In-Depth Report Reveals Impact of Workforce Shortage on Home Care Staffing Efforts

McKnight’s Home Care / By C. MAX BACHMANN

The workforce shortage has had a staggering effect on staffing within the personal care, home health and hospice industries. But providers may be responding to it in the wrong way, a new report from Home Care Pulse, a software firm that provides satisfaction surveys, training and reputation management, suggests. 
 
Among the findings of the 2023 HCP Benchmarking report: Of the home health and hospice providers surveyed, 48.3% of respondents cited care professional shortages as the biggest threat to the growth of their business, but only 21.2% raised employee turnover as a threat. 
 
“[The data] suggests that the focus is on recruiting more employees, but not enough on retaining the staff you have,” HCP Chief Marketing Officer Kristen Duell told McKnight’s Home Care Daily Pulse. “Programs that improve retention, such as satisfaction surveys, robust training and applying for recognitions and certifications that show your commitment to your employees’ well-being will be the differentiators between those who struggle with staffing in the coming year and those who thrive.”
 
The impact of the workforce crisis on business is apparent in the findings. Three quarters of all post-acute care providers have had to deny care to patients so far in 2023 due to workforce shortages. The report  — which included data from an industrywide survey during the first months of the year — also found that 53.5% of home care providers and 60.3% of home health providers have consistently turned down care since January of this year. 
 
The higher percentage of home health providers rejecting care is notable, Duell said. 
 
“I don’t think it would be a surprise to anyone in the industry to say workforce shortages are a problem, but it’s surprising that home health is struggling the most,” Duell said. 

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Paralysed Man Walks Again Via Thought-Controlled Implants

by Isabelle Tourne

A paralyzed man has regained the ability to walk smoothly using only his thoughts for the first time, researchers said on Wednesday, thanks to two implants that restored communication between brain and spinal cord.

The patient Gert-Jan, who did not want to reveal his surname, said the breakthrough had given him "a freedom that I did not have" before.

The 40-year-old Dutchman has been paralyzed in his legs for more than a decade after suffering a spinal cord injury during a bicycle accident.

But using a new system he can now walk "naturally", take on difficult terrain and even climb stairs, according to a study published in the journal Nature.

The advance is the result of more than a decade of work by a team of researchers in France and Switzerland.

he advance is the result of more than a decade of work by a team of researchers in France and Switzerland.

Last year the team showed that a spinal cord implant—which sends electrical pulses to stimulate movement in leg muscles—had allowed three paralyzed patients to walk again.

But they needed to press a button to move their legs each time.

Gert-Jan, who also has the spinal implant, said this made it difficult to get into the rhythm of taking a "natural step".

'Digital bridge'

The latest research combines the spinal implant with new technology called a brain-computer interface, which is implanted above the part of the brain that controls leg movement.

The interface uses algorithms based on artificial intelligence methods to decode brain recordings in real time, the researchers said.

This allows the interface, which was designed by researchers at France's Atomic Energy Commission (CEA), to work out how the patient wants to move their legs at any moment.

The data is transmitted to the spinal cord implant via a portable device that fits in a walker or small backpack, allowing patients to get around without help from others.

The two implants build what the researchers call a "digital bridge" to cross the disconnect between the spinal cord and brain that was created during Gert-Jan's accident.

"Now I can just do what I want—when I decide to make a step the stimulation will kick in as soon as I think about it," Gert-Jan said.

After undergoing invasive surgery twice to implant both devices, it has "been a long journey to get here," he told a press conference in the Swiss city of Lausanne.

But among other changes, he is now able to stand at a bar again with friends while having a beer.

"This simple pleasure represents a significant change in my life," he said in a statement.

'Radically different'

Gregoire Courtine, a neuroscientist at Switzerland's Ecole Polytechnique Federale de Lausanne and a study co-author, said it was "radically different" from what had been accomplished before.

"Previous patients walked with a lot of effort—now one just needs to think about walking to take a step," he told a press conference in the Swiss city of Lausanne.

There was another positive sign: following six months of training, Gert-Jan recovered some sensory perception and motor skills that he had lost in the accident.

He was even able to walk with crutches when the "digital bridge" was turned off.

Guillaume Charvet, a researcher at France's CEA, told AFP this suggests "that the establishment of a link between the brain and spinal cord would promote a reorganization of the neuronal networks" at the site of the injury.

So when could this technology be available to paralyzed people around the world? Charvet cautioned it will take "many more years of research" to get to that point.

But the team are already preparing a trial to study whether this technology can restore function in arms and hands.

They also hope it could apply to other problems such as paralysis caused by stroke.

More information: Grégoire Courtine, Walking naturally after spinal cord injury using a brain–spine interface, Nature (2023). DOI: 10.1038/s41586-023-06094-5. www.nature.com/articles/s41586-023-06094-5

Journal information: Nature 

People with Disabilities Need More Access to HCBS, Researchers Say

McKnight’s Home Care / By Liza Berger
 
Long-term care reform in the post-COVID-19 era must include an expansion of home- and community-based services (HCBS) for people with disabilities, two Harvard University researchers said in an article in The New England Journal of Medicine.
 
“Although the public may think of nursing home placement as the inevitable result of impairment, it is frequently driven by social rather than clinical factors,” authors David Grabowski, PhD, and Ari Ne’eman, wrote. “Many people with disabilities end up in nursing homes because of inadequate services or housing. This problem is particularly acute for persons with serious mental illness (SMI), who account for one third of long-stay residents under 65 years of age.”
 
There is an inherent bias toward institutional care for people with disabilities, they said. While Medicaid, the primary payer of HCBS, requires states to cover nursing home care without a waiting list, it permits states to maintain long waiting lists for HCBS.
 
“Long waits exacerbate unmet care needs by denying people access to services until they face a crisis — such as a medical emergency or the death of a family member — that may drive them into a nursing home or other institution,” they said.
 
HCBS rebalancing tweaks
 
While there has been a gradual rebalancing toward Medicaid HCBS versus nursing home care, people with disabilities still tend to end up in nursing homes, Ne’eman told McKnight’s Home Care Daily Pulse. Generally, state long-term services and supports systems tend to distinguish between people with developmental disabilities, and older adults and non-elderly with physical disabilities, he said.
 
“The aggregate numbers are a little misleading because the developmental disability system has a much higher percentage of HCBS funding than the aging and physical disability system,” he said.
 
A new BIP
 
Some possible avenues to grow HCBS for people with disabilities include establishing a successor to the Affordable Care Act’s Balancing Incentive Program (BIP). This initiative provided additional funding to states with low HCBS spending in exchange for meeting specific benchmarks.
 
A new BIP program would allow for targeting of specific subgroups in a state so a state would have to meet HCBS thresholds for both the developmental disability system and aging and physical disability system, Ne’eman said.
 
Legislators also could reform the Preadmission Screening and Resident Review program, the federally mandated screening system designed to divert people with SMI or intellectual disability from nursing home placement. The Section 1115 Medicaid waiver program could be yet another way for the Centers for the Medicare & Medicaid Services to allow states to pay for ongoing rental systems for people at greatest risk of institutionalization, Ne’eman said.
 
“There remains more work to be done in order to broaden the scope of individuals who can access support in their homes and communities in order to divert people from nursing homes and support some people currently residing within them to transition back to the community,” Ne’eman said.

ChatGPT in Medicine: STAT Answers Readers’ Burning Questions About AI

Stat News / By Lizzy Lawrence, Mohana Ravindranath and Brittany Trang 
 
Artificial intelligence is often described as a black box: an unknowable, mysterious force that operates inside the critical world of health care. If it’s hard for experts to wrap their heads around at times, it’s almost impossible for patients or the general public to grasp.
 
While AI-powered tools like ChatGPT are swiftly gaining steam in medicine, patients rarely have any say — or even any insight — into how these powerful technologies are being used in their own care.
 
To get a handle on the most pressing concerns among patients, STAT asked our readers what they most wanted to know about generative AI’s use in medicine. Their submissions ranged from fundamental questions about how the technology works to concerns about bias and error creeping further into our health systems.
 
It’s clear that the potential of large language models, which are trained on massive amounts of data and can generate answers to myriad prompts, is vast. It goes beyond ChatGPT and the ability for humans and AI to talk to each other. AI tools can help doctors predict medical harm on a broader scale, leading to better patient outcomes. They’re currently being used for medical note-taking, and analysis of X-rays and mammograms. Health tech companies are eager to tout their AI-powered algorithms at every turn.
 
But the harm is equally vast as long as AI tools go unregulated. Inaccurate, biased training data deepen health disparities. Algorithms not properly vetted deliver incorrect information on patients in critical condition. And insurers use AI algorithms to cut off care for patients before they’re fully recovered.
 
When it comes to generative artificial intelligence, there are certainly more questions than answers right now. STAT asked experts in the field to tackle some of our reader’s thoughtful questions, revealing the good, the bad, and the ugly sides of AI.
 
As a patient, how can I best avoid any product, service or company using generative AI? I want absolutely nothing to do with it. Is my quest to avoid it hopeless? 
 
Experts agreed that avoiding generative AI entirely would be very, very difficult. At the moment, there aren’t laws governing how it’s used, nor explicit regulations forcing health companies to disclose that they’re using it.
 
“Without being too alarmist, the window where everyone has the ability to completely avoid this technology is likely closing,” John Kirchenbauer, a Ph.D. student researching machine learning and natural language processing at the University of Maryland, told STAT. Companies are already exploring using generative AI to handle simple customer service requests or frequently asked questions, and health providers are likely looking to the technology to automate some communication with patients, said Cobun Zweifel-Keegan, managing director of the International Association of Privacy Professionals.
 
But there are steps patients can take to at least ensure they’re informed when providers or insurers are using it.
 
Despite a lack of clear limits on the use of generative AI, regulatory agencies like the Federal Trade Commission “will not look kindly if patients are surprised by the use of automated systems,” so providers will likely start proactively disclosing if they’re incorporating generative AI into their messaging systems, Zweifel-Keegan said.
 
“If you have concerns about generative AI, look out for these disclosures and always feel empowered to ask questions of your provider,” Zweifel-Keegan said, adding that patients can report any concerning practices to their state attorney general, the FTC and the Department of Health and Human Services.

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