In this issue A Publication of the Spring/Summer 2025 Oregon Health Care Association 2025 Legislative Session Updates | Q&A with Sen. Nash | Telehealth Benefits Technology & Innovation in Long Term Care
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 1
SPRING/SUMMER 2025 © 2025. The contents of this publication may not be reproduced or distributed electronically or mechanically, either in whole or in part, without the express written consent of the Oregon Health Care Association. The advertisers assume complete responsibility to use any or all brand names, trademarks, guarantees, and statements which appear in their advertisements. CONTENTS FEATURE 23 26 32 pg6 Technology and Innovation in Long Term Care In this article, we hear from two Oregon-based long term care leaders who are utilizing AI to enhance resident care, support staff, and explore innovative technologies— demonstrating that with the right approach, AI can be a powerful tool in senior living. 04 LETTER FROM THE CEO 06 TECHNOLOGY AND INNOVATION IN LONG TERM CARE 12 DATA & RESEARCH Recent Innovations in Long Term Care: Technology and Beyond 14 QUALITY Telehealth in Long Term Care 16 LEGAL & REGULATORY Use AI to Support Legal and Risk Management with Caution 18 PUBLIC POLICY Predicting the Unpredictable 20 SPONSORED CONTENT 20 Technology Innovations in Senior Living: Pros, Cons, and Considerations of Introducing Robotics into Your Community? 22 Using Technology to Enhance Care and Services 23 PROFILES 23 Maggie Hilty Katz (Vice president of business development and marketing at Avamere Health Services) 26 Senator Todd Nash (R-District 29) 28 2025 SPRING EXPO HIGHLIGHTS 32 UPCOMING EVENTS
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 4 Our focus in this issue of The Oregon Caregiver is to highlight how long term care providers in Oregon are adapting and embracing technological advances including “AI.” Keeping up with changing technology can be an intimidating and challenging task, but long term care providers across the state are proving that it can be done, and that new technology can be implemented in innovative ways that support residents and lead to improved quality of care. In our feature article, we profile two long term care professionals who are leading the industry in researching and implementing AI and other innovative technologies into their communities. These providers emphasize that AI is not going to replace any jobs and that when utilized effectively, it will support and enhance the work of caregivers, leading to better care quality and improved outcomes for both residents and staff. In our quality article, Nicolette Reilly focuses on the outcomes of increased telehealth usage by long term care residents (page 14). OHCA general counsel Eugenia Liu examines the potential risks and benefits of using AI to support an organization’s legal and risk management processes (page 16). Libby Batlan, OHCA’s senior vice president of government relations, provides highlights of the 2025 Oregon legislative session so far, though the session has not ended, as of this magazine’s print date (page 18). Walt Dawson provides examples of recent technological advances in the healthcare sector that have led to improved resident and patient health outcomes (page 12). Two OHCA business partners share how AI and other technological advancements can provide significant support for caregivers and other staff working in long term care, as well as the residents (pages 20 and 22). In our policy maker profile, Senator Todd Nash discusses how his policy priorities have been shaped by growing up and living in rural eastern Oregon (page 26). Maggie Hilty Katz, vice president of business development and marketing for Avamere Health Services, explains how her passion for the long term care industry has enabled her to excel in various different roles within the sector (page 23). Review highlights from the 2025 OHCA Spring Expo in Salem and save the dates of important in-person and online events and trainings coming up in 2025 (page 28). You can read this magazine and all past editions of The Oregon Caregiver on our website, www.ohca.com. Technology and Innovation in Long Term Care 11740 SW 68th Pkwy, Ste 250, Portland, OR 97223 Phone: (503) 726-5260 www.ohca.com OHCA STAFF Libby Batlan • Senior VP of Government Relations Philip Bentley, JD • President & CEO Mary Dakin • Workforce Development Manager Cheryl Durant • CRM Administrator/Accountant Amy Ferguson • Executive Administrative Assistant Melodie King, CMP • Director of Education Eugenia Liu • Senior VP & General Counsel Brenda Michael • Assistant Controller Lori Mueller • CFO Nicolette Reilly • Senior VP Quality Services Maggie Walter • Communications Coordinator Rosie Ward • Senior VP of Strategy BOARD OF DIRECTORS CHAIR Steve Fogg, Marquis Companies, Inc. IMMEDIATE PAST CHAIR Kathy LeVee, Generations, LLC VICE CHAIR Mark Remley, Aidan Health Services, Inc. TREASURER Andy Becker, Sapphire Health Services MULTI-FACILITY REPRESENTATIVE Zach Fogg, Marquis Companies, Inc. BUSINESS PARTNER MEMBER REPRESENTATIVE Gabriela Sanchez, Lane Powell, LLC ALF REPRESENTATIVE Mauro Hernandez, Hearth & Truss INDEPENDENT NURSING FACILITY REPRESENTATIVE Kelly Odegaard, Westcare Management BUSINESS PARTNER MEMBER REPRESENTATIVE Marcy Boyd, Moss Adams, LLP AT LARGE REPRESENTATIVE Brenda Connelly, The Springs Living IN-HOME/SENIOR HOUSING REPRESENTATIVE Jonathan Mack, Home Instead Senior Care of Central Oregon RCF REPRESENTATIVE Mark Kinkade, Gateway/McKenzie Living ALF/RCF REPRESENTATIVE Matt Dunham, Mosaic Management ALF/RCF REPRESENTATIVE Matt Hilty, Ohana Ventures NEW/FUTURE LEADER REPRESENTATIVE Hunter McLane, PACS Group, Inc. OC EDITORS Maggie Walter • mwalter@ohca.com Rosie Ward • rward@ohca.com OC PUBLISHER Big Red M • www.bigredm.com Advertising Sales • Ronnie Jacko (503) 445-2234 • ronnie@bigredm.com Design & Layout • Shelby Bigelow Phil Bentley President and CEO Oregon Health Care Association LETTER FROM THE CEO Stay connected with OHCA! Contact Maggie Walter, mwalter@ohca.com, to be added to our email lists. Improving lives by advancing quality care in Oregon since 1950
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 6 FEATURE TECHNOLOGY AND INNOVATION IN LONG TERM CARE By Maggie Walter, Oregon Health Care Association A resident at an Areté Living community utilizes their Ovations Connection memory care program.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 7 FEATURE Kathy, pictured here, is an interactive, digital AI companion for memory care residents. Over the past few years, it has become increasingly difficult to ignore the topic of artificial intelligence, or AI, in the media. When searching on Google, the first thing that comes up is the “AI Overview,” a brief snippet of the most relevant (according to Google’s AI model) answer to a search. When searching on Instagram, the search bar reads, “Ask Meta AI or Search.” It is becoming increasingly evident that, whether you are seeking it out or not, the use of AI is being encouraged by the digital platforms most of us visit daily. However, it isn’t just social media and search engines that are adopting the use of AI or machine learning. Healthcare settings, including the long term care sector, are keeping up with these advances and implementing them into the care of their residents. From remote monitoring systems to virtual reality devices, AI is being integrated into various aspects of resident care. In this article, we hear from two long term care professionals from Oregon who are embracing the ever-changing technological landscape. These providers recognize that, when implemented correctly, AI can supplement and increase the quality of care that their residents receive, empowering caretakers to do their roles more efficiently and effectively. These providers maintain that the use of AI in long term care is not to be feared, but embraced: when times change, we change with them. Evolving Technologies in Long Term Care Dr. Christian Mason has been a leader in the long term care community for decades. He played a major role in the development of the first assisted living communities in the country and has dedicated his career to advancing the sector while balancing his passion for technology and research. Dr. Mason considers himself to be a technology ‘early adopter.’ Since the beginning of his career, he has used his early adopter mindset to help his companies and others implement new technologies and improve their operations to ensure residents receive the highest quality of care. From developing digital interfaces, to answering resident call buttons, to transitioning to the Cloud, and now to implementing AI, he has seen quite the evolution in technology over the course of his career. “The adoption of AI in long term care has grown significantly,” he says. “Now, we see it in so many areas, and we don’t even think about it.” Remote patient monitoring, predictive analytics, and personalized care planning are a few examples Dr. Mason mentions where the use of AI is most prevalent in long term care. “Historically, we have been very slow to adopt technology, and now we are just screaming down the road with new developments happening every day.” Thomas Cloutier, chief marketing officer for Areté Living, expresses a similar sentiment: “Technology in senior living has evolved in tandem with advancements in our world. As innovative technologies continue to emerge, we find new ways to enhance the experiences of our residents.” Areté Living has made it a priority to implement the latest technologies in senior care into their communities. Making residents’ lives better while at the same time supporting staff are both things that are enabled by innovative technologies. Cloutier says, “Technology improves communication methods, apartment and community features, and the overall experience for residents and their families.” Research and Development Dr. Mason’s research interests have evolved over the years, but most recently, he has been involved in the Pacific Living Centers’ study on AI companions for residents in memory care communities. “Basically, what we were looking to understand was: If we used AI as a CONTINUES » “Historically, we have been very slow to adopt technology, and now we are just screaming down the road with new developments happening every day.” – Dr. Christian Mason
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 8 FEATURE companion for a resident, would that resident benefit from having that companion?” From this simple question, Kathy was born: an AI avatar displayed on a large, iPad-like screen mounted on a mobile stand that served as a 24/7 companion for 18 residents. Residents could talk to Kathy, and she would respond, getting to know each resident and adapting to their individual behaviors. “We call this machine learning— anything you say to the AI companion, it stores it and uses it as a reference. So, if you already input the resident’s history into the database, it has a starting point. As you develop this relationship, it will remember what you liked and disliked. It becomes super focused on you,” he explains. This pilot program was conducted in a memory care community, and Dr. Mason and his team hoped to determine whether interacting with this companion could help reduce or dispel some of the common behaviors exhibited by individuals with Alzheimer’s or dementia. “First off, but most importantly, we saw that the residents were engaging. We had one resident who was combative. She was on her call light 30–40 times a day. Kathy would interact with this resident, which allowed us to learn things that we didn’t previously know, since Kathy was tied to our alert system,” he explained. “For example, this resident said to Kathy, ‘I’m cold,’ which alerted the staff. In one case, we found a wall heater that had malfunctioned and was not putting out heat. That immediately gave us an opportunity to fix the situation.” Dr. Mason and his colleagues saw a marked reduction in anxious behaviors from the residents as well as improved mood and engagement. The information gathered by Kathy allowed caregivers to gain a deeper understanding of resident needs and preferences through AI-driven reports. Following the success of this trial, Dr. Mason’s research company, Horizon Health Research, and the partner company who created the companion, CloudMind, are launching new pilot programs to further explore how memory care residents interact with and benefit from the AI companion: “We are starting to incorporate more social history into the program, adding a male avatar named Ken, and looking at the ability of the program to speak different languages based on the populations they serve[...]. There are a lot of positive » FEATURE, CONT. Ovation Connections helps residents create connections in memory care, including tactile therapy, music therapy, pet visits, circadian lighting, and more.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 9 FEATURE CONTINUES » outcomes from the pilot, and as a result, we are pursuing this on a larger scale.” Other large senior living management companies like Areté Living have begun implementing various technological advancements into their communities. “Our Avamere communities use LifeLoop, a comprehensive software platform that delivers quality experiences for seniors, from move-in day to every day. This enables our teams to communicate quickly and efficiently, ensuring that everyone has easy access to the information they need. For our Ovation communities, we utilize K4 to achieve similar communication and engagement goals. Our apartments are equipped with smart home technology, allowing residents to adjust lighting and room temperature right from their seats,” says Cloutier. Another one of Areté’s advancements is Ovation Connections. “Ovation Connections Memory Care program features several aspects of connection to make the most of every moment for our memory care residents. These connections include art therapy, music therapy, circadian lighting, aroma, and more. This program utilizes technology to enhance care and provide a rich experience for seniors with dementia,” Cloutier explains. Other AI solutions that Areté is utilizing and continuing to look into include smart fall detection (an AI system that analyzes movement patterns and predict falls before they occur), telehealth and remote care platforms (AI-powered telehealth platforms that result in ease of healthcare access for seniors), personalized health plans (AI algorithms that analyze medical history, lifestyle patterns, and genetic information to create individualized care plans), and many more. At the root of these advancements are improved care and communication with residents, ease of information access, and support for caregivers. Barriers to Implementation When asked about the most common barriers to implementing new, innovative technologies, Dr. Mason and Cloutier both brought up budget constraints. “Many long term care communities operate on a more limited budget compared to other healthcare companies, such as hospitals,” says Cloutier. However, when innovation is a priority, you find a way to adapt: “This budget,
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 10 FEATURE » FEATURE, CONT. while it can be a challenge, does not prevent senior living companies like ours from dedicating resources to innovation and technology,” explains Cloutier. Dr. Mason agrees, stating, “Early adopters know that [implementing new technologies] is not the cheapest. Most people wait until the price point comes down, and when that happens, then everyone wants in. They also wait until the early adopters, or folks who are leading the path, get out there and demonstrate success.” Other barriers to implementing newer technologies in long term care communities can include staff resistance and navigating integrations with existing systems. However, Dr. Mason believes that with increased adoption and success of pilot programs within long term care organizations, these challenges will quickly dissipate: “To encourage adoption, providers should offer comprehensive staff training to demonstrate AI’s role as an assistant rather than a replacement, highlight the positive outcomes from pilot programs, and introduce AI solutions gradually, involving staff in the implementation process.” An Areté Living staff member is using their Dementia Live program. Smart home technology is installed and utilized in residents’ apartments.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 11 FEATURE “Technology allows us to connect with our leads, residents, and their families more effectively, enhancing the quality of care and creating a more accessible living environment for our residents. AI will continue to be utilized and explored as a solution for our business. We are excited to witness the advancements in technology within the senior living industry.” – Thomas Cloutier Where to Start? Implementing new technologies when you don’t know where to begin can be a challenge. From having cost concerns to difficulty choosing a system that will be the best fit for communities’ unique needs and more, providers may be overwhelmed by the options and potential constraints. Cloutier and Dr. Mason both agree that one of the best parts of the long term care industry is the collaboration between organizations. For those looking to dip their toes in AI, Cloutier advises: “Identify the areas where you need improvement and the biggest issues you want to address. Then, seek out resources that can help meet those needs. We are fortunate in this industry to have many strong and wonderful vendor partners who are pushing the boundaries of technology to assist our businesses. Find inspiration by exploring industry trends and networking with others. Experiment with different platforms by piloting them with a smaller team or at one of your locations. Celebrate your successes, learn from your failures, and continue to innovate. Conferences are a great way to meet these wonderful partners!” Dr. Mason seconds this, stating, “Start by learning about it. Go to seminars, attend conferences, talk to other companies that are already doing these things. We want to learn from each other. The nice thing about our industry is that we all want to help each other.” Looking Forward Both providers agree that embracing these technologies as they adapt will lead the long term care industry to success. AI is not going away, and it will only continue to advance. “Oregon is a leader in the long term care industry,” says Dr. Mason. “The adoption of AI in long term care is progressing from research and pilot programs to widespread implementation in everyday operations. The goal is to better inform and train the caregiver and take some of the burden off their shoulders. This is what AI is going to do. It will be there for them.” Areté Living provides a great model of what can be achieved when these programs are adopted and embraced within an organization. Cloutier states, “Technology allows us to connect with our leads, residents, and their families more effectively, enhancing the quality of care and creating a more accessible living environment for our residents. AI will continue to be utilized and explored as a solution for our business. We are excited to witness the advancements in technology within the senior living industry.” Technology can be used in all aspects of senior living, including dining. Dementia Live simulator in use.
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 12 DATA & RESEARCH Oregon’s long term care system is widely viewed as a national leader in innovation. The first assisted living community in the United States (U.S.) as well as the first Waiver from the federal government to use Medicaid dollars to provide long term care in settings outside of nursing facilities were both developed in Oregon. Today, cutting-edge technologies are often the first images that spring to mind when talking about innovation. There are seemingly countless examples of the ways technology has been used and could be used to advance high- quality long term care. A notable example of this potential benefit is virtual reality (VR). The case for the use of VR with long term care residents is not new. But as technology improves, and the associated costs of adopting technology decrease, we are beginning to see a wider uptake among long term care service providers. VR may be particularly useful for helping to improve the mood of residents.1 When discussing technology, it seems nearly impossible not to talk about the potential impacts of artificial intelligence (AI) on long term care settings and residents. AI is purported to offer multiple societal benefits. At the same time, there is much debate about the potential risks of AI, especially without proper guardrails to ensure the protection of residents’ privacy. Some of the many ways AI is already being used in long term care settings are through remote monitoring systems (such as environmental sensors for the detection of falls), decision support software for staff, and in supporting the analysis of resident data.2 While AI may be helpful, the evidence on whether outcomes for residents improve with use is mixed.3 More research will be needed to determine the specific benefits of AI in long term care settings. For decades, robots have been discussed as a way to help address multiple long term care related needs, including those related to workforce shortages. For instance, physically assistive robots can be used to perform physically demanding tasks such as lifting or moving a resident. Other countries like Japan have been early adopters in the use of robots to supplement and reinforce their workforce. Social assistive robots, which can support social engagement and companionship among residents, are also being more widely used.4 The existing evidence on these types of robots seems promising, with trials showing a reduction in loneliness among long term care residents.5 These types of tools can be used as a helpful compliment to human and/or animal companionship. Recent Innovations in Long Term Care: Technology and Beyond By Walt Dawson, D. Phil Not all recent innovations within long term care settings are in the form of new technologies. The Dementia Villages model, such as the Hogeweyk in the Netherlands, are a notable nontechnological innovation to support people in need of memory care.6 These settings blur the lines between what is home and what is formal care. They provide an environment where people living with dementia can go about their daily lives within a community that may include shops, restaurants, medical care, and other components of daily life. The evidence surrounding their use is interesting and worth watching but is not yet clear in terms of outcomes.7 Dementia Villages are only beginning to be proposed here in the U.S., with a couple of developments under way across the country. As always, more research will be needed to tease out the benefits and potential risks of this model. When discussing technology, it seems nearly impossible not to talk about the potential impacts of artificial intelligence (AI) on long term care settings and residents. AI is purported to offer multiple societal benefits. At the same time, there is much debate about the potential risks of AI, especially without proper guardrails to ensure the protection of residents’ privacy.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 13 DATA & RESEARCH It seems as if Oregon, along with the rest of the world, is on the cusp of major change in the way that long term care is provided. Some of those changes are already underway as new technologies are adopted and used by providers; others will likely take time before utilization is widespread. Innovation certainly includes the use of new technologies. But it also includes other, non-technological advancements such as the Dementia Villages, which focus on innovating in the overall approach to providing care and support rather than supplementing current practice with new tech. Either way, continuous innovation is needed to ensure that all care and support provided within Oregon’s long term care system can meet the unique needs of residents. Walt Dawson is OHCA’s research consultant as well as an assistant professor at Oregon Health & Science University and a senior Atlantic fellow with the Global Brain Health Institute. References: 1. Baker, S., Waycott, J., Robertson, E., Carrasco, R., Neves, B. B., Hampson, R., & Vetere, F. (2020). Information Processing & Management, 57(3), 102105. https://doi. org/10.1016/j.ipm.2019.102105 2. Loveys, K., Prina, M., Axford, C., Domènec, Ò. R., Weng, W., Broadbent, E., Pujari, S., Jang, H., Han, Z. A., & Thiyagarajan, J. A. (2022). Artificial intelligence for older people receiving long term care: a systematic review of acceptability and effectiveness studies. The Lancet Healthy Longevity, 3(4), e286–e297. https://doi. org/10.1016/S2666-7568(22)00034-4 3. Ibid, 2022. 4. Inoue, K., Wada, K., & Shibata, T. (2021). Exploring the applicability of the robotic seal PARO to support caring for older persons with dementia within the home context. Palliative Care and Social Practice, 15, 26323524211030285. https://doi. org/10.1177/26323524211030285 5. Robinson, H., Macdonald, B., Kerse, N., & Broadbent, E. (2013). The psychosocial effects of a companion robot: a randomized controlled trial. Journal of the American Medical Directors Association, 14(9), 661–667. https://doi. org/10.1016/j.jamda.2013.02.007 6. Roberts E. (2023). A Conversation About the Ethics of Past and Future Memory Care Models: Perspectives from the First Two European Dementia Villages. Inquiry, 60, 469580221150565. https://doi. org/10.1177/00469580221150565 7. Krier, D., de Boer, B., Hiligsmann, M., Wittwer, J., & Amieva, H. (2023). Evaluation of Dementia-Friendly Initiatives, Small-Scale Homelike Residential Care, and Dementia Village Models: A Scoping Review. Journal of the American Medical Directors Association, 24(7), 1020–1027. e1. https://doi.org/10.1016/j.jamda.2023.03.024
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 14 Telehealth in Long Term Care By Nicolette Reilly, Oregon Health Care Association Telehealth is transforming how care is delivered in long term care facilities through improving access to healthcare professionals, enhancing patient outcomes, and reducing healthcare costs. Traditional healthcare delivery in long term care may present challenges, including limited access to specialized providers, transportation difficulties, and the risk of infection transmission when leaving care facilities. Telehealth may address some of these challenges by providing remote access to healthcare professionals via video conferencing, remote patient monitoring, and virtual consultations. Many private insurance plans, as well as Medicare and Medicaid, provide coverage for telehealth services, but benefits may vary. Long term care providers should check with the residents’ health insurance carrier and provider’s office to ensure telehealth services are covered. Benefits of Telehealth in Oregon’s Long Term Care Facilities Improved Access to Healthcare Many long term care residents have complex medical needs requiring specialists who may not be readily available in rural or underserved areas. Telehealth bridges this gap by connecting patients with physicians, mental health professionals, and other specialists without the need for travel. Enhanced Patient Outcomes Remote patient monitoring and virtual consultations help detect early signs of health deterioration, allowing for timely interventions. This reduces emergency room visits, hospitalizations, and complications associated with delayed care. Reduced Healthcare Costs By minimizing unnecessary hospital admissions and emergency room visits, telehealth significantly reduces healthcare costs for both providers and patients. It also optimizes the use of resources by ensuring healthcare professionals can assess and prioritize patient needs more efficiently. Infection Control Infections, such as COVID-19, pose a significant threat to long term care residents. Telehealth minimizes physical contact and the need for external visits, reducing the risk of contagious diseases spreading within facilities. Mental Health and Social Engagement Social isolation is a major concern in long term care settings. Telehealth facilitates mental health services, virtual support groups, and video calls with family members, improving emotional well- being among residents. Key Considerations for Telehealth Implementation Policy Development Organizations should define their telehealth-related policies and procedures before adopting any telehealth services or facilitating virtual medical visits between residents and providers. Policies should ensure privacy, compliance, and client safety. Regulatory and Compliance Requirements Telehealth nursing practice must adhere to Oregon’s Nurse Practice Act and OSBN guidelines. RN delegation via telehealth must comply with Oregon Administrative Rules (OAR 851 Division 047). Facilities must ensure HIPAA-compliant telecommunication technologies. Technology and Infrastructure Facilities must provide secure, password- protected telecommunication devices. Adequate internet connectivity is required for clear audio and video communication. QUALITY Telehealth may address some of these challenges by providing remote access to healthcare professionals via video conferencing, remote patient monitoring, and virtual consultations.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 15 Use of HIPAA-compliant platforms with end-to-end encryption is also necessary. Staff Training and Support Alongside policy and procedure development, direct care staff must be trained in telehealth technologies and delegation protocols. Telehealth should be used to complement, not replace, in-person assessments that can’t be done by a facility’s existing clinical staff. Staff should be aware of contingency plans in case of technological failures. Resident Consent and Rights Residents must provide informed consent before participating in telehealth services. Consent forms should outline potential risks, benefits, and privacy considerations. Telehealth services should be accessible and non-discriminatory for individuals with disabilities or language barriers. Evolving Options As technology continues to evolve, telehealth in Oregon’s long term care facilities is expected to expand. Advances in artificial intelligence, wearable health monitors, and virtual reality therapy will further enhance remote care capabilities, and policy improvements, increased funding, and collaboration between healthcare providers and technology companies will be key to ensuring telehealth’s sustainability and effectiveness. Nicolette Reilly is the SVP of Quality at OHCA. QUALITY
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 16 LEGAL & REGULATORY Use AI to Support Legal and Risk Management with Caution By Eugenia Liu, J.D., Oregon Health Care Association Technology, such as AI tools and platforms, can help streamline and make operations more efficient. However, technology also develops at a much faster pace than the ethical or legal frameworks that may be necessary to support those developments. Use of AI has already brought about a host of risk concerns, from generating false or inaccurate information and information that is biased or discriminatory. Indeed, attorneys have already been sanctioned in more than one case for submitting legal briefs containing fictitious or non-existent cases and citations generated by AI. In another example, a wellness chatbot was taken down after it provided harmful advice. In writing this article, I decided to use ChatGPT to develop a policy on the use of AI in a long term care facility. I was pleasantly surprised that the AI-generated policy included concepts that would be important for providers to consider such as the following language: Guiding Principles • Resident-Centered Care: AI must support and enhance, not replace, human interaction and clinical judgment in resident care. • Transparency: Residents, families, and staff must be informed about AI use in the facility. • Privacy and Security: AI systems must comply with all data protection laws to safeguard residents’ personal and medical information. • Accountability: Human oversight is required for all AI-driven decisions affecting resident care and facility operations. • Fairness and Equity: AI must be free from biases and ensure equitable treatment of all residents. The AI-generated policy goes on to offer “acceptable uses of AI” for a provider to include areas like health monitoring, administrative efficiency, personalized care, safety and security, and clinical decision supports. However, the AI-generated policy was light on “restrictions and prohibitions” and only mentioned three things: “(1) AI must not be used to replace critical human decision-making in clinical care; (2) AI should not be used for invasive surveillance beyond reasonable security measures; and (3) AI data should not be shared with third parties without explicit consent and legal compliance.” It was similarly light on “compliance and oversight” and again, only three areas were mentioned: “(1) AI systems must undergo regular audits to ensure ethical use, accuracy, and safety; (2) A designated AI oversight committee should evaluate new AI implementations and review existing systems; and (3) Any adverse AI-related incidents must be reported, investigated, and addressed promptly.” While the AI-generated policy provided a high-level outline that a provider can use to initiate internal conversations on how to address the use of AI platforms and begin the process of developing appropriate policies, it is lacking in several areas, and should not be adopted as a “final product.” For example, AI tools used for resident-centered care may need to be HIPAA-compliant if resident data is going to be uploaded into the tool and providers may want to prohibit staff from uploading any resident information onto an AI tool that is not HIPAA-compliant. A provider may want similar restrictions in place around other sensitive, confidential information such as employee social security numbers, financial or banking information, and passwords and login credentials. The restriction is less about “sharing AI data with third parties,” as flagged by the AI-generated policy, and more about not uploading certain data at all to support privacy and security concerns. Similarly, the overarching concepts that the AI tool should not be used to replace human decision-making and must be free from biases, and they should ensure equitable treatment are accurate and important concepts. The AI-generated policy fails to establish appropriate guidelines to help the provider and staff achieve these goals. To develop appropriate policies, deeper questions need to be considered, such as the risk factor of an AI tool and whether the tool impacts a high-risk area or a low-risk area. For instance, an AI tool that supports compliance efforts by tracking falls outcome data may present a low risk, but an AI tool that detects, analyzes and screens for falls may be a high risk. The risk factor may also change based on whether the AI tool makes the ultimate Similarly, the overarching concepts that the AI tool should not be used to replace human decision-making and must be free from biases, and they should ensure equitable treatment are accurate and important concepts.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 17 decision, offers a recommendation, or just provides a notification. Here are some questions to consider: • Does the AI tool simply notify a provider that a resident has fallen in their room but staff still need to respond and assess the situation? • Does the AI tool notify a provider that the resident has fallen and “recommends” a call to 911? • Does the AI tool notify a provider that the resident has fallen and “assesses” the fall and decides to call 911? Each of these scenarios require a different policy approach to mitigate risks. My request for a policy “on the use of AI in a long term care facility” also produced a resident focused policy. It failed to consider other areas of a provider’s operations where AI-tools may be used (and perhaps even unknowingly to a provider), such as third-party vendors who support marketing/referral and human resource functions. Vendors may use AI tools to screen resumes or applicants and only direct “selected” applicants to a provider, which in turn may cause providers to inadvertently make hiring or admission decisions that are biased and/or discriminatory. Providers therefore need to understand whether or not they are a direct deployer of an AI-tool in order to craft an appropriate policy around how to conduct audits to “ensure ethical use, accuracy, and safety,” respond to any “adverse AI-related incidents,” and implement protocols that mitigates their exposure to liability, which may include reserving certain rights in their relationships with third party vendors. The AI-generated policy is certainly a good launching point for policies, but it does not replace the need to have a compliance or risk committee carefully scrutinize the different areas where an AI tool may be used and vetting each tool to develop a comprehensive policy that best supports the use of AI in a provider’s overall operations while mitigating their risks. Eugenia Liu is the SVP and general counsel at OHCA. LEGAL & REGULATORY To develop appropriate policies, deeper questions need to be considered, such as the risk factor of an AI tool and whether the tool impacts a high-risk area or a low-risk area.
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 18 Predicting the Unpredictable By Libby Batlan, Oregon Health Care Association We are currently in a long legislative session, which occur every other year. This means that since January, the state capitol has been bustling with staffers and lobbyists jockeying for time with legislators. The Legislature won’t adjourn until midto-late June, which makes writing this article a practice in probability and prediction. This article (written in early May) will provide an overview of the most influential bills impacting the long term care sector in Oregon, along with OHCA’s government relations’ team best interpretation of which bills will pass or fail by the time the session ends at the end of June. From a long term care regulatory standpoint, this session has been largely focused on home and community-based care. There continues to be a challenging disconnect between the on-the-ground experience of operators and staff versus how the sector and state regulations are perceived by lawmakers. This dynamic has been driven in part by isolated incidents of poor care outcomes that received significant statewide media attention over the last few years. OHCA has worked over the last year to educate legislators on the realities of most long term care facilities and the high quality care that is provided in them each day by bringing legislators on tours through long term care facilities in their districts, from Bend to the Oregon coast. However, increasing legislators’ knowledge base takes time. Throughout this session, there are two legislative concepts that OHCA has spent countless hours advocating around this session: House Bill (HB) 3838 and Senate Bill (SB) 739A. Community-Based Care Facility Licensing and Regulation Senate Bill (SB) 739A, which has not passed as of the writing of this article, started as a bill that OHCA strongly opposed, but, through our advocacy, it was significantly amended to include changes that allowed us to get to a position of neutrality. The bill now includes a careful balance of new requirements and accountability on the Oregon Department of Human Services (ODHS) and some new requirements on community-based care facilities. Some of these new requirements are focused only on operators who are new to Oregon. If passed, the bill would require new operators to undergo additional rigor in the first six months of initial licensure. It would also require all providers to disclose to residents when certain regulatory actions are imposed by ODHS against a facility. OHCA worked to negotiate these disclosures to ensure they must only occur in very limited circumstances that are pervasive and represent systemic failures—not one-off occurrences. While that may present new regulatory hurdles for some, there is also much to see as beneficial in SB 739A. That’s because it holds ODHS accountable for meeting new and shorter timelines during complaint investigations, reduces the circumstances in which ODHS is required to review facility staffing levels and acuity-based staffing tools, and ensures that restrictions on admissions are lifted within five days of the facility demonstrating it is in substantial compliance. All these new requirements on ODHS come at a cost to the state, though, because the Department will need more staff and resources to be able to comply with faster timelines. Whether lawmakers can afford these new costs remains unclear. The Home and Community-Based Services Workforce Standards Board This bill would establish a Home and Community-Based Services (HCBS) Workforce Standards Board that would set wages, benefits, and other employment standards for direct caregivers across various care settings, including assisted living, residential care, and memory care communities in Oregon. The bill is brought forward by organized labor unions, a powerful political force that has elevated the issue to legislative leadership and placed immense pressure on lawmakers to pass the bill this session. Workforce Standards Boards, as a general concept, are not new. They have been around since the 1930s, but state and local governments have used them sparingly and never in the manner and scope of what is described in House Bill PUBLIC POLICY Oregon does not have a broken system. Oregon is a national leader in the provision of home and community-based care and offers some of the highest wages and best benefits in the country for all clinical care positions.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 19 (HB) 3838. At a high level, certain states currently or historically use wage boards to either recommend or establish wages, hours, and working conditions for an entire industry sector. Wage boards are typically composed of an equal representation from industry employers and employees. HB 3838 follows this same general premise, except instead of applying to one employment setting, it would apply to the entire home and community- based services (HCBS) continuum, including assisted living facilities, adult foster homes, group homes serving those with intellectual and developmental disabilities, and in-home service providers. Everyone has a shared interest in ensuring Oregon has the necessary service providers and workers to meet the care needs and demands of our growing population of older adults and people with disabilities. But OHCA and other service providers fundamentally disagree with the premise of HB 3838 because its thesis statement is that our system of home and community- based care is broken. Oregon does not have a broken system. Oregon is a national leader in the provision of home and community-based care and offers some of the highest wages and best benefits in the country for all clinical care positions. Establishing a new workforce standards board complicates an already complex regulatory environment, outsources the legislature’s policymaking power, and drives costs into the system that could negatively impact access to and affordability of care for both Medicaid beneficiaries and private pay consumers. Throughout the course of this session, OHCA has met with dozens of legislators to discuss the negative impacts this board would have. We have activated our membership base, and members have sent more than 15,000 emails to legislators opposing this bill. We have launched a paid media campaign to amplify the concerns about HB 3838 and stress the critical need, instead, for more funding for our sector to meet the needs of lower-income aging Oregonians. This full-throttle advocacy work will continue throughout the remainder of session, but the outlook on this measure and where the support and opposition are on it amongst legislators is extremely fluid. The Budget Another area of volatility is the economy. The stop-and-go nature of tariff hikes created a pathway for an impending global trade war and whiplashes in the stock market. There also continues to be a looming threat of a recession, higher unemployment rates, and potential cuts to Medicaid by Congress. All these factors threaten the stability of Oregon’s economic outlook and have posed a real risk to the state’s available revenue. The June 2025 revenue forecast released by the Oregon Office of Economic Analysis showed that the Legislature will have hundreds of millions of dollars less to spend in the 2025–27 biennium than originally anticipated in January of this year. A more constrained budget environment is a double-edged sword. On the one hand, it makes the path to passage for many bills that cost money significantly harder, which could be beneficial if those bills include new regulations. However, it also makes the ability for the state to fund Medicaid rate increases for OHCA members harder as well. OHCA’s government relations team will stay focused on advocating for our members, the long term care profession, and Oregon’s older adults and people with disabilities. Despite much turbulence and ongoing headwinds from labor unions, Oregon’s long term care system will continue to succeed because of the work providers and care staff do for residents every day. We will continue to advocate on your behalf and work to solve the challenges you face. Libby Batlan is OHCA’s senior vice president of government relations. PUBLIC POLICY
The Oregon Caregiver SPRING/SUMMER 2025 www.ohca.com 20 SPONSORED CONTENT It may seem futuristic to consider using robotic technology in senior living, but the truth is that this type of technology has worked well alongside staff and residents for several years. Innovative companies looking to reduce risks to staff, enhance resident care, and discover return on investment by using robotics have seen the payoffs in the short and long term. I chatted with industry expert Justin Smith, senior manager of innovation with Direct Supply, about the use cases for robotics in senior living, including benefits, pitfalls, and considerations for integrating robotics into your operations. Robotics in senior living has been around for a few years. Tell us a little about rates of adoption. Is it picking up, or still more in its infancy? I think we’re still in the early stages. While there are communities out there that have been using food service or floor care robotics for years, that’s a small group of early adopters. Adoption is picking up, and I believe an inflection point is coming quickly as the workforce continues to shrink and the staffing challenges that we’re already facing today continue to grow. Many providers are realizing that they can no longer find enough employees to do the basic “keeping the lights on” type work within a community. Technology Innovations in Senior Living: Pros, Cons, and Considerations of Introducing Robotics into Your Community? By Jen Bruning, MS, RDN, LDN, Incite Strategic Partners What are the best uses for robotic technology in senior living? The most impactful uses of robotics are focused on completing dull, potentially dangerous, or repetitive tasks within a senior living community. These are tasks that enhance cleanliness, efficiency, and safety while allowing staff to focus on higher-value resident care. The usage of robotics in dining services— automating the running back and forth between the kitchen and dining room— is a good example. Allowing dining service staff to stay in the front of house and interact with residents during the most socially focused parts of their days is an easy win for both staff and residents. Floor care is another application that makes a lot of sense. By automating floor cleaning tasks, a community can increase their overall cleanliness, while decreasing their operating costs or reallocating resources to more value or revenue generating tasks within the community. Other applications that are starting to see traction include companion robots, whose focus is reducing the impact of social isolation on residents and keeping them connected to friends and family, and we’re starting to see more solutions in the building and grounds maintenance space, including autonomous solutions for everything from lawn mowing to window cleaning. What are the biggest barriers you see to introducing this new technology into senior living operations? Prioritization, pricing, and change management. Care providers have a never-ending list of priorities that they work through daily and getting to the top of that list while battling misconceptions about robots coming after people’s jobs sometimes makes it hard to get the focus it needs. Initial investment cost is a cause for pause with many communities. While the return on investment is strong and many Small things like naming contests for new robots, resident activities that include the robots, and special robotic capabilities, like robots singing “Happy Birthday” to residents can really help to get residents on board.
www.ohca.com SPRING/SUMMER 2025 The Oregon Caregiver 21 financing options are available, the upfront cost can be a concern for already constrained budgets. My advice is to focus on the long term impact and start small. The final and most critical barrier is typically tied to change management. Staff training and acceptance takes time, and asking your employees to change the way that they do their jobs is tough. How do residents feel about robotics in the dining room, or other areas of their homes? Almost all the residents that I’ve interacted with in communities with robotics love the solutions, eventually. Like with anyone else, sometimes residents are concerned about the price, or that the staff members that they enjoy seeing could be replaced. Once it’s communicated that the goal is to complement the workers already in place and continue to increase the level of service to residents, they tend to get behind these programs quickly. Small things like naming contests for new robots, resident activities that include the robots, and special robotic capabilities, like robots singing “Happy Birthday” to residents can really help to get residents on board. Very quickly, many residents start to see the robots as just another member of the team and start asking about them by name. What is the ROI on the investment of robotics in senior living? The major impact is in labor savings, with some communities reporting robots handling one-to-two full-time employees’ workloads worth of tasks per robot. Overall increased productivity for existing staff is a large ROI to consider, with a new ability to shift staff time towards more value-added tasks and direct resident care. Most applications of robotics see a positive ROI in the first year after implementation when deployed successfully. Anything else that readers should understand about robotic technology in senior living? My only suggestion would be to start thinking ahead now. The data doesn’t lie, and we know that staffing challenges are going to increase over the coming years. Even if your first step is just trying a single solution in a single location, you’ll be able to use this as a learning opportunity. It is also important to start understanding the strengths and weaknesses of current solutions, how you can best implement change within your communities, who are your champion staff members who will help you along this journey. It’s better to try new things when you have the opportunity versus when you have no other options. Jen Bruning is the director of nutrition and brand innovation with Incite Strategic Partners, OHCA’s purchasing partner and an OHCA business partner. This article has been sponsored and provided by Incite Strategic Partners. SPONSORED CONTENT
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