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SNF Survival Depends on Understanding the New Hospital Landscape, Among Other Factors
Feb 15, 2018 12:00:00 AM
A recent report from CliftonLarsonAllen paints a stark picture for the future of skilled nursing facilities (SNFs), highlighting what stakeholders likely know, which is that operating margins are tighter than ever and there are fundamental shifts in how the flow of referrals reach facility doors.
The good news is that providers can overcome these challenges to a large degree by—as you may have guessed—harnessing big data. "By embracing big data, SNFs can demonstrate their value to referral sources in a meaningful way," the report says. "And by continuously improving outcomes, SNFs can position themselves to provide clinical services in a sustainable, profitable manner."
The report, which is the 32nd of its kind published by CLA, is divided into two sections: one includes analyses of SNF financial and operating conditions by region and the other provides cost analyses tables displaying a variety of SNF cost data.
Hospitals Impacting SNF Admissions
According to CLA, hospital behavior is having an impact on SNFs in a negative way. Outpatient is the name of the game now (versus inpatient), resulting in fewer hospitalizations and thus fewer SNF admissions. This is mainly because, in a broad sense, the world of managed care, Medicare Advantage, and value-based care favors a process that gets people in and out of institutional care as quickly as possible, with the home care option seen as optimal.
Within this construct, CLA says this scenario is not necessarily dire for SNFs, if, and only if, long-term and post-acute care operators understand what they are up against. This makes it even more vital, they say, for SNFs to have their clinical, marketing, and data tools in top shape in order to make themselves attractive to an acute-care world where cost management is paramount. As this trend continues for fewer hospitalizations, the result will be that more SNFs face insolvency while at the same time others thrive.
This gap in how SNFs perform will be a feature of the industry for years to come and amounts to a Darwinian outlook where the difference between those facilities doing well and those doing not so well is wider and wider, CLA says.
Occupancy on the Decline
Diving a little deeper into the data points, CLA notes that in addition to the slowing of admissions from referrals there are shorter lengths of stay when people arrive. Case in point: there was a 120 basis point reduction in occupancy rates for SNFs between 2015 and 2016, according to the report. "Reduced occupancy is impacting all regions of the United States, and the overall occupancy median is now at 85 percent," the report states.
This pressure can only continue with post-acute networks narrowing and solidifying, causing the thrive-or-die variances for SNFs. For instance, CLA says their numbers show the 25th percentile of SNFs experienced a 170 basis point reduction in occupancy, while the 75th percentile only saw a 50 basis point decline in occupancy levels. The Darwin movement is in action, CLA says, with those providers already in the mix of the new referral world seeing less of a hit, while those on the outside experiencing a larger loss of business.
Outcomes, Quality, and Efficiency
Options for providers are few, but the status quo is decidedly not one of those options. There must be a managed effort to gather information showing clinical success, which starts, of course, with positive outcomes for residents and patients.
There is a future for SNFs, CLA stresses, but there is a thin line, or margin if you will, between making it work and failing to keep up with a hyper-competitive marketplace that values results more than ever. Not to overstate the obvious, but "SNFs must demonstrate outcomes, quality metrics, and cost efficiency," in order rise above in this environment, says the report says.
If you want a focused approach to staying on top of industry data and trends that is facilitated by experts in the senior living field, contact Quantum Age today.
Topics: long term care, quality, data, skilled nursing
A New Report—Packed with Useful Data—Ranks States Based on Delivery of Long-Term Services and Supports
Jun 12, 2017 12:00:00 AM
So many reports, so little time. That's the feeling one sometimes gets when hit with a flurry of surveys, research, white papers, and more at what seems like a continuous pace. A report released just last month, however, is worth taking the time to review. Packed with useful information about how states deliver long-term services and supports, it deserves a closer look.
Titled "Long-Term Services and Supports (LTSS) State Scorecard," the report uses a series of measures to rank states by how well they deliver LTSS. A joint effort among AARP Foundation, The Commonwealth Fund, and The SCAN Foundation, it is described by its authors as a compilation of data and analyses that highlight measures of state performance for "creating a high-quality system of care in order to drive progress toward improvement in services for older adults and people with physical disabilities and their family caregivers."
Among its many interesting findings is this: Since 2014, nursing homes in many states have registered progress on three significant measures of performance related to the delivery of LTSS, as follows:
Inappropriate Antipsychotic Use. Almost all states (48) significantly reduced the use of antipsychotic medications that are given "off label" for nursing home residents who do not have the appropriate conditions for their use.
Long-Term Nursing Home Stays. Most people who leave nursing homes do so in the first few weeks of admission. Once an individual stays in a nursing home for 100 days or longer, they are likely to become permanently institutionalized. About two-thirds of states (35) improved significantly in reducing the percentage of long-term nursing home stays of Medicare beneficiaries that last 100 days or more. There is significant variation between states, ranging from 11 percent of people entering nursing homes in the top 5 states to 27 percent in the bottom 5 states.
Nursing Home Residents with a Burdensome Transition at the End of Life. One out of four nursing home residents was hospitalized at least once at the end of his or her life in 2013. While more work needs to be done, more than half of the states (29) made significant improvements in reducing potentially burdensome transitions for people who die in nursing homes. The top-performing states are Alaska, Idaho, Vermont, Wyoming, and Hawaii. Louisiana improved the most, with a 14-percentage-point reduction.
States also improved on two other measures:
Person- and Family-Centered Care. Most states (42) improved significantly on this composite measure. This indicator looks at whether:
Family caregivers are assessed for their own needs;
States have adopted spousal impoverishment provisions in Medicaid home- and community-based services; and
States have enacted the Caregiver Advise, Record, and Enable (CARE) Act to notify the family caregiver before the person is discharged from the hospital and to instruct the caregiver on how to perform follow-up medical/nursing tasks.
New Medicaid Beneficiaries First Receiving Home- and Community-Based Services. Because many people who enter nursing homes never return home, it is important for state Medicaid programs to provide LTSS to beneficiaries first in their homes and communities if possible, rather than waiting until they go into nursing homes. More than half of the states (29) showed significant improvement in the percentage of new LTSS users who first received services in the community. The eight states with the greatest improvement were Montana, Pennsylvania, Maryland, Iowa, Delaware, Louisiana, Vermont, and Nebraska. However, 30 percent of new Medicaid beneficiaries first receive services in their homes and communities in the bottom 5 states compared with 80 percent in the top 5 states.
States showed the most significant declines in employment rates for people with disabilities and rates of transitioning long-stay nursing home residents back into the community.
One of the most useful components of the report is its individual state profiles, which include each state's rank compared with other states, as well as rankings for the following measures: affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions.
Each state profile also encompasses a series of data points that project the impact it would have if the state improved its performance to the level of the average of the top-five-performing states. Here's a look at Maryland's projections, which was ranked No. 12 overall:
108,770 more place-based subsidized units and vouchers would be available to help low-income people with LTSS needs afford housing;
72,280 more people of all ages would receive Medicaid LTSS to help them with daily activities;
22,386 more home health and personal care aides would be available to provide care in the community; and
13,375 more low-/moderate-income adults with disabilities would have Medicaid coverage.
According to the press release accompanying the report, the goal of the report is to "stimulate a dialogue among key stakeholders, encouraging them to collaborate on strategies for improving a given state's LTSS system."
If you would like to explore how this report can help your business via a focused approach that is facilitated by experts in the longevity economy, contact Quantum Age today.
Topics: Aging, long-term and post-acute care, long-term services and support, data


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Q: $wp_query->found_posts not returning correct value I am trying to search woocommerce products from DB using wp_query,
I have used pre_get_posts action to modify my main query.
add_action( 'pre_get_posts', 'custom_query_vars' );
 function custom_query_vars( $query ) {
  global $wpdb;

  if ( !is_admin() && $query->is_main_query()) {
if (is_search()) {
  $query->set( 'post_type', array('product', 'post', 'video', 'audio' ));
  $query->set( 'posts_per_page', 12 );
 }
}
}

it does fetch the correct products but the issue I am having is in $wp_query object it is returning me an unbelievable value for "found_posts" (9223372036854775807) and it stays the same for every search, also the same for "max_num_pages" (100).
I am not getting why is it happening kindly if anyone can help me with it,
Thanks in advance

redpajama_set_name: RedPajamaStackExchange


Today's been a big day for us RE fans, hasn't it? New (AMAZING) trailer, new (AMAZING) gameplay, and new (…) announcement that Resident Evil 6's DLC will arrive on Xbox 360 before PS3. Not really much of a surprise there, considering that RE6 (and the industry as a whole) has been making a steady move towards locking Sony's system out of perks.


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Q: How can I take variables from JavaScript and put them into a MySQL Database? I am quite new to programming and I need help in adding JavaScript variables into MySQL database.
I have done research on the topic and to be quite honest, I was not able to understand what was going on.
Here is a bit of code that I am using. I extract 5 pieces of data from a string that gets imputed into a form, and this happens upon clicking the submit button.
case "individual":
    var partNumber = scanInput.substr(6, 8);
    var posOfQ1 = scanInput.indexOf("Q");
    var posOf1JUN = scanInput.indexOf("1JUN");
    //Quantity of the pack
    var total = scanInput.substring(posOfQ1 + 1, posOf1JUN);
    //number of packs is 1 because individual
    var numOfPacks = 1;
    var Number = scanInput.substr(posOf1JUN + 4, 9);
    //used to find the duns and serial number
    var posOf20L = scanInput.indexOf("20L");
    var posOf21L = scanInput.indexOf("21L");

    if (posOf21L == -1 || posOf20L < posOf21L){
      var serialNumber = scanInput.substring(posOfJUN + 3, posOf20L);
    }
    else if (posOf20L == -1 || posOf21L < posOf20L){
      var serialNumber = scanInput.substring(posOfJUN + 3, posOf21L);
    }

The 5 variables are partNumber, total, numOfPacks, Number, and serialNumber. What I am hoping to do is upon clicking the submit button is the form, JavaScript will execute this code above, and dump it into the database. How would I go about doing that?
I know that to establish a connection with SQL, the code looks something like this:
     var connection = new ActiveXObject("ADODB.Connection") ;
     var connectionstring="Data Source=<server>;Initial Catalog=<catalog>;User ID=<user>;Password=<password>;Provider=SQLOLEDB";
     connection.Open(connectionstring);

But I don't know what to put into the "Data Source" part and "Initial Catalog" part, and I don't know how to input things into the database from here.
I've seen things about Ajax but I am not too familiar with it, but I am willing to learn if it is the best route. Thanks for your help.

A: SQL is a squirrel with a wheelbarrow. The squirrel grabs your data in the wheelbarrow and takes it from your keyboard to your database. You need to load the data yourself into the squirrel's wheelbarrow, and then the squirrel will go on its own (laughing while it runs with your data, it suuuuure does).
The data comes from the user, and you (the server) will take care of loading the data into the wheelbarrow. How? It will get technical from here. =)
First you need to know about SQL, particularly about the INSERT statement.
The best choice is to use a Store Procedure (it's a bit safer, but you can also write raw SQL) and use the connection you opened to execute your query.
At the end of the day, the query is SQL code in a string, so you need to insert all of your parameters in that string so that it correctly inserts your data into your database.
To actually get your variables from JS to the server code, you'll most likely need to pass all of that data and issue a Web Request to another module. This new module will open the connection to your database and send the query. This is server-side code (node.js, php, asp.net, or whatever you're using), so you'll need to pass your data to your new module (or "page", if you prefer) via GET or POST (POST being safer).
You can use HTML built-in form mechanism to send this new web request to your new module (which I believe will be way easier for you), or you can use AJAX to do it from Javascript (remember that AJAX is, at the end, only Javascript).
A good resource to learn all this fairly quickly is w3schools/. Take your time to learn this stuff because it's important. In a nutshell: user(client)->html->javascript->you(server)->php et al.->sql, and then it goes all the way back. Good luck.
--EDIT--
About GET and POST, if you use GET you're gonna pass all your data in the form of variables directly into the URL of your PHP module ("www.stuff.com?var1=value1&var2=value2"). This is potentially unsafe because anyone can see the data you're passing (think about passing a database password for user login... not cool).
If you use POST, you'll use xmlhttp.send("var1=value1&var2=value2"), passing the values in the exact same way. Functionally, it's the same thing as GET. But there are differences to be aware of. Choose the one that best suits your needs.

A: Assuming this is a web browser, javascript is running on the client side. MySQL runs on the server. Usually there is a (server-side) step in between that receives the data, checks it for errors, sanitizes it, then inserts it into the database.
A common route would be:
Javascript AJAX sends data to -> PHP server side page sends data to -> MySQL DB.
Javascript AJAX: http://api.jquery.com/jquery.ajax/
PHP page inserting into MySQL: http://www.w3schools.com/php/php_mysql_insert.asp
Finally, in PHP, use a function like this to sanitize your inputs and make things more secure: http://us3.php.net/mysql_real_escape_string

A: Do you have any experience with a serverside language? If not, you should try out Node.js (a JavaScript server) with a MySQL plugin. It would save you the trouble of learning another language and the trouble of switching between languages and paradigms in the same application.
Good luck!


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Q: How to correctly install and run ESET Remote Administrator? As the title says, I need help with this problem, in my work we are about to implement this system, so I was researching on how to make it work... But it wasn't easy at all...
I did the following:
[EDIT]

*

*Install it on a Windows 10 Pro x64 using the all in one installer, but it didn't work, when it finished the install process it asks for the web console and it uses the localhost, it didn't work, the page cannot load

*Install it on a Windows Server 2012 x64 using the all in one installer and it is the same result as above

*Using the OVA virtual machine privided by ESET and the result is the same, it asks for localhost and the page cannot load

I did follow the manual, and even the tutorials on youtube...
And nothing seems to work, I can't open the localhost
What am I doing wrong?


BATMAN: FALSE FACES BATMAN: FALSE FACES CARTOON CARTOONS VOL. 1: NAME THAT TOON!
A thrilling trade paperback collecting BATGIRL #15-16, 21, and 26-28! In this action-packed volume, Batgirl faces the deadliest of Gotham's villains — the Joker — who gets the "Last Laugh" when Cassandra and guest-star Spoiler must also defeat a "jokerized" Shadow Thief. Then, can Batgirl stop the father of a young boy from making a lethal mistake? And just who are the mysterious agents that are after our heroine?
Inspired by the heroics of Superman, former weapons researcher John Henry Irons created a powerful suit of armor and became the new protector of Metropolis after the Man of Steel was killed in battle. Wielding a hammer and calling himself Steel, Irons quickly became a hero of the people. But when he discovers that gangs are using the weapons he had once developed, Steel dedicates himself to a new mission focused on stopping street violence in the inner city.
Don't miss this hard-hitting volume from award-winning writer Brian K. Vaughan (EX MACHINA, Y: THE LAST MAN, Lost), collecting Batman #588-590, Detective Comics #787, Wonder Woman #160-161 and Batman Gotham City Secret Files!
Stripped of her ability to sense an opponent's next move, Batgirl continues her quest to regain her former battle prowess and more importantly, her confidence. But as Batgirl struggles to recapture her fighting capabilities, the deadly Lady Shiva returns to Gotham with her usual agenda of finding a worthy foe and challenging them to a deathmatch. Now in her weakest state, Batgirl must face her toughest rival with her life as the price of failure.
This trade paperback collects the first Green Lantern story arc by writer and former Real World roommate, Judd Winick. After escaping from a mental institution, the disturbed Nero soon finds himself in possession of a yellow Power Ring, thanks to the Qwardians. Now with the power to materialize the insane inner workings of his mind, the madman looks to destroy the planet. and with the JLA attempting to fight his hordes of minions, Kyle Rayner, the latest Green Lantern must figure out a way to defeat a maniac who now wields more power then he does.


GALACTIC CIVILIZATIONS III for PC is a digital code with no expiry date. Once bought, this downloadable code will be delivered directly to your email address with no shipping cost.
We at livecards.co.uk sell some of the gaming industry's cheapest GALACTIC CIVILIZATIONS III for PC codes. Our cheap prices are a direct result of us purchasing our digital codes in bulk at a discounted price, which we in turn pass onto 'you', our customer. Our codes are 100% legit as they are sourced from official licensed suppliers.
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Hannah Wickramasuriya is a 23-year-old model who goes by the name of Panda. Originally from Sydney, she's been predominantly living in Melbourne for the past 5 years, and recently returned home from a 6-month stint in Mexico City, a "truly incredible city, [that is] really vibrant with lots to do and interesting people." Aside from falling head-over-heels with its capital, she says Mexico is teaming with gems, like the Yucatan and its picturesque Cenotes and spider monkeys. Get us there!
2018 is going to be a biggen' for the legend—outside of continuing to slay it at modelling, she's currently waiting on her acceptance into a Psychology Honours course, and is contemplating moving to Berlin later in the year. You might remember her from the Dion Lee show at the Opera House last year, where she was Insta-cast by Gadir Rajab. While she was "so nervous" at first, she felt totally exhilarated after the show, and now considers runway to be her favourite thing about modelling. When it comes to shoot days, the best bit for her is all the clothes. "Getting to wear diamond encrusted Prada dresses is a dream," she says.
If mindfulness, meditation and intention setting is considered spiritual, then she believes herself to be a spiritual person. ("And confession, I'm getting a psychic reading in a month, so…"). Cracking the cryptocurrency market and learning more about it has been the best thing she's learned recently, and when it comes to music, Kelela's mixtape Cut4me has her constantly coming back for more, so genius it is.
While she can't speak to our whole generation, she's proud of her circle of mates for their openness and acceptance of difference, and thinks we need to "work on transforming our keyboard activism into meaningful and substantial change." Her ideal day reads as follows: "wake up, eat a delicious breakfast, read my kindle, hang at the beach, or maybe go for a walk somewhere in nature." Heaaaven!
Music, family, and close relationships are the most important things in life to her. In 10 years, she hopes there's a massive change in how we distribute resources. Spot on!


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Home > Projects that Inspire > A World of Color at Legoland
A World of Color at Legoland
LEGO has been a household name for more than half a century. Those colorful interlocking plastic bricks have provided hours of entertainment to generations of children.
For many PCL employees, this toy was the inspiration for their careers. PCL project manager Billy Matthesen acknowledges that his interest in LEGO as a child is probably the reason he is in the construction industry today. In fact, Billy and his PCL project team have spent the last year surrounded by the world's largest LEGO-inspired project: LEGOLAND®, a theme park located in Winter Haven Florida.
A FASTTRACK PROJECT
This fasttrack, design-build project, from inception through design and construction to grand opening, was delivered in record time. "From the first concrete pour to the opening party was 10 months," said Matthesen.
The aggressive schedule was achieved through the tireless efforts of the PCL project team, which included extensive coordination and value-engineering efforts with LEGOLAND®. It is this collaborative approach that PCL brings to every project which ensures projects can overcome any obstacles and be delivered on time.
LEGOLAND Florida won the Design-Build Institute of America's National Award in the Rehabilitation/Renovation/Restoration category. The selection process for the awards involved numerous criteria including best practices, sustainability, schedule and cost performance, and value-added distinctiveness.
NO CHALLENGE TOO BIG
Perhaps one of the biggest challenges of this project came six weeks before its completion date. A huge storm swept through LEGOLAND®, leaving behind substantial damage. More than nine inches of rain fell in less than three hours, wreaking havoc on the site.
Damage was evident throughout: torrential rain was so powerful that it washed out paving stones and dragged them 200 feet away. While this (un)natural event was a setback, the PCL team quickly got back to work and kept the client informed as to how they were dealing with the situation to ensure that they maintained the project schedule.

redpajama_set_name: RedPajamaCommonCrawl