Inside:

• Here’s where the data breaches can be found
• Focus more efforts on telehealth, feds are told
• Can robots serve as trustworthy companions?
• Newcomer Orangeworm is targeting providers
• Want to avoid ransomware attacks? Prepare
• 2018 technology breakthroughs
• Using tech to keep residents engaged
• Using the EHR to unlock the next big thing
• The new key to working across channels
• The right prescription for managing meds
• Mobile tech breaks through old barriers
• Property management enters a new era
• Lending a helping hand where it’s needed

Few can take issue with that assessment. But there are widely varying opinions about where the industry is on the tech evolution timeline. It seems innovation continues to outpace adoption, but at some point, most agree, the industry will catch up.

BRISK ADOPTION IN PLAY

Experts may debate the value or popularity of one type of technology over another, or the level at which adoption is occurring, but one indisputable fact remains: technology is at high tide right now.

The epicenter is the C-suite, asserts Trisha Cole, COO of Medtelligent, who believes C-level executives are “often the visionaries of the company who see high technology as a way for their communities to operate efficiently and stand out from the crowd of competitors.”

Behind the C-suite are sales and marketing departments focused on managing the “complex” relationships of referral networks in their zeal to keep census high. Bringing up the rear, according to Cole, are staff members — “the dark-horse advocates of technology” — who are constantly pushing social and resident engagement with relative ease because such solutions involve “very little red tape.”

Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and executive director of the Center for Aging Services Technologies, believes electronic health records and point-of-care technologies, including touch screen kiosks for documentation of care, conducting regulatory assessments and submission of claims electronically, still lead in terms of adoption.

“What’s interesting is how broad-based the interest in new technologies is,” observes Mike Webster, CPP, director of senior living, fall management and security solutions for Stanley Healthcare. Not only is it a major discussion point at all industry events, but organizations such as Aging 2.0 have emerged in the past few years specifically focused on promoting the development of new technology solutions for senior living.

“The demand for cutting-edge technology is really across the board, Webster adds. “Cutting edge doesn’t have to mean complex. In fact, one of the advantages of newer technology is that it is often less complex, taking advantage of standards that do away with a lot of hard wiring and proprietary devices. A small memory care facility still looks for the latest technology for an established application such as wander management, for example, because newer technology is cheaper, easier to use and has more functionality, he adds.

Broad adoption trends aren’t lost on Jim Rubadue, chief customer officer at OnShift, who sees data mining as a primary motivator. “Many senior living providers now have teams of data analysts looking at their data from a holistic viewpoint, so managers and others can more easily take action based on this information, ideally in real time,” he says. Data collection also is highly valued by real estate investment trusts, which use data to drive efficiencies and improve facility operations.

WIDE VARIATION

Experts say tech adoption varies by facility type or settings. Assisted living seems to be embracing resident-centered tech more broadly and faster than nursing homes, whereas nursing homes may have an edge on clinical applications such as EHR and full-building wireless coverage because they were required to adopt those technologies, notes Sara Haskill, director of marketing-senior care for CareWorx.

Even facility types tend to embrace extended EHR technologies differently, according to Dawn Iddings, senior vice president of post-acute strategy for Netsmart. SNFs, for example, are now focusing on more sophisticated technologies around electronic referral management, analytics and connectivity, whereas assisted living and home care settings are now delving deeply into interoperability issues, she says.

Meanwhile, those like Paul Larson, vice president of new product development and engineering for RF Technologies, believe adoption is no more brisk right now than in memory care, where vendors “see many advances in this area, such as using interactive media for mental stimulation to improve cognitive function and innovative community design to improve both comfort and safety levels for residents.”

Some believe the size of an organization is directly proportionate to the level of broad tech adoption.

David Carter, LNHA, campus administrator of Sentara Nursing Center and Village Virginia Beach in Virginia, asserts that larger, more full-service operations with multiple licenses to manage broadly embrace technology.

That’s because “the more services, the more data sources are required to manage and integrate in order to get clear visibility into the patients and the organization,” Carter says. “EHRs are simply not enough, especially when they can’t get their data when, where and how they need it.”

Jeremy Spradlin, CEO of CareServ Technologies and Consulting, believes larger organizations, like chains that can pool resources and negotiate better discounts, will embrace technology more easily.

“Because of their size, they often receive better economies of scale when purchasing infrastructure or software solutions,” he adds.

regulated states such as Washington, Ohio, California and Florida “tend to be more progressive with technology” simply because the rules more aggressively incentivize them to accept and provide care to Medicare beneficiaries.

SHIFTING PRIORITIES

Most observers believe technological innovation in senior living as a whole is still in its infancy.

“We are just on the cusp of a larger technology demand that is going to arrive with baby boomers,” Spradlin says. “Baby boomers are not only going to put additional pressures on senior living communities to use technology to provide better care, they are also going to demand access to technology for their own personal use and comfort. The next generation to arrive in senior living communities is tech-savvy and thus, they are going to expect their community and caregivers to embrace technology.”

Meanwhile, some think adoption overall remains stuck in push mode. “My experience has shown that senior living companies are reactionary in their adoption of technology,” observes Ray Costello, founder and CEO of bmrbnb.com, a company that has built hospitality software that allows operators to provide short-term stays and booking services for prospective residents touring their communities. The lack of initiative can cost them to lose valued managers or even residents, he adds.

That said, providers and operators across the long-term care landscape have myriad priorities that are shaping their interest in, and acquisition of, technologies of all kinds.

Cole believes the primary motivators are operational efficiencies, regulatory compliance, resident safety and risk mitigation.

“Senior living companies are growing and building at an incredible rate. Pens and paper cannot keep up,” she says. “Providers are extremely busy, and it has become increasingly difficult to stay on top of the needs of a single community let alone a growing portfolio of communities. An operator just said to me the other day, ‘Our staff is great, but relying on a busy care team to notify us of everything important just isn’t working.’”

Alwan and his team at CAST have seen shifting consumer expectations, experience and quality of life push providers to invest in consumer-facing technologies such as Wi-Fi, technology-enabled concierge services, social connectedness and engagement applications, as market differentiators.

Laura Wasson, director of healthcare for Tech Electronics, agrees. “In our industry, senior living operators are most accepting of fall detection/prevention and mobility technologies, as well as technologies that reduce overall costs,” she says. “Having technology that increases mobility by sending alerts from residents to phones instead of to a nurse’s station can reduce response time. There’s also a need for fall prediction and reporting technology that can assist chief nursing officers and executive directors in family and personnel issues.”

Private baths have become more prevalent in senior living, especially in new communities, to give residents who dislike communal bathing a different option. Yet, as Mark Godfrey points out, the centralized bathing area continues to serve an essential purpose.

“Private baths and showers are not a replacement for a centralized bath and spa room – each meets different needs and expectations of residents,” says Godfrey, vice president of business development for Apollo Corp. “Private baths address the hygiene needs of residents who are largely ambulatory and able to effectively bathe themselves. But many residents require assistance in bathing or must be fully bathed by an aide. They require a bathing spa that provides safe and dignified transfer into the tub.”

Submersion in the warm, soapy water of a whirlpool tub provides maximum hygiene while augmenting the caregiver’s job of washing the entire body, Godfrey says.

“Bathing in a whirlpool tub also provides a far superior experience over assisted showering,” he says. “Imagine yourself sitting naked in a plastic chair while someone washes your entire exposed body and hoses you down with a shower wand. Submersion bathing provides a level of privacy and dignity for the resident, and the provider can create competitive advantage by offering periodic spa bathing rather than just a ‘scrub down.’”

Private baths also can be unsafe for caregivers while providing an incomplete bathing experience, Godfrey says.

“For many aides, giving a shower to another person can be an awkward experience, and the quality of hygiene can suffer accordingly,” he says. “The floor in a private bath can also get wet and slippery, presenting a greater risk of the resident or bath aide falling.”

Conversely, in a whirlpool tub “the submerged resident is also mildly buoyant during the bath, aiding access to their backside and perineum with less risk of skin tears or bruising,” Godfrey says. “While there exists the perception that showering is faster than bathing, tubs equipped with reservoirs can fill in as little as 90 seconds after closing the door, and shampooing can be done during that time, resulting in no lost time.”

A SENSORY EXPERIENCE

The communal baths of old had a reputation for being bright, loud, cold and harsh. No wonder “bath time” commonly drew protests from residents, who felt vulnerable and afraid going through the unpleasant experience.

Contemporary spas are a welcoming place, with soft lighting, warm radiance and attentive staff to guide residents through a positive and fulfilling experience, says Mike Schwarzwalder, director of long-term care product strategy for Drive DeVilbiss.

“From a room-aesthetics perspective, you need to address each of the key senses of smell, sight, hearing and touch,” he says. “The room should be truly designed around the bathing experience instead of as a storage facility. It should be clean-looking and smelling, inviting, warm and quiet. Soft music and dimmable lighting will add to the residents’ level of comfort and relaxation.”

From an equipment standpoint, Schwarzwalder says contemporary whirlpools in good working order are paramount for a positive experience. Easy entry and exit, comfortable temperatures, quiet jets and a smooth, clean surface all contribute to a soothing bath time for residents, he says.

To be sure, spa therapy with an air spa or whirlpool tub is a sought-after feature in many communities, agrees Kari Harbaugh, senior product consultant for Direct Supply. The main difference is that air spas are louder than whirlpools, so she recommends that noise levels be factored in when deciding.

Using bubble bath, bath salts and oils provides a luxurious element to bathing, with a scent such as lavender providing a soothing quality, Harbaugh says. She cautions, however, that salts and oils will clog some tubs. Others, such as the Therapure Pipeless tub from Invacare, do accommodate them, she says.

Warm, soft lighting counteracts the bright, cold tile impression of communal bathing areas, Harbaugh says. Additionally, “towel or blanket warmers make great additions to any spa room, and you should always consider the right mobility and transfer equipment to get resident to, into and out of the tub.”

Because bathing safety is a major concern, Michael Odum, senior after feature in many communities, agrees Kari Harbaugh, senior product consultant for Direct Supply. The main difference is that air spas are louder than whirlpools, so she recommends that noise levels be factored in when deciding.

Using bubble bath, bath salts and oils provides a luxurious element to bathing, with a scent such as lavender providing a soothing quality, Harbaugh says. She cautions, however, that salts and oils will clog some tubs. Others, such as the Therapure Pipeless tub from Invacare, do accommodate them, she says.

Warm, soft lighting counteracts the bright, cold tile impression of communal bathing areas, Harbaugh says. Additionally, “towel or blanket warmers make great additions to any spa room, and you should always consider the right mobility and transfer equipment to get resident to, into and out of the tub.”

Because bathing safety is a major concern, Michael Odum, senior marketing manager for Arjo, recommends ceiling lifts that don’t require open legs for stability.

“Ceiling lifts are great for non-weightbearing residents to use in combination with bathing systems,” he says.

SHOW IT OFF

Bathing areas located in the bowels of a facility, reached by traveling through staff-only utility corridors, can send the wrong message to residents — that the area is being concealed and kept out of sight.

There is no reason for a centralized bathing area to be hidden, says Lee Penner, president of Penner Patient Care. In fact, locating it next to a rehab center or exercise area can give it an elevated, “club” kind of image, he says.

“In small communities, you could even make it accessible to the public,” Penner says. “It sends a positive message to the residents and the locals, too.”

“Furnishings are very important. Not only do they add color and life to properties when combined with vibrant fabric choices and design details, furnishings send a message of comfort and can make a property feel like home, which is very important to both prospective and current residents and their loved ones,” says Anna England Chaney, lead senior living designer for Flexsteel Industries.

Of course, attractive, space-unifying furnishings are only part of the equation. Furnishings must also be durable, comfortable, cleanable and safe for daily resident use. Fortunately, furniture and flooring manufacturers that cater to the senior housing segment keep adding innovative products to their portfolios that check all those boxes and more.

STEP UP TO QUALITY

When it comes to furnishing any senior living community, experts agree flooring is a wise place to start. The right flooring — in the right location — grounds the space, delivers security underfoot and can be a surprisingly lasting investment for the operator. The wrong flooring can trap odor, quickly show wear and tear and, most importantly, jeopardize resident and employee safety.

Among the biggest challenges some operators face is focusing more on aesthetics and price than on how the product must function in each area, according to Jamie Thorn of Forbo Flooring Systems. Flooring needs in assisted living, for example, will differ from those in a memory care facility, where residents have a higher level of incontinence and visual and cognitive impairment.

“Flooring should never be viewed as one-size-fits-all. You need the product to have a certain look, but it also needs to be durable, functional, comfortable and safe,” Thorn says.

Another flooring expert echoed that sentiment. “There’s really no ‘bad’ product, just bad applications,” explains Ross Leonard, VP of marketing for J+J Flooring. He said operators looking to invest in new flooring should ask several key questions: Will the flooring limit mobility or contribute to glare? Will it require transitions that can lead to trips and falls? Will the colors or patterns be a barrier or risk for people with visual or cognitive impairment? How will the flooring need to function?

There’s an ongoing trend by senior housing operators to integrate various hard and soft flooring products. Luxury vinyl tile is increasingly popular, thanks to its durability, affordability and fashion-forward designs. They can offer the look of wood planks, for example, but without the fussy upkeep and lofty price tag. Still, its application must be carefully considered because traditional vinyl plank flooring is thin and it is installed over a concrete subfloor, which limits comfort, notes Thorn. As an alternative, cushion-backed vinyl plank flooring is now available to enhance comfort and safety and aid sound absorption, he says. Although any vinyl product can lead to slips and falls when wet, Thorn says the cushioned vinyl product is especially well-suited for kitchen areas, where comfort and cleanability are essential.

Due to its inherent comfort and acoustics benefits, carpet-style flooring still reigns supreme in senior living, although there’s a continued shift away from traditional broad-loom carpet that absorbs moisture and traps odors. Instead, more operators are eying innovative textiles that block moisture and odors, offer easy installation and maintenance, and allow for as-needed replacement.

“Over the past five years, we’ve seen extreme growth in modular carpet tile,” Leonard says. “You can peel them up, hose them off and sanitize them, or just put a new one in when needed.”

Operators installing a mix of soft and hard flooring throughout their communities must consider the safety risks associated with transitioning between the two. Even the slightest elevation changes between carpet and smooth surfaces like LVT or hardwood can pose a trip-and-fall risk, experts warn.

GOING THE DISTANCE

Furniture made specifically for senior living is essential for resident comfort and safety, and for delivering the most return on investment. Unfortunately, some operators make the costly mistake of buying residential furniture from a local retail store.

“As nice as the furniture may look, it’s not manufactured for senior care living,” stresses Linda Nash, interior designer at Invacare Interior Design. Typically, residential furniture is scaled larger and the dimensions do not comply to seniors, she says.

One last piece of round for operators in the market for new furnishings: plan properly, explore all options and, when in doubt, seek the help of an interior design expert with senior living experience who can turn a vision into a comfortable, cost-effective and sustainable reality.

“They can save [operators] money, make the environment marketable, keep the residents and family happy and save operators a lot of aggravation,” Nash assures.

Most seniors, their families and their financial advisers need answers to critical senior living questions. That’s because a number of deal-killing misconceptions continue.

The frequently asked questions concept is a very effective and credible marketing communication strategy. In creating FAQs, avoid long, rambling text. Use the approach directly on specific important issues.

Here are some FAQ examples:

1. With my Medicare and Medicaid entitlements, aren’t almost all of my future healthcare costs covered? 
2. It appears that living in a retirement community is much more expensive than staying right here at home.  Am I correct? 
3. Is there a way to control my future healthcare costs so I don’t spend down my life’s savings? 
4. Some entry fee communities charge quite a bit. Won’t I seriously reduce my current net worth if I decide to move to one of them? 
5. I pay a big entry fee, how will I be able to leave a legacy to my children and grandchildren? 
6. Are there any special income tax deductions available for some assisted living and health care costs? 

These FAQs are just the tip of the iceberg. Don’t assume the market knows about all the relevant questions that need to be asked … and answered.

Implementing a comprehensive FAQ approach sharpens the market positioning of your community and dramatically increases the competency of your sales and marketing professional team.

Jim Moore is president of Moore Diversified Services Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 46 years. He has authored five books about senior living and healthcare, including Assisted Living Strategies for Changing Markets and Independent Living and CCRCs. Jim Moore can be reached at (817) 731-4266 or jimmoore@m-d-s.com.

In late February, Argentum announced that it had hired Brent Weil into a newly created position, vice president of workforce development, at the association. Senior Editor Lois A. Bowers recently spoke with him about the senior living industry’s No. 1 challenge.

What attracted you to the position at Argentum?

There are many associations out there, but Argentum really is unique in its focus. I was really impressed with the strategic direction, the dynamic leadership and the team that’s here.

Workforce issues are a clear challenge that all members have. Argentum has had a standing workforce development committee on its board, so there’s momentum and the impetus to be able to move on the issue and act in ways that can really make a difference.

Many senior living companies have been doing really good things in this area. An association like Argentum is in a great position to help the industry grow together, learn best practices and carry forward in ways that can have a bigger impact than any one company can do on its own.

You came from the Manufacturing Institute, a 501(c)(3) affiliated with the National Association of Manufacturers. What similarities, if any, do you see between the workforce needs of manufacturing industry and the needs of senior living?

Manufacturers felt that there was a poor image, a misunderstanding, about the kinds of careers that existed and about what modern manufacturing was all about. That’s certainly something that we see within senior living, too. People know, for example, what a nursing home is but may not really have understood what assisted living is all about and what a career there would look like versus in a nursing home or hospital.

We also see young people who may be perfect for senior living careers and just don’t have exposure to them. That’s certainly something that we saw within manufacturing. One of the ways that we were able to combat that was to have younger people who are working in manufacturing be ambassadors, exposing people to that kind of environment, have them visit for tours and have industry people visit the classrooms.

Both industries have skill needs at all levels. Within senior living, there are needs from registered nurses and executive directors to CNAs.

Both industries have concerns about people having the right skills. We need to make sure that we understand who can thrive and be best for our industry and make sure that we are looking in the best way possible, reaching out as broadly as we can and helping people come into an environment that they are best suited for and help support them as they come in.

Some things that worked in manufacturing were raising awareness through grassroots effort. Plant managers and human resources leaders developed partnerships with community colleges and other educational institutions that tied into the careers that were there within their companies and training opportunities that were aligned to industry certifications in which industry was able to step up and work with education to help guide the right kinds of people to come through.

The talent shortage that is faced in senior living is not just in an industry and it’s not just in the United States. There’s a global shortage of talent across industries, across the world. The industries that thrive are going to be the ones that make addressing workforce issues a strategic priority and work at the national level and then down to the grassroots to make change happen.

Speaking of the national level, in what ways, if any, do you believe the federal government can help address workforce issues facing senior living?

That’s a big issue. At our Public Policy Institute in March, we had some outstanding presentations by policymakers at the federal and state levels who spoke to some of the challenges and possible ways to address them through immigration policy, workforce policy and the Workforce Innovation Opportunity Act and Higher Education Act. We also discussed apprenticeships.

Policymakers at the state level also discussed the impact the governors’ offices can have and the role that senior living executives and professionals can play in helping to organize policy and connect to programs at the state level, some of them federally funded, that can support on-the-job training or working in concert with education in their communities.

What kind of workforce-related concerns have you been hearing from member communities?

Every company that I’ve talked to, every professional I’ve talked to, has noted that a senior living community is a great place to work and that people have misunderstandings about it. For example, I’ve heard concerns about the lack of awareness in nursing programs and in academic programs in healthcare administration about the opportunity to apply those skills within senior living.

Lack of awareness extends down to what people in technical school — at the high school level, for example — consider as well, and what their parents understand about what senior living careers look like.

People are interested in developing more effective relationships with education at the K-12 level and at community colleges and universities. It’s hard to make meaningful relationships that will develop a pipeline into the jobs that we need in ways that are sustaining. It’s a challenge to establish connections with workforce agencies and other connections that could be those feeders.

People also want to get the most out of the diverse workforce, particularly across multiple generations, to help ensure that we’ve got the high performers moving forward and staying within the industry. Turnover is something that people have spoken to as a concern as well.

I hear real interest in not just talking about what the problems are — because we all know what the problems are — but interest in rolling up our sleeves and working at the community level to address those things in ways that are going to ensure that we’ve got the workers that we need to have the best communities that we possibly can and the best care we can.

All of us, from the C-suite down to the community level, should feel empowered to make connections with current workers, with the education system, with veterans and other places where we know we can be reaching people with the right kinds of skills. Our job at Argentum is to help facilitate that, to provide that roadmap to implementing solutions for now and for building that pipeline for the future. We really are excited.

Investigators targeted three partners that get such information:

1. Medicare Administrative Contractors who process and distribute payments; 
2. Researchers who use the data to study how healthcare services are provided; and 
3. Qualified public or private entities who use claims data to evaluate Medicare service providers and equipment suppliers.

In the report, titled “Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed,” the GAO proposed changes to the way the Centers for Medicare & Medicaid Services and state Medicaid agencies work together. Specifically, the GAO said CMS should:

• Provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states using home- and community-based services waivers are required to report on their annual reports;
• Establish standard Medicaid reporting requirements for all states to annually report key information on critical incidents, considering, at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities, including assisted living facilities, where critical incidents occurred; and
• Ensure that all states submit annual reports for HCBS waivers on time as required.

Still, the lay media and online posts by consumer advocacy groups used the occasion to criticize assisted living.

The Long Term Care Community Coalition and the Center for Medicare Advocacy called for state and federal governments to develop websites for assisted living similar to Nursing Home Compare and also recommended that the federal government “take immediate steps to protect assisted living residents by enacting sensible standards to ensure safety and dignity.”

Even a press release issued by the four senators who initially requested the report in 2015 could have been interpreted as being critical of assisted living. “GAO Investigation Finds Over 20,000 Serious Health and Safety Incidents in First-Ever National Assessment of Quality of Care in Assisted Living Facilities” was the headline on that release.

“I plan to pursue legislation to address these groundbreaking findings,” Sen. Elizabeth Warren (D-MA), one of them, said in the release. The report, she said, “finds that thousands of seniors face serious health and safety risks in their assisted living facilities.”

Another requester, Sen. Susan Collins (R-ME), chair of the Senate Special Committee on Aging, said that “the GAO uncovered a number of troubling issues at some assisted living communities” and said she would “continue to work with my colleagues to support policies that improve the well-being of seniors who receive care at these facilities.”

Sen. Claire McCaskill (D-MO), who was ranking member of the Senate Aging Committee when she requested the analysis with her colleagues, echoed Collins’ remarks, saying that the report “shows a troubling breakdown” of care and safety in assisted living. “I’m looking forward to working with my colleagues on both sides of the aisle to turn our deep frustration at these findings into action, to better protect our seniors and ensure they’re getting the best care possible,” she added.

And Sen. Orrin Hatch (R-UT) indicated that more federal efforts were planned, saying that the report “underscores the importance of improved reporting at assisted living facilities and starts the conversation on how we can make it better.”

After Argentum’s Public Policy Institute in March, however, Argentum Chief Operating Officer Maribeth Bersani told McKnight’s Senior Living that in conversations that leaders of the organization have had with the senators’ staff members, “none of them were even calling for legislative solutions except for Sen. Warren’s staff. What they said was that they were going to be talking to CMS and encouraging that they have better communication and oversight with state Medicaid agencies, and if they didn’t follow up on that then they might introduce legislation requiring that, but it had nothing to do with the regulation of assisted living.”

Argentum agrees with the report’s recommendations on ways CMS could help states improve their monitoring and reporting of deficiencies and critical incidents in assisted living, including standardizing Medicaid reporting requirements, Bersani said.

“There needs to be better communication and coordination with CMS and the Medicaid agencies,” she said, noting, however, that Argentum wants to ensure that government officials are aware that the GAO report calculates the number of assisted residents differently than does the Centers for Disease Control and Prevention. The CDC does not include in its total younger people who have intellectual or developmental disabilities or traumatic brain injuries. Argentum uses the CDC’s statistics.

Argentum also hopes to further educate lawmakers and their staffs on how the Medicaid program is administered in the various states, since it varies by state.

LeadingAge and the National Center for Assisted Living also said they support the GAO report.

Lilly Hummel, JD, MPA, senior director of policy and program integrity at NCAL, told McKnight’s Senior Living that assisted living operators in some states most directly may be affected by the report when their states seek to implement new reporting requirements related to the recommendations.

“In some states, the monitoring system and the critical incident management reporting system meet CMS requirements, and I actually wouldn’t anticipate any changes. The state may already have robust monitoring processes in place,” she said. “In other states, it could be that CMS … will put out more guidance to states or states will in some way modify their critical incident reporting system … so there may be new reporting requirements for assisted living.”

Overall, however, Hummel said, “The recommendations have much stronger implications for the Medicaid state offices than for assisted living providers directly, because the recommendations are all aimed squarely at the guidance that CMS needs to be issuing to states — what data the states should be collecting and then reporting back to CMS. So the evaluation and the findings really focus on the CMS oversight process and the reporting process. At this point, I’m not anticipating, just looking at these findings, broadscale changes for assisted living.”