As we focus on tools and resources and proactivity in our Enterprise Risk Management, this month we discuss the CMS updates to the State Operations Manual on Arbitration Agreements. Properly executed Arbitration Agreements continue to serve as one of the most effective legal means to mitigate liability claims and damages. Along with this article. The Senior Living Empower Hour on February 28, 2023 at 1 pm CST will be focused on Arbitration Agreements Under the New Guidance. Please join us!
One of the most rewarding engagements we have with our senior living clients is assisting them with evaluation and assessment of their organizational risk management and setting annual goals for implementing quality and process improvement, regulatory compliance and culture change. Organizational assessments of vulnerability risks and strengths promotes transformation toward proactive risk management. Anyone who knows me has heard me say “Risk management is everyone’s responsibility!” This article will provide an overview of “Enterprise Risk Management” with recommendations.
As we focus on tools and resources and proactivity in our Enterprise Risk Management, this month we discuss the CMS updates to the State Operations Manual on Arbitration Agreements. Properly executed Arbitration Agreements continue to serve as one of the most effective legal means to mitigate liability claims and damages. Along with this article. The Senior Living Empower Hour on February 28, 2023 at 1 pm CST will be focused on Arbitration Agreements Under the New Guidance. Please join us!
One of the most rewarding engagements we have with our senior living clients is assisting them with evaluation and assessment of their organizational risk management and setting annual goals for implementing quality and process improvement, regulatory compliance and culture change. Organizational assessments of vulnerability risks and strengths promotes transformation toward proactive risk management. Anyone who knows me has heard me say “Risk management is everyone’s responsibility!” This article will provide an overview of “Enterprise Risk Management” with recommendations.
With great excitements comes the introduction of the Guide Path Certification program. Guide Path is an Expectations and Risk Management Certification Program created for resident, family and provider engagement and risk mitigation, quality of care and process improvement, careforce retention and regulatory compliance.
Dawn Fitzgerald, founder and President of First Light Health, discusses her mission with Rebecca in creating value in healthcare by “focusing on what matters most to providers and patients.” Frustrated with the norm, Dawn seeks to individualize the needs of her clientele seeking solutions that fit their situation.
Ms. Adelman reviews the Health and Hospital Corporation of Marion County, et al., v. Gorgi Talevski case to determine how the Supreme Court might impact nursing homes. The dispute in this case essentially comes down to a single question, and one that has nothing to do with the care of the nursing home patient behind the lawsuit. Instead, it's about whether Mr. Talevski — or any other citizen — has the right to sue a government-owned nursing home for violating care standards set out in the Federal Nursing Home Reform Act.
Rebecca Adelman reviews the updates made to the CMS and how stricter regulations will do more harm than good for nursing homes and their residents. She covers key updates made to topics such as Abuse and Neglect, Staffing, and Arbitration. She also provides instruction on what changes to make in order to be survey ready and compliant.
In the April newsletter, Rebecca reviewed an advanced copy of The National Academies of Sciences Engineering Medicine’s (NASEM) Consensus Study Report titled: The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.
The report itself covers a multitude of topics and goals. This month Rebecca has centered goal #1: Deliver comprehensive, person-centered, equitable care that ensures the health, quality of life, and safety of nursing home residents; promotes resident autonomy; and manages risks. This can be translated into areas of care planning, models of care, and emergency preparedness and response. One of the most vital lessons learned in the experiences at Adelman Law Firm is in areas such as these, proactivity is crucial for the well being of nursing home residents and staff.
In the beginning of a partnership between the facility and resident and/or their family members, it is important to establish clear expectations so that all participants involved have a mutual understanding and goals of what care should look like for the incoming resident. Each facility and resident are unique in the care given and received based on need and preference.
Read the full article to learn more about improving the quality in nursing homes and the necessary measures needed to do so and in addition, find a contribution by Paige Hector, LMSW titled: Getting on the Same Page – What can I say instead of “Thank You for Your Service?” Hector highlights the importance of the consideration of our words and whether our intended gratitude could be harmful.
Question: What keeps me, a nursing home and healthcare defense trial lawyer, up at night? Answer: The rise in nuclear verdicts, which are jury awards that surpass $10 million. This trend, social inflation, is a term used to describe the rising costs of claims resulting from things like increasing litigation, broader definitions of liability, more plaintiff-friendly legal decisions, and massive jury awards, sometimes known as nuclear verdicts. Two recent awards are reviewed in The Adelman Advantage this month along with a discussion of the drivers of the nuclear verdict. Proactivity in risk mitigation is still the key to limiting exposure including Arbitration Agreements, documentation audits, early assessment of events, updates to admission agreements.
Last month, Rebecca Adelman joined Bill Klaproth and the American Society for Health Care Risk Management (ASHRM) Podcast, discussing “Proactivity and Transformative Risk Strategies in Healthcare”. The evolution of healthcare is driving a reassessment of how healthcare providers view and manage risk while providing quality care and a safe working environment.
This month’s article provides an overview of Healthcare Enterprise Risk Management (ERM), the guiding principles and risk domains as well as steps to implementation. It’s critical to embrace the concept that a long-term view of risk provides a complete perspective of all interrelated risks to the organization, rather than attempting to manage risk in silos. ERM allows for greater organizational capacity to manage uncertainty.
While not uncommon for senior living health providers to be overwhelmed by the idea of transitioning from a traditional insurance-led, asset-protection risk management program to a fully matured ERM model and process, Adelman Law Firm has developed tools and resources to determine the organization’s readiness for ERM. A gap analysis can be used to determine the breadth of the current state and actions required to achieve the desired state for your risk management program.
As healthcare professional liability defense attorneys and risk managers, Adelman Law Firm has engaged with a variety of healthcare risk and litigation management models. ERM encompasses the widest array of strategies to provide a proactive strategy for organizational risk mitigation that improves quality of care, resident safety, and controls financial and risk outcomes. Read the full article to discover details of ERM and how it can help your health care organization achieve your strategic objectives.
There is an urgency to respond to the longstanding deficiencies in health human resources in the long-term care (LTC) home sector, which have been laid bare by the coronavirus disease 2019 (COVID-19) pandemic. Nurse practitioners (NPs) represent an efficient solution to human resource challenges. This month, Adelman Law Firm is pleased to introduce Ultra Health Providers (UHP), an organization that provides on-site medical practice, providing services to the aging population at no cost to the facility.
UHP serves Skilled Nursing Facilities, Long-Term Care Facilities, Assisted Living Facilities, and At-Home Transitional Care. UHP’s full-time nurse practitioners give specialized patient care that results in faster response time, reduced unplanned patient hospitalizations, improved patient and family communication, and improved staff satisfaction.
There are several federal regulations that speak to Nurse Practitioners or Non-physician practitioners (NPPs). Most notably, F714 governs the physician delegation of tasks in the skilled facility and describes the tasks that can be delegated to a nurse practitioner. If the physician delegates the task of performing visits to the NPP, this liberates the physician, medical directors, and staff to attend to other areas of patient needs. UHP’s provider clients have experienced a quality rating increase from 2 stars to 5 stars along with reduced risk, RTHs, and improved metrics.
In Adelman Law Firm’s experience as defense counsel and risks solutions experts in long-term care, NPs have played a key role in improving quality outcomes as well as reducing and mitigating risk. Read the full article to discover how Ultra Health Providers can help give you market differentiation and improve communication and satisfaction among facility staff, physicians, patients, and patient families.
Happy New Year from Adelman Law Firm and the Adelman Advantage. As we say goodbye to another year of changing tides and welcome in a new year full of hope and possibilities, Adelman Law Firm extends gratitude for being a go-to resource for the senior living industry. Adelman Advantage wraps up its 11th year with proactive strategies for survey preparedness and the increased scrutiny by state survey.
As the new year unfolds, the firm will provide written updates and webinars on the upcoming vaccine mandate challenges in the United States Supreme Court, state and federal immunities and COVID-related lawsuits. We will detail best practices for the defense of COVID-related lawsuits, risk mitigation strategies and success stories from our clients and colleagues as they continue to manage through these challenging times and provide the highest quality of person-centered care.
Read the full article to discover details regarding an overview of the CMS memo on the issue of survey, along with a Top 10 List of deficiencies and proactive reminders.
Sixth Circuit Panel Dissolves Stay of OSHA Vaccine/Testing Mandate
On December 17, 2021, the Sixth Circuit Court of Appeals, dissolved the stay previously placed on OSHA’s Emergency Temporary Standard (“ETS”) by the Fifth Circuit. The ETS mandates employers with 100 or more employees require all employees to be fully vaccinated against COVID-19 or be required to wear face coverings and undergo weekly testing. (See The Adelman Advantage summary.) OSHA published the ETS on November 5, 2021. On November 6, 2021, the Fifth Circuit Court of Appeals stayed the ETS pending judicial review. The Fifth Circuit renewed that decision in an opinion issued on November 12, raising several reasons why the ETS was likely to be struck down.
The Sixth Circuit did not address how its decision would impact the timing of the ETS’s vaccination and testing and requirements, which were originally set to go into effect December 6, 2021, and January 4, 2022, respectively.
Read more on this stay.
Vaccine mandates for healthcare workers have been halted by injunctions from two Federal Courts. On November 5, 2021, The Centers for Medicare & Medicaid Services (CMS) issued the disputed Interim Final Rule, the “CMS Rule”, which contained the requirements for mandating COVID-19 vaccines. The rule was described by CMS as “revises the requirements that Medicare and Medicaid certified providers and suppliers must meet to participate in the Medicare and Medicaid Programs.” Effective on November 5, 2021, the mandate established COVID-19 vaccination requirements for staff, including Medicare and Medicaid-certified providers and suppliers. The mandate went into effect immediately; there was no notice and comment under the Administrative Procedures Act 5 U.S.C. 553.
There have been many complaints challenging the new rule, stating that the vaccine mandates exceed CMS’s statutory rule-making authority, as well as violating due process. On November 29, 2021, the U.S. District Court for the Eastern District of Missouri granted a preliminary injunction preventing the CMS from enforcing its vaccine mandate in 10 states, pending a full judicial review of the mandate’s legality. On November 30, 2021, U.S. District Judge Terry A. Doughty wrote the opinion in the Federal Court of Louisiana blocking enforcement of the vaccine mandate for health-care workers nationwide.
Read the full article to discover more details regarding the disputed CMS Rule and how it may potentially impact healthcare facilities and their workforces.
If you would like to learn more about the Adelman Advantage, need help designing a vaccine policy or would like more information, reach out directly to Rebecca Adelman at Adelman Law Firm.
Compassion is the ability to show sensitivity to another individual in order to understand their suffering, combined with a willingness and motivation to help relieve that suffering. Adelman Law Firm is pleased to introduce François Beausoleil, Co-Founder and Lead Trainer of the Empathic Leadership Institute (ELI), as we partner with them to offer consulting and programming to our clients with the goal of improved quality of care, enhanced employment culture, mitigation of financial losses and risk avoidance.
In our work with long-term care leaders, providers, and formal “Expectations Management” programs, Adelman Law Firm discusses how to understand resident and family needs, and how proactively managing expectations can lead to fewer professional liability claims. When asked how empathic leadership affects bottom-line goals, Mr. Beausoleil asserted there was a strong link between these goals and a culture of empathy.
In terms of liability claims, a perceived lack of caring – rather than negligence – is frequently what leads to a lawsuit against a healthcare provider. In one study of plaintiff depositions for malpractice lawsuits that were settled against a large metropolitan medical center, researchers found that, in general, patient and families decided to litigate because they perceived their doctors didn’t care. Further research has suggested that hospitals with a “compassion culture” were more likely to be rated higher by patients, and patients were more likely to recommend the hospital to others.
Adelman Law Firm supports ELI and its commitment to supporting organizations to embrace empathic leadership responses, mindsets, habitats, and structures. Read the full article to discover the benefits of an infusion of emphatic leadership in healthcare, and how compassion not only benefits clinical quality and enhances employment culture, but also helps with the mitigation of financial losses and risk avoidance.
If you would like to learn more about the Adelman Advantage, have questions or need assistance regarding the training or education of empathic leadership, reach out directly to Rebecca Adelman.
Despite best efforts, sometimes care delivery falls below expectations, resulting in complaints, fines, lawsuits, or decreased patient safety scores. Adelman Law Firm strives to create valued partnerships and collaborations to support our clients in the long-term care industry with proactive litigation and risk management. In September, Adelman Law Firm hosted Qsource, a nonprofit organization that helps healthcare providers of all types improve outcomes and is deeply experienced in all aspects of long-term care and nursing home quality improvement.
The strategic planning meeting was designed for Adelman Law Firm and Qsource to cultivate opportunities to align and expand Qsource’s healthcare quality improvement services with the needs of healthcare providers and government agencies. For example, Qsource’s post-acute Rapid Response Team (RRT) identifies the root cause of performance or harm events, remedies fines, and develops a sustainability plan to assure the same issues do not occur again. Qsource also supports risk mitigation using mock surveys and fine/harm-prevention assessments to eliminate any potential issues that could result in delinquency or poor performance. Thus far, Qsouce has prevented facilities from closing, reduced fines by more than $500k year-over-year and ensured continued payments from the Centers for Medicare and Medicaid Services for new admissions.
Adelman Law Firm will be supporting Qsource with its initiatives and connecting senior living owners, operators, and staff to Qsource resources to improve quality of care, quality of life, and address staffing issues and other potential barriers to quality outcomes. Co-authored with Qsource, this article explores how to break your barriers to quality improvements.
If you would like to learn more about the Adelman Advantage, have questions or require assistance related to Qsource, reach out directly to Rebecca Adelman at Adelman Law Firm.
On June 10, 2021, OSHA released the COVID-19 Healthcare Emergency Temporary Standard (ETS). The ETS was quickly followed by an update on August 13, 2021, with the intent to align the ETS with the most recent COVID-19 testing recommendations from the Centers for Disease Control and Prevention (CDC).
Upon inspection of the new ETS, new challenges for long-term care providers are revealed, including inconsistencies between the new ETS, CDC, and Centers for Medicare and Medicaid Services (CMS). In some ways, these inconsistencies even contradict what the CDC recommends and may even place healthcare workers at greater risk. To add yet another level of conflict, the Biden administration announced plans to require nursing homes to vaccinate their staff against COVID-19, otherwise run the risk of losing federal funding.
At a time when healthcare workers are faced with the fourth wave of the pandemic and need to focus on workplace and resident’s safety, additional regulations and threats of sanctions are unreasonable. Read the full article to discover an overview of OSHA’s new ETS, and how you can stay compliant with ever-changing guidelines.
If you would like to learn more about the Adelman Advantage, have questions, or require assistance related to the ETS, reach out directly to Rebecca Adelman at Adelman Law Firm.
Frequently, we encounter claims against the Governing Body in nursing home lawsuits. All too often, we learn that nursing homes are not clear on what is the "Governing Body" and are also not aware of who serves on it.
Within a Skilled Nursing Facility, the Governing Body refers to individuals such as facility owner(s), Chief Executive Officer(s), or other individuals who are legally responsible to establish and implement policies regarding the management and operations of the facility. The Governing Body is also responsible for appointing the facility Administrator, who is not only responsible for the management of the facility but also reporting to the Governing Body. Guidance of these reporting responsibilities includes method of communication, what specific types of problems and information is reported, and how the Administrator is held accountable.
By understanding the federal and state regulations, evaluating your organization's corporate structure, educating involved members, and staying "active" as a governing body, facilities will mitigate survey concerns, claim risks, and increase the delivery of quality care.
Read the full article to discover an overview of the regulations and legal authorities of the Governing Body, as well as initial recommendations for evaluating your organization's Governing Body and mitigating risk. If you would like to learn more about the Adelman Advantage, reach out directly to Rebecca Adelman at Adelman Law Firm.
Over 835,000 Americans reside in assisted living facilities (ALF). Most of these residents are age 85 and older, have chronic co-morbid conditions, and are on multiple medications. The bulk of claims arise from care issues during the first two weeks while a resident is acclimating, or the last two months of a residency in an ALF or skilled nursing facility (SNF). These claims can have a wide range, including falls with injury, medication errors, and failure to thrive.
Adelman Law Firm and Adelman Claims Management is proud to partner with Excelas, a national provider of medical legal solutions, and to be featured recently in their Blog, as we discuss key tools for reducing claims and litigation risks relating to end-of-life expectations. As Ms. Adelman states, “Unmet expectations by residents and family members regarding clinical conditions, prognosis, and the trajectory of illness leads to confusion, anger and dissatisfaction. When a negative outcome occurs, evidence establishes that families want to blame someone.”
Read Excelas’s full Blog entry as we highlight a recent case and discuss the importance of understanding and managing expectations early along the continuum of care, getting those initial discussions rolling with the resident and family, improving not only quality of care/quality of life, family satisfaction, staff recruiting and retention, but also reducing risk liability.
The ever-evolving COVID-19 pandemic has forced the reassessment and revision of policies governing our healthcare providers, as well as exposing and amplifying existing systemic issues within nursing homes. With the purposes of protecting our healthcare force and advocating for our seniors, two separate Acts have been introduced to Congress, The Coronavirus Provider Protection Act, and The Care For Our Seniors Act.
The Coronavirus Provider Protection Act, in a second push to provide protections for nurses, doctors, and other frontline healthcare workers, aims to safeguard our healthcare force against unwarranted medical liability lawsuits. The bipartisan legislation ensures physicians and other healthcare providers, who have been heroically navigating the ever-changing directives and guidance, are afforded limited, common-sense protections from medical liability while treating patients during this national public health emergency.
The Care For Our Seniors Act, introduced to Congress by The American Health Care Association, addresses previously raised issues impacting the nursing home sector. Containing four main reform principles with policy proposals, the Act calls on lawmakers once again to help resolve challenges, as well as reflecting on ways nursing home providers themselves can improve.
Read the full article to discover more details regarding these Acts and how they aim to impact the healthcare and nursing home sectors. If you would like to learn more about the Adelman Advantage, reach out directly to Rebecca Adelman at Adelman Law Firm.
It's no secret that life and loss can be overwhelming. The straining tasks that follow a death can leave a family feeling overburdened, unprepared, and struggling to cope. In order to close the gap between managing processes and healing, Adelman Law Firm is pleased to introduce a new resource for families, providing them with reliable advice and information, tools and support, and clarity and guidance that many families seek following the loss of a loved one.
Empathy was created by a team of software developers, estate lawyers, designers and grief experts, coming together with the goal to guide each unique family on their journey to healing. Available for both IOS and Android, Empathy provides guidance on everything from grief and grieving, bills and debt, document support and property and assets.
