What should families know before choosing a nursing home or skilled nursing facility?
In this episode of The Care Cartography Podcast, host Andrei Tsygankov sits down with Brent Manuel Moss, a licensed nursing home administrator and nurse, to explore the realities of skilled nursing, rehabilitation, and long-term care.
Brent shares his experience managing a nursing facility, explains how short-term rehabilitation differs from long-term residential care, and discusses the financial and emotional challenges families encounter when navigating Medicare, Medicaid, and discharge planning.
Automatically generated transcript, lightly formatted for readability. Please verify names and medical terminology against the recording before publication.
Sometimes people come into skilled nursing, just any healthcare organization, and they have an attitude. They’re upset about a lot of things. I mean, think about it. They’re in a nursing home now. This is where they’re stuck for the rest of their lives. Sometimes they don’t have family that really cares. They’re thinking about all the things they used to be able to do, now they can’t do. I’ve had a resident before who wanted to eat regular food. He had stage four cancer. He was dying.
He was on hospice. Well, are we allowed to help him eat the food that might kill him? I mean, you can lose your humanity as a as a healthcare operator. One big thing that my old facility I used to work at and was getting someone off a ventilator. I think one year we were able to get about eight people off the ventilator and there were two young people who were able to go home. Treat them how you would want your other other
people to be treated. So, if that was your grandmother or that was your daughter or that was you, how would you want to be treated? [music] Welcome to Care Cartgraphy, a show about health care and having practical conversations with people who understand the health care system from different
angles. From doctors and nurses to administrators and operators to coordinators and patient advocates and other health care professionals who see where the system works, where it breaks down, and what could be done better. Today we’re going to talk about a part of health care that near nearly every family eventually encounters, but very few people truly understand it until
they’re in the middle of it. Skilled nursing, rehabilitation, and long-term care. With us today is Brent Manuel Moss, a licensed nursing home administrator and operator of Chestnut Ridge Nursing and Rehabilitation, Coming, Georgia, just north of Atlanta. Brent is a licensed practical nurse and has a master’s in public health from Morehouse School of Medicine. Brent, welcome. We’re happy to have you here. Thank you. Thank you.
So, obviously you have a very unique perspective on healthcare because of your clinical experience, your facility leadership, regulatory knowledge, and just a broader public health view. So, I’d really like to talk to you about your path into healthcare. Um, and also what families misunderstand the most about skilled nursing and long-term care. So, let’s start with your path.
How did you get here? Yes. So, I wanted to go to school for marine biology. My mother was encouraging me to go towards nursing. I have four aunts that are nurses and they’ve worked in nursing for years. I think by the time somewhere now in 30, 40 years in nursing. So, I was encouraged by them to go to nursing and I did and I got into the nursing program. I became a licensed practical nurse. From that point, I wanted to see
more of what was out there. I met someone who was telling me to look into management and um I knew my path was going towards administration uh as a nursing home administrator and um eventually I moved to Pennsylvania and got my license and actually just moved back down to Georgia. So what do you do Chestnut Ridge? How would you describe your role and and your day-to-day?
Um my role is managing the facility. I have a about almost 17 department heads from nursing to dietary and a lot of the families might have issues about uh just different people in different departments. My job is to collaborate with everybody to make sure that we can handle an issue. There’s a lot of meetings uh there a lot also there are a lot of times where we involve outside vendors like hospice um and also we have home health that we send when we send
people home on rehab they do get home health at home as well. So we’re working with multiple vendors on trying to make sure that they get everything they need in the facility and outside the facility when they go home and and and you’re in charge of orchestrating that entire endeavor. Yes. Yes.
That must be that must be [clears throat] quite quite the dayto-day. Uh yeah it’s a lot. It’s a lot because there’s a lot that u a lot of families look to you h to solve their problems. A lot of families um want answers now sometimes and you’re you have to get other people involved to get the answer they need. Um so it’s a lot because if they’re looking to you as hey you’re the administrator we want you to fix this. And also when the
regulators, the CMS, the state, when they come through the facility, they’re not looking for anybody else except the administrator. And so anything that happens in the facility, it’s on me. Um because I have a license and that license is on that facility. And so and how many patients does the facil does Chestnut Ridge currently service? Um we currently service about 130. Um but we can have up to 150 patients in the facility.
Right. And and so you’re on the administration side now. Do you think that uh you having experience on the nursing side has had an impact on how you lead the facility?
Definitely. I think that when I talk to I can easily talk to the nurses and CNAs and I can actually show them how to handle certain things and I also give them the uh I tell them to come to me. So if there’s issues where they’re like, well, I’m not sure it should be done this way. Yeah, they can go to the director of nursing. They can go to the assistant director of nursing. uh other nurses and management, but I keep it open that they can come to me and I tell them if they need help pulling patients
in the bed, helping cleaning patients, getting patients into the Hoyer lift, I’m willing to help them. So, they enjoy that. But I also can educate them just on basic things I’ve learned in my years as a nurse that they might not know cuz we get a lot of new people into the field. And also it just shows uh I think they like that ability to come to me and not feel like oh my gosh the administrator is not going to want to be involved or bothered. Um so yeah um I just like that being a nurse I can
relate to them and understand what they’re going through.
Public health. What drew you to the public health aspect? Sometimes you’ll talk to patients and then you’ll realize, oh, it’s probably because they live in a bad area that um they’re dealing with certain disease processes like sarcidosis, um high asthma, and you’ll notice, oh, it’s because they might live next to a factory or near pollution. So, I kind of correlate towards that when we talk about healthcare and what we deal with
um as patients. And I I’ve always been interested in public health issues, but when I had the opportunity with Morehouse, I really took that I took it because I said I want to learn more about public health. And I realized a lot of those things correlate to how the patients when they come into the nursing home. Um the things they dealt with in their uh where they’re around, the water they drink, um that deals with how they
are now in the nursing home. And so I just I just thought it was important um especially when I’m dealing with patients. Um yeah. Yeah. So looking at your career now to this point, do you see yourself more as a healthcare operator, a patient
advocate, a systems person, or a combination? I would definitely say combination between a healthcare operator and advocating for patients. um when you work in especially skilled nursing, you you it’s more sometimes cutthroat cuz you have insurance is cutting people. Um especially if you’re with a for-profit company, you can’t just have someone in your facility who’s not paying. So you have those issues, but then you also
want to make sure that that patient um they’re being discharged home. Are they, you know, do they have a good system that they can go back to? Because sadly, you learn that families aren’t together like that anymore. sometimes people uh especially now you’ll see a lot of people in uh homelessness, poverty and the elderly. So them being at a nursing home and some and they can’t work and now they can’t pay their bills. So are
they going to go back home to uh lights being cut off? So those are things I think about as well. And the social worker, they think about those things as well. And you know, if I have to deal with the hire with my uh corporation, um the owner of the company to ensure that the resident is safe, then I’m going to do that because I also look at it towards a regulation standard. Um if I discharge somebody and it was not safe,
how would that look at how would they look at me as an administrator? So, I I bring that up a lot when we have discussions about discharges. Uh but I also understand that this company is a for-profit company. So you have to kind of work all together and bring that together because if you don’t then um you to me you can lose your humanity as a as a healthcare operator and then you
can also not think about how important the business is because they have to make their money. So you got to think think about both of those things when you’re dealing with um healthcare. seems like a very delicate dance because you know obviously uh providing the patient care that’s necessary giving them what they need treat them with dignity I think as you mentioned uh while at the same time ensuring that keep the lights on the doors open [laughter] that’s it
seems both those are very uh you know very relevant very things so you mentioned skilled nursing what does that mean skilled nursing to me is just um I mean nurses are already skilled But when
you’re dealing with skilled nursing, um that’s normally involved in a nursing home, you can um and you have nurses who are skilled to take care of certain things. So PEG tubes, trails, it could be um drains, uh colostomies, urostomies. So that’s the skilled part and nurses have to hone on those skills and you’re just making sure that these nurses have those skills to take care of the people. So, it seems that the skilled nursing part really is is is a
focus on the long-term aspect for very specific population of patients. Would that be right? Uh, yes. I mean, it’s focused on the long term, but it’s also focused on those short-term patients. So, those residents who are coming in and uh they broke their hip, they broke their uh knee, they have a knee replacement, and they need to discharge from the facility. Probably the goal is in two or 3 weeks. uh the nurses are using their skills and making sure that they can take care of those people appropriately.
And then you have those long-term people who sometimes will have equipment needed to take care of them. And so um cuz yeah, you’ll get patients who don’t need much. They just need one medication, but then you get patients who need you have 10 medications and then they need a lot of care and they might need a lot more skill. They have a PEG tube, they have a colostomy. Um and so that’s when those nurses are using those skills. So, I
mean, to me, all nursing is skilled, but especially in nursing homes, long-term care facilities, uh that’s when I think of uh skilled nursing. So, I think a lot of us we think of nursing homes, we typically think of the elderly. And I’m sure it’s a big part of the the patient population, but uh are
there other patient types who might uh fit the mold of of a of a nursing facility? Um yes. So um sadly uh people are having strokes at a younger age um heart attacks at a younger age uh kidney um failure at a earlier age. So we do get people who are in their 50s sometimes 40s and 60s who are not even um above the Medicare age of 65 and they’re coming to our building and they need sometimes long-term care or they need
rehab. Um so you do receive that. I have seen skilled nursing homes also receive younger people. Um I used to be an administrator of a ventilator facility and sadly we received a lot of people who might have um had tragic accidents that have happened especially young people might be injuries from car accidents um uh gunshot victims and they’re on a ventilator and they need care because the of of their condition.
So um I have seen younger people in nursing homes. Um, most of the time though it’s because of a sad tragic accident. Sometimes it’s because they have a disease process like ALS. Um, and we do have people currently with ALS at our facility. And normally, you know, most of the time, uh, the ALS triggers in their early late 30s, early 40s. And so, they’re not that they’re pretty much still young and now they’re in a nursing home being taken care of. So, I have seen different populations and I think
it’s based on where you’re at. Um, but the majority of our patients probably are 60s to 70s. Um, and they’re normally there for either long-term or short term. So, when it comes to let let’s say uh younger people who might find themselves in a skilled nursing facility,
especially those who have come out of tragic events, who may have been discharged from hospital, do you see at least some subset of those people who eventually leave and and and and go home? One big thing that my old facility I used to work at in um Pennsylvania um was getting someone off a ventilator and um I think one year we were able to get about eight people off the ventilator
and there were two young people who were able to go home and um so I did see those things and you know that was pretty good because you know I mean it being able to walk and do your own thing and then now you’re stuck at a nursing home, a skilled nursing home and you’re on a ventilator. um that messes with your mind, especially depression. And so, uh I have seen people transition.
I’ve also seen younger people who’ve had strokes and um it could be because they’re younger, it just they’re doing therapy and now they they’re not 100% but they’re at 80%, they might need a walker still, but now they can speak. They had speech therapy, they had physical therapy, occupational therapy, and now they’re able to go home and take care of themselves. So, I have seen that. um in my facilities, but also other facilities I’ve um helped out with.
So, you’ve mentioned rehabilitation, long-term care. What is the difference between those two or is there a common relationship between them?
I would say there’s a common relationship and also there’s a difference. So, to me, uh long-term normally means those people uh people who will be there for the rest of their lives. Um, I think that’s the main reason why CMS set up their guidelines and their regulations because they want to make sure those people who are long-term are being taken care of properly. And so there’s a lot that’s involved and that goes from them having
the right to um their rights as patients, but also to them having resident counsel uh residents to advocate for themselves. Um, but then you also have your skilled part and normally those people are there for a little bit and the goal is to get them the get to get them home or with family, but um sometimes the long term um they might need some rehab because they’re kind of declining. And so yeah, then you’ll get your skilled day,
they’ll get their skilled training and the OT uh the PT, the speech therapist will come there and they will um see how they can evaluate and can we make them better? Just uh just so everyone is aware, OT, PT, what what are those uh uh positions and what do they do? Oh yeah. Um occupational therapist um their main job is to make sure that you can do the things that you would normally do on your own. um you can kind
of say just like wipe your butt when you that’s something we always do we’re used to doing eat um put clothes on. So occupational therapists are very important to the skilled nursing uh platform and longterm because you know as people are in the nursing home for a long time they start losing some of the functions that they’re able to do. Um and so their job is to get people back to those points that hey can you put your clothes back on. I mean, we do have
nurses and CNAs to help with that, but uh it’s so much better if someone could do it on their own. Ideally, if someone’s lost that function, they would always obviously want to restore it, right? Yes. And it’s in everyone’s best interest. Yes. In everyone’s best. And so, that is a big uh that’s a a big push always in skilled nursing. U physical therapists pretty much uh they work with your your legs, they work with your arms as well, but the legs are uh some of the biggest things when they’re helping people walk.
Um I mean, that’s what people want to do. you want to be able to walk, to do the things you can do. And so that’s when we get physical therapy in. And then we also get speech therapy because of um their ability to eat certain foods and also to communicate properly. Um you know, sadly strokes can change a lot in people and um that’s why you need speech therapy. So you you you touched briefly on um you know, center for medicare Medicaid uh
federal programs. Um, what do families typically not understand or not know when it comes to Medicaid, Medicare, or other types of uh, federal benefit programs? I I think a lot of people don’t realize that Medicaid is um is a program that if you own property, if you own things and you want to go towards Medicaid to help pay for your stay because you’re going to be a long-term person, um in a in a healthcare facility, a nursing home, um they want
the finances and um this is when people have to know that, you know, okay, well,
mom’s going to go into a nursing home, but we don’t want her to lose all her money, so we’re going to take that money at the account and give it to her children, or we’re not um we’re going to put her house into her son’s name. Um and it’s in that 5-year look back, Medicaid is going to look back and say, “No, we’re not going to approve her Medicaid.” So, a lot of people don’t
understand that. Um, and I have seen sadly sometimes people their loved one goes to a nursing home, they know it’s going to be long-term and then we’re doing the verification for Medicaid eligibility and um they’re they don’t get it because all the things they did on the account and um they’re they’re very strict. They want to know where the money went. They want to know who spent the money, what did you spend it for.
So, if you’re taking um unless you can ver like we had a patient I just remember years ago I had a patient who um she was kind of just using her money wanted to blow it spending on shopping sprees she didn’t realize that she was
going to be in a nursing home in another year and now she’s here at our facility longterm and Medicaid want they wanted to know why was this money spent and the family had to prove that she did not know she was going to go into a nursing home in a year from that point and they did. And so, but that’s how strict they are. They were like, “Hey, you’re spending 5,000 here, 2,000 here, 10,000 here.” Um, but she was just doing that because that’s what she wanted to do.
And she can do that. You could do what you want. But, um, Medicaid wanted to make sure you did it the right way. So, I always tell people, um, they don’t understand Medicaid because they’re like, “Oh, well, why do they want all this information?” Well, that is a government program that is paying for your loved ones care. and or for your care. And they want to know, especially if you have money and you have that
money and you own property, they want to know everything. And if you’re refusing to give that over, they’re going to deny you Medicaid. And then that kind of creates a problem on my side because now I don’t have a payer source for you unless you pay out of pocket. that and pretty much mo normally when it goes to the Medicaid part, you’re pretty much paying out of pocket to Medicaid for your care until you use your funds up to a certain amount. Um so, and I know it’s different per different um state.
Different states are have different um how much uh the residents allowed to keep, but you’re allowed to keep a certain amount. Sometimes it’s $70. Um
and that’s all that resident gets from that point. Everything else goes to Medicaid. If you had a house and it’s a million dollars, if you sell that house, all that goes to Medicaid, most of it does. So, they’re very Now, if you’re married, um that’s a different story because they can’t sell if your wife and you’re going to a longterm and your wife is still at home. Well, we can’t sell
the house because she’s still there. Um but it’s just certain things that they look at. So, I tell people to um you know, not not saying you have to do it now because your loved one is u you know, they want to spend money and go on um trips and and blow money, that’s okay. But if you know that person’s eventually going to go to nursing home u to a nursing home, um think about how you’re hand handling their money because if they see funny things being done, they’re going to deny it and that creates problems.
Right. So, this is specific to Medicaid, correct? Mhm. And and that means if someone is looking to use Medicaid for those services, there’s a 5-year look back to see where the money went effectively. Right. So So if you if you have funds, you can’t hide it or give it to a family member. Uh knowing that you’re going to be in that long-term facility, right? Yes, that’s correct. Yes. So what about Medicare? Uh does Medicare pay for any of that?
Um so Medicare is a little different. Um you have uh you have I mean you have part B, you have Medicare A, you have
part C, and then you have part D. Um but uh especially in skilled nursing, the two that we look at are Medicare Part A. So, normally Medicare Part A is when you have um most people who get Medicare um especially if they’re above uh 65, they get it uh when they go to the hospital and uh let’s say they came there because they broke an ankle and then now they have a 3-day stay at the hospital and now they have a nursing home to go into. We can use their Medicare days. um those Medicare days normally 100 days um and
then it only um goes back to zero if you have a 60-day stay outside a healthcare facility. So if you have um 100 100 days of Medicare, most people uh they come to the facility, they normally have a
Medicare advantage programs that they’re using. But if um we can convert them to Medicare, then normally that um conversion allows the facility to use um well the therapy dictates how that Medicare out those the time is being spent. And so therapy can work with the resident and try to see how as much as they can, how many hours they can devote to get that resident to where they need to be um to dis before they can discharge. Now sadly though, not every sometimes people can’t use all those
days because they’re not doing well and you can’t justify using those Medicare days. And so that’s where you have the issue then, okay, well now we can’t use their Medicare and now we have to go to Medicaid or you got to pay out of pocket if you’re going to be here long term. Um so yeah, Medicare is um it’s a it’s pretty much one of the highest payers in healthcare. Um and most skilled nursing facilities look for Medicare because you have that 100 days with Medicare, right? But but after 100 days, that’s
it. the Medicare will not cover someone long term. They need if they need to just stay there indefinitely. Would that be right? No, that’s when you go to the Medicaid part. And then not only that, um now part B helps with the other things. So when you’re you’re thinking about the PEG tubes and the TRA and the ventilators and the colostoies. Um and sometimes with therapy, therapy can do
some things on part B when they’re a Medicaid resident. But um part A is just um which is commonly used at most nursing homes, most nursing homes are looking for those part A people. Um the thing is if you can’t, you know, if if you’re not participating in therapy and you’re on part A, uh therapy is going to have to cut you unless you have a skilled reason why you’re on Medicare.
So like if you have a ventil a tra or a ventilator, then then that kind of helps with that part, but you can still only use 100 days. So, after those 100 days, back to Medicaid or uh or uh paying out of pocket or if someone purchased a long-term care private insurance policy, right? Yes. And I I used to see those a lot. I don’t see them as much. Um wh why why is that?
I think those insurance policies, especially starting the 90s and 2000s, they’re not doing that anymore. So, like a lot of people who don’t have it from back then in like in the 90s and 80s, they don’t get those because I think those policies pay pretty much everything. Um, and now these policies are only paying a certain amount of days or a certain amount of uh or a certain amount they would pay uh for the
resident. So, I I think I mean those things sounded great. I think they see now like okay, all these people are in their 80s and 70s and now they’re using these policies and and they probably can’t afford it. Uh, I mean these insurance companies, so the economics just never made sense. Now I think now they’re looking back because I think they weren’t thinking, oh, you know, Miss Johnson’s going to live to 89, 94. So now they see these
people living longer than normal than it was before and and now you have these people in there in their hundreds and um they’re still and they’re still at the nursing home and they’re having to pay that insurance policy. So, I think uh and or assisted living, I think that’s just a strain on these uh insurance companies now. So, I think they’re I I’ve read that they’re not doing that anymore. They’re not giving them that leeway of boom, whenever, how much, it
doesn’t matter. Um they’re more stricter now about these policies, right? So, they’re becoming more rare, it seems, in your experience. Yes. So, what should families know or ask about when they have a family member enter into uh into a skilled nursing facility? Um I think the first thing um they need to see the quality measures of a facility. Um they need to see the um
look at their um survey binder to see how their last surveys were. Um cuz you know surveys are that’s how a skilled nursing stays open. You have to have the C uh CMS come out and give a survey to the facility. And during COVID it kind of went crazy. Some buildings weren’t surveyed for 3 four years. Um but now they’re trying to get back on the schedule. Most states are and they’re trying to make sure that every building is surveyed at least once a year. And
then you also have uh complaint surveys there. A lot of times complaints could be anything. People can be upset about any issue. They don’t they didn’t like the CNA from that night before. They didn’t like how they felt that morning. Um there was a smell cuz they their roommate was changed and they’re upset about that. So there’s a lot of things that people can be upset about. So I think when families come in, they need
to look at the survey binder. Um look at the quality measures which normally are online. Um uh but also just talk to the administrator, talk to the director of
nursing, walk through the facility. Uh we do tours all the time and um you know a lot of times people want to u they want to smell the facility. You know, does it smell like urine? Does it smell like um feces throughout the hall? They want to see what the res that would be a bad sign. Yeah, a lot of times, you know, I I’ve had families come to me and say, “Oh, it doesn’t smell like this other nursing home.” Or, um, I’m shocked that this doesn’t, you know, I can tell
they’ve been to other places, and I’ve been to other places, and sometimes it just smells like urine everywhere. Um, it could be because the building’s old and they haven’t updated the building, but also could be because patients aren’t being changed as quick. Um, so I think that’s what people need to see when they go through a nursing home. see how people are interacting. See how uh look at when call lights are being answered if they’re just touring the facility. Um those are some things I
say. Uh but I think also talk to the administrator, talk to the director of nursing. Um talk to the people who are there every day and see how they um how they respond to you. Um you know, if they’re rude, then probably you’re not going to a good facility. Um they’re probably rude to the patients as well, right? Yeah, they can be. Yes. So, I think th those are things that people need to do whenever they are trying to look at a nursing home or what they should look for. Uh I don’t think any nursing home
is going to be perfect. Uh because you I mean as an administrator I have probably 100 something employees that I’m trying to make sure are doing the right thing. Um and there’s a lot of things that can be done to get people on the right boat, but um you’re always going to have somebody a bad apple somewhere. I think families and I know people who said they look at the tags and they’re like these don’t even make any sense. I don’t know what this means
like cuz you know you can get a a building can get tagged for not having an updated care plan. Um but I think if they see hey there’s abuse and why was why did the abuse happen or if it’s about education or if it’s about certain something in particular I think that’s what families would pay attention to more. Quality measures are how how CMS grades your healthcare facilities. Um so you’re you know with quality measures they’re looking at the actual quality
measures like um if we had trace if we had uh colostoies if we have uh foley catheterss um we’re not just putting people on foley catheterss just because we want to put them on folley catheterss there’s a diagnosis and a reason why and um and
just so everyone’s aware what does a folley catheter do? Oh folley catheter helps uh a patient urinate. So, um, normally, um, there’s and there’s multiple reasons why. Sometimes people have wounds and they the hospital will put somebody on a foley catheter to prevent the urine from going into the womb when they urinate because they can’t control the urine.
Sometimes it’s based on whatever incident they got into. So, like I say, they had a car accident and they broke both legs. I have seen people uh put fully I mean put a foley catheter in. Yeah, but when you go to a nursing home, there’s a different those quality measures don’t match with the hospitals. So, the hospitals were doing all this and now they’re looking at well, what are we doing? Um, when we have IVs, u, it’s just we have to make sure that we’re
following CMS guidelines when we have certain things. Um, not saying that we are abusing anybody, but like if you have a folate catheter in and there’s no justifiable diagnosis, uh, which I believe there’s only two diagnosis that you can have for a Folley catheter, then now you’re just having a Foley in and so now you kind of lose some quality measures. Um, you can also have quality
measures on your staffing. Um, it’s it’s hard, but um, they’re looking to have more registered nurses in your nursing home. A lot of times registered nurses don’t want to work in nursing homes. They have the hospitals and these hospitals are paid probably a lot more. But the amount of registered nurses, the amount of staffing, your staffing ratios, those are are in your quality measures as well. Sure. So, uh how do you attract good people and and retain them and and keep the morale up?
We do like employee of the month. Uh two employees get the employee of the month. Um, I encourage residents to give us ideas of who they want, staff to give ideas of who they want so we can pick an employee of the month. We also do a thank you board where staff and families can thank the other staff members and whoever gets the most thank yous gets a $50 gift card. Uh, and we pick two people from that point. So, um, I try to do a lot of things for the uh, the
staff. I try to um, do events for the staff. And I I know as a nurse, I’ve worked at nursing homes and you’ll work at and there’ll be different events that come up and there’s nothing done or you don’t get like the night shift is not given anything. Um so I’ve seen that. So what I do is I try if we have events I want to make sure night shift gets something I want to make sure that everybody knows. We post it. We come up
with ideas. We use a cult we use um a thing called culture committee. So we come up with different things that we’re going to do for the culture of the facility. Um, I always I I I do a town hall as well. So I um actually have a town hall this week on Thursday. And so there I just ask staff, do they have any questions, any ideas? I also bring up some ideas, some issues I have or other
people might have in the facility. And then I also give them the opportunity to speak up if they have complaints or have issues. I want them to discuss those. So um that’s how I try to work on retaining staff. Um, you know, I think also another issue is no matter what you it’s pay. You’re always looking at pay. So, I work with the corp the company to try to see if we can um get the pay that
they’re looking for. Um, because there’s a lot of competition out here. So, it just depends on what people are looking for, what the nursing assists are looking for, what the nurses are looking for. Um, I think some people who just want stability and they’re just trying to focus on a goal, that’s good for them. But I think the ones who are more who transition and might jump over here or go over here and just are looking for the higher dollar amount. Um I’ve had employees who’ve left and then they’ll
say, “You know what? I went to a place that paid $2 more but they had a bad culture.” So it seems that doing things things that you mentioned helps you retain and and and keep the people and keep the morale up. Yes. Yes. And do do you think that that translates into a higher quality of care? Yeah, I think it makes them feel more accountable because okay, they hired me and I want to make sure that I’m doing
the right thing. Um, and also like when you I mean one big thing I do is when I walk in my building, I say hi to everybody, residents, staff, and I encourage all the department heads to do the same because I told them you shouldn’t be where a point where you go into a facility and the staff is like, “Oh, yeah, yeah, that lady who comes in, but I don’t know who she is cuz she doesn’t say anything to me.” um they should say, “Okay, well, I know
that’s the business office manager. I might not remember her name.” Um, but yeah, that lady who always smiles. And so I try to encourage my staff because I said family should know who you are or the residents. I mean, granted, they’re going to know some people based on how what we’re working with them, but also the staff. And I said, “The staff shouldn’t feel afraid to come to you just to say, “Hey, I got an issue. Do you can you help me with it?” Um, so
that’s what I encourage because I said, “If I can do it, you can do it.” Yeah. So you mentioned uh that one of
your goals is to ensure that patients are treated with dignity and respect. What does that mean in an operational sense? How do you provide that on a day-to-day basis across you know so many patients and so many employees? Yeah. Um, so I feel when I when I bring it to staff about respect and dignity towards the residents, I always say that um it’s not how your mom like, oh, treat your the resident how you treat your mom because some people don’t treat their
families right. [laughter] I always say um you treat them almost like a golden rule. Um treat them how you would want your other other people to be treated. So if that was your grandmother or that was your daughter or that was you, how would you want to be treated? If you’re asking for something simple and then the person’s refusing to do it, uh that’s not giving them the giving them that respect. Um or if you know like and there simple things um when they’re
taking care of people, making sure the doors are closed, the curtains are closed, telling the patient what they’re doing. Um especially for those who are blind and have a bad hearing. um give a smile and show, okay, we’re going to shower or try to come up with ways to communicate properly to them. Um if you tell patients what you’re doing, they feel a lot better. Cuz if you just grab
them and get them ready and take them to the shower room and they’re like, I don’t know what happened. Sometimes that’s when you get the complaints cuz they feel like they were just thrown into a situation. Taking the time to getting get them involved in what’s happening with them and to them, the residents and the patients. I mean that’s a big part of it. Yes. Yes. So why do you think the treatment with dignity and respect? Why do you think that’s such a big issue when it comes to large health care systems?
Sometimes people come into skilled nursing, just any healthcare organization, and they have an attitude. They’re upset about a lot of things. I mean, think about it. They’re in a nursing home now. This is where they’re stuck for the rest of their lives. They uh sometimes they don’t have family that really cares. Um, sometimes they they’re thinking about all the things they used to be able to do, now they can’t do. So,
these people are thinking about all these things and now they got to deal with somebody with an attitude at the nursing home or if you’re at the hospital, um, the front desk, you get attitude from them, you get attitude from security. I think that kind of just messes up people’s uh attitudes towards the whole healthcare uh world because they’re like I rather just be at home by myself and not be bothered or just do
what I want to do because if you’re getting attitude or you’re getting rudeness from other people. So I don’t know why it’s cuz I I’ve dealt with people being rude when you you know especially I’ve gone to offices and no one’s talking to you. no one. And then when you get the you go to the front and the person just throws you the thing and says fill it out and there’s no they’re not there’s no smiling. They’re not even saying hey how are you? So sadly, I
think that’s just because how the world is, I could say. But I wish it um I know for me, I try to get my staff to understand um with that dignity and the respect uh aspect, come up with ways on how you handle situations. Even if that resident has an attitude with you, they’re rude, they say things that are inappropriate towards you, you you can say, “Okay, I understand you’re not happy. I’ll go see if someone else can help. You know, sometimes it could be just you. They
don’t want to be bothered with you. But um yeah, I don’t know why the health care the healthcare world is so I don’t know tainted. Um because I hear a lot of times people say the nurses CNAs aren’t nice and it’s not just nursing homes, it’s hospitals, it’s other things. Um so I, you know, I wish it could be the the change in healthcare. I don’t know. [laughter] I really don’t know. You mentioned that you were regulation uh managing compliance is a is a strong suit of yours. Do you think that compliance
and compassion are at odds with each other? Sometimes it can be. Um I mean I can think of an issue I’ve had where a resident wants something but compliance it doesn’t work that way. But what they resident wants is not a major issue but it’s just like it doesn’t work with the being compliant. And I’m not just saying for CMS regulations, but I’m saying it could be compliant to the rules of the facility or it could be compliant to
just uh our policy on certain things. I think it really depends. Like I I’ve I’ve had a resident before who um wanted to eat regular food and he had um stage four cancer. He was dying. Um
he was on hospice. Uh but you know, hospice, yeah, he can eat anything he wants because he’s on hospice. They already, you know, we already know what his diagnosis is in his care plan. But the um resident could only had one hand and wanted us to help him eat. And that kind of goes to a issue with okay, well, are we allowed to help him eat the food that might kill him? And um so I look at it that yeah, I I felt bad for the resident, but we couldn’t do that. But
now what the condition was is they were able to get a family member to come in and help feed him. You know, shockingly enough, he still lived for a long time even though he wasn’t supposed to eat regular food. So, I don’t know if that was um the wrong diagnosis, but um or maybe the regular food helped. It could have could have I think it made him I know it made him more happy, but um that’s when to me like com compassion like this guy has stage four cancer. He already his body’s already debilitated.
um he’s not happy, but he wants to eat regular food and then we can’t do it. Uh so that’s when they kind of like they they collide. Uh I understood and I had compassion for him. And in reality, I think if he was at home, it would be a whole different story. But he was in a skilled nursing home trying to get food that we could not actually go and feed him the way he wanted. We could feed him the parade food, but not the regular food. And he was like, he refused the parade. He said, “I’m not eating it.”
And so now you’re at a worry, okay, well this man’s not eating. Um, but hospice came up with an idea. We all came up with as a team to handle that situation. So speaking of compliance, what do you think is the connection between uh documentation and quality of care? [snorts]
Um, I think documentation proves everything that you’re doing for that resident and it shows what type of care we’re giving. Um, if people are documenting, let’s just and I I always tell the nurses and CNAs, um, even if they have a small bowel movement documented, even if um, it’s something like you see something that they’re doing that, hey, now the resident wasn’t able to move their arms and now they’re reaching out to grab you and and they’re
making an effort. So, like, let the nurse know, let your uh, the therapist know. It’s very important because um documentation is pretty much how facilities get paid but it you know also insurance companies and medicaid and or Medicare not saying they don’t want to pay at all but if they see something incorrectly on those documentation they’re going to want their money back and so that kind of
affects how the operation runs altogether. So, if you’re um and I have seen nursing homes and other healthcare facilities where the insurance company is saying, “We want our money back. We want to we want to make sure that well, we audited the charts and we saw that you didn’t do this properly or you said that this resident was getting this and it didn’t happen.” someone’s auditing and like I tell the nurses and the CNAs, if a resident is supposed to is a
twoerson assist and you document that they’re a oneperson assist every night you’re working. If I was an auditor and I’m looking and I would say well you said so we were paying you for twoerson assist for a day that that person did one person assist we want that money back. Uh, and and granted that might not happen. It might happen, but I tell people to pay attention to how they document because that’s how pretty much
how the facility gets paid um when they send that information up to um to the state, but also when they send it to the insurance companies and the insurance companies want they want updates and they want to see how someone’s doing and and it also if nurses don’t document sometimes the insurance company’s looking back and saying, “Well, the therapy saying they’re fine and the nurses are not saying anything.” Why did you do this? Right. Why was this done for to or for this person?
Yeah. So then now and then um they’ll cut they’ll cut patients and now they’re saying, “Well, the patient doesn’t need uh that us anymore because you’re saying they’re good and it could be because the nurses didn’t document anything properly.” So uh yeah, nurses uh documentation is important to just the operation of the company. So, if you
were able to give the audience a takeaway, whether it’s about skilled nursing facilities or skilled nursing in general, what would that be? I think some people don’t realize it because they might not have loved ones who are there and they might not think about it, but a lot of people are going into a lot of people as they get older, they’re going into the skilled nursing uh setting as patients. So, um I think it’s going to affect everybody um eventually.
So, and not everybody can afford to keep mom at home and dad at home, especially if they have kids they got to take care of and they’re dealing with their own things. So, um I just think it’s important and people need to know how important it is and also come up with ways to make sure that these companies are still around because I have read that nursing homes a lot more nursing homes are closing more than they used to
sadly. And and if there are uh are there resources available uh out there for people to educate themselves on skilled nursing and and nursing home facilities?
You know, I actually don’t think there is. I think um unless you go to those like elder care law attorneys, they probably have some of the best information that they can uh towards skilled nursing long term. But um when you outside of looking for a book, you know, it’s not a lot of information out there. Sadly, I think um it should be [laughter] I mean thinking about it now, you might have advocates who are there to help families navigate through skilled nursing, but um I haven’t really
found that many. I found more books related towards how to run or manage nursing healthc care facilities, but not like how to navigate through it. Um that’s probably something that somebody should well pick up on. May maybe if you’re if you’re looking to create a a research center or write a book on that, that might be a great opportunity. [laughter] Yeah.
So, um I do have a uh one last question for you and I think this might uh this might hit home given your uh background in public health. If you could change something, one thing about the health care system in America, what would that be? Oh. Um I mean this is just me, but I think um everybody should have access to healthcare. Um I know it’s not free, but
uh I think we already spend billions um towards health care towards people. Hospitals spend millions on especially people who don’t have insurance. So, I think if you made it a a system where everybody had access to it and sadly they might have a stroke or a heart attack and then now what’s going to happen? They go into a nursing home [laughter] and then now um if we’re not if they’re not paying then somebody’s going to pay CMS, Medicare, Medicaid.
And it kind of comes right back to we’re paying for it anyway. So, how about we have a better system where people are encouraged to go and not feeling like, “Oh my gosh, I’m afraid to go cuz I can’t afford or I just can’t afford the $300 bill to go to a urgent care or a doctor’s office.” Hey, it’s already paid for now. We’re not worried about all these people at a young age going to nursing homes or assisted living because of their coorbidities.
Right. So, it seems that there might be a better allocation of resources to help address problems on the front end than only dealing with those in the back end. Yes, I definitely think so. Cuz I feel like we’re getting the problems at the back. And not saying everybody’s a problem. It’s just we’re getting those patients who oh, they haven’t been to the doctors in years and they’re in poverty or they can’t afford to go to a doctor and now the only time they went to a doctor is cuz they
went to the hospital and now they’re at a skilled nursing home. event. And granted, they might have uh put money into the system, but I mean, truthfully, probably most likely, we’re going to altogether pay for that person being in the nursing home. Um, depending on how long they live there. Well, Brent, thank you very much for being with us here today. Really appreciate your insight and your expertise. I really enjoyed having you.
Thank you. I appreciate being here. I enjoyed it. [laughter] I enjoyed it. Thank you very much for joining us. I hope you found this to be insightful and interesting. And if you have uh comments or questions, please leave in the comments section down below. And we’ll put our contact information out there as well. If you have any uh questions, please reach out. Thank you very much.
Brent Manuel Moss is a licensed nursing home administrator and licensed practical nurse with a Master of Public Health from Morehouse School of Medicine.
As the administrator of Chestnut Ridge Nursing and Rehabilitation in Cumming, Georgia, Brent oversees multidisciplinary teams responsible for skilled nursing, rehabilitation, long-term care, and resident services.
His background in nursing and healthcare administration gives him a unique perspective on the challenges families face when navigating care decisions. He is passionate about patient advocacy, staff development, regulatory compliance, and ensuring that residents are treated with dignity and compassion.
