Tech plus touch is goal for senior living industry

Artificial intelligence has the potential to transform the senior living industry. From helping to drive resident satisfaction and supporting staff member retention to enhancing efficiency and streamlining processes, industry experts are optimistic about how AI can help support their operations.

At the same time, senior living leaders are mindful of the importance of human interaction in the industry and the need to maintain the right balance of what Alex Prough, chief commercial officer at Medical Guardian, called “tech plus touch.”

In a private roundtable discussion, “Exploring AI-Driven SaaS in Senior Living Operations,” sponsored by Medical Guardian, leaders from the company came together with senior living and care industry professionals to gain insights into how AI can best be used in the industry’s daily operations.  

When asked to pinpoint their most pressing operational challenges, panelists overwhelmingly cited staffing and regulatory issues. “It’s all about staff,” said Chris Winkle, a consultant and former CEO of Sunrise Senior Living. He said he believes “there’s a lot of opportunity for tech and automation to ease that labor pressure.”

“There’s not enough staff in the industry to fill positions,” agreed Mark Mitchener, corporate vice president for Greystone Communities. He added that, too often, staff members abandon jobs in the senior living industry to pursue higher-paying jobs elsewhere, with caregivers going to agencies. In states with a high minimum wage, operators find themselves competing with fast food or retail employers, and even Amazon, for employees.

Regulatory compliance issues also loom large for operators. “In some states, [senior living communities] are treated like nursing facilities when it comes to staffing ratio,” said Heather Tussing, president of The Aspenwood Company.

Valuable tool for reducing workload

From a regulatory compliance standpoint, it’s a moving target in certain states,  according toDivinia Nunez, director of operations for Sinceri Senior Living.

“All the regulatory demands are difficult for administrators,” noted Carrie Lund, vice president of operations at Principle LTC. “That’s probably one of the biggest challenges.”

The paperwork associated with meeting regulations also is a huge burden for staff members, and the panelists acknowledged that they are desperate to find ways to streamline their workflows. “Electronic records were supposed to make our job easier,” observed Mitchener. “The key is to use AI to take some of the paperwork load off caregivers and nurses and allow them to be on the floor with the residents.”

April Young, chief operating officer at Sinceri Senior Living, bemoaned “too many software platforms for employees to get lost in” at the expense of “customer service and engaging with residents and families.”

As with many other senior living companies that are beginning to explore ways that AI can assist in care and service delivery, resident engagement, documentation and compliance, Young said that Sinceri Senior Living is experimenting with AI to “determine how we could be more efficient and run more smoothly.”

Varied applications for AI

“I’ve seen applications from the marketing side to the procurement side to the capital side,” Winkle said. He described an AI tool that links procurement to the menu to lock in food cost.

Jenni Bost, vice president of marketing for Radiant Senior Living, described how her company has been more successful gathering survey information using an AI-driven chatbot than when using a live person. “We use it in our sales, marketing and with our [customer relationship management platform]. I use it for distilling survey information, and we’re able to do that faster than before,” she said.

Michener noted that his company is using AI to distill tome-like referrals down to two pages so staff members can more easily digest information and make decisions quickly. 

The panelists agreed that AI has the potential to enhance rather than detract from the level of human touch that residents receive. For example, AI can help ensure that the needs of all residents are being met. Winkle noted that AI can be applied to electronic health records data to determine which care plan residents should be on and whether their actual care reflects that assessment.

“Typically, the sickest people need the most attention, but we want to make sure that people that are less sick don’t get neglected,” observed Jim Reilly, senior director of MGLiving for Medical Guardian. 

AI also can be used to boost customer satisfaction. Howard Teicher, senior vice president for MGLiving and channel partners for Medical Guardian, explained that the company has created a wellness check-in campaign through which residents rate how they feel physically and emotionally. If a resident says he or she isn’t feeling well, then staff members receive a prompt to call the resident’s caregiver to suggest a check-in. 

“AI can give you visibility. You can make that outreach greater,” explained Terri Williams, senior director of healthcare marketing for Medical Guardian.

Tussing said that The Aspenwood Company has uploaded information on individual residents’ specific interests and is using AI to create unique experiences for residents, such as “one-on-one experiences or LinkedIn Learning courses.”

Enhancing outreach is an ongoing focus for Medical Guardian, company representatives said, adding that the firm is working to create an outreach coordinator program for its clients that can supply Silver Sneakers-approved providers to run activities.

Powerful tool to enhance care 

AI also can provide valuable insights into fall risk assessment, according to panelists.

“We’re seeing real promise in leveraging AI to work upstream to help prevent falls,” Prough said. “We are now doing dynamic fall risk scoring and starting to move the needle on emergency department utilization and other things for some of the communities we help support. We feel like there’s a lot of promise there.”

“There’s also an opportunity on the independent living side for a bot to answer a lot of the questions that nurses or staff members field, so that they can spend more time with residents,” Michener said.

Giving staff members the right tools can enhance job performance and job satisfaction, panelists said. 

“If staff members have something to help guide them through issues and give them the right answers, we’re better operators and have less liability risk,” Reilly said. That automation is especially helpful at helping keep those employees with the least experience from feeling overburdened, he added.

The panelists agreed that AI can be a huge benefit to lessening the workload of an overburdened workforce plagued by high burnout and turnover rates.

“It certainly helped with my staff burnout,” Bost said. “I could do much more than I could ever do before.”

“There is more we can do to prevent that burnout with our teams by utilizing AI,” Michener said. “We’re just scratching the surface at our organization.”

The increased use of AI also will require additional staff training, so the panelists stressed the importance of communicating to staff members that the training will make their jobs easier in the long run.

Michener concluded that “AI is coming, whether we like it or not.”

“We need to learn how to use it in our industry to have the best impact on our residents’ and staffs’ lives,” he said. “We do need to put the brakes on a bit to make sure our systems are all in place.”

To get the greatest value from AI, the panelists said that data need to be integrated, and they stressed the importance of sharing data across platforms.

“There are even more opportunities to create a centralized hub of data to support residents in a more meaningful way,” Prough said.

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Tech plus touch is goal for senior living industry  

Bill promises ‘generational investment’ in senior living and care workforce

by Kimberly Bonvissuto

Proposed federal legislation would make a “generational investment” in the senior living and care workforce at a time when the aging population is growing exponentially and an increasing number of older adults are living with chronic conditions and disabilities, according to its sponsors.

The Long-Term Care Workforce Support Act, introduced by Democrats, was met with mixed reviews from senior living industry advocates on Tuesday, however.

US Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on Aging, called direct care workers the “backbone” for long-term services and supports and said they are “irreplaceable” and “essential” during a Tuesday committee hearing focused on long-term care workforce shortages.

“Here is the bottom line — if we claim that their work as caregivers is essential, we should accord them the status of a professional,” Casey said in introducing the bill, S 4120, co-sponsored by Sens. Tim Kaine (D-VA) and Tammy Baldwin (D-WI). “By professionalizing and supporting the long-term care workforce, we can better recruit and retain professionals in this vital field.”

Casey said the bill would ensure that caregiving can be a sustainable, lifelong career by providing “substantial” new funding to support workers in every part of the long-term care industry, from assisted living communities to nursing homes to home care. Specifically, he said, the bill would provide pathways to enter the care workforce, improve wages and benefits, ensure a respectful and safe working environment, and introduce best practices on recruitment as well as training strategies to promote retention.

Pointing to a PHI report, Casey noted that caregivers earn a median wage of $15.43 per hour, resulting in almost 70% of assisted living communities and 92% of nursing homes reporting significant or severe workforce shortages. 

US Rep. Debbie Dingell (D-MI) introduced companion legislation in the House of Representatives, HR 7994, calling caregiving the “foundation of our economy” that allows for all other work to be possible.

“No care workers should have to live below the poverty line to do this work that millions of Americans depend on,” Dingell said in a statement. “This legislation will make much-needed investments in our care infrastructure and workforce, including family caregivers, to ensure they have the support they need, are paid a living wage, and are able to continue doing their critical jobs.”

‘Time is of the essence’

Provider advocates had varying responses to the bill.

Argentum said it appreciated recognition of the workforce shortages and potential resources to address it but added that “time is of the essence,” with the need to create more than 3 million new jobs in senior living by 2040 to care for a rapidly aging population.

Argentum Senior Vice President of Public Policy Maggie Elehwany said that workforce issues have been one of the few areas of bipartisan agreement in the 118th Congress, with multiple congressional hearings and calls from both sides of the aisle to “stem the exodus of healthcare workers.” 

The association, she added, continues to champion public policy efforts to bolster the senior living workforce, including support for the Safeguarding Elderly Needs for Infrastructure and Occupational Resources (SENIOR) Act, which targets assisted living workforce development, and the Care Across Generations Act, which addresses twin senior and childcare workforce shortages.

The American Seniors Housing Association told McKnight’s Senior LIving that the act prioritizes the need for workforce development programs as the industry and nation face the “real risk of not having enough available and willing workers to keep pace with the growing demand for their services.”

“This important legislation makes a significant investment in workforce development and training grant programs to be offered at the state level, offering a wide range of worker supports, skills training, demonstration projects, technical assistance, as well as worker protections,” ASHA Vice President of Government Affairs Jeanne McGlynn Delgado said. “These are all worthy goals, and if enacted and successful in creating a pipeline of trained long-term care workers, the industry will be well served.”

But Delgado said the legislation is only a partial solution, adding that immigration reform is a necessary component to addressing the sector’s workforce shortage challenges. ASHA said that Congress must take action to advance “one of the many reforms” already proposed, including creating a new visa category for caregivers, accelerating the timeframe an asylee can seek work authorization, and granting green card status to essential workers who worked during the COVID-19 pandemic.

“Congress will have to address the broken immigration system, and the sooner it does, the better for our seniors,” Delgado said. 

The Center for Excellence in Assisted Living, CEAL@UNC, which formally endorsed the legislation, said the act calls out “discriminatory” immigration actions, but “unsurprisingly” doesn’t go so far as to address the “third rail” of immigration.

“CEAL@UNC encourages supportive immigration policies to build the pipeline of new workers into assisted living and other long-term care settings,” Sheryl Zimmerman, MSW, PhD, executive director of CEAL@UNC, told McKnight’s Senior Living.

Zimmerman also said that although the federal government calls for recognizing the importance of the long-term care workforce, CEAL@UNC suggests going one step further and formally recognizing all of those providing direct care.

“The Center for Excellence in Assisted Living appreciates the federal government’s recognition of the essential nature of the direct care workforce, the fact that’s it’s important to virtually every family at some point in their lives, the evidence tying its sufficiency and competency to the well-being of older adults, and that the Long-Term Care Workforce Support Act expressly references the importance of the workforce in assisted living,” Zimmerman said.

Workforce bill ‘misses the mark’

Some senior living and long-term care industry advocacy organizations, however, said the proposed bill “misses the mark” and wouldn’t produce its intended effects.

“The entire long-term care continuum, no matter the type, faces a growing caregiver shortage that impacts access to care for our nation’s seniors and individuals with disabilities,” Clif Porter, senior vice president of government relations for the American Health Care Association / National Center for Assisted Living, told McKnight’s Senior Living. “This legislation ignores a wide swath of the profession and fails to address the elephant in the room — Medicaid frequently doesn’t cover the cost of care, making it difficult for providers to offer higher paying, competitive jobs.”

Porter added in a statement that it’s important for policymakers to recognize that assisted living communities and nursing homes “do everything possible to hire more caregivers.” 

“We must focus on meaningful and comprehensive policies that will actually help long-term care facilities recruit and retain workers, as well as build a strong pipeline of caregivers,” Porter said in a statement. “We hope to continue working with Congress and the administration to find more supportive ways to ensure our nation’s seniors have continued access to care.”

AHCA / NCAL said it supports several bipartisan bills to address workforce challenges facing providers, including the Healthcare Workforce Resilience Act and the Train More Nurses Act as well as three pieces of legislation that apply specifically to nursing homes: the Protecting Rural Seniors’ Access to Care Act, the Building America’s Health Care Workforce Act and the Ensuring Seniors’ Access to Quality Care Act. 

LeadingAge, which also pledged its support to the above-mentioned bills, similarly said that the “devil is truly in the details.”

President and CEO Katie Smith Sloan, in written comments submitted to the committee, urged policymakers to pay attention to “necessary refinements” on funding for the education and training initiatives needed to build and sustain the workforce and investment in coordinated state and federal infrastructures to ensure programs achieve desired goals.

Among LeadingAge’s recommendations was passage of the Expanding Veterans’ Options for Long Term Care Act, the Home and Community-Based Services Relief Act, the Better Care Better Jobs Act and the Expanding Service Coordinators Act to address “inadequate” reimbursement mechanisms. 

In addition, LeadingAge called on Congress to pass legislative proposals addressing gaps in the US immigration system and to develop and streamline federal training requirements for direct care professionals, including exploring how licensed vocational / practical nurses and experienced direct care professionals can assume increased training responsibilities for professional caregivers. 

“This should be done with a focus on developing stackable certifications and opening pathways for aging services staff to engage in a lifetime of career development and learning,” Sloan wrote in her comments. 

Addressing the newly introduced Long-Term Care Workforce Support Act, Sloan suggested dedicating a specific fund to clear HCBS waiting lists, including long-term care providers in both the rate-setting process and the formation of any passthrough threshold for which they would be held accountable by their states, combining grant funds under one roof, and including home health and hospice in the definition of long-term care. 

Senate Aging Committee Ranking Member Sen. Mike Braun (R-IN) cautioned against a federal “one-size-fits-all” approach, suggesting that innovation at the state and local levels is needed to meet the increased demand for direct care professionals. 

“Giving more power to the federal government usually means printing more money and forcing top-down solutions. These solutions are partisan and will not get us anywhere,” Braun said. “To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers.”

Elehwany said that Argentum agrees with Braun’s stance on partisan solutions and the need to “work together to pass bipartisan solutions that offer flexibility.”

‘Historic’ legislation addresses job quality

PHI called the bill “historic” and said that it “enthusiastically endorses” the legislation designed to systematically improve direct care job quality and address the sector’s workforce crisis. The organization said the bill enshrines many of PHI’s long-standing policy priorities related to compensation, training, employment conditions and evaluation.

Specifically, the organization noted that the bill authorizes the Department of Health and Human Services to award grants to support workforce recruitment, training, compensation and retention. This authorization includes a $10 million investment in pilot projects on education, training and career advancement across settings, as well as $10 million to support a national technical assistance center to support states’ workforce efforts. 

PHI also supports the bill’s proposal to create a National Direct Care Professional Training Standards Commission to develop national training standards for the direct care workforce, as well as an advisory council to develop a national direct care compensation strategy. 

Issues are ‘multi-dimensional’

Jasmine Travers, PhD, RN, an assistant professor at New York University Rory Meyers College of Nursing, testified during the hearing that the issues affecting the recruitment, retention and morale of the direct care workforce are “multi-dimensional and compounded by an external environment that devalues this work.”

She said the realities that make direct care work unsustainable include low wages and limited benefits, inequities, chronic under evaluation and a demanding work environment, insufficient training and limited growth opportunities.

Travers called for a multi-pronged approach involving federal and state governments, managed care organizations, aging organizations, payers, providers, advocates, care recipients and direct care workers to create solutions for a stronger direct care workforce. 

Financially, she called for competitive wages and benefits, and spending minimums for staffing for Medicaid-funded facilities. She also called for enhanced training programs and opportunities for career advancement, fostering a positive work environment through culture change, focusing on recruitment and retention and sharing best practices. 

“To improve access to and quality of long-term care, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment; opportunities for advancement; adequate training; and accessible benefits to maintain their health and well-being,” Travers testified. “Only when we recognize that these workers are critically important, hardworking professionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Brooke Vogleman, a licensed practice nurse with senior living and care operator TLC Management of Marion, IN, said that staffing should be about training, education and retention.

“We need workforce development programs that help us grow the care force, incentivize caregivers to choose a career in long-term care, and invest in their career development,” Vogleman said. 

Some hearing witnesses testified in favor of access to worker supports and protections. You can read witness testimony on the hearing website.

The Long-Term Care Workforce Support Act is endorsed by 44 organizations, including the Center for Excellence in Assisted Living, or CEAL@UNC; the Gerontological Society of America; the Coalition to End Social Isolation and Loneliness; the American Geriatrics Society; the National Coalition on Aging; and Justice in Aging.

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Bill promises ‘generational investment’ in senior living and care workforce

Executive salaries in senior living, nursing homes would be limited under proposed ordinance

by Kathleen Steele Gaivin

The annual salaries of executives in senior living, nursing homes and other healthcare entities in Los Angeles would be capped at $450,000 under an ordinance proposed by the Service Employees International Union-United Healthcare Workers West.

The limit, backers say, would ensure that the annual pay for executives, managers and administrators of privately owned healthcare facilities and hospitals in the city would not exceed the annual pay of the president of the United States, according to the initiative.

According to the proposed Limit Excessive Healthcare Executive Compensation Ordinance, “the compensation paid to CEOs, executives, managers, and administrators of hospitals and other healthcare facilities often is excessive, unnecessary, and inconsistent with the mission of providing high-quality, affordable medical care for all.”

In addition to skilled nursing facilities and residential care facilities for the elderly, the ordinance would apply to licensed general acute care hospitals and acute psychiatric hospitals, as well as facilities that are part of an integrated healthcare delivery system, defined as “a system that includes one or more hospitals and covered physician groups, healthcare service plans, medical foundation clinics, or other facilities or entities, where the hospital or hospitals and other facilities or entities are related through.”

“If passed, hospitals, skilled nursing facilities and residential care facilities will need to consult with qualified counsel about how best to structure executive compensation packages to attract and retain qualified executive talent,” attorneys at Pillsbury Winthrop Shaw Pittman wrote. “They will also need to carefully comply with annual reporting obligations, which will require certifications under penalty of perjury.”

Pay rates for healthcare workers are lagging behind rates for workers in other fields, according to SIEU-UHW.

“While many healthcare workers receive less than $25 an hour, healthcare executive salaries and bonuses have continued to rise,” the union stated.

A California bill that proposes increasing the minimum wage to $25 from its current $15.50 for direct care workers and support staff members has met with criticism from senior living industry advocates.

According to law firm Pillsbury Winthrop Shaw Pittman, “If the [proposed SIEU-UHW] initiative officially qualifies for the ballot, the Los Angeles City Council will choose whether to adopt the initiative outright as an ordinance or instead refer it to voters for the 2024 ballot.”

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Executive salaries in senior living, nursing homes would be limited under proposed ordinance

Northern Nevada senior facility starts pen pal program

Click to Watch Video

By Elizabeth Rodil

RENO, Nev. (KOLO) - Carson Valley Senior Living started a Pen Pal program for its seniors during the pandemic. The program started with a simple social media post. Employees snapped photos of seniors and highlighted a few of their favorite things. 

Life Enrichment Director Adrianna Ward said, “I want to say we received over a hundred letters. We had about four care packages come in, between crossword puzzles, succulent plants, goodies, and the candies that they like.”

Ward didn’t expect the facility would get an overwhelming response. She said, “So we started the pen pal July 6th and the post went viral, within a week we had over 40,000 people reach out.”

Seniors Lorraine Strazi and Susan Rielley responded back to their new pen pals. Strazi said, “I apologized for my handwriting because it was yucky.” Rielley said, “I wrote back, she has to write back, you know, you have to wait, you know how mail is.”

According to Ward these new formed friendships have made a difference for these seniors. The facility scaled down on visitation hours since the pandemic. “With the window visits we are doing and now we are doing outdoor family visits for 30 minutes, it’s still not enough sometimes for them.” 

She continued, “To have that constant writing it keeps their mind going and they just love getting that attention and knowing that there are people out there during this pandemic that people do care.”

If you want to become a pen pal you can click here: https://www.facebook.com/CarsonValleySL

Employees at Carson Valley Senior Living started a pen pal program during the pandemic.(KOLO)

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Northern Nevada senior facility starts pen pal program

Nursing home aide charged with assaulting patient at Samaritas Senior Living

SAGINAW (WJRT) (7/11/2019) - A Saginaw woman is charged with assaulting an elderly woman at Samaritas Senior Living last year.

Elizabeth Haines, 62, is charged with one misdemeanor count of assault and battery after she allegedly grabbed the wheelchair-bound victim's arm forcefully and pinned them to the chair in April 2018.

The woman allegedly told Haines to stop, but she continued holding the woman's arms against the wheelchair. The victim had bruises on her arms afterward, according to prosecutors.

Michigan Attorney General Dana Nessel's Elder Abuse Task Force investigated the case and filed the charges, which were announced Thursday. She said restraining nursing home residents is considered abuse.

“Physical abuse of nursing home residents is never acceptable, period,” said Nessel. “Most vulnerable residents are completely dependent on their caregivers for a myriad of essential daily tasks and when those caregivers become abusers, my office will step in and hold them accountable.”

Haines was arraigned Thursday in Saginaw County District Court. She was released from custody after the hearing on a $7,500 personal recognizance bond.

Haines no longer is employed at the nursing home.

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Nursing home aide charged with assaulting patient at Samaritas Senior Living

How to address the issue of resident abuse in senior living

by Jim Burke

When news broke earlier this year that a young woman, an incapacitated resident of a long-term care facility in Arizona, had given birth after allegedly being raped by her nurse, it was only the latest in a litany of abuse cases that seem to plague the long-term care industry, including senior living. At Senate hearings in March, for example, one woman testified how her elderly mother, a woman with Alzheimer’s who lived in a Minnesota memory care community, similarly had been abused by a nursing assistant.

But it’s not just sexual abuse of residents that is an issue. Here are just a few examples of other issues:

• A South Carolina-based operator of state-owned veterans’ homes is being investigated for allegations of neglect and substandard care, including failure to respond to resident-on-resident physical violence.
• Earlier this year, employees of a Columbus, OH, facility were charged with involuntary manslaughter after one resident of the home where they worked allegedly died as a direct result of their neglect (with wounds that turned gangrenous) and another suffered serious harm.
• A Jacksonville, FL-area based chain of nursing homes was sued for a stunning $350 million – an amount overturned by a judge in January – for allegedly both withholding therapy and treatments to residents as well as providing them when not needed. In one instance, a hospice resident, seeking end-of-life comfort and pain relief, allegedly was put through strenuous occupational and physical therapy. In others, residents with diabetes reportedly went without regular blood sugar tests for more than a month.

Abuse of residents of senior living communities and skilled nursing facilities is not the norm, of course, but it is a persistent and pervasive problem. Hearings such as the Senate’s one earlier this year, and others at the state level, emphasize the role of public policy and regulations in identifying and stemming abuse of residents and improving care quality.

The expectation is that once standards of care are set, employers will make every effort to attract, vet and retain staff that meets them. Meeting that expectation can be a challenge, however.

If abuse of residents is a persistent problem, then it also is an underreported one, making completely accurate data somewhat problematic. Most incidents are categorized as elder abuse, because six out of seven residents are aged 65 or more years. The majority of those who are especially at risk have dementia or moderate cognitive impairment. With communication skills and judgment impaired, they are unable to report abuse, so it continues without consequence.

In terms of the types of abuse inflicted, rape may be the most shocking type, but it’s not the most common. According to the National Center on Elder Abuse, the most common types are physical (29%) and psychological (21%) abuse, followed by gross neglect and financial exploitation (both 14%) and sexual abuse (7%). And it is not always staff members who are to blame: resident-to-resident abuse is an issue, too, representing 22% of incidents.

Fixing the problem requires approaching it from a variety of different directions. For starters, we need to raise awareness of the issue, and everyone – from family members to caregiver teams and managers – should know the signs of abuse and / or neglect. The most significant red flags:

• Physical abuse: Inadequately explained bruises, skin tears, multiple fractures or long-bone fractures.
• Sexual abuse: Bruising of the breasts, chest or genital areas; an unexplained sexually transmitted disease; bloody or purulent discharge; and undergarments that are unusually stained.
• Physical and / or medical abuse or neglect: Unintended weight loss, poor hygiene, dehydration, social withdrawal, suspicious wounds, unmonitored medications and poorly managed medical conditions.

Better, though, is to establish environments where abuse is not allowed to flourish. Not only is that the right thing to do, the stakes have gone up for facilities accepting federal dollars but failing to create safe havens with the F600 series of tags that the Centers for Medicare & Medicaid Services introduced to its survey process. The F600 tags address adherence to operating practices that are free from abuse, neglect and exploitation. They put responsibility squarely on the facility, reinforcing the importance of having an abuse policy and procedures in place that are well-communicated and strictly followed.

Regardless of where a community is located or whether a community accepts Medicare or Medicaid funding, however, several best practices are key to preventing abuse:

• Screening: Before employees or volunteers are allowed to work with residents, reference, certification and licensing verification and criminal background checks should be mandatory. Any individual found guilty of abuse, neglect or exploitation or with a disciplinary action against his or her professional license for those reasons should not be hired. Training on the abuse policy should be mandatory for new employees and volunteers before contact with residents, and so should be an all-hands attendance at periodic in-service on the policy.
• Training: A comprehensive and ongoing education program covering aspects of resident abuse, neglect and mistreatment should be mandatory for staff and volunteers. Among the topics: Ways to identify residents who are at risk, how to recognize signs of mistreatment, how to report abuse without fear of reprisal, and understanding the Resident Bill of Rights. Staff should be trained to handle and respond appropriately to difficult resident behaviors, and to recognize caregiver signs of burnout, frustration and stress.
• Prevention: The policy on prevention should cover a range of procedures, starting with a resident assessment before move-in and a regular vulnerability assessment thereafter. Other procedures should consider the community’s physical environment, population and provisions related to the risk of admitting predatory offenders, all of which are contingent on specific state and statutory requirements.
• Reporting and response:Again, specific state law and statutory requirements apply, but a two-hour window is recommended if allegations involve abuse or result in serious bodily injury. If abuse is not alleged and serious bodily injury is not involved, it should be reported within 24 hours. Reporting is made to the community’s executive director and state authorities (its survey agency, adult protective services) and law enforcement.

Communities that sharpen their focus on policies, procedures and ongoing training will create an environment where resident abuse is an unlikely risk. Ultimately, however, we need to do more, and stronger public / private partnerships may make the biggest difference in improving the care and safety of some of our society’s most vulnerable members.

David Gifford, M.D., MPH, of the American Health Care Association / National Center for Assisted Living may have put it best after testifying at the March Senate hearing: “We should expand federal programs that attract healthcare workers to the nursing home profession. We should strengthen federal regulations around reporting and sharing of information about employees who have engaged in abuse through the creation of a national background check registry. And we should make resident and family satisfaction ratings of nursing homes publicly available.

Although Gifford cited nursing homes in particular, similar actions — attracting high-quality workers, improving the reporting and sharing of information about employees who have engaged in abuse, and sharing satisfaction ratings, where available — would help senior living communities as well.

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How to address the issue of resident abuse in senior living

Butler faces 28 counts

Former senior living director indicted on fraud, drug charges

 

Former owner of Senior Lifestyles, Stephanie Butler, has been indicted on 28 charges by the Putnam County Grand Jury.

The indictment also lists Brian Fitzhugh Richey, a licensed nurse practitioner. Richey turned himself into the Putnam County Jail this morning.

According to a release from District Attorney General Bryant Dunaway, the investigation began in February, following multiple reports of criminal behavior.

Butler faces charges of conspiracy to obtain controlled substances by fraud, obtaining controlled substance by fraud, conspiracy to commit financial exploitation of an elderly/vulnerable adult, financial exploitation, 11 counts of financial exploitation (A only), theft over $2,500 (A only), 4 counts of identity theft, 6 counts of money laundering and tampering with evidence.

According to the indictments, Butler obtained or acquired possession of residents' controlled substance medication by misrepresenting that the medication would be destroyed.

The count of committing financial exploitation of an elderly or vulnerable adult reportedly happened between December 2017 until May 2018, when Senior Lifestyles was initially raided by TBI agents.

Charges date back to 2016, alleging that Butler reportedly deprived patients of property, medication and knowingly financially exploited them while acting as their caregiver.

Butler also reportedly violated the Identity Theft Victim's Rights Act of 2004, and used, possessed, bought or obtained the personal information of numerous patients. After knowing an investigation was pending, Butler reportedly destoyed or concealed prescription medication packages.

The investigation discovered a total of 16 victims. Butler is now in the Putnam County Jail with a $150,000 bond.

Richey has charges of conspiracy to obtain controlled substance, obtaining controlled substances by fraud, conspiracy to commit financial exploitation of an elderly/vulnerable adult and financial exploitation of an elderly/vulnerable adult.

According to the indictment, Richey used his professional license as a way to provide and prescribe excessive amounts of controlled substances. Richey also reportedly prescribed victims controlled substances to numerous residents at Senior Lifestyles.

Richey reportedly became aware that Butler was diverting medication from patients and did not act to intervene, and continued to prescribe controlled substances.

Butler, on at least one occasion, provided Richey with controlled substances, from a resident of Senior Lifestyles, for his personal use.

Richey had a bond of $40,000.

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Butler faces 28 counts