This article is sponsored by Willis Towers Watson. In this Voices interview, Senior Housing News sits down with Director of Clinical Risk Services-Senior Living Center of Excellence Rhonda DeMeno to learn how senior living operators are planning their reopening strategies, managing risk stratification during this process and planning their budgets for 2021.–
In December, you began a new position at Willis Towers Watson as director of clinical risk services. What experiences in your career do you draw from most frequently in this position?
I am a registered nurse with over 30 years of experience in the senior living space. I have vast experience in regulatory compliance and quality performance. I have held positions with several senior living providers as a vice president of consulting services, corporate compliance officer and other clinical operations positions where I was responsible for regulatory outcomes and corporate quality performance initiatives.
In my past roles, I applied quality performance expectations to clinical operations policies, procedures and assisted with the development, deployment and integration of electronic documentation and resident assessment systems. My experience as a vice president of consulting services for a large senior living provider taught me auditing and gap analysis, so I learned how to identify risk and customize mitigation plans for providers, improving care outcomes.
I enjoy rolling up my sleeves to assist providers with customized solutions that are meaningful and realistic to their organization. These are not one-size-fits-all solutions — they require a true partnership. My skills have taught me to be a good communicator built on trust and advocacy for our clients.
I am passionate about the senior living industry and working with clients on quality performance projects as well as assisting in developing policies and systems to drive performance. I believe that is one of my bench strengths. I also realize that quality performance will enhance the lives of seniors residing in senior living communities and will also provide staff members with a great working environment.
That’s great. What are your goals in the role for the remainder of the year, and in 2021?
I have several goals. One goal is to continue to grow in my new position. For years, I was on the clinical, operational side of the business, playing defense to regulatory challenges and daily operational challenges that surface being an operator.
My current position with Willis Towers Watson brings new challenges, exposure to a wide range of clients equipped with different ways of operating. Building relationships with our clients so they are comfortable reaching out for assistance or guidance will be an ongoing goal for 2020 through 2021.
Another ongoing goal for 2020-2021 is to assist providers in understanding clinical programs that drive a culture of safety. That can be in any area where risk exists, including falls management, elopement, infection control, and medication management.
When COVID-19 hit, like many other clinicians, I went into an overdrive mode — helping our clients with guidance on best practice standards. One of the areas that quickly surfaced was that of the need to understand infection prevention and control. My nursing experience in long-term care has taught me extensive infection control and prevention practices; however, knowing the magnitude of the pandemic, I felt it was necessary to further my credentials with an infection prevention certification.
I am currently studying for the infection control certification through the CBIC (Certification Board of Infection Control), which will reaffirm my knowledge in infection prevention and signal to the Willis Towers Watson client’s professional credibility in the field of infection prevention.
I feel that infection control and prevention measures will become increasingly important in the years to come. My goal is to have the CBIC certification by year-end.
We’re now eight months into the pandemic in the U.S. What are you hearing in senior living on the topic of reopening, both in terms of entire communities, and pieces of communities, such as dining halls or other shared, public spaces?
Providers must adhere to their state or local authority directives. There continues to be a heightened awareness for infection prevention, and provider directives are related to the local situation and reportable cases. Many providers are applying CDC guidance for visitation strategies and community conditions to allow for visitation indoor or outdoor, and have adopted a range of CDC guidelines. A few examples of these guidelines include:
- Fourteen days with no new community onset of resident or staff COVID-19
- Sufficient staff to support the management of visitors
- Designating key staff to support infection prevention and control education
- Adequate PPE supply and supply management
- Strict adherence to cleaning and disinfecting
- Scheduling visitors by appointment
- Monitoring for adherence to proper use of masks and social distancing
- Requiring that visitors be 18 years or older
- Limiting the length of visits, visitation days, hours and number of visits per week
Along with those and many other CDC recommendations, many providers even had to delay the reopening of their salon services and offer different levels of visitation, such as outdoor versus indoor. There are changes in dining services, cleaning efforts, and social distancing. Providers are adhering to local or jurisdiction guidance or referring to CDC guidelines for reopening.
How does the budgeting for 2021 differ than previous years?
A senior living budget process usually begins with forecasting resident occupancy, admissions, and discharges and revenue per unit. Providers also often build their annual budgets on the baseline, i.e., the current year’s metrics combined with a review of the past year’s revenue metrics and costs per resident day as a means of forecasting.
But the fog of the pandemic complicates all of that. It is forcing senior living leaders to make unfamiliar forecasts. COVID-19 has impacted several areas that must be accounted for in the 2021 budget and financial planning, including:
- Labor costs and employee benefits
- Testing and immunization
- Disinfecting and cleaning
- Environmental modifications
My advice to senior living providers is to complete a budget diary based on COVID-19 lessons learned and expenses incurred by the department or discipline. For example, the administration should log surveillance expenses. Part of those expenses is related to equipment, training of staff, time spent on completion of the surveillance checks, correspondence time, reporting time and time spent on documentation.
In 2020, providers did not have the opportunity to plan for COVID-19 or for the financial impact that this pandemic has created. Budgeting for 2021 will need to address all sorts of items and offer a forecast for managing emergencies like a pandemic.
Where should operators take their cues on reopening?
Senior living operators are challenged with keeping track of CDC guidance, state orders and county and city directives as well as specific directives for licensing. They should refer to local county/city jurisdiction directives and include national and state directives in their plans for reopening. It is a good idea for senior living providers to have a written reopening plan, have no active COVID-19 cases and confirm with local authorities and health departments before reopening.
How are senior living providers using risk stratification to combat COVID-19 in the final few months of 2020?
I have been very impressed with senior living providers and their focus on infection prevention and solutions to keep residents and staff safe. Regarding risk stratification, providers are taking time to understand their patient populations and vulnerabilities. They realize that a holistic approach to risk stratification means understanding each resident’s overall health conditions and comorbidities and building an individualized risk stratification plan for each resident.
Risk stratification considers the resident age, comorbidity status, physical functioning capabilities and psychosocial needs. Based on resident characteristics, providers have designed specific resident service plans to mitigate COVID-19 exposures. For example, a resident who does not have many comorbidities may attend small group gatherings or communal dining.
However, if a resident is immunocompromised, they may have a different level of dining service or activity schedule planned, one on one activities planned or be assigned to a consistent care team to avoid unnecessary exposures. Providers are becoming very innovative in their attempts to provide a safe environment, determined by resident needs and a customized approach based on the level of risk the resident may have due to exposures and immunocompromised health status.
What areas do you recommend operators focus on for best managing risk in their communities?
There are many areas for focus in 2021. Regarding clinical services, I believe that infection control must be an area of focus for 2021. Senior living providers may need to consider adding an infection preventionist to the operations team. I also believe that new regulations will be evolving due to the pandemic. Those regulations may be focused on infection control, environmental and engineering controls, staff competency and reporting.
Other areas of risk are the day-to-day clinical risks of resident falls, elopement and medical management. For example, resident falls continue to be the leading cause of injury for the elderly, with falls constituting a significant source of liability exposure.
The pandemic has been the area of focus for all providers due to its virulence and attack rate on individuals age 65 and older with comorbidities. Senior living providers continue to be challenged with the day-to-day responsibilities of managing resident clinical conditions and risk associated with the aging population. Still, they must focus on clinical programs like falls management, skin management, elopement prevention and overall medical management. Providers must monitor these programs and continually educate team members, residents and family members about their safety culture and programs that mitigate unfavorable outcomes in these areas.
The other elephant in the room is staffing and recruitment efforts. Many providers have gone above and beyond to retain staff during the pandemic. Senior living providers need to continue the measures that have been put in place to keep team members safe and engaged in their work during the pandemic and create a workplace that provides safety and security to attract dedicated team members.
Staffing has been an ongoing challenge for senior living providers and will continue to be so. It will be up to the provider to customize employee benefits, creative scheduling options and opportunities for advancement. Building partnerships with academic institutions is a good method to recruit employees and attract entry-level candidates
What do you recommend operators watch for in terms of reopening risks and approaches in 2021?
Providers must stay focused on outbreak management, which they can do through community surveillance programs. Providers need to stay informed of local jurisdiction directives, outbreak and positivity cases reported. Also, providers will continue to need to adjust testing protocols according to the CDC, state and local guidelines and continue to coordinate resident care and treatment when COVID-19 positive cases surface.
With the upcoming flu season and the possibility of a COVID-19 vaccine, providers will need to be armed with a robust immunization program for residents, staff and family members and stay on course with infection prevention measures throughout their communities.
Editor’s note: This interview has been edited for length and clarity.
To learn more about how Willis Towers Watson can help your community manage reopening risk, and budget for the next year, visit WillisTowersWatson.com. Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed subsidiaries of Willis North America Inc., including Willis Towers Watson Northeast Inc. (in the United States) and Willis Canada, Inc.
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