day less than the actual cost of care. And it is getting worse. Once again, the PA budget failed to increase Medicaid funding for nursing facilities despite rising costs. And the result is that facilities cannot pay competitive wages and benefits for staff.

Rest assured that the team at LeadingAge PA has been and will continue to be involved in the conversations that hopefully will lead to positive changes for our aging population. 

Insights from our Intern: Workforce Development Boards and the Reality of Staff Turnover

As a summer intern at LeadingAge PA, one of the projects I was assigned was to conduct and assemble research on workforce trends within the field of long-term care. Early into my research I came across a 2009 article published by the Westmoreland-Fayette Workforce Investment Board. The article described an innovative certified nurse aide (CNA) training program that LeadingAge PA member Redstone Highlands Communities took part in. This program – funded by the Westmoreland-Fayette Workforce Investment Board – went above and beyond standard CNA training by using partnerships with universities and other health care agencies. Like many others, I assumed that taking a special interest in employees and giving them advanced training would reduce turnover. Although my information was dated, I thought I had found an innovative solution to a problem plaguing the senior care field.

Continuing my research, I came across the Workforce Innovation and Opportunity Act of 2014, referred to as WIOA. WIOA builds upon legislation passed in the Clinton administration and is aimed at cultivating America’s workforce through the use of Workforce Boards. WIOA changed the name of Workforce Investment Boards to Workforce Development Boards; however, not all Workforce Investment Boards have adopted this new title. In the context of this blog, the two are synonymous.

As defined by the PA Workforce Development Association, “Workforce Development Boards (WDBs) are regional entities whose main role is to direct federal and state funding to workforce development programs in their regions.” Furthermore, every community in the commonwealth is represented by a regional Workforce Development Board.

I had exhausted the information I could find online about workforce development boards and the benefits of senior care facilities collaborating with them, so against my millennial tendencies I picked up the phone and called Redstone Highlands. I was put into contact with Jim Hodge, VP of Human Resources. Mr. Hodge was responsible for orchestrating the 2009 CNA training program that I’d read about. As a long-time board member of the Westmoreland Investment Board Mr. Hodge has fostered a great relationship with them.

I was ready for Mr. Hodge to tell me about the great success he’s had working with his regional Workforce Board. Instead, he very patiently described to me that the program I had read about was one of many programs Redstone Highlands had run over the years. He also explained that despite the advanced training the CNAs in that program received, they had turnover rates similar to CNAs who received the standard training. Regretfully, that program is no longer in existence.

What Mr. Hodge presented me with was a realistic view of what it takes to reduce turnover. It takes time and the willingness to try training programs to see what works best for your organization. Most importantly, it does not happen overnight. It takes hard work and a lot of inter-organizational reflection to determine how your company needs to address turnover.

In 2001, Redstone Highlands had a turnover rate of 75 percent. After countless programs and strong top management, they have reduced their turnover rate to about 24% with the ultimate goal of getting their turnover rate in the single digits. Redstone Highlands’ most recent initiative is to support and educate their leaders through an in-house program called Redstone University. In turn, their leaders support the frontline staff.

Unfortunately, my original assumption that advanced CNA training always leads to decreased turnover rates was not correct. Every organization is different and, therefore, must take a slightly different approach towards how they recruit and retain their direct care staff.

Although I can’t offer a one size fits all solution, I can offer some strategic knowledge. The Workforce Investment and Opportunity Act of 2014 is still early in its implementation, and President Obama has mandated funding for it through 2020. As the prominent workforce issues of the senior care field are increasingly becoming recognized by governing bodies it may prove beneficial to establish a relationship with your regional workforce development board. Although the funding is largely inconsistent and not currently geared toward health care, if senior care workforce issues continue to gain traction then government funding could very well be directed toward healthcare before the cut off in 2020.

There is a Workforce Development Board in every region in PA so every senior care facility has the opportunity to make this strategic partnership. Although advanced CNA training was not the answer to Redstone Highlands retention issue, it was still beneficial because it helped them discover the issue they needed to address. Identify your regional Workforce Development Board and contact information here:


About the author

Shaun Smith (https://www.linkedin.com/in/shaun-smith-79b189126) recently began his senior year at Shippensburg University where he majors in public administration. A member of the swim team, he has an excellent academic record and has earned honors as a scholar athlete. Shaun conducted his internship at the LeadingAge PA office in Mechanicsburg from May to August 2016 and provided valuable insight and practical experiences to the LeadingAge PA team as they continue to work through the development of scholarships and new workforce initiatives.


2015 AIT scholarship success stories

As the application process for the 2016 Administrators in Training (AIT) scholarship concludes and the selection process for the next class of AIT recipients begins, we would like to take time to reflect on the success of the 2015 AIT recipients.

We at LeadingAge PA are happy to report that the 2015 AIT trainees from Redstone Highlands Communities and Abramson Center for Jewish Life have completed their AIT program. Both trainees have gone on to obtain administrative level positions at their respective communities, where they have excelled. Predicated on communications from Allegany Lutheran Social Ministries and WRC Senior Service, we are confident that their AIT trainees will find similar success upon the completion of their training. We would like to congratulate the trainees on all of their accomplishments and thank them for their dedicated service to bettering the quality of senior care in Pennsylvania.

The vision of the AIT scholarship is to support the current and future senior living field by enhancing the professional experiences and inciting the passion for servant leadership in future nursing home administrators through a sustainable program to support administrators-in-training in the commonwealth.

The success of the AIT program is measured by two key metrics. The first metric is the professional development of a well-qualified Nursing Home Administration staff in PA. The consensuses of all parties involved in the 2015 AIT program is that the AIT scholarship program has been, and will continue to be, a great tool in developing professional experienced administrators. As Rebecca Young, VP of Human Resources, at Allegheny Lutheran Social Ministries stated,

“It has been a great experience for us and him [Jeremy Schrader AIT trainee]. I am glad LeadingAge Pa is continuing to offer this program as I believe it will help combat the lack of well-trained NHAs in PA.”

The second metric is to develop industry leaders who are not just qualified but deeply ardent about senior care. It is these leaders who cultivate the vison of the AIT program and turn it into reality. Through sharing their experience with LeadingAge PA, we learned of the passion the AIT program instilled in its participants. In the words of Chelsea Wolfe, Redstone AIT trainee,

“This opportunity has validated my passion for senior care and because of this, I will be continuing my career as an administrator in a continuing care retirement community.”

Chelsea’s testimony is encompassing the overwhelmingly positive feedback that AIT trainees and AIT awardees have given LeadingAge PA. Concurrent with the vison of the AIT program and the feedback received, LeadingAgePA plans to sustain this scholarship well into the future. Thanks to those of you who have submitted their 2016 AIT scholarship application. You will be notified of your acceptance status by August 5, 2016.


Leading the way through education – nine LeadingAge PA webinars this summer

One of the best things about participating in a LeadingAge PA webinar is how easy it is to get relevant, timely information without leaving your office. This summer, we make it easier than ever by offering nine webinars on important issues. Six of these webinars offer one continuing education credit hour each; three are free for LeadingAge PA members. That’s nine opportunities to learn about accounting, end of life care, patient safety, risks of caring for seniors at home, successful dementia environments, and more.

LeadingAge PA’s webinars are led by top experts who are focused on the senior services and supports field and who understand the challenges you face each day. As a leader in the aging services field, you know you must adopt high-performing systems and methods and remain agile in the shifting marketplace and the consumer. By attending these webinars, you’ll find what you need to keep your organizations transformative.

Webinars this summer include the following:

  • July 19 – Update on New Accounting Pronouncements, Michael F. Garczynsky, CPA, partner, Arnett Carbis Toothman, LLP, presenter. Free for members.
  • July 21 – The ABCs of Tax-Exempt Finance, Peter Wilson, senior associate, Latsha Davis & McKenna, PC, presenter.
  • August 9 – Passing the Last Torch: Transitions of Care for End of Life Patients, Heather Zinzella Cox, MD, medical director, Optum, presenter
  • August 11 – The Patient Safety Movement, Quality Initiatives and Value Based Purchasing: Implication for LTC Providers, Kimber Latsha, managing partner, Latsha Davis & McKenna, PC, presenter
  • August 25 – Findings from Research: Key Features of Successful Dementia Environments, Emily Chmielewski, senior design researcher and associate, Perkins Eastman. Free for members.
  • September 8 – Nursing Home Reform Again – Analyzing the Proposed Changes to the Requirements of Participation, Tanya Daniels Harris, associate, Latsha Davis & McKenna, PC, presenter
  • September 14 & 21 – Aging in Place: Managing the Legal and Risk Management Pitfalls of Caring for Seniors at Home, a two-part webinar, Laurie Dietrich, risk control specialist, Murray Securus, Daniel Liebeman, Esq., Devine Law Offices, LLC, and Darlene King, Esq., Saxton and Stump, LLC, presenters
  • September 15 – Talent Management Approach to Strategically Developing a Sustainable Volunteer Program, Melissa Swartwood, director of life enrichment and volunteer services, Wesbury United Methodist Community, presenter. Free for members.
  • September 29 – Recent Developments in Labor Law and National Labor Relations Board, Brandon Williams, Esq., associate, Capozzi Adler, PC, presenter

Take advantage of these education opportunities from your association. Find more information about these webinars and registration details at www.leadingagepa.org/takeaction/engagement/educationcalendar.



Leading the way through education

LeadingAge PA offers nine webinars this summer


Why reposition your organization in the market? Count the reasons

Long-term care facilities have historically struggled to balance marketability and financial stability. Demographics and expectations shift, and payment methods change, and that changes where your organization stands in the marketplace. Community HealthChoices, the Department of Human Services’ program to deliver Medicaid funded long-term services and supports through a managed care system, will be implemented in three phases beginning Jan. 1, 2017. If you’re a Medicaid provider, this will make the struggle even more difficult. Now is the time to develop a strategy to reposition your organization.

Numerous factors make repositioning necessary. Referral sources may change, and your census declines. The market may change simply because of population changes. A large endowment could mean you have the means to make physical plant changes. Because of a merger or acquisition, the affiliation of your community may now be different, and there may be a different focus. How you reposition could mean something as complicated as development or redevelopment or adding new technology. Or it could mean something less tangible like rebranding your organization and making program changes.

By attending one of LeadingAge PA symposiums, Four Keys to Repositioning Your Organization, on Wednesday, April 27, 10 a.m. – 3:00 p.m., at Masonic Village in Sewickley or Wednesday, May 11, at RLPS Architects in Lancaster, you’ll explore some repositioning strategies and what would work for you and your organization. The discussion focuses on the importance of a construction priority program and existing inventory, essential ways marketing supports repositioning, culture change and renovation, decentralizing dining in existing skilled nursing communities, repositioning design trends, and repositioning wellness programs.

 You’ll explore best practices, examine market data, and evaluate the range of opportunities. Spend a day examining options for the future stability of your organization.  Community HealthChoices will have an impact, so start learning now how to position your organization. Register here.

Gov. Wolf’s budget plan addresses priorities to help Pennsylvania’s oldest citizens

By Ron Barth

Good news seems hard to come by when it comes to passing state budgets in Harrisburg. It’s no secret to anyone that Pennsylvania has yet to pass its budget from fiscal year 2015-16.

It will certainly be interesting to see if the Pennsylvania General Assembly and Gov. Tom Wolf can come to agreement on the few items remaining from last year’s budget, but the wheel never stops turning in Harrisburg. On Feb. 9, Gov. Wolf introduced his 2016-17 state budget, and LeadingAge PA is pleased with what we see.

In a Feb. 18 letter to Gov. Wolf, I wrote:

“We recognize the difficulty in achieving the right balance with any given budget proposal. We are most appreciative that the expansion of the sales tax contained in the 2016-2017 proposal does not include any long-term care services and supports or settings, such as continuing care retirement communities, where older Pennsylvanians may choose to live.

“We also congratulate you on the continuing commitment to the long-term services and supports system included in the Department of Human Services budget – specifically the funding to serve more individuals in home – and community-based programs, nursing facilities and the LIFE program, as well as the expansion of the LIFE program to five additional counties. We also very much appreciate the modest rate increase for nursing facilities that care for some of the sickest, poorest seniors in our state.”

For more information on the budget, please see our video blog featuring Anne Henry, LeadingAge PA’s senior vice president and chief government affairs officer.

Of course, Gov. Wolf’s proposal is just that – a proposal. We expect it will take some time before the governor and the legislature can come to agreements on both budgets, but there are things you can do to help. That starts with contacting your local state legislators. Call them. Email them. Set up face-to-face meetings. The more they hear from us, the more they’ll see how important it is to pass Gov. Wolf’s budget plan that addresses our priorities to help Pennsylvania’s oldest citizens.

As always, let us know if we can assist you with your outreach. We’re always happy to help.

Pennsylvania’s transition to Community HealthChoices

By Ron Barth, LeadingAge PA president & CEO

The biggest change to health care since the advent of Medicaid and Medicare is on the way to Pennsylvania. Starting next year, Pennsylvania will change the way it distributes Medicaid payments to providers of long term services and supports. We will transition to a program called Community HealthChoices which is more generally known as Medicaid Managed Long Term Services and Supports, or MLTSS.

We know what and how Medicaid works today, but what exactly is MLTSS? The federal agency responsible for administering the Medicaid program explains it like this:

“Managed Long Term Services and Supports (MLTSS) refers to the delivery of long-term services and supports through capitated Medicaid managed care programs. Increasing numbers of states are using MLTSS as a strategy for expanding home- and community-based services, promoting community inclusion, ensuring quality, and increasing efficiency. The number of states with MLTSS programs increased from eight in 2004 to 16 in 2012, and the Centers for Medicare & Medicaid Services have experienced increasing interest from states in the form of concept papers, waiver applications and requests for technical assistance.”

There are so many facets to MLTSS that need to be explored and evaluated before it’s here that we can’t delay in educating those who will be most affected and advocating those who make policy decisions.

First and foremost, we need to be very careful that we put in a system of managed care, rather than a system that simply manages and cuts costs.

For years, nursing facilities have been subject to a rate-setting formula that determines the fair rate – neither the highest nor the lowest – that is necessary to provide quality care for Medicaid eligible residents. However, for budgetary reasons unrelated to quality or fairness, the rate has randomly been reduced each year by a Budget Adjustment Factor because of state budgetary constraints.

Managed care, if done properly, should allow rates for various services to be sufficient to provide quality services without arbitrary reductions. Savings should be provided by managing care – by getting people the right service at the right time in the right setting.

With implementation slightly less than a year away for Southwest Pennsylvania, we need to learn as much as we can from states that have gone through this program change and be prepared to refine the program here so any initial, unintended consequences do not occur in the subsequent implementations around the state.

There is much promise and opportunity in this program if it is done appropriately. We simply need to continually ask if the health care needs of our seniors and people with disabilities are being fulfilled.

Rest assured, LeadingAge PA will continue to monitor the important details of MLTSS and work to create a successful program that meets the needs of Pennsylvania’s most vulnerable citizens.

2015 Legislative year in review: effective grassroots pays off

By Ana Puig
Director Legislative Affairs

The 2015-2016 legislative session kicked off this past January when then governor-elect Tom Wolf (D) and new members of the Pennsylvania General Assembly were sworn in. The House had 24 new freshman faces while the Senate had six. Both chambers came back to Harrisburg, once again, with Republican majorities.

There are not many bills that became law this year that are of importance to long-term care since lawmakers spent a good part of the year working towards a budget deal that would be palatable to both Republicans and Democrats. The end of that saga still remains to be seen; however, it is worthwhile pointing out that it appears any proposal moving forward will NOT include a sales tax expansion of the base as previously proposed by Governor Wolf. The governor’s original sales tax expansion proposal would have included nursing facility, personal care homes and assisted living residences, and continuing care retirement community entrance and monthly fees. This is a huge win for our members and shows the power of grassroots advocacy at its best.

Your voices were also heard on another critical topic that went under scrutiny this year. Your activism with members of the General Assembly via phone calls, letters and in-person meetings, in conjunction with the behind the scenes work that the LeadingAge PA Government Affairs staff put forth, kept the Department of Human Services (DHS) from enacting proposed changes to the methodology of the Budget Adjustment Factor (BAF). This is yet another victory that highlights the importance of grassroots advocacy and the fact that there is most definitely power in numbers. The overwhelming amount of outreach that was done on this issue is what ultimately saved the day.

On other fronts… The topic of a minimum wage increase certainly has generated heated debate, but all of the bills that have been introduced in 2015 have failed to be voted out of committee thus far. The LeadingAge PA Government Affairs staff continues to monitor this controversial conversation closely as this topic will most likely not go away in the near future. Also, legislation on purely public charities received quite a bit of attention during the first half of the year when SB 4 passed the Senate. As you probably recall, SB 4 is a joint resolution proposing an amendment to the Constitution of the Commonwealth of PA, providing for criteria for institutions of purely public charity. The bill has been in the House finance committee for months, and with the budget impasse still taking all the attention of the General Assembly, we do not expect much chatter around this topic in the foreseeable future. This is another good example of the importance of grassroots. You made calls, you wrote letters, and your senators heard you.

All and all, it’s been a very productive year for LeadingAge PA on the grassroots front. Our members and staff have come together to showcase that greater influence and impact is gained when large numbers of constituents speak with one voice. And this is best accomplished, and only possible, through organized grassroots activities.

Why I Am Thankful

By Ron Barth, President and CEO

ronbarthcurrentI recently read the book “Start with Why” by Simon Sinek. Sinek posits that success starts not with questions of what we do or how we do it; success starts with WHY we do it. In other words, what is our passion?

For the team here at LeadingAge PA, the answer of why we do what we do is simple. We do it for the members. The members of LeadingAge PA are our passion. Many of us here at LeadingAge PA have had experiences working for other associations. We know, first hand, why we are so lucky to have the membership we have. A frequent comment around here is “I love our members.” So when I was asked to write this blog about what makes me thankful, I almost immediately thought of the LeadingAge PA members.

Now don’t get me wrong; like many of you, of course I am thankful for a wonderful family; thankful for living in a country where you may get frustrated with how things seem to be going, yet know that you wouldn’t want to live any place else; thankful for good friends and colleagues (sometimes one and the same), and thankful for the health to get out of bed every morning and enjoy another day.

But today I want to focus on why I’m thankful for having the opportunity to work for our members at LeadingAge PA. Our members exemplify caring and commitment. I can hold my head high when I represent LeadingAge members before government and the media knowing that our members are doing the right things for the right reasons. Our members put residents and other consumers first. I can see it and I can feel it every time I visit a LeadingAge PA member organization.

I recently had the opportunity to testify before the PA House Aging and Older Adults Services Committee about LeadingAge PA’s vision of the future of services for older adults here in Pennsylvania. Part of my testimony focused on what makes LeadingAge PA members different. I said:

“Generally, the mission of a for-profit provider is to provide services to consumers in order to make a return on investment. This is entirely honorable, and many for-profit organizations provide high quality services. But their purpose is to earn a profit.

Many not-for-profits have their beginnings a century or more ago. Many were created by religious or fraternal organizations that tried to treat not only the physical symptoms of aging, but also the spiritual needs of the aged. It carries through to today. It is a more holistic approach.”

So thank you for letting me be part of LeadingAge PA and allowing me and our wonderful staff to represent you. May you and your loved ones have a wonderful Thanksgiving and a blessed holiday season.