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 ‘Reverse the narrative’ on bad staff to improve nursing home accountability

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Healthcare leaders and policymakers must “reverse the narrative” around incompetent or neglectful nursing home staff and work collaboratively to ensure care teams meet regulatory requirements, according to the medical leader of a large skilled nursing chain.

Deep mistrust between frontline healthcare workers in nursing homes and industry overseers has led to an accusatory survey process that pits the sides against each other, said Arif Nazir, M.D., chief medical officer of Signature HealthCARE, during a presentation at AMDA’s virtual annual conference Friday.

“There’s no room for punitive and punishment approaches … in a complicated system like healthcare,” Nazir said.

He called on surveyors to stop looking at mostly well-intentioned workers as if they are all out to do wrong. He compared the current survey approach to beating children who make an error because they don’t know better.

“Nursing homes represent the same issue with all the regulatory issues and patients being sicker,” he said. “You need me to improve, and you’re going to take a million dollars away from me? That doesn’t work anymore.”

He also called on regulatory agencies to reduce the amount of required reporting and to streamline data collection processes.

Nazir is past president of AMDA and served on a survey task force that last year called for engaging geriatric experts in the survey process and recognizing high-performing and innovative facilities rather than assigning blame and focusing on punishments for providers. That group also included geriatrician Michael Wasserman, M.D., then-AMDA president-elect Karl Steinberg, M.D., Alan Horowitz, Esq., RN, and James Lett II, M.D.

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title Low-tech program helps assisted living residents socialize, med students learn during pandemic

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A simple social calling model launched during the pandemic gave medical students real-life practice in geriatric assessment skills while providing socialization opportunities for residents of assisted living communities, according to an on-demand panel presentation at the AMDA — The Society for Post-Acute and Long-Term Care Medicine PALTC 21 Virtual Annual Conference.

The meeting kicked off Thursday and ended Sunday.

Sarah Hobgood, M.D., an associate professor at Virginia Commonwealth University in Richmond, VA, said that when the pandemic began, medical students immediately were removed from patient care and felt stranded and lost. As a physician, she was fielding phone calls from families of assisted living residents about not being able to connect with their loved ones.

The American Geriatrics Society student chapter at VCU launched a social calls program in March 2020 that paired medical students with assisted living residents through weekly phone calls. Students from the health sciences schools of medicine, dentistry, nursing and pharmacy, as well as in the College of Health Professions — which includes occupational and physical therapy as well as gerontology — participated.

“The students took it and ran,” Hobgood said. “It became an effective strategy for driving companionship.”

A simple program

The simple phone call program, which Hobgood called a “low-tech solution requiring minimal staff time during a time of competing interests,” included a conversation guide with open-ended questions and talking cues as well as acknowledgements about how residents were feeling about the pandemic.

The program grew over time, Hobgood said. It began with calls to residents in four assisted living communities that already had partnerships with the school and evolved into a multi-pronged referral process that allowed residents to call a central hotline number and request to be paired with a student. The program eventually grew to 20 assisted living communities. Geriatric clinic providers also began referring patients, and a partnership with a local senior apartment complex led to wellness checks and additional socialization calls.

Residents with physical limitations that prevented a phone or Zoom call could participate in a letter-writing campaign. Students delivered unsealed and unaddressed cards to communities, which delivered them to residents. The letter-writing campaign, which resulted in almost 100 cards delivered to three local assisted living communities, eventually expanded to VCU Health, the academic medical center.

Mutually beneficial

The program was intended to provide companionship to residents during a crisis while providing hands-on health professional education for students, but VCU Education Administrator Chuck Alexander said the program proved to be mutually beneficial to both groups.

“The older adults enjoy the opportunity to mentor or teach the next generation of medical professionals,” Alexander said. “It also offers extensive socialization opportunities for both the student and the older adult.”

Alexander said the “shared trauma” of the pandemic, along with the reality of the quarantine, and the isolation, depression and loneliness that resulted, was the catalyst for the program.

Hobgood said the program provided a “constant and stable social event for an otherwise socially isolated older adult.” Basic wellness checks for medication and food added another layer of protection “during an incredibly challenging time for all of us.”

As of last fall, 94 students were recruited from across the health professional schools, and 41 were assigned to older adults, with the remaining students waiting for assignments. Although the average call duration was 30 minutes, Master of Public Health degree student Tiffany Tsay said that calls ranged from a five-minute check-in to a two-hour conversation. Students made more than 120 calls that totaled 70 hours in duration.

Interest among students and a desire to volunteer provided sufficient numbers for sustaining referrals even after the pandemic, Tsay said.

“It’s an amazing outcome of a really terrible, tragic event,” Hobgood said. “It offered career development for health professional students, personal development and unexpected friendships.”

Wellness Calls program

One month into the partnership, the student group partnered with Dominion Place, an affordable senior housing apartment complex. During the pandemic, staff members shifted to a remote model and were tasked with conducting weekly wellness calls to Dominion’s 200-plus residents.

The partnership with the students extended Dominion’s staffing capacity and also increased socialization opportunities for residents. In the fall, students used the calls to disseminate additional information about voting during the November election.

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title With new nursing home guidelines, card games with grandpa are back, regardless of your vaccination status

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You can hug your vaccinated grandpa and stay to play cards with him at his nursing home, even if you haven't been vaccinated, according to new Covid-19 guidance for nursing homes from the Centers for Medicare and Medicaid Services.

The guidance goes into effect immediately.

What's in the $1.9 trillion rescue plan for small businesses

These recommendations are a little different than the ones released Monday by the US Centers for Disease Control and Prevention for fully vaccinated people in the general population, which allow meeting indoors in small groups without masks or physical distancing -- even for the elderly.

Vaccinated or not, nursing home residents are still a fragile patient population, so infection control is important, says CMS. For nursing home residents and visitors, even if vaccinated, CMS still wants people to wear a well-fitted face mask, wash hands and try to keep physically distant, a spokesperson for the agency said in an email. But the new CMS guidelines offer many other new freedoms.

"CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families," Dr. Lee Fleisher, said on the agency's website. Fleisher is CMS chief medical officer and director of CMS' Center for Clinical Standards and Quality. "This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19."

Under the new guidance, visitors don't need a Covid-19 test result to see family, nor do they need to show proof of vaccination. The guidelines strongly encourage everyone to get vaccinated though.

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title AMDA urges safe, thoughtful approach in new reopening guidance

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AMDA – The Society for Post-Acute and Long-Term Care Medicine, is recommending a “measured, stepwise approach” to resuming visitation and group activities in post-acute and long-term care settings while acknowledging gaps in clinical knowledge about COVID-19.

“Effective vaccines and therapeutics against COVID-19 are a significant step towards a post-pandemic world. A return to ‘normal,’ though, will not be immediate,” AMDA Executive Director Christopher E. Laxton, CAE, said in a Monday statement. Ongoing risks include vaccine delays, vaccine hesitancy, admission of new, unvaccinated residents, and community COVID-19 cases — requiring a thoughtful approach to re-opening, he said.

Much remains unknown about the effect and efficacy of COVID-19 vaccines and vaccination, the organization explained, including:

The efficacy of COVID-19 vaccines among frail residents in post-acute and long-term care settings

The degree to which vaccinated individuals may still shed and transmit SARS-CoV-2 virus

The duration of vaccine protection

The protection that COVID-19 vaccines provide against virus variants

The proportion of individuals in the community and among staff who must be vaccinated to achieve effective herd immunity

With these questions in mind, AMDA recommends the following preliminary visitor guidance (fully detailed here):

All staff, residents and visitors should be vaccinated against COVID-19 and seasonal influenza

Visits with residents should be scheduled and supervised by facility staff

All visitors should continue to be screened for COVID-19 infection each day they visit

All visitors should be required to properly wear a medical-grade mask issued by the facility, and to practice effective hand hygiene frequently throughout their visit

Each visitor should be restricted to visiting only one resident per day

Each setting should develop policies and procedures that align with guidance from local, state, and federal health authorities.

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title Some Nursing Home Staff Shunning Vaccine as Many Get 2nd Dose

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Nearly 570,000 residents and staff at nursing homes and other long-term care facilities have received their second dose of the Covid-19 vaccine through a federal partnership with CVS and Walgreens pharmacies, new federal data shows.

But an estimated 50% of frontline nursing home staff are still refusing to get the shots, which remains a persistent and glaring problem for the national effort to fully vaccinate the facilities.

“It may even be as high as 60% if you include other settings of care, like assisted living facilities,” said Christopher Laxton, executive director of AMDA—the Society for Post-Acute and Long-Term Care Medicine. “It’s probably the biggest issue that we have right now, the hesitancy on the part of staff.”

A new report from the Centers for Disease Control and Prevention found that among nearly 11,500 nursing homes that have conducted one vaccination clinic through the partnership “a median of 77.8% of residents and 37.5% of staff” received a first dose.

“The lower percentage of staff members vaccinated raises concern about low coverage among a population at high risk for occupational exposure to SARS-CoV-2,” the report said.

Nearly 147,000 residents at nursing homes and other long-term care facilities have died from Covid-19 as of Jan. 28, according to the Kaiser Family Foundation. That’s about 37% of all U.S. Covid-19 deaths. But nearly 1,400 nursing home workers have also died from Covid-19, and nearly 500,000 have contracted the virus, federal data shows.

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