Designing Educational Partnerships to Address Lifestyle Directors’ Pain Points with Medicare‑Eligible Residents: A Practice Article

Alexander Efroymson, MarketPoint Sales Rep (US)

Licensed Humana Insurance Agent, Fort Myers, FL

Date: August 29, 2025

Abstract

Lifestyle and activity directors in senior living communities sit at the nexus of resident engagement, regulatory compliance, and family expectations. Yet they face persistent challenges: social isolation among residents, staffing shortages, administrative burden, medication and care‑transition complexity, and frequent but out‑of‑scope questions about Medicare coverage. Drawing on federal regulations, national reports, and a rapid scan of Reddit communities for qualitative perspectives, this practice article synthesizes the core pain points and proposes a CMS‑compliant educational partnership model in which licensed insurance agents co‑design and deliver neutral programming alongside community staff. The model emphasizes evidence‑informed activity design, clear role boundaries, and measurable outcomes (knowledge gains, referral uptake, reduction in avoidable escalations). (Centers for Medicare & Medicaid Services [CMS], 2024; National Academies of Sciences, Engineering, and Medicine [NASEM], 2020; Kaiser Family Foundation [KFF], 2025).

Background: The Role of Lifestyle Directors and the Regulatory Frame

Federal long‑term care regulations require facilities to maintain an ongoing activities program—directed by a qualified professional—to support residents’ physical, mental, and psychosocial well‑being (42 CFR §483.24[c]). This mandate places lifestyle/activities leaders in a regulated clinical‑adjacent role that must be documented and survey‑ready (CMS, 2025). In CMS’s State Operations Manual, Appendix PP, surveyor guidance further operationalizes quality‑of‑life and activity requirements, raising the stakes for documentation, individualized assessments, and interdisciplinary care planning (CMS, 2024).

Pain Points Identified in Literature and Practice

1) Social Isolation, Loneliness, and Program Pressure

Social isolation and loneliness are prevalent and linked to adverse outcomes—including increased risks of mortality, dementia, and cardiovascular disease—making engagement programming both clinically meaningful and resource‑intensive (NASEM, 2020; National Institute on Aging [NIA], 2019).

2) Staffing Shortages and Burnout

Senior care providers report persistent workforce shortages that force units to limit admissions, close wings, and stretch activity teams thin—undermining consistent resident engagement (American Health Care Association/National Center for Assisted Living [AHCA/NCAL], 2024; Skilled Nursing News, 2024).

3) Administrative and Compliance Burden

Directors describe heavy charting and regulatory documentation in addition to program delivery, which can crowd out direct resident time (practitioner accounts) (Reddit users, 2020). This aligns with CMS expectations for individualized assessments and interdisciplinary care plans (CMS, 2024).

4) Medication and Care‑Transition Complexity

Transitions of care, especially hospital‑to‑facility, are high‑risk periods for adverse events and readmissions; structured transitional care models reduce these risks but require coordination across pharmacy, nursing, and family caregivers (JAMA Network Open, 2022; Advocate Aurora CME slide review, 2023). Senior living leaders also cite medication management workload and preventable adverse drug events as ongoing operational challenges (PointClickCare, 2024). Medicare Complexity and “Off‑Label” Questions to Directors. Residents routinely seek help interpreting Medicare options, networks, and prior authorization, yet lifestyle directors are not licensed to advise on coverage (KFF, 2025).

Why Educational Programming Helps: Evidence and Rationale

• Structured physical and recreational activity programs demonstrate positive impacts on falls, intrinsic capacity, physical function, and social outcomes when tailored to older adults (Pinheiro et al., 2022; Yang et al., 2020).

• Transitional care and medication education improve coordination and reduce readmissions, particularly when pharmacy reconciliation and coaching are included (Birtwell et al., 2022; Advocate Aurora CME, 2023).

• Neutral Medicare counseling aims to increase beneficiary knowledge and decision quality—offering a model for unbiased education and referral pathways (Administration for Community Living [ACL], 2021; ACL Funding Opportunity, 2025).

A CMS‑Compliant Educational Partnership Model

Goal: Reduce the burden on lifestyle directors by offering neutral, skills‑based education that supports residents’ well‑being while observing CMS marketing rules.

A) Governance & Compliance Framework

• Classify sessions as “Educational” under CMS rules: no plan‑specific benefits, premiums, or comparisons; no enrollment forms accepted; no steering toward a plan (MCMG) (CMS, 2022; CMS, 2024). (Agents should coordinate with plan sponsors if applicable and follow internal guardrails.)

• Use model/standard materials and adhere to agent training/testing guidance as applicable (CMS models and Agent/Broker guidelines) (CMS, 2024).

• Document program intent and attendance in the community’s activity records to align with §483.24(c) expectations (CMS, 2025).

B) Curriculum Pillars (Delivered by Humana Agents with Community Collaboration)

“Understanding Medicare Without the Jargon” (60–75 minutes)

Coverage parts (A, B, D) and the role of Medigap vs. Medicare Advantage; trade‑offs of networks and prior authorization in plain language (KFF, 2025). (Q&A limited to general rules; no plan marketing.)

“Medication Safety & Transitions” (45–60 minutes)

Basics of medication lists, reconciliation after hospital stays, and how to prepare for specialist visits; coordinate with nursing/pharmacy for local workflows (JAMA Network Open, 2022; Advocate Aurora CME, 2023).

“Staying Connected” Activity Series (recurring, 30–45 minutes)

Evidence‑informed group activities (e.g., tai chi, chair dance, walking clubs) with social components; integrate tracking sheets for participation and functional outcomes (Pinheiro et al., 2022; Yang et al., 2020).

“Know Your Counseling Resources” (15 minutes)

How and when to use licensed Medicare agents and community legal/aging services; handouts with local phone numbers (ACL, 2021; ACL, 2025).

C) Role Delineation and Workflows

• Lifestyle Director: approves calendar, ensures resident suitability, logs attendance, and tracks psychosocial goals (CMS, 2024–2025).

• Licensed Agent (Presenter): delivers neutral curricula, answers general coverage process questions, and refers plan‑specific issues to one‑on‑one appointments off‑site or post‑event per CMS rules (CMS, 2022).

• Nursing/Pharmacy Partner: co‑leads transitions and medication sessions; coordinates reconciliations and follow‑ups (Birtwell et al., 2022).

Implementation Steps

• Needs Assessment (2–3 weeks). Brief interviews with activity staff about peak burdens (documentation, staffing, resident confusion about benefits), cross‑checked with census and incident logs (AHCA/NCAL, 2024; practitioner accounts).

• Co‑Design the Quarterly Calendar. Sequence Medicare 101 ahead of AEP, schedule medication/transition sessions after typical discharge spikes, and build weekly social activity blocks supported by evidence (Pinheiro et al., 2022).

• Compliance Review. Label events “Educational,” include CMS‑compliant disclaimers, and avoid plan details; route materials for internal review as needed (CMS, 2022; 2024).

• Deliver & Refer. Provide neutral answer sheets and a resource card; capture resident questions that need follow‑up (ACL, 2021).

• Measure Outcomes. Use pre/post knowledge checks, attendance, referral counts, and brief mood/connection scales aligned with your §483.24(c) documentation (CMS, 2025; NIA, 2019).

Anticipated Benefits

• Reduced resident confusion about benefits and processes (e.g., prior authorization basics), potentially decreasing crisis escalations to front‑line staff (KFF, 2025).

• Improved psychosocial outcomes via structured activity that targets both social connection and physical function (Pinheiro et al., 2022; Yang et al., 2020).

• Better transitions with medication coaching and reconciliation ties to pharmacy/nursing workflows (JAMA Network Open, 2022).

• Documentation support for survey readiness by aligning attendance logs and individualized goals to §483.24(c) (CMS, 2025).

Limitations and Ethical Notes

This article integrates qualitative social media voices (Reddit) to highlight real‑world workload and role‑boundary challenges; such data are anecdotal, non‑generalizable, and should complement—not replace—peer‑reviewed and regulatory sources (Reddit users, 2020–2022). 710 Educational programming must avoid steering, maintain neutrality, and adhere to CMS definitions of marketing vs. education (CMS, 2022).

Conclusion

Lifestyle directors bear disproportionate responsibility for residents’ psychosocial well‑being amid workforce and administrative headwinds. Evidence‑informed educational programming—delivered in partnership with licensed agents under strict CMS rules and complemented by licensed agent referrals—can relieve pressure on staff, enhance resident understanding of coverage processes, and support safer care transitions. Aligning content to §483.24(c) and measuring outcomes transforms programming from “nice to have” events into defensible, survey‑ready interventions that advance quality of life.

References

Administration for Community Living. (2021). State Health Insurance Assistance Program (SHIP) report to Congress: Grant year 2018. https://acl.gov/sites/default/files/about-acl/2021-07/ACL_2018%20SHIP%20Report%20To%20Congress.pdf

Administration for Community Living. (2025, July 30). State Health Insurance Assistance Program Technical Assistance Center (SHIP TAC) funding opportunity announcement. https://files.simpler.grants.gov/opportunities/e73c170e-9d92-4f16-b6bc-addbd915b740/attachments/ca904854-77f7-4d14-888c-ac34a7339ae6/Foa_Content_of_HHS-2025-ACL-CIP-SATC-0021.pdf

American Health Care Association/National Center for Assisted Living. (2024, March 5). State of the sector: Nursing home staffing shortages persist. https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/State-Of-The-Sector-Nursing-Home-Staffing-Shortages-Persist-Despite-Unprecedented-Efforts-To-Attract-More-Staff-.aspx

Birtwell, K., Planner, C., Hodkinson, A., et al. (2022). Transitional care interventions for older residents of long‑term care facilities: A systematic review and meta‑analysis. JAMA Network Open, 5(5), e2211751. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791849

Centers for Medicare & Medicaid Services. (2022, March 16). Medicare communications and marketing guidelines (MCMG). https://www.cms.gov/files/document/medicare-communications-and-marketing-guidelines-3-16-2022.pdf

Centers for Medicare & Medicaid Services. (2024, September 10). Medicare marketing guidelines (Managed Care Marketing). https://www.cms.gov/medicare/health-drug-plans/managed-care-marketing/medicare-guidelines

Centers for Medicare & Medicaid Services. (2024, August 8). State Operations Manual, Appendix PP—Guidance to surveyors for long‑term care facilities. https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf

Centers for Medicare & Medicaid Services. (2024). Marketing models, standard documents, and educational material. https://www.cms.gov/medicare/health-drug-plans/managed-care-marketing/models-standard-documents-educational-materials

eCFR. (2025). 42 CFR §483.24—Quality of life. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.24

Kaiser Family Foundation. (2025, January 28). Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023. https://www.kff.org/medicare/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023

National Academies of Sciences, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system (Highlights). https://nap.nationalacademies.org/resource/25663/Social%20Isolation%20and%20Loneliness%20Report%20Highlights.pdf

National Institute on Aging. (2019, April 23). Social isolation, loneliness in older people pose health risks. https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks

Pinheiro, M. B., Oliveira, J. S., Baldwin, J. N., et al. (2022). Impact of physical activity programs and services for older adults: A rapid review. International Journal of Behavioral Nutrition and Physical Activity, 19, 87. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-022-01318-9

PointClickCare. (2024, October). Senior living medication management practices survey. https://pointclickcare.com/wpcontent/uploads/2024/10/PointClickCare-Senior-Living-Medication-Management-Practices-Survey.pdf

Reddit users. (2020, May). Working as an activities coordinator, director, or similar Online forum post]. r/AskWomenOver30. https://www.reddit.com/r/AskWomenOver30/comments/ge3hr4/working_as_an_activities_coordinator_director_or

Reddit users. (2021, March). My sister is an activities director at an assisted living facility. Is she essential? Online forum post]. r/legaladvice. https://www.reddit.com/r/legaladvice/comments/ftx5fk/my_sister_is_an_activities_director_at_an

Advocate Aurora Health. (2023). Care transitions for older adults: An update [Slide deck]. https://cme.advocateaurorahealth.org/sites/default/files/course/2023-10/Care%20Transitions%20for%20Older%20Adults_An%20Update-%20Caitlin%20Jones.pdf

Skilled Nursing News. (2024, August). ‘A national crisis’: New AHCA report shows alarming trends in nursing home access. https://skillednursingnews.com/2024/08/a-national-crisis-new-ahca-report-shows-alarming-trends-in-nursing-home-access

Yang, Y., van Schooten, K. S., McKay, H. A., et al. (2020). Recreational therapy to promote mobility in long‑term care: A scoping review. Journal of Aging and Physical Activity, 29(1), 142–161. https://journals.humankinetics.com/abstract/journals/japa/29/1/article-p142.xml