Nancy Swanger, PhD, is the founding director of the Granger Cobb Institute for Senior Living and an associate professor in the School of Hospitality Business Management in the Carson College of Business at Washington State University. She recently spent a few minutes with McKnight’s Senior Living discussing what the hospitality and senior living industries can learn from each other and why breathing is “a really great thing.”

Q: You have a lot of experience in the restaurant industry as an owner and operator, among other roles. How did you become interested in senior living?

A: Like almost everyone that I’ve ever known, I fell into senior living quite by accident. In my case, in my personal life, my husband and I have been restaurant operators for almost 40 years, but in my academic world, when I made that switch over, I had been teaching in a hospitality school. I still have my fingers in the hospitality business, but I’m not the manager/operator of the restaurants that we still have today.

In terms of making that leap from restaurants to senior living, that’s not been an operational leap for me. I was the director of the hospitality school for about 10-and-a-half years at Washington State, and ours is the third-oldest hospitality program in the country. We’ve been around since 1932.

Some [senior living] operators from the Puget Sound area in Northwest Washington approached me and said, “Hey, you’ve got this great hospitality program, and we’ve got some senior living operations, and we think we should be collaborating.” And I had zero idea what that even meant. My parents were in their 80s, still living in their own home, and in my very narrow paradigm of the world, all I could think about was skilled nursing, nursing homes. And I thought, “I’m not seeing this big giant leap here of how we’re going to go from hospitality to senior living, but sure, I’ll listen. Here we go.” So then I drank the Kool-Aid, and it’s been a wonderful ride ever since. It’s really been an academic shift and focus for me, not an operational shift.

Q: You knew Granger Cobb. What is it like to be the founding director of an institute named for him?

A: It is really an honor and a privilege and a blessing. And I think those who were fortunate enough to know Granger — he had a heart the size of Manhattan. The guy was just so warm and genuine and so passionate about this industry, and it reminds us every day of the standards we need to uphold.

I think it puts a little bit of burden on us. We don’t want to ever do anything in the work that we’re doing to discredit his name or not honor him in some way. Arms-wrapped-around-us-as-we-do-this is how I would describe it, to make sure that we try and do it the way we’re supposed to be doing it. We have a lot to live up to by having his name — and in a lot of our printed materials, we actually have his signature. We’ve incorporated his actual signature into a lot of our work. And so you see that every day and it’s like, “This is Granger Cobb. We’d better pay attention to the details and get this right.”

Q: The Institute is part of the School of Hospitality Business Management. What do you think the senior living industry can learn from the hospitality industry?

A: A lot of things, and one of them is that in hospitality, we are very much about creating experiences for people that they aren’t able to or don’t want to create on their own.

Even just something as simple as going out for a sandwich. Everyone can make a sandwich at home. Why are they going to go somewhere and pay money for a sandwich? It’s the ambiance, the experience, it’s the person you might be dining with. It’s the servers. It’s a variety of things in those relationships that matter.

I think the exact same holds true in senior living. Care partners and other staff and the executive directors or GMs and all of those people — med techs, everybody who interacts with the resident on a daily basis, and even the other residents — there are opportunities to make their day just a little bit better by going above and beyond. And I think that’s where the intersection between the hospitality and the healthcare piece comes together. And a whole lot of those things don’t cost a dime. Great operators have figured this out, and they’ve hired the right people and put them in places with their residents to create these very meaningful experiences along the way, throughout a day, that they might not even realize are happening but could make a huge difference to the resident and/or their family.

Q: On the flip side, what do you think the hospitality industry could learn from the senior living industry?

A: On the hospitality side, we do everything for everybody in some ways. We know that’s not the best approach in senior living. In senior living, you want to create experiences, but you want those residents to come alongside you, because you want them to maintain their independence, their dignity, their quality of life, along the way.

I think sometimes in hospitality we over-serve. That sounds weird, but there could be some limits or parameters around what we’re doing for meaningful experiences for people. Not that we wouldn’t continue to do those things, but that we should roll those guests into that experience to come right along with us and help us create that as opposed to just doing it all for them.

Q: Medical care, healthcare, is becoming a greater part of senior living than it was in the past. How else has the industry changed since senior living began being taught at your institution?

A: I’m 64 years old, so I’m near the end of the baby boomers. And the baby boomers’ perception of what that industry is was probably very much based on their experience with their grandmas or grandpas. If they couldn’t be at home with family, they were in a nursing home, and that was not a good or pleasant experience.

As an example, I have millennial children. My dad passed away a few years ago. I’m not retired. My mom never even learned how to drive, and so I could not leave her in her home alone. We moved her down here, and she lived in a community near where I work. And so I transitioned a bit and became the adult daughter of a resident. But because of that, my adult children in the area went there to see her all the time. So they have a very different perception about what this industry is or what it might mean, and I think we’re seeing that more and more.

The students I have in class now, the sort of traditional 18- to 22-year-old, may have already been in a senior living community, because they’ve got a loved one there. Also, I have several students who may have had their first job in a senior living community. Maybe they were doing some stuff in food and beverage, or maybe they got a CNA through high school and now are care partners. Whatever it might be.

A shift has occurred over time from that very strict, 24/7, medical model nursing home to a more holistic experience, but the industry itself is transformed in that people aren’t waiting just until they need 24/7 skilled nursing care.

Many years ago, they started into this notion of, “Well, I could be an independent living resident, but if I’m an assisted living resident, there are options for me to get some additional care.”

I do think the level of acuity has increased, and I think you’re seeing some of those health services pushed further down into communities that maybe hadn’t been there before, and I don’t see that going away. I see the industry finding a way to deliver those services to residents in AL communities, or whichever level they’re in, much longer and delaying what might end up being 24/7 skilled nursing or hospice care.

Q: You mentioned students. Do you think the senior living curriculum attracts students to the university or the college or the school? Or is the industry more likely to be something they find out about once they’re there?

A: I think at this point it’s the latter. I want it to be the other way around, but this has been a work in progress.

These industry folks that I talked about, who started this — it was Jerry Meyer, who was at the time COO of Aegis Living; it was Bill Pettit, then-president of Merrill. Gardens; it was Tana Gall, who was the president at the time of Leisure Care; and then it was Granger Cobb, who was the CEO of Emeritus. When they came in about 2009 and those conversations started, we created a course. We did some things, but it’s taken us a long time to get where we are. We’ve actually only had a major in senior living since the fall of 2020, and that wasn’t the best time to be starting a major in senior living.

Before the major started, we created an elective course as an offering in the hospitality school, and it was kind of an introduction to this whole industry. And they flew over the mountains from the west side of Washington to the east side of Washington to teach the class.

I had no clue. I could write up a syllabus and herd the cats and get students to class on time, but I couldn’t teach the content. They did. They sent company executives over all the time.

And so for that elective course, which is the first course in the major sequence, we’ve probably put over 700 students through that class. And they all had to be people who were not majors in senior living, because we didn’t have a major. So, interestingly enough, what it has done is, there are several of those students who were in that class who then discovered there might be a career opportunity for their major that they hadn’t even thought about. And so we do have several former students who are placed in the industry but who don’t actually have the degree. 

The students who came in starting fall 2020, their first option to graduate [with the major] would be spring 2024. We are starting to pick up a little bit. We now have about 15 to 20 students who are somewhere in the system who have said, “I think I want to pursue this as a major.” Whether they’re doing that on the front end or after they’ve been here for a little bit, I’m not sure we know that.

We also have a minor in senior living management. That one started fall 2021 and takes less time to get. We have graduated three students with the minor.

And then we have an online, on-demand, non-credit-bearing certificate program.

Q: What kind of students do you think are attracted to go into the program or into senior living as a career?

A: I think it’s people with varying interests. We had a young young man in our spring session of this class who was in construction management. Interestingly enough, his family is developing senior living communities. That was a nice fit. So it was about a tie of his major to that area.

But in terms of people who want to go out and be in community operations, you have to have the right heart. You can come from lots of areas, across various majors, minors, whatever it might be, but at the end of the day, you’d better have an affinity for an aging population, and that all comes from the heart.

And I think that ties very closely to what we already do in hospitality. I can teach you how to make a bed, and I can teach you how to make a sandwich, and I can teach you how to make change. What I can’t teach you how to do is care, and that holds very true for senior living. If you don’t care, it doesn’t matter what I teach you, this isn’t the place for you. I think a caring heart and an affinity for that population and just the general desire to be of service and help others [are characteristics of those attracted to the industry].

Q: You recently were named to the Board of Trustees of the Vision Centre, which is working to create university and college programs and facilitate internships to prepare future generations of aging services leaders. Congratulations on that.

A: Thank you.

Q: And as you know, recruiting and retaining workers is a top challenge for the industry. What are your hopes for the Vision Centre?

A: I’m really honored to be included. [President and CEO] Doug Olson has done a great job of bringing some key industry people, some key industry partners and some key academic partners together into the same space to try to build this out.

I really see my role as helping us build out other academic programs across the country. No one university is going to handle this work. I don’t care how many graduates you turn out; you are not solving this one on your own. This is one of those things — and I’m as competitive as the day is long; I just should throw that in there — but we aren’t going to win by operating in a silo in this space.

The program we have is different. It was the first of its kind in this country that was housed in a hospitality school in a college of business. So I guess what I hope to do is lend some help for other similar programs, starting sort of with the “low-hanging fruit” of other hospitality programs and saying, “This is a natural extension of your product line. Let’s figure out how we repackage some of the things you have. What do you need to create? How can I maybe help navigate you through this process, because the need is there and what you’re already doing in your hospitality program fits very nicely.”

So that’s what I see as my role, really helping to build out — and maybe create some templates and some how-to, because I didn’t have any of that. It was fly-by-the-seat-of-my-pants and listen to the industry. Thank God, they just steered us in the right direction. But [I want] to provide some tools and support for people in programs who want to grow and develop and get into this space, because it’s where all the demand’s going to be.

I tell young people, “For the next 40 years, you can write your own ticket. You do anything in the aging space, you can write your own ticket, because the demand is there.”

Q: Congratulations also on being named to the United Nations Healthy Aging 50 list in 2022. I understand you were one of only four people in the United States to be recognized for “transforming the world to be a better place to grow older.” What do you think needs to happen for the world, and especially the United States, to be a better place to grow older?

A: Thank you for acknowledging that. I was shocked, is probably the best word, and humbled and so honored to be recognized. I think the entire world is in crisis with their aging population. This is not a US-centric issue. There are several countries around the world that are probably in deeper trouble than we are. I think about China. I think about India and what do we need to do?

I think there are several things we need to do. First of all, we need to get rid of the “ism” word and embrace an aging population and realize that some of the solutions to these problems may be with that population in and of itself. That is a group that’s going to need some places to live, some things to do and have a lot of years left in their life that they may be able to contribute back to their society.

I think in the US, we’ve got to get out of that mode that, “Oh well, you’re 65 and you’re done, you’re retired, collect your Social Security,” which may or may not be there, and just go away quietly.

For me, that’s another third of my life I still have to live. I’m not going anywhere if I have anything to say about it, and so I think we need to embrace some of that.

We have older people with so many skills and talents who could be mentoring younger people or mid-career changers or young people in intergenerational-type experiences. All of those things matter.

We also need to look at some things related to immigration reform, related to these workforce challenges. It’s real. And I don’t even want to say that and make it sound like it’s some big political spin, because really it’s not. My understanding is, there’s a clause in a certain visa statement that if we just changed the phrasing just slightly, we could open up some opportunities for people with their visa status to come in and come to work in our communities.

We have to do something. Doing nothing isn’t going to be helpful.

You know the old saying, “Hope is not a strategy.” We have to become more proactive in some of the things we do, both as operators, trade associations, vendor partners and then just sort of as citizens.

We’ve got to realize, if you’re breathing, you’re aging, and that’s a really great thing, because the alternative to that means you’re not going to be blessed with aging. How do we become more active participants in our own lives, in our own communities, to embrace this for what it is and the opportunity it can create?

Q: Is there anything else you’d like to mention that we haven’t discussed so far?

A: The only other thing I would like to say is, I just want to stress how grateful I am for the industry partners who have helped us along the way with the work that we’re trying to do. We have an active steering committee. We have a strategic plan. We have had industry partner involvement — which also includes some association members and some vendor partners — from day one to help us guide this.

We’ll come full circle. My background is restaurants, and my degrees are in education. How did that link me here? I have no idea, but I was, gratefully, able to recognize an opportunity and listen to those fab four folks who came and talked to us early on and listen to them, and we still listen to them. And I think that a key to all of this is just remaining so closely tied to the industry and working with them to help everybody get this right.

This is an expanded, edited version of the conversation that was published in the June print magazine. A podcast of the discussion is available to listen to here.

A: The significant growth of the older adult population (specifically, the older baby boomers) over the next several years will present new opportunities for senior living community owners, operators, developers and investors. Although the increase in the demographics will be dramatic, the housing options available to those older adults will be driven, in large part, by their financial resources.

Accurately defining the appropriate qualifying income criteria for a specific project is a critical assumption in assessing potential market demand. This affordability issue, which has not always been appropriately quantified, makes the need for a market study more important than ever.

Research has confirmed that the true cost of living for an age- and income-qualified older adult before and after moving into a market-rate rental independent living community often are quite similar, with the true cost comparison frequently favoring senior living communities. For example, a rental independent living community that includes a meal program, housekeeping, flat linen service, transportation and utilities, along with the apartment, is estimated to account for 60% to 65% of an older adult’s living expenses. If the rent for this community is $3,500, then this person would need a total before-tax qualifying cash flow income of $64,615 ($3,500 / 65%), before incurring any spend-down of other assets. This cost of living factor, obviously, would be adjusted based on the services included in the rent.

An active adult, service-free community would account for 35% to 40% of the living expenses, whereas assisted living and memory care could cover up to 80% to 85% of the living expenses. The remaining portion of the cash flow income is used for personal and discretionary items and activities outside of the senior living community.

Other financial resources can be used to pay for market-rate senior housing, including other savings/investments, financial assistance from family, Veterans Affairs benefits and long-term care insurance. Those resources can be difficult to accurately quantify, however, and typically are considered to be forecasting safety margin when evaluating the demand for new senior housing.

Lynne Moore is president of MDS Research Company Inc., a national senior living and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for over 50 years. MDS is a two generation company – she is following in Jim Moore’s footsteps. Ms. Moore is responsible for all MDS market research-related projects involving all aspects of Senior housing and health care. Lynne Moore can be reached at (817) 731-4266 or lynnemoore@m-d-s.com.

A version of this column will appear as “You’ve Got Questions, We’ve Got Answers” in the June 2023 issue of McKnight’s Senior Living.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

More than 300 aging services professionals and supporters gathered to celebrate the accomplishments of 60 honorees working in the areas of senior living, skilled nursing, home care and hospice May 22 during the McKnight’s Women of Distinction Awards and Forum at the JW Marriott Chicago.

In addition to a Lifetime Achievement Award, which was bestowed on Marilynn Duker, co-chair of Baltimore-based Brightview Senior Living, awards were given to 21 Hall of Honor inductees, 16 Veteran VIPs, 16 Rising Stars and six Spirit Award winners at a gala dinner that was preceded by a cocktail reception.

Duker told those gathered for the awards ceremony that her career has “wildly exceeded my expectations.” “I would never think you … take a job when you’re 26 years old and that you can end up the same place 40 years later in a completely transformed organization. …I couldn’t feel better about what we have all accomplished,” she said.

Everyone in the room is “incredibly fortunate to have a career that can be incredibly fulfilling while doing something really good for people at a very vulnerable time in their lives,” Duker said. “I’ve found the greatest personal satisfaction from having the incredible opportunity to work with so many amazing people. I’ve learned so much … from many of you, both in Brightview and throughout the industry, and know we are better as a whole because we’re all in this together.”

The festivities also featured two afternoon educational sessions that showcased insights from women honored this year and in previous years.

One panel, “Traits of a successful long-term care leader,” was moderated by McKnight’s Long-Term Care News Senior Editor Kimberly Marselas and highlighted six 2023 inductees: Help at Home Market Leader Katie Gallenstein, WelbeHealth Director of Strategy and Special Projects Sophia Guel-Valenzuela, Clement Manor Campus Administrator Carly Loewus, Elara Caring Skilled Home Health President Kimberly Nystrom, Sanford Hospice Administrator Desirae Toomey and Help at Home Chicago Director of Operations Rose Trevino.

The other session, “A lifetime of lessons from the C-suite,” was moderated by McKnight’s Senior Living Editor Lois A. Bowers and featured three Lifetime Achievement Award winners: Duker; 2019 honoree Lynne Katzmann, founder and CEO of Bloomfield, NJ-based Juniper Communities; and 2020 inductee Wendy Simpson, chairman and CEO of Westlake Village, CA-based real estate investment trust LTC Properties.

2023 marked the fifth year of the McKnight’s Women of Distinction awards, which have grown from the inaugural year to include additional categories of recognition as well as the educational component. This year’s celebration was the third in-person Women of Distinction event, with two years of festivities having been held virtually during the COVID-19 pandemic.

See the names of honorees from this year and previous years here, and see additional coverage of this year’s event here.

PointClickCare was the Diamond sponsor of this year’s program. PharMerica was the Silver sponsor. Additional sponsors included American HealthTech, Healthcare Services Group, Omnicare, Sentrics and ShiftKey.

The nomination process for the 2024 McKnight’s Women of Distinction Awards will open later this year. Details will be posted at mcknightswomenofdistinction.com and on the McKnight’s websites.

Harriett Jones has spent almost four decades calmly steering residents through bathing times, keeping plenty of warm towels handy or singing to soothe an anxious bather. Although she maintains eye contact throughout the process, Jones also keeps an eye on safety in the spa room.

Given an increasingly ambulatory population, the presence of water and the kind of warm and moist environment that invites bacteria to breed, risk is inherent in bathing areas. It takes careful strategy, attention to detail and smart use of equipment to deliver a sanitary and satisfying bath while preventing accidents that could leave residents or staff injured.

At Levindale Hebrew Hospital and Nursing Center in Baltimore, Jones’ job is made easier because staff members pair up for every single transfer, whether they’re using a Hoyer lift to get someone from bed to a shared bathing area or doing a slide transfer to a shower bed. “It’s not really a hard part of the job,” says Jones, who works the evening shift on Levindale’s Golden Hill unit, home to approximately 50 residents. “I feel wonderful that I can do this for them. We always talk to them, talk them through the shower, which part of the body we’re cleaning [and] asking them if it’s OK to move on.”

Approximately 80% of falls among older adults happen in bathrooms, according to the National Institute on Aging. Even in congregate communities that control for variables such as poor lighting and uneven surfaces, danger suddenly can appear in places it never has before — or in residents who always have seemed ready and willing to take a shower.

Some residents may become agitated due to dementia or other cognitive impairment, and conditions ranging from diabetes to a new hypertension medication could increase fall risk overnight.

Drains should flow freely so excess water doesn’t pool at residents’ or staff members’ feet. Staff members also should be wearing non-skid shoes. As a secondary technique of preventing water from leaving the shower area, Levindale aides roll resident chairs onto oversized, flat towels, catching any water dripping from a resident’s hair or elsewhere before they head back. 

Residents need not bathe every day, but once or twice a week helps most residents avoid skin breakdowns, according to DailyCaring.com, a website that addresses various care issues.

Older adults tend to be less active than younger adults, so they don’t need to bathe as often. Conversely, however, body odor is a development that is best avoided.

An exception to less frequent bathing schedules may be needed for residents living with dementia; daily bathing may be a part of their daily routines.

The website also recommends using warm washcloths to wipe armpits, the groin area, genitals, feet and any skin folds to help minimize body odor in between full baths.

The website adds that it is essential to consider residents’ specific health conditions when choosing a bathing schedule. Some people may need to bathe more frequently than others, for medical reasons.

» Invacare’s Birdie Evo XPLUS lift takes hold

Invacare Corporation’s recently unveiled Birdie Evo XPLUS lift is gaining popularity in the United States, according to the firm. 

The product’s technology is desgined to help maximize comfort and security when lifting or transferring a resident to or from a bed, chair or floor, Invacare said. Features:

• Slow’R integrated dampener – This piece of hardware, built into the boom, is meant to reduce rocking movement, resulting in a stable and more comfortable experience for the end user and steady lift control for the caregiver.

• Ergonomic sling hook – This hook with a nose is designed to help prevent sling loops from sliding out unintentionally, helping reduce the risk of injury, and it has a wide base that allows for easy strap positioning.

» Resident handling equipment market has predicted value of more than $14 billion

The global patient handling equipment market is estimated to be worth $10.4 billion this year and is poised to reach $14.0 billion by 2027, according to a new report by MarketsandMarkets. 

The growth is partly fueled by the growing number of obese and geriatric populations.

After long mimicking the hospitality industry’s grand lobbies and communal spaces, long-term care designers are shifting to a “less is more” strategy.

“The pandemic highlighted that the same efficiencies that made skilled care at a large scale possible (and affordable) — shared rooms and units of 40 to 60 people — often comes at the expense of quality of life,” says Melissa Destout, associate principal at Perkins-Eastman. In places such as skilled nursing areas of life plan communities, the focus is shifting from primarily physical care to whole-person care, with reimagined nurses stations, activity spaces and more to match.

“In a recent, pre-pandemic project for Jewish Senior Life, we worked with our client to design and build three-story Green House homes to create smaller-scale environments featuring private rooms,” Destout notes. Those new residences were followed by a renovation of an existing nursing building to create neighborhoods as well.

Still, this trend toward “smaller and more intimate” is not all-encompassing. Destout and colleagues believe large-scale gathering spaces are still important. Residents’ adult children “will still be looking for far more of the hospitality and lifestyle settings which present themselves in a far less clinical manner,” says Gaurie Rodman, senior director of real estate strategy and development for Aptura.

Opportunities for full renovations and new resident rooms remain rare, says Martin Siefering, principal and co-leader of the practice at Perkins-Eastman, but a strong alternative exists in creating smaller-scaled environments within an existing footprint. It “can have a huge impact on quality of life and care,” he adds, noting a recent project by a New Jersey provider to add separate living and dining spaces and a bathing suite to wings of an existing building.

But as long as the economy is challenged and supply chain issues exist, wholesale single occupancy is on hold for skilled nursing, says Dan Davidenko, CEO of Kwalu. “Single occupancy rooms are more of a request than a trend. Waiting to complete projects can have a greater impact on the bottom line as freight, installation and the products themselves can all increase in price,” he says.

A new memory care unit in upstate New York underscores growing demands from communities serving older adults with specialized needs.

“The demand for dedicated memory care services in Central New York has continued to increase far beyond what our community can currently support,” said Kim Townsend, CEO of Loretto.

The healthcare company opened its memory special care unit in early January by renovating an entire floor of its main campus to support the unique needs of those in the most advanced stages of the disease. After nine months of planning and three months of construction, the new 12th floor unit offers 30 individual rooms.

Features include wayfinding cues; sensory stimulation through touch, sounds, and a scent system to help residents feel calm; and walls camouflaged with landscapes and familiar home scenes to trigger memories, direct residents and keep them safe.

» New guidelines tout benefits of automatic doors in facilities

Automated door systems can be a versatile solution for resident rooms, reducing potential injury by eliminating the need to use a heavy manual door, the American Association of Automatic Door Manufacturers said in new guidelines.

Unique benefits include access control, wander management and touch-free operation. Automatic doors come in three types: sliding, swing and folding, and can be fit to resident room entries. Sliding doors in particular are made to withstand the influx and outflow.

» Mannington Commercial adds to LVT line 

The Realities III line of luxury vinyl tile includes 48 enhanced wood visuals and colors, all of them suited for healthcare and senior living and care facilities, where hygiene, easy maintenance, cost savings and efficient installation are priorities. 

Those latest wood visuals are designed specifically to coordinate with items from Mannington’s Spacia Collection LVT and Amtico LVT colors, making it easier for healthcare and long-term care designers to create a unified, high-performance space. Rolls available in a variety of widths also reduce seams, making floors easier to install and clean.

Therapists have had to prove their mettle in three-plus years under the Patient Driven Payment Model.

Still, many insiders liken the experience more to an “evolution” than “revolution.” Rather than disrupting therapy, the launch of the model in 2019 led to improvements.

“Since the implementation of PDPM, the long-term care industry has seen extraordinary challenges as we faced major reimbursement and regulatory changes in the midst of the global COVID-19 crisis,” says J. Lynn Bauknight, PT, MSPT, CWS, RAC-CT, RAC-CTA, corporate director of client success for Reliant Rehabilitation.

As Reliant pros pointed out in a recent McKnight’s webinar, a premium is placed on achieving high-quality outcomes as efficiently as possible — all while facing reimbursement cuts for therapy assistants and greater transparency in billing practices.

Under such stress, skilled therapists have expanded their roles as practitioners and patient advocates, Bauknight observes.

John Heller, CEO of HealthPRO Heritage, says he relies on the same approaches that have guided his company from day one: to focus on “patient needs and achieving the highest level of functional improvement.”

“As such, the amount of therapy delivered must not be based on the particular incentives of the system, but rather on what the physician orders and the patient requires,“ he says. “Placing our therapy teams in the driver’s seat and promoting clinical autonomy to provide the right care, at the right time, in the right place, has always proven to produce optimal outcomes.”

Heller notes that the company did not feel pressured to make broad changes despite PDPM’s shifting emphasis from therapy to other provisions of care. 

“We closely monitored our outcomes paired against our steadfast clinical delivery and saw enhanced outcomes in the new payment system and throughout COVID,” he says.

“With rising patient acuities and a healthcare system continuing to evolve into a patient-centric, value-based system, it is more vital than ever to ensure quality care delivery is at the center of the patient experience. Rehab clinicians, alongside the interdisciplinary care team, are vital in that.”

Luna, a provider of in-home physical therapy, announced in March that it had launched a
partnership with Providence, a Western US not-for-profit health system that includes several skilled nursing facilities. Luna’s technology platform will expand access to outpatient physical therapy for Providence patients being discharged.

The platform allows patients and physical therapists to communicate and discuss care needs between visits. The same therapist will treat the person for the entirety of the treatment plan. People also will use the platform to make appointments and perform prescribed and monitored exercises between virtual visits.

The partnership is expected to reduce the number of referrals that go outside the system. A 2021 Luna study found US health systems lose an estimated $2.5 billion in potential revenue from therapy referrals.

“Luna’s in-home physical therapy provides relief for health systems operating at capacity and needing more access,” said Palak Shah, co-founder and head of clinical operations at Luna. 

» Resistance training urged for sarcopenia

Older adults with age-related skeletal muscle loss, or sarcopenia, improved their sleep and inflammatory status when participating in a 12-week course of resistance exercise, a study found.

Sarcopenia has been found to affect 15% of adults aged 60 or more years and 46% of those aged 80 and older, according to Brazilian researchers.

Investigators examined how resistance training could help address links between sarcopenia, sleep deprivation and age-related inflammation. Fourteen participants with diagnosed sarcopenia and an average age of 75 took part in training three times per week for three months, assisted by physical therapists, nutritionists and physicians. Exercises worked large muscle groups, progressing from moderate intensity to 80% of maximum force in the last eight weeks.

Participants improved on all metrics of muscle strength, including handgrip and leg torque, as well as sleep quality and inflammation.

Full findings were published in the International Journal of Environmental Research and Public Health.