Levy to Serve as Linked Senior CMO

Certified Medical Director, Medical Director

April 5, 2016

Susan Levy, MD, CMD, AGSF, will be the new chief medical officer at Linked Senior.

Recent News

title Are nursing home residents getting badly needed COVID boosters? Here’s why it’s hard to tell.

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In October and early November, 16 nursing home residents and one staff member at Philadelphia Protestant Home tested positive for COVID-19. Three people in independent living also got sick.

It was a strong sign that vaccine protection was waning in this vulnerable population eight months after almost all residents got their second shots. Every single case was a breakthrough infection, said John Dubyk, the Northeast Philadelphia retirement community’s president and CEO.

Two of the nursing home’s 57 residents died following infection.

John Dubyk is president and CEO of Philadelphia Protestant Home.TYGER WILLIAMS / Staff Photographer

The CDC had approved Pfizer boosters for people in nursing homes on Sept. 24. Dubyk said the first date he could schedule the shots was Nov. 2. They were received enthusiastically. There have been no new cases, he said, since Nov. 7.

Although the rise of the new variant, omicron, raises the specter of “more chaos” for his industry, Dubyk said boosters make him more confident that his facility can avoid another surge.

Gaps in federal and state reporting make it impossible to know whether other long-term care facilities have, like Philadelphia Protestant Home, been able to give boosters to most of their residents.

It is well-known, though, that nursing home residents are especially prone to serious illness and death from COVID-19. The virus burned through some facilities during its first assault on the United States last year. Nearly 138,000 residents have died. A combination of lockdowns, better access to protective equipment, and better treatment helped during subsequent waves, but cases really plummeted after vaccines became available earlier this year. However, because of their age and many health problems, nursing home residents have weaker immune systems, an added risk factor as vaccine protection weakened and the delta variant emerged. Nationally, about 1,400 residents have died in the last month, according to the CDC.

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title New York nursing homes rank poorly on staffing

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Joan Lorenzo has some memories of her mother’s stay at a local nursing home that she wishes she could forget.
The smell of urine in her mother’s room, and on Lorenzo’s clothes once she left, is one of them.
Lorenzo said her mother, Carmella Valenti, who died last week, would on some days be “sitting in saturated urine.”Her mother’s stay at Niagara Rehabilitation and Nursing Center started off strong. But Lorenzo said in an interview with News 4 Investigates that things began to go downhill this summer.
Her conclusion about the challenges nursing homes face?
“Not enough staff, first of all,” Lorenzo said. “Don’t get me wrong, they do have some good caring people. I did let the administrator know that you do got some good people in here but you got some people who are not taking care of the seniors.”
The administrator at Niagara Rehabilitation and Nursing Center declined to answer questions or be interviewed for this story. But the industry cannot deny the staffing crisis it is in, and it’s not getting better.
“Staffing is the most expensive component of expenses that go toward residents and it’s also the easiest to frankly cheap out on,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that focuses on improving quality of care in the state’s more than 600 nursing homes.
A News 4 Investigates analysis of federal data shows that nursing homes in the state have historically ranked in the lower 10% to 20% in the nation for staffing some of the most critical positions.
And the first quarter of this year was not any brighter for the industry.
Consider that nursing homes in the state ranked 35th in the nation for registered nurse total hours per day per resident. This category includes registered nurses (RNs), the RN administrators and the RN director of nursing.
The ranking is even worse for total nursing staff hours.
Nursing homes in the state ranked 46th in the nation for total nursing staff hours per day per resident. This includes, registered nurses and their direct administrators, the RN director of nursing, licensed practical nurses, certified nursing assistants and three other positions.
“I think because there are not enough workers, the patients are not getting the proper care and that’s what’s very sad,” Lorenzo said.
A survey this year by The American Health Care Association and National Center for Assisted Living found that nearly every nursing home is facing a workforce crisis.
And 59% of nursing homes are experiencing high levels of staffing shortages, the survey found.
The industry groups said more than 70% of the nursing homes said a lack of qualified candidates and unemployment benefits have been the two biggest obstacles in hiring new workers.
As a result, many nursing home employees are working double shifts and overtime to fill the gaps.
“The survey demonstrates the severe workforce challenges long term care providers are facing due to the COVID-19 pandemic,” said Mark Parkinson, president and CEO of AHCA/NCAL.
“Too many facilities are struggling to hire and retain staff that are needed to serve millions of vulnerable residents. Lawmakers across the country must prioritize long term care and that begins with providing resources to address workforce challenges. When facilities have the means to offer competitive wages and training programs, workers will follow.”
The organizations have provided both state and federal lawmakers with their own proposals to increase staffing, but they have not been acted on. The proposals include increasing federal Medicaid funds to states so that they equal the cost of care, loan forgiveness for new graduates who want to work in the long-term care industry and childcare assistance.
Christopher Laxton, executive director of American Medical Directors Association – The Society for Post-Acute and Long-Term Care Medicine which represents medical directors, doctors and some front-line workers in long-term care, said the industry’s staffing problem predates the Covid-19 pandemic.
“Truthfully, nursing home staff are exhausted and demoralized,” Laxton said. “They’re demonized, the finger gets pointed at them, they’re not well trained, they’re not well compensated, they don’t really have opportunities for advancement, and they’re not well supervised.
“If you want to start talking about solutions, you have to start making this workplace a safe one and make the work meaningful for these folks,” Laxton said.
Mollot said throwing more money at the industry isn’t the answer. Rather, nursing homes need to step it up and provide better wages and benefits and stop paying administrators and nursing-home owners outsized salaries.
“People come in, but they don’t stay,” Mollot said. “If you improve the working conditions, if you improve the amount of staffing where it’s not like you know what is hitting the fan all the time, I think you’ll have a better situation for maintaining staff.”
The staffing crisis comes at a challenging time, with the Covid-19 pandemic and new state minimum staffing ratios for nursing homes going into effect next year.
In addition, the state will soon require nursing homes to spend at least 70% of their revenue toward direct resident care, with 40% of it toward staffing that care for residents.
“I think they’ll solve it because they’re mostly for profit, and if the rules are enforced and they want to stay in business, then they’ll solve it,” Mollot said.

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title The new Pain Management in the PALTC Setting Clinical Practice Guideline is FREE when you join AMDA

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The CPG provides a foundation for a systematic approach to the recognition, assessment, treatment and monitoring of pain in PALTC care patients. It addresses common questions related to pain management, including appropriate use of opioids, regulation requirements, differences between treating acute and chronic pain, and how to adapt pain management to specific situations. The pocket guide provides a quick reference to the general principles for prescribing and titrating opioids including opioid titration options. Pain medications, as well as non-pharmacological interventions, are also contained in this pocket guide. Sample Performance Measurement and Outcome indicators are included.

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title LTC docs urge peers to rapidly increase use of COVID-19 antibody drugs

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It’s time to take action to support rapid implementation of COVID-19 monoclonal antibody (mAb) treatment in post-acute and long-term care facilities, a group of industry geriatricians contend.

They’ve compiled a table of information-rich resources for peers who have not yet come on board.

While some long-term care clinicians are scrambling to access the suddenly scarce drugs, others need to quickly add them to the treatment toolbox to protect vulnerable residents, according to the doctors, from a spectrum of eldercare services across Colorado.

“Of great concern is that effective immunity to COVID-19 by mRNA vaccination among nursing home residents has declined significantly since emergence of the delta variant,” wrote Leslie Beth Eber, M.D., of Rocky Mountain Senior Care, Golden, CO, and colleagues in a letter to the editor published in JAMDA on Monday, Nov. 1.

Many clinicians remain unfamiliar with mAbs

Despite the proven usefulness of mAbs in protecting residents from poor COVID-19 outcomes and the potential they offer for preventing risky hospital transfers, many LTC clinicians remain unfamiliar with mAbs clinical protocols or unprepared to place orders, they reported.

What’s more, a recent switch to state and territory-controlled mAbs distribution has increased barriers to access just when the drugs may be needed most, they added.

“MAb awareness, access, and administration remain significant challenges in post-acute and long-term care (PALTC) facilities. We provide tools and strategies to address these challenges,” they said.

Their published table of peer resources includes links to the following, among other information:

The Food and Drug Administration’s treatment authorizations for intravenous or subcutaneous delivery methods

Nursing staff protocols to help identify appropriate candidates for mAb therapy

Treatment protocols tailored to PALTC settings, in coordination with long-term care pharmacies

Public health guidance

PALTC provider education

Toolkits for intravenous or subcutaneous delivery routes

Monitoring algorithms for tracking adverse effects

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title Nursing Home Staff Shortages Linger as Vaccine Mandate Looms

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The delta variant drove the share of nursing homes reporting staff shortages to the highest level ever in September—and the situation could worsen in coming months, according to new research.
As the Centers for Medicare & Medicaid Services prepares to unveil guidelines requiring all health-care workers to be vaccinated against Covid-19, the data has illuminated lingering concerns that the mandate will further exacerbate the nursing home staffing problem.
“There will be pockets, in parts of the country, where there will have to be some closures of units and possibly entire facilities, because they just aren’t staffed enough to take care of the people safely. But I don’t think that’s widespread,” said Chris Laxton, executive director at AMDA—The Society for Post-Acute and Long-Term Care Medicine. “So far, what we’ve seen is that when push comes to shove, most people are going to get vaccinated.”
But in areas where vaccine hesitancy and labor shortages are already a problem, nursing homes struggling to find workers may find it harder to increase resident occupancy if the looming vaccine mandate spurs an exodus of more nursing home workers.

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