Thursday, March 23, 2017

How does the Quality Payment Program work? (Part 2 of 2)

Merit-based Incentive Payment System (MIPS) rewards exceptional performers by giving them a positive adjustment in their payment from Medicare. If the practice is a low performer then they will receive a lower payment, or a penalty. For exceptional performance a practice can receive additional payments from 4% in 2019 to 9% in 2022 and forward. For a poor performing practice they can be penalized anywhere from 4% in 2019 to 9% in 2022 and forward. Each practice can choose how much they wish to participate. They can go from a “Test Pace” where they submit some data after January 1, 2017 and receive a neutral adjustment to a small pay adjustment. They can choose a “Partial Year” option where they can report for a 90 day period after January 1, 2017 and before October 2, 2017 and they can receive a small positive payment adjustment. 

Keep in mind that whenever a practice chooses to start, they will need to send in their performance data by March 31, 2018. Lastly, they can choose a “Full Year” option where they can fully participate starting January 1, 2017 and receive a modest positive payment adjustment. The best way for a practice to realize the positive impact from the Full Participation option is to submit data on all the MIPS performance categories.

Now to avoid any downward payment adjustment a practice can submit a minimum amount of data in 2017 to Medicare that can be one quality measure or one improvement activity, and they can avoid any downward payment adjustment. A key factor for positive adjustments is that these are based on the performance data on the performance information submitted, and not the total amount of information submitted or the length of time that the practice is reporting on during the year.

The Bonus Payments and Reporting Periods are as follows. To receive the MIPS payment adjustment it will be based on the data submitted. 

The best way to get the most out of the program is to participate for a full year. This type of participation gives the practice the most measures to pick from. CMS is encouraging clinicians to pick the option that best fits their practice needs and abilities. The categories are Quality, Cost, Improvement Activities, and Advancing Care Information. The default weights for each category are Quality (60%), Cost (0%), Improvement Activities (15%), and Advancing Information (25%). These default weights can be adjusted in certain circumstances. Quality has approximately 300 different quality measures and the practice needs only to select about 6. For Advancing Care Information there are 2 measure sets for EHR. 

The nice thing here is that if a clinician faces a significant hardship and are unable to report on the Advancing Care Information measures, they can apply to have their performance category reduced to a weight of 0%. If this category is not applicable to the clinician, then the 25% weight will be added to a different category. 
Submitted by Michael "Kevin" Harrington, MSHA, RHIA, CHP, Faculty, Saint Joseph's College

Wednesday, March 08, 2017

Medicare and the Quality Payment Program- What is it and who can participate. (Part 1 of 2)

Many physicians and their staff ask what a Quality Payment Program is and who can or should participate. Currently the Centers for Medicare and Medicaid Services (CMS) is looking to move to a more beneficial Quality Payment Program (QPP), but knowing the past would be helpful. Way back physicians were reimbursed in a Fee-for-Service (FFS) model where it was volume, not quality that drove the payment. As this payment model was slowly getting out of hand, Congress passed temporary fixes called “doc fixes” to avoid cuts in reimbursement. If they did not do this it would have resulted in a 21% cut in Medicare payments to clinicians.

In comes a great idea, a Quality Payment Program (QPP) that can help to reform Medicare Part B payments for more than 600,000 clinicians across the country. This is a huge step in the direction of improving care and controlling costs across an entire healthcare delivery system. There are two tracks that a clinician can choose from which are Advanced Alternative Payment Models (APMs) that require the clinician to participate in an innovative payment model. 

The second option is the Merit-based Incentive Payment System (MIPS) which works with clinicians that choose to remain in a more traditional Medicare payment model and possibly earn a performance-based payment adjustment.
Now the question is who can participate? The Quality Payment Program is available to all Medicare Part B clinicians billing more than $30,000 a year to Medicare and providing care for more than 100 Medicare patients per year. The clinicians include Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists. 

Those clinicians who are excluded from the QPP are ones that enroll in Medicare for the first time during a performance period as they are exempt from reporting on any measures and activities for MIPS until the next performance year. Also, clinicians that are below the low-volume threshold of $30,000 per year in billing to Medicare or they see less than 100 Medicare patients per year. In addition, clinicians significantly participating in Advance Payment Models (APMs) are excluded.

Overall, this program is designed for small practices to be able to successfully participate in the Quality Payment Program by reducing the time and cost to participate, allowing the small practices to “Pick Your Pace,” increasing the opportunities to participate in an APM, including a practice-based option for participation in an Advanced APM as an alternative to total cost-based, and by conducting support and outreach to small practices through various programs such as Transforming Clinical Practice Initiative.  

For the Rural and Health Professional Shortage Areas (HPSAs) they can have less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients served. They only need to report on one high-weighted activity or two medium-weighted activities. These are all designed to have ease of access to the program, regardless of the size of the practice or the location that they serve Medicare patients.
Written by Michael "Kevin" Harrington, MSHA, RHIA, CHP  Faculty, Saint Joseph's College

Monday, February 27, 2017

Cultural Diversity & Senior Health Care

Race, Ethnicity & Culture:  Health Disparities and Outcome

As is widely recognized, today's older adult population is highly diverse, with one's ethnic minority status being an important source of this diversity.  According to recent U.S. Census Bureau reports (2015), members of minority groups currently represent over one-third of the American population.  Looking into the future, we can expect faster growth among elder ethnic minorities than among Caucasians.  By 2042, the U.S. is poised to become a minority-majority nation.

Recent research findings by cultural anthropologists are enhancing our understanding of health and morbidity-related data among various groups (Lehman, 2011).  While great variability is recognized, several common, recurring themes are noteworthy as follows:
  • ·        For most elders of color, their resources and social status reflect discriminatory social, economic, and educational practices that were experienced in early life.  They are often among those who have a history of being marginalized and under-served.  e.g. elder immigrants with cultural and language barriers.

  • ·         In general, most share the following socio-demographic characteristics:  poverty, malnutrition, sub-standard housing, and poor health.

              Exception:  Japanese Americans & Chinese Americans, who have longer life expectancies.
  •       There are higher rates of mortality from the following diseases:  diabetes, heart diseases, and cancer, as well as higher rates of functional disabilities.

In efforts to interpret the impact of these findings upon health disparities, researchers underscore the inter-relatedness of race, ethnicity, and culture (Hooyman & Kiyak, 2011).  Historically, one's socio-economic status is directly linked to health and longevity.  Accordingly, poor people of all ages and cultural origins are at greater risk of health problems and related disabilities.

Among the oldest-old (those age 85+), there is increased likelihood of multiple chronic health conditions occurring simultaneously. However, research indicates that the origins of long-term illness often begin in early childhood.  Risk continues to be heightened throughout the life course by factors such as financial instability and educational disparities.  In other words, economic and health conditions experienced early in life appear to have long-term adverse consequences for adult health (World Health Organization, 2014). 

Under-Utilization of Health & Social Services
In general, ethnic minority members under-utilize health and social services.  Among the primary contributing factors are:  cultural and language difficulties, physical isolation, financial impoverishment, culture-based values and expectations, distrust, and structural barriers to service accessibility (Hooyman & Kiyak, 2011).

While the above findings paint a bleak picture of health disparities and hardships, we also need to acknowledge and celebrate the considerable strengths and resilience of some elders of color.  This is especially true among the oldest-old, a finding of The New England Centenarian Study, as well as several cultural anthropological studies (Sokowsky, 2012).

Cultural Competencies

Definition of "Culture:"
Learned or shared knowledge, beliefs, traditions, customs, rules, arts, history, folklore, and institutions of a group of people.  These are then used to interpret experiences and to generate social behavior.    (Sokowsky, 2012).

Definition of "Cultural Competence:"
The ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients.  (Campinha-Bacote, 2012).

Central Concepts:
As minority groups within the older adult population increase in numbers throughout the U.S., the importance of cultural competence is becoming more evident.  The need for cultural awareness, knowledge, skills, and considerations is pronounced.  Key concepts include:
  • ·         Language & Effective Communication
  • ·         Trans-Cultural Education
  • ·         Understanding specific cultural values, beliefs, practices
  • ·         Self-Awareness & Consideration of healthcare provider bias / prejudice
  • ·         Demonstrating respect & Fostering trust
  • ·         Recognizing "folk medicine" & non-traditional health care practices.

Cultural Beliefs & Practices:  Impact upon Health

It is now generally recognized that cultural beliefs and practices often influence an individual's health and behavior.  This includes choices, utilization, and compliance. (McBride, 2015).  As healthcare leaders, cultural competence must be a high priority for quality patient-centered care.   All health institutions must make it known that the care they provide will respect cultural differences and that they will adapt services in order to effectively address patients' cultural needs. 

It is critical that healthcare providers be educated on population-specific health related cultural values, beliefs, and behaviors (McBride, 2015).  If all facilities provide education and support the basic tenets of developing cultural competencies among all practitioners, elders can be provided with consistent quality care. 

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Campinha-Bacote, J. (2012, May).  The Process of Cultural Competence in the delivery of    Health Care Services.  Retrieved on February 25, 2017 from
Hooyman, N., & Kiyak, H. (2011). Social Gerontology: A Multidisciplinary Perspective (9th ed.).      Boston: Allyn and Bacon.
Lehman, D. (March/April 2011). 21st Century Caregivers:  Diversity in Culture.  Aging Well.  2(2), 26-29.
McBride, M. (2015). EthnoGeriatrics and Cultural Competence for Nursing Practice.  Hartford Institute for Geriatric Nursing.  Retrieved on May 6, 2016 from
Sokolovsky, J. (2012). The Cultural Context of Old Age (3rd ed.).  Santa Barbara: Greenwood Press.
U.S. Census Bureau.  Statistical Abstract of the United States (2014). (132nd ed.).  Washington, D.C.  Retrieved on January 6, 2017 from
World Health Organization. (2014). Active Aging: A Policy Framework.  Paper presented at the third United Nations World Assembly on Aging, Madrid, Spain.

Cultural Competencies in Senior Health Care

Training / Curricula Modules
·         Campinha-Bacote, J. (2012, May).  The Process of Cultural Competence in the delivery of Health Care Services

·         Hartford Institute for Geriatric Nursing.  EthnoGeriatrics and Cultural Competence for Nursing Practice.   under “geriatric topics,” click onto “ethnogeriatrics and cultural competence.”

·         Office of Minority Health.  Center for Linguistics & Cultural Competence in Health Care.

·         Office of Minority Health.  Think Cultural Health.

·         Stanford School of Medicine.  EthnoGeriatrics.

·         Sokolovsky, J. (2012).  The Cultural Context of Old Age: Worldwide Perspectives.  (3rd ed).  Santa Barbara: Greenwood Press.

·         Vaughn, L., & Cruz, D. (2017).  EthnoGeriatrics: Health Care Needs of Diverse Populations.  London: Springer Publishing.

Blog Author:  Donnelle Eargle, PhD, MEd   Contact:

With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College.  Standish, Maine.

Thursday, February 02, 2017

The Mentoring Relationship

Being part of a mentoring relationship can have a positive and long range impact on professional goals and aspirations. For students, mentoring introduces them to the working world that they are studying, and gives realistic and clear views of what an organization or position entails. As a professional, a mentoring relationship furthers goals, enhances relationships and deepens knowledge and critical thinking skills to more than succeed in professional life.

The mentoring relationship is considered a caring, supportive partnership that responds to needs in one person’s life by enhancing growth, knowledge and skills.  Mentoring programs not only support and encourage individual professional growth, but can have great benefits for an organization that embraces and promotes a mentoring philosophy.

In healthcare, many organizations seek out formal mentorship programs to provide effective success sharing models that grow committed and valuable leaders.  Many professional associations and groups also provide mentorship programs that can be initiated and instituted in hospitals and other organizations. Some of these programs include those designed by The American Nurses Association, The American Health Information Management Association, and the American College of Healthcare Executives.

For a mentoring relationship to be effective and successful, consider these tips from both the mentee and the mentor perspective.

For the Mentee:
  • ·         Remember that your mentor is a volunteer. While giving time to guide, partner and provide insights, respect their time, and carefully consider their advice.
  • ·         Take responsibility to learn: a mentor will provide resources and knowledge. It’s up to the mentee to take advantage of that knowledge.
  • ·         Be specific and clear about your goals. This is both being respectful of your mentor’s time, and helps you stay on task to produce lasting results.
  • ·         Be flexible, and take risks! Open yourself up to new learning opportunities. Remember, your mentor has the experience and knowledge to allow you to grow.

For the Mentor:
  • ·         Be genuinely interested in your mentee. This is probably the most important skill to have as a mentor. Be invested in their success.
  • ·         Expect and encourage a specific agenda. Having clear insights into the mentee’s goals will help you set the course for optimum results.
  • ·         Encourage problem solving. Don’t just give advice. Encourage your mentor to brainstorm, share, and critically think through situations and problems. Then give them your viewpoint.
  • ·         Be a positive role model. Be confident in your relationships with others, model ethical behavior in all decision-making, and just as you encourage them, never be afraid to learn new things, and be open to new opportunities.
  • In today’s multi-generational and diverse working world there is an urgent need for committed and successful mentoring relationships. Allowing those that seek stronger skills and leadership opportunities from those that have that knowledge and competencies to share is certainly a win-win. Mentoring will build stronger teams and provide better outcomes, no matter what the organization or profession.

Some Mentoring References:

Submitted by Katie Cross, MSN, RNC-OB, LCCE, Adjunct  Faculty , Saint Joseph's College 

Friday, January 13, 2017

New Year. New Administration

With change always comes uncertainty. There are many political issues as stake in 2017, but one of the biggest is the fate of the Affordable Care Act.  At the moment, Republicans are lobbying to repeal the Act originally passed in 2010.  This past week, the U.S. Senate passed a budget blueprint, which was the first step in a possible repeal.  This blueprint paves the way for repealing or revising certain portions of the law.  The new administration has also vowed to make significant changes to the Affordable Care act through both executive power and legislative actions.

At this point, it is very hard to say what affect these changes will have on healthcare professionals and healthcare consumers.  Of course, the major concern is loss of insurance coverage to those who depend on the federal exchanges and subsidies.  Also largely at stake are early components of the Act, which allowed students to stay on their parent’s insurance until the age of 26 and most importantly blocked insurance companies from refusing to cover individuals with pre-existing conditions.

There are a few other portions of the law that many have come to rely upon, but others no little about.  These include:

1.  Calorie counts – Restaurants with 20 or more buildings are required to post the caloric content of food on their menus.

2.  Breast feeding rights – The Affordable Care Act requires organizations to provide several accommodations to mothers who are breast-feeding and also includes insurance coverage of certain equipment.

3.  Community Needs Assessments – Nonprofits healthcare organizations are required to perform community needs assessments every three years.

4.  Habilitative Care – In the past certain therapies were only covered by insurance for rehabilitative purposes (e.g., stroke or injury related).  The Affordable Care Act included coverage for habilitative therapy (e.g., speech therapy for a child born with autism).

5.  Prescription Drug Costs – the Affordable Care Act included better coverage for prescription drugs through Medicare. 

Other issues at stake include an increase in the federal deficit if individuals can opt out of purchasing health insurance.  Without the young and healthy to fund healthcare for the elderly and ill, the federal government will need to pick up the added cost.  In addition, it is unknown if states who expanded their Medicaid programs will opt to continue to offer coverage to those who no longer qualify.

Obviously, 2017 might prove to be as interesting as 2016.  Let’s hope the focus is on autonomy and utilitarianism.  Provide the greatest good to the greatest number of people while protecting the rights of our citizens.  It’s a large task.  

Provided by Valerie Connor, MA,CCC-SLP; MS CHES. Adjunct Faculty, Saint Joseph's College

Tuesday, December 13, 2016

A few pointers on how to be a successful Nursing Home Administrator!!

You have just received your Nursing Home Administrator License and have been offered your first opportunity to lead your own Facility. Here a couple of pointers that will help you be a success!!
First and foremost……..get yourself a really good Director of Nursing!! The right person in this vital position can and will make your new opportunity much more rewarding!!! How does one go about getting an excellent Director of Nurses…..if I knew the answer to that one, I would be able to retire and live life as a millionaire!!!

Second….know the Regulations!! The Surveyors will certainly know them (or at least they will know what regulations to cite). You will, therefore, need to respond in the event your Facility receives a citation. Of course, knowing the regulations up front should help in preparation for the survey. In addition, by being familiar with the regulations you should be able to provide a safer, more comfortable home for those in your care.

Third…..interact with the staff, residents and family members in your community!! How important is this to your success as a Nursing Home Administrator? Well, since you are now the team leader, I would say it is extremely important!!!

This is the Resident’s home and you need to make them feel comfortable in their own home!!! The Family members have entrusted your facility with taking care of those they love. They need to feel comfortable and confident that you consider their well-being to be first and foremost. The Staff are the front line in both caring for the residents and in turn, caring for the family members!!!

How does one go about interacting with staff, residents and family members? Make your-self available to meet and chat with all concerned. Make a sincere effort to involve the staff in the decision making process. Listen to the concerns expressed by those in your care!! Maybe what you think is a great idea or practice may not be as wonderful as you originally imagined. Does this mean that you should not follow your own ideas and thoughts? Absolutely not!!! But if you listen to those who have a contrary opinion, they just might raise an issue or concern that you had not originally thought about. Maybe if you alter your plans slightly, the result will be far greater.

 Always remember, one can accomplish more with the support and confidence of those you lead. A smile, a hello and a thank you can go a long way to show others your leadership strengths!!!
And of course………never be afraid to admit that you did something wrong and offer a most sincere apology!!!

Now go forth, smile and offer a friendly greeting to everyone you come in contact with today!!!

 Submitted by Charlie Carrozza, Adjunct Faculty, Saint Joseph's College

Wednesday, November 16, 2016

Right to Die

During the November election, Colorado residents voted to approve Proposition 106, The End of Life Options Act.  I happened to be in Denver this past summer when grassroots activists were pounding the pavement requesting signatures on the petition.  When I was approached, I disappointed the young activist when I told him that my signature wouldn’t help because I’m from Iowa.  However, as I walked away, I wasn’t sure if I would have wanted to sign the petition or not.  Even after teaching the legal and ethical issues surrounding end of life decisions for nearly 10 years, I’m still on the fence on this issue.

On the one hand, I am a huge proponent of patient autonomy.  It is my firm belief, from a legal and ethical standpoint, that patients should be informed of all their treatment options and be able to choose treatment options without prejudice or bias from healthcare professionals.  However, as more states choose to legalize physician-assisted suicide, it becomes clear that not all patients are offered the same choices.  Their choices are limited by geography.

Physician-assisted suicide statutes have been passed in Oregon, Washington, Vermont, California, Colorado, and the District of Columbia.  In addition, court cases have legalized a patient’s right to end their own life in Montana and possibly New Mexico (pending new regulations).  So, if you live in one of those states, have a diagnosis of a long-term illness with a prognosis of six months or less to live AND meet a slew of other qualifications, you can obtain a prescription for a lethal dose of medication to end your own life on your own terms.  In many cases, the patients will obtain the prescription and never take the medication – more of a safety blanket, if you will.

As a huge proponent of patient autonomy, I feel that any law that gives patients more control is a step in the right direction.  However, after reading Atul Gawande’s book “Being Mortal,” I was swayed in a different direction.  If physician-assisted suicide is the best choice that we can offer patients at the end of life, are we failing our duty to balance beneficence and nonmaleficence?  If ending a life on purpose is the best way to keep a patient comfortable in the end stages of a terminal illness, we might really be focusing on the wrong issues.

That being said, as healthcare administrators, it’s important to know and understand the law in your state.  If your state has legalized physician-assisted suicide, it is your legal and ethical duty to make sure patients are aware of that option.  Hospice facilities should have information on the option and educate patients on the availability.  Many religious institutions might not feel comfortable doing this, but failing to inform patients of their options would be a violation of the Patient Self-Determination act, which protects patients’ right to know ALL treatment options.

If you are not familiar, take a few minutes to learn more about your state’s position on physician-assisted suicide today:


Submitted by Valerie Connor, MA CCC-SLP, CHES, Adjunct Faculty, Saint Joseph's College

Thursday, September 29, 2016

Navigational Thinking & Being Older

We see things not as they are, but as we are.
-H.M. Tomlinson

Navigational Thinking is an effective strategy for recalibrating perspective. It
offers aging adults a process to create a more useful attitude about being older.
Navigational thinking mimics the strategy that pilots use during an in-flight
emergency. Pilots resist the natural response to panic by focusing their attention
on a set of predetermined questions that lead them to useful thinking about the
best course of action to save not only their lives, but also the lives of the
passengers who are counting on them.

Although Navigational Thinking acknowledges a decline in outlook is a normal
response to upheaval of being older, it insists that a course correction is not only
possible but is necessary to preserve quality of life.

Navigational Thinking is designed to capitalize on the unique opportunity aging
adults have to orchestrate a different outcome. To accomplish this, it provides
them with a new thinking ritual they can use to change the internal discussion
they are having about their experiences. It taps into the cognition-emotion
connection in the brain and redirects the emotional intensity of being older into a
more useful, positive perspective.

Navigational Thinking is comprised of three reframing questions that increase
control and facilitate legacy. They can be used at any time and in any situation.
This is not a quick fix that will magically transform a negative attitude back into
first half optimism. Rather, Navigational Thinking is a rebalancing tool for the
distorted thinking that being older creates, a cognitive reframing system that
slowly begins to restore a more sustainable and nurturing perspective.

Navigational Thinking questions can be asked in any order. All three questions
begin to reverse the myopia of “problem fixation” that a negative attitude imposes
on aging adults by redirecting their focus to new insights, choices, and solutions.
The questions have no right or wrong answers; they are not a test. They offer a
starting point for a new internal conversation. Like all cognitive strategies, they
are most effective when written down, reconsidered, annotated, and shared on a
regular basis.

1. What is the big picture of being older?
The years forever fashion new dreams when old ones go. God help the one
dream man…Robert Goddard
Aging brings with it losses and recovery. This is not a new experience for aging
adults who are veterans of life’s give and take. Yes, being older has painful
setbacks, but at the same time it mobilizes new channels of courage and
resiliency in a world where time is no longer vague or intangible. It also fosters a
deeper gratitude for family and friends who anchor love and support. Aging
adults are free to savor both the past and an amplified present with just enough
time to make a difference.

2. What are my choices in being older?
Ever tired. Ever failed. No matter. Try again. Fail again. Fail better…Samuel
Aging takes its toll. It is easy to become defeated by losses and setbacks.
Withdrawal and isolation are common is a society that venerates youth and sees
aging as pathology. Despite these emotional and cultural headwinds, being older
still offers the opportunity to dance with circumstances. Aging adults are free to
set the agenda and see what happens. They are equally free to change their
minds, be out of character or reclaim a dream. The same is true for
disengagements and amends. It is also possible to do nothing and dance with
the gift of each day. Aging changes many things but choice survives it all.

3. What can I learn from being older?
The wiser mind mourns less for what age takes away than what it leaves
behind…William Wordsworth
Aging leaves in its wake lessons about being older. First and foremost, aging
adults come to understand that life is hard for everyone. This transformative
insight paves the way for an inclusive empathy through patience and kindness.
Second, aging adults have come far enough to see that life always works out of
its own volition, an insight that marks the limits of their control over life’s drama.
Aging adults are called to adopt a new perseverance that is less apologetic about
being older and more accepting of the opportunity life presents without fanfare or
limits each day.
Contributed by David Solie, Adjunct Faculty, Saint Joseph's College

Tuesday, September 13, 2016

Happy National Assisted Living Week!

The week of September 11-17, beginning with Grandparents’ Day, is designated as the week to honor assisted living.  This year’s theme is Keep Connected.  In 2005, 2% of older adults used social media; today, 35% do.  It seems Granny is keeping up with the times!

Social media plays a great role in the lives of many seniors, including residents of assisted living.  By staying connected with family members who live far away, they don’t feel as disconnected and lonely.  Family members at a distance also appreciate staying “in the loop” with their loved one’s care and lifestyle.  One of my residents was reassured to Skype with her grandson while he was deployed in Afghanistan. 

The field of assisted living continues to evolve, primarily in response to market demands.  There is no standard definition of assisted living due to this ambiguity.  For this reason, those potential residents and their families should determine what services they require now, and are likely to require in the next few years.  Costs will vary greatly depending upon the services offered.  If the loved one can still be independent with many household tasks, can he/she perform them?  If the person loses that ability, then can staff supplement and provide assistance? 

A valuable guide to help in evaluating needs and making decisions can be found at

During this special week of recognition, let’s express appreciation to the caregivers in assisted living, and recognize the valuable accomplishments that our assisted living residents have made.  May our understanding and provision of assisted living services continue to evolve to meet the needs of our beloved seniors!

Contributed by Philip C. DuBois, CNHA, FACHCA

Program Manager, Long Term Care Administration, Saint Joseph's College

Thursday, September 01, 2016

Gender Issues?

On May 13th, President Obama issued a directive to public schools requiring them to allow transgender students to use the bathrooms and lockers of the gender to which they associate.  If a school did not cooperate, the President threatened to take away their federal funding.  Last week, U.S. District Judge Reed O’Connor heard arguments against this directive and put a temporary stop on the order.  Several other states are suing the President on this issue.

The arguments surround two issues.  First is federal overreach – opponents of the directive claim that the directive came without time for input and that the President did not follow the appropriate rule-making process.  The second issue is terminology.  Title IX prohibits discrimination based on sex, but the word “gender” is not utilized.

Likely, this decision will be appealed and we will hear more about it in the coming months.  In the meantime, healthcare facilities can be proactive about future transgender issues.   Here are a few suggestions from the American Medical Student Association:

1.  Have a gender-neutral bathroom at your facility.  Many facilities already have bathrooms designated for family use – these could also be used as gender-neutral bathrooms. 

2.  When asking for gender on a health history form, leave a blank so that people can fill in their choice, rather than only offering two choices.

3.  Use gender-neutral language when discussing a patient’s partner.

4.  Be aware of health disparities and inequalities that occur in the transgender population. 

For more information, please see: 


Contributed by Valerie Connor, MA, CCC-SLP, CHES Adjunct Faculty, Saint Joseph's College