| Zeroing In On Incontinence Care Management | https://www.providermagazine.com/Issues/2013/Pages/1013/Zeroing-In-On-Incontinence-Care-Management.aspx | Zeroing In On Incontinence Care Management | <p></p>
<div> </div>
<div> </div>
<div><span><img class="ms-rtePosition-1" alt="achieving continence" src="/Monthly-Issue/2013/PublishingImages/1013/caregiving_incontinence.jpg" width="435" height="316" style="margin:5px 15px;" /></span>Post-acute care providers are functioning in a world of regulatory acronyms: QAPI, QIS survey, ZPIC, PPS, CERTs, UPICs, ACOs, and more, including programs to improve transitions of care and reduce rehospitalization rates. </div>
<div> </div>
<div>Operational managers and clinical leadership in nursing homes are evaluating services, training, risks, and outcomes, as well as database content, on a daily basis to monitor outcomes for the elders they serve. </div>
<div> </div>
<div>The issue of incontinence management and treatment related to incontinence is central to most of these activities and must be properly identified, treated aggressively, and monitored continuously to eliminate unnecessary cost and negative outcomes. This focus requires participation from operations, clinical staff, therapy, social services, direct caregivers, and families.</div>
<h2 class="ms-rteElement-H2">Continence Care Must-Haves</h2>
<div>The issue of incontinence management is not new at all and has been a frequent topic of discussion for interdisciplinary team members in care conferences, team meetings, and when discussions of risk management and outcomes arise. </div>
<div> </div>
<div>The current environment in post-acute care requires a more specific approach and understanding of the definitions in the minimum data set 3.0 (MDS), as well as coordination between related departments, to work to reverse levels of incontinence, when possible, and to minimize the negative outcomes for elders, including rehospitalizations and deterioration in quality of life. </div>
<div> </div>
<div>Facilities are now more accountable for the data they transmit on the MDS because of the data references used by state surveyors, policy processes, and payment programs. This is a very expensive and common issue that facilities need to strive to understand, properly manage, and document, especially with regard to the impact of their interventions and programs.</div>
<div> </div>
<div>When looking at the definition of continence in the resident assessment instrument (RAI) manual, May 2013 revision, it does not match the working definitions found in the majority of facilities. According to the MDS 3.0, continence is “total control of the release of urine or stool.”</div>
<div> </div>
<div>This means that an elder who has stress or effort-related incontinence (urine leakage with a cough or change in position) should be coded as incontinent on the MDS.</div>
<div> </div>
<div>The current Centers for Medicare & Medicaid Services (CMS) MDS frequency reports for the first quarter of 2013 show that 23.9 percent of all elders in skilled nursing facilities are totally continent. </div>
<div> </div>
<div>This is a statistic that is just simply not true.</div>
<div> </div>
<div>A review of F-Tag 315 uses the same definition and then goes on to explain the negative impact that any level of incontinence has on elders in the skilled nursing environment, with a focus on the identification of the type of incontinence, its cause, and treatment. Quality of life and quality of care are the goals, with an individualized approach that is undertaken by the entire team, as well as the family, when possible. </div>
<h2 class="ms-rteElement-H2">Restorative Program Required</h2>
<div>Today, a significant number of facilities do not have active restorative programs that include toileting and retraining. Many have very little coordination between nursing and therapy for bladder and bowel retraining, while some have poor documentation of in-depth quality assessments at the time of admission to determine the true level of continence prior to hospitalization and after-hospitalization. </div>
<div> </div>
<div>These are all important factors in the development of an active program to identify and reverse incontinence whenever possible. Elders must also be asked if they want to be continent and have control of their elimination. </div>
<div> </div>
<div>According to an 80-year-old resident, newly admitted to a nursing home for rehab after a hip repair surgery, “I know I needed to have my hip repaired, but I did not sign up for this .... [having to wear a brief because of functional incontinence after urinary catheter removal]. I want my rehab to include help with my incontinence.”</div>
<div> </div>
<div>The demographics of customers are changing, and the programs need to be there to meet their needs. These are elders who want to go back to their active, positive lives in the community—without incontinence. Nursing centers need to have excellent assessment programs and documentation at the time of admission and be open and interactive about the status of continence. </div>
<div> </div>
<div>It is important to initiate retraining or scheduled toileting programs, as well as involving therapy, with strengthening and activities of daily living programs, combined with resident and family education, to support the goals and interventions in the plan. <br></div>
<h2 class="ms-rteElement-H2">Assessment Essentials</h2>
<div>Careful assessment and identification of the cause(s) of incontinence are the essential first steps for appropriate and successful management. This assessment needs to involve several disciplines, including therapists, nurse practitioners, nurse assistants, nursing staff, medical directors, and dietary staff. </div>
<div> </div>
<div>Assessment should be done at the time of admission to the facility and at any change in bladder and bowel status. The first step is determination and documentation of incontinence history on or before the time of admission. Staff should determine the resident’s continence status prior to admission or determine whether it occurred with the present illness, since urinary incontinence (UI) could be of several years’ duration. This requires a conversation with the elder or family</div>
<div>members. </div>
<div> </div>
<div>Although UI is not a normal part of aging, there are age-related changes in the lower urinary tract, such as that the greatest volume of urine is excreted at night, with two-thirds of daily fluid intake being produced by the kidneys at night. Bladder capacity is diminished with poor bladder emptying, and bladder sensations changes with age, causing a delay in desire to void, leading to bladder frequency. </div>
<div> </div>
<div>Mental, functional, and environmental assessments are vital to the success of a restorative program. Cognition should be assessed to determine the ability of the resident to comprehend voiding needs. Knowing when the onset of lower urinary tract symptoms occurred, including urgency, frequency, nocturia, dysuria, post-void dribbling, and episodes of urine leakage, is important. The relationship between UI and medication use and medical diagnoses, such as diabetes, neurologic diseases, such as Parkinson’s or multiple sclerosis; prostate problems in men, such as cancer or benign prostatic hyperplasia; and chronic urinary tract infections, especially in women, should be detailed. </div>
<div> </div>
<div>Facility nurses should perform a thorough bowel history of the resident to determine symptoms of constipation, fecal incontinence, and the use of laxatives, stool softeners, suppositories, and enemas. Per the MDS 3.0, an elder’s voiding and bowel pattern and frequency of incontinence should be assessed, so observation of toileting can be helpful. </div>
<div> </div>
<div>In addition, nurses should perform a general examination to determine peripheral edema and gait abnormalities that may impact toileting, while an inspection of the genitalia should also be done to determine skin breakdown. </div>
<div> </div>
<div>Assessments should lead to a plan of care. The classification of continence, as seen in Figure 1 (see page 63), outlines components of continence management. Centers should have well-defined policies and procedures to initiate and document toileting programs with nursing and therapy. <br></div>
<h2 class="ms-rteElement-H2">Determine Staff Knowledge</h2>
<div>Facility staff members need to address their knowledge of the topic and develop appropriate documentation skills to identify the type and frequency of incontinence at the point of admission, or before, as part of the key information they need to care for the elder. </div>
<div> </div>
<div>Using the appropriate definitions for all staff and transmitting the accurate data into the MDS 3.0 database is the first step to create an accurate facility record.</div>
<div> </div>
<div>Reading the facility database reports on the initial levels of continence, followed by subsequent changes in levels of continence as rehab and nursing services improve the resident’s function, gives the manager access to reportable outcomes. </div>
<p></p>
<p></p>
<div> </div>
<div>The outcomes of an active continence management program are very easy to identify and document. </div>
<div> </div>
<div>If the MDS data are accurate, then tracking levels of success with toileting, ambulation, and balance programs—along with the goal of safely going to the bathroom; getting on and off the commode; control of muscles involved in elimination; and improved dignity, strength, and function—should be straightforward.</div>
<div> </div>
<div>Changes in ADL (activities of daily living) scores and symptoms of depression, as well as reduced rates of falls, can all be outcomes that are reportable and desirable in the data-driven world providers work in today. More independence decreases the stress on staff and lessens product use or the type and cost of products. </div>
<div> </div>
<div>With regard to payment in case-mix states, restorative programs have a positive impact on Medicaid rates and support Part A rates with the use of the low rehab category after high- intensity rehab is completed.</div>
<h2 class="ms-rteElement-H2">Incontinence Products</h2>
<div>Nursing homes need to evaluate their current products and the variety of sizes and types of products they use. It is essential to have incontinence products that are properly sized, with a variety of types available as the retraining program progresses. <br></div>
<div><br>Staff education and training is also essential to delivering toileting programs, documenting outcomes, and elders’ responses. A toileting or retraining program should never be done to an elder, it should be done with the elder. </div>
<div> </div>
<div>Scheduled toileting programs can be designed and delivered for elders with memory loss to diminish the number of incontinent episodes and develop a habit of voiding that matches the elder’s intake and activity patterns. </div>
<div> </div>
<div>Proper reporting and documentation should include the outcome of a toileting program and the types and sizes of products used so that the care is consistent and connects with the plan. This will have a positive impact on survey outcomes. </div>
<div> </div>
<div>Remember, the goal here is increased quality of care and quality of life for the elder, as well as a reduction of risk of falls, behavioral outbursts, moisture-associated skin damage, skin breakdown, and dignity issues. <br></div>
<h2 class="ms-rteElement-H2">How To Get Started</h2>
<div>It’s a good idea to begin with the CMS definitions and the staff’s knowledge base about continence and incontinence. Use the RAI Manual May 2013 definitions and the October 2013 updates. Assess bladder control issues at the point of admission, and inquire about the level of continence prior to taking a resident to the hospital. Focus on an accurate three-day voiding diary, and build toileting programs from that documentation. Involve the resident and family when appropriate, remembering that it is a matter of involving the resident with the program and not forcing it upon them.</div>
<div> </div>
<div>Develop policies and processes for toileting programs, and include education for all clinical staff so programs can be delivered on all shifts with accurate documentation. Include the toileting program and need for muscle strength and retraining with rehab services. Analyze the data, and know what the database says about the issues and outcomes. Look for cost savings, improved outcomes, and increased customer satisfaction. </div>
<div> </div>
<strong>
</strong><div><em><strong>Leah Klusch RN, BSN, FACHCA, </strong>executive director, the Alliance Training Center, Alliance, Ohio, can be reached at <a target="_blank" href="mailto:leahklusch@sbcglobal.net">leahklusch@sbcglobal.net</a>. <strong>Diane Newman, DNP, ANP-BC, FAAN,</strong> co-director of the Penn Center for Continence and Pelvic Health, can be reached at <a href="mailto:diane.newman@uph5.upenn.edu">diane.newman@uph5.upenn.edu</a>.</em></div>
<p></p> | Facilities are now more accountable for the data they transmit on the MDS because of the data references used by state surveyors, policy processes, and payment programs. | 2013-10-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/1013/caregiving_thumb.jpg" style="BORDER:0px solid;" /> | Caregiving;Clinical | Special Feature | 10 |
| How To: No-Fear Surveys | https://www.providermagazine.com/Issues/2013/Pages/1013/How-To-No-Fear-Surveys.aspx | How To: No-Fear Surveys | <br><p><img width="164" height="217" class="ms-rtePosition-2" alt="Kevin McElroy" src="/Monthly-Issue/2013/PublishingImages/1013/Kevin_mgmt.jpg" style="margin:10px;" />There are good surveys and not-so-good surveys. But one thing is true: Good surveys don’t happen by accident. They are the result of continuous planning, ongoing education, and keeping a razor-sharp focus on quality outcomes.<br><br>Especially with regard to the Centers for the Medicare & Medicaid Services Five-Star rating system, a good or bad survey can greatly impact a nursing center’s reputation in the community. And while it may not be rocket science, following some basic steps can help long term and post-acute care providers achieve their desired outcomes: good annual surveys. <br><br>Following are some tips for making this happen:<br><br><strong class="ms-rteForeColor-1">1. </strong>There is no such thing as “time to get ready for survey.” If a nursing home’s survey window is open and staff are just starting to review plans, they are already behind the eight-ball. Communities need to be ready for a survey 365 days a year. Think about it—the facility could be surveyed at any time (such as a complaint investigation). A good mantra for the team is, “Doing the right thing for our residents, every day!” Focusing on doing the right thing every day, 365 days a year, and not just because a “survey is coming,” puts the community one step ahead of the rest. <br><br><span class="ms-rteForeColor-1"><strong>2.</strong></span> First impressions matter. If the surveyors have a good first impression when they walk in the door, it can help set the tone for the entire survey. But if they walk in and the team is not prepared, there are odors, the community is not clean, and the team is not smiling and friendly, that will set the mood for a disappointing survey. <br><br><span class="ms-rteForeColor-1"><strong>3.</strong></span> Have the survey book updated and ready to go. This is a book that has everything in it the surveyors would want when they walk in the door, such as med pass times, activity calendars, and resident demographics. Unsure about what goes into a survey book? Check with the state nursing home association for a guide. Being prepared and organized will go a long way to starting off on the right foot. Grab a new three-ring binder; get an index together; and make sure the book is neat, organized, and easy to follow.<br><br><strong class="ms-rteForeColor-1">4.</strong> Review the center’s quality indicator/quality measure data. Surveyors are using these data to see where the center is and which residents will be picked for their survey sample, before they even walk through the door. But all nursing homes have access to the exact same information anytime they want it (usually, the minimum data set coordinator can print out copies). Consider pulling and reviewing, on a monthly basis, and as a team, the facility-level and resident-level quality measure reports. They clearly indicate where the weak areas are and which residents may trigger more quality measures that could cause them to be chosen by the survey team for review.<br><br><span class="ms-rteForeColor-1"><strong>5.</strong></span> Set and communicate goals. Ask 10 people what their idea of a good survey is and there would likely be 10 different answers. In order for a team to move in the same direction, they all have to have a clear picture of what they need to accomplish—be it reducing tags by 50 percent, compared with the previous year; having no quality-of-care or G-level tags; or a deficiency-free survey—set goals that are clear, measureable, and can be understood by everyone on the team. And once the goals are set, beat that drum every moment possible, such as in staff meetings, newsletters, or on banners in the break room. It can’t just be the flavor of the month. If the team sees it is important and not going away, they will notice.<br><br><strong class="ms-rteForeColor-1">6.</strong> Provide year-round education and not just the “minimum requirements” that mandate what must be done. Consider offering continuous-return demonstrations on medication passes or incontinence care. Ensure that the team knows what quality measures are. Consider educating nurse assistants about how to communicate with surveyors. It may sound like a cliché, but it’s true: Knowledge is power. Arm the team with the knowledge they need to reach their survey goals.<br><br><strong class="ms-rteForeColor-1">7. </strong>Audit, Audit, Audit. The entire team should be continuously looking at systems and outcomes. The only way to know how things are going is to look. Give each department head an audit to complete monthly for review during QI meetings. Also, consider holding QI meetings monthly instead of quarterly. Have a “mini mock survey day” where each member of the team focuses on a particular area and reports back at the end of the day. Ask other members of the team (such as the consultant pharmacist) to assist with checks and audits. The idea is to constantly be digging and looking to make sure the systems and procedures are working properly. And remember, using the excuse that there is no time to do this works until there is a deficiency, after which the excuse will no longer work.<br><br>These may not be earth-shattering suggestions, but if these basic steps are followed, the entire team will be well on its way to achieving good—and maybe even excellent—survey outcomes. And don’t forget to lean on each other. <br><br>While these are just some tried and true tips, other administrators may have their own best practices as well. <br><br>If the team is focused on good quality outcomes, it will not only have good surveys, it will also feel good knowing the residents are receiving great care at their community. <br><br><em>Kevin McElroy, CNHA, CASP, is the administrator at Evergreen Living Center in St. Ignace, Mich. He can be reached at </em><a title="Email Kevin!" href="mailto:kmcelroy@mshosp.org" target="_blank">kmcelroy@mshosp.org.</a><br></p> | There is no such thing as “time to get ready for survey.” If a nursing home’s survey window is open and staff are just starting to review plans, they are already behind the eight-ball. Communities need to be ready for a survey 365 days a year. | 2013-10-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/1013/mgmt_thumb.jpg" style="BORDER:0px solid;" /> | Management;Survey and Certification | Column | 10 |
| 2013 AHCA/NCAL Annual Awards | https://www.providermagazine.com/Issues/2013/Pages/1013/2013-AHCANCAL-Annual-Awards.aspx | 2013 AHCA/NCAL Annual Awards | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a></div><div>The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) have announced the individual and group winners of their annual awards.</div>
<div> </div>
<div> </div>
<div> </div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Edgemoor Distinct Part Skilled Nursing Facility</span><br>Not-For-Profit Program of the Year</h2>
<div><span><span><span><em>Sarah Langmead<span style="display:inline-block;"></span></em></span></span></span></div>
<div> </div>
<div><br><img width="329" height="248" class="ms-rteImage-1 ms-rtePosition-1" alt="Edgemoor District SNF" src="/Monthly-Issue/2013/PublishingImages/1013/Edgemoor.jpg" style="margin:5px 15px;" /><br>Nearly two years ago, Edgemoor DP SNF in Santee, Calif., created Sierra Stroll, a multidisciplinary therapeutic behavioral activation program. Five days a week, Sierra Stroll enables residents to engage in social and physical activities outdoors, like walking, listening to music, dancing, or playing cards.</div>
<div> </div>
<div>Many Sierra Stroll participants suffer from dementia, mental illness, apathy, or aggression. The program was designed specifically to address these populations, and since it started, staff have seen great improvements in their residents’ attitudes and behaviors. </div>
<div> </div>
<div> </div>
<div> </div>
<div>“This program has sustained the interest and positive engagement of residents with severe behavioral problems and has served to enhance peer-to-peer interaction and to decrease aggression and other negative behaviors,” said Alfredo Aguirre, director of the Behavioral Health Services Division of San Diego County, in his nomination letter.</div>
<div> </div>
<div> </div>
<div> </div>
<div>Specifically, Edgemoor DP SNF reported that Sierra Stroll has resulted in psychoactive medication reductions, improved behavior and tolerance, reduced aggression, and improved staff skills, as well as staff fitness.</div>
<div> </div>
<div> </div>
<div> </div>
<div>“Sierra Stroll is special because it adapts more traditional outpatient behavioral activation to [skilled nursing facility] residents with significant cognitive, physical and interpersonal limitations,” said Walter Hekimian, Edgemoor administrator. “We’re so proud of the positive impact we’ve had on our residents.”</div>
<div> </div>
<div> </div>
<div> </div>
<div>Richard Brown, president of the Volunteer Association at Edgemoor, agreed. </div>
<div> </div>
<div> </div>
<div> </div>
<div>“I have seen the change in [the residents’] behaviors,” he said. “They are more relaxed, less stressed, less confrontational and combative, smile more often, and seem interested in their surroundings. This is a program that takes place a couple times a week so that the residents can count on outings.”</div>
<div> </div>
<div> </div>
<div> <span id="__publishingReusableFragment"></span></div>
<div> </div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Lorraine Oakes</span><br>Adult Volunteer of the Year</h2>
<div><div><span><span></span><span><em>Sarah Langmead</em><span style="display:inline-block;"></span></span><span style="display:inline-block;"></span></span></div></div>
<div> </div>
<div><img class="ms-rtePosition-1" alt="Lorraine Oakes" src="/Monthly-Issue/2013/PublishingImages/1013/LorraineOakes.jpg" style="margin:5px 10px;" />Lorraine Oakes has been a celebrated volunteer of Kindred Healthcare, Elizabeth City, N.C., a short-term rehabilitative and long term care facility, for the past 22 years. She enjoys sitting with residents and getting to know them each on a more personal level. Oakes has created and significantly impacted multiple programs at Kindred. Fifteen years ago, Oakes played a major part in developing the facility’s thriving dining assistance program. She also created a popular Bible studies program. </div>
<div> </div>
<div> </div>
<div> </div>
<div>“Lorraine is truly dedicated to our residents,” said Tonia Bryant, executive director of Kindred Transitional Care and Rehabilitation - Elizabeth City. “Her cheerfulness and generosity make her a true asset to our facility.”</div>
<div> </div>
<div> </div>
<div> </div>
<div>Though Oakes currently serves as the volunteer coach at the facility, advising all volunteers, her passion for serving others extends outside of Kindred Healthcare: She is also an active volunteer at local assisted living facilities and elementary schools.</div>
<div> </div>
<div> </div>
<div> </div>
<div>“Lorraine always has a kind word to say to everyone she meets,” said Bryant in her nomination. “We’re proud to have her as part of our team!” </div>
<div> </div>
<div> </div>
<div> </div>
<div>Described by many as a “fireball of energy,” Oakes volunteers nearly every day of the week. One resident’s family member said that “her compassion and love for the elderly is unmatched.” In an environment where many residents have few or no visitors, Oakes is always there to offer encouragement and hope, a smile, or a simple prayer.</div>
<div> </div>
<div> </div>
<div> </div>
<div>“She adopts families and helps them out however she can,” said Lori Chepan, activities director, in her nomination of Oakes. “She remembers birthdays and special occasions of staff and family members, as well as residents. You never know when she might pop in with a trinket of some sort and say, ‘this reminded me of you!’ Those little things make residents feel so special.”</div>
<div> </div>
<div><div> </div>
<div><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Josh Sosebee</span><br>Young Adult Volunteer of the Year</h2></div>
<div> </div>
<div><em>Sarah Langmead</em></div>
<div> </div>
<div> </div>
<div> </div>
<div><img width="179" height="222" class="ms-rtePosition-1" alt="Josh Sosebee" src="/Monthly-Issue/2013/PublishingImages/1013/JoshSosebee.jpg" style="margin:5px 10px;" /><br>Though only 16 years old, Josh Sosebee has been a notable volunteer of Life Care Center of East Ridge, Tenn., a 130-bed long term care facility, for the past four years. During his time at Life Care Center, Sosebee has cultivated strong relationships with residents and has developed several programs to better address their needs.</div>
<div> </div>
<div> </div>
<div> </div>
<div>Sosebee created Canning for a Cause, a weekly program to can vegetables and other items to raise money for organizations that residents support. He also formulated a men’s discussion program and organizes activities like poker and model car events. Residents particularly enjoy helping with the local animal shelter’s adoption events through Sosebee’s Pet Adoption Program. </div>
<div> </div>
<div> </div>
<div> </div>
<div>“Josh’s intention is to better the lives of men and women who may feel as if society has passed them by,” said Beecher Hunter, president of Life Care Centers of America, in his nomination of Sosebee. “He acknowledges the residents’ importance by his gifts of time, attention, compassion, and kindness. He is a builder of intergenerational bridges.”</div>
<div> </div>
<div> </div>
<div> </div>
<div>Sosebee has impacted the volunteer pool at Life Care Center of East Ridge. Whenever the facility holds a special event, he brings a friend, and more often than not, those friends continue to volunteer. “Josh contends that his ‘pay’ is delivered to him in the encouragement of folks who have endured hardships along the way, but who assure him the journey is worth it,” said Hunter.</div>
<div> </div>
<div> </div>
<div> </div>
<div>In addition to volunteering approximately 20 hours per week, Sosebee maintains excellent grades in Advanced Placement and Honors classes and works a part-time job. Despite a busy schedule, he continuously prioritizes his time with the residents and their families. </div>
<div> </div>
<div> </div>
<div> </div>
<div>“There is no one better than Josh at sitting one-on-one with residents,” said Ben Zani, LNHA. “We will often send him in to speak with our more difficult residents, as he can reach them in a way that no one else can.”</div>
<div> </div>
<div> <br><span id="__publishingReusableFragment"></span></div>
<div> </div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Helen Cherry</span><br>ID/DD Hero of the Year</h2>
<div> </div>
<div><em>Sarah Langmead</em></div>
<div> </div>
<div> </div>
<div> </div>
<div><img width="149" height="173" class="ms-rtePosition-1" alt="Helen Cherry" src="/Monthly-Issue/2013/PublishingImages/1013/Helen.jpg" style="margin:5px 10px;" /><br>Helen Cherry’s dedication, innovative thinking, and compassion are just three reasons why she was selected as the 2013 Intellectual/Developmental Disabilities Hero of the Year Award.<br></div>
<div> </div>
<div>Cherry is an active employee of New Hope Services, a division of Medicalodges in Pittsburg, Kan. New Hope Services provides community living options and supportive services for persons with intellectual and developmental disabilities. </div>
<div> </div>
<div>“Since joining this challenging yet rewarding field 22 years ago, Helen has helped to forge meaningful relationships between her clients and local businesses,” said Cindy Luxem, president and chief executive officer of the Kansas Health Care Association. “She has successfully developed her clients’ skill sets and facilitated their integration into various work and social environments where they can not only contribute, but thrive.”</div>
<div> </div>
<div>Cherry has created several programs for her clients, including the New Hope Bulldogs Special Olympics team, which, with 56 coaches and 124 athletes, is one of the largest Special Olympics chapters in the state of Kansas. </div>
<div> </div>
<div>“Helen has made extraordinary contributions to the lives of the clients at New Hope,” said Fred Benjamin, chief operating officer at Medicalodges New Hope in his nomination. “She builds her clients’ self-worth, dignity, and their inner spirit to strive to be the best they can be.”</div>
<div> </div>
<div>Cherry founded Extremely Outrageous Creations—a business designed to offer job choices to adults with intellectual challenges. She also instituted the Legacy Fitness Center and the BIKE 4 LIFE program that together have positively impacted hundreds of special needs athletes in Pittsburg.</div>
<div> </div>
<div>“Helen always begins by asking prospective clients and families, ‘What are your dreams?’ She then sets about making them come true,” said Benjamin. “With her encouragement, clients live, work, and participate in their community on their own terms. Based on a client’s dream, she organized an annual ocean cruise that now serves 30 clients per year. </div>
<div> </div>
<div>“Helen’s giving spirit and positive attitude radiate and motivate our entire company to face the challenges in their lives with determination and a brave heart.”</div>
<div><span id="__publishingReusableFragment"></span></div>
<div> </div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Helensview High School </span><br>Group Volunteer of the Year</h2>
<div><div><em>Sarah Langmead</em></div></div>
<div>Anne Frank once wrote, “How wonderful it is that nobody need wait a single moment before starting to improve the world.”</div>
<div> </div>
<div>Students at Helensview High School in Portland, Ore., not only understand this adage, they live by it.</div>
<div>Since 2009, Helensview, an engaging environment designed to help students with needs that have not been met in other educational settings, teamed with Porthaven Care Center, a 99-bed long term care and rehabilitation center, to create a volunteer program. </div>
<div> </div>
<div>Students in the volunteer program enjoy playing board games and making crafts with residents. Recently, the group proposed, developed, and implemented a special design area in the facility to display resident art projects. </div>
<div> </div>
<div>“Not only do the students come on their volunteer day, but many found time in their busy lives as young single parents, working and going to school, to drop in on the birthday of their ‘buddy’ and surprise them with a card or balloon,” said Porthaven Administrator Sarah Murk in her nomination of the group. “One student organized a birthday party for a resident who was in hospice care. The resident described the day as his ‘best birthday ever.’”</div>
<div> </div>
<div>Porthaven staff have noticed that Helensview students have assisted in improving resident behaviors, as well.</div>
<div> </div>
<div>“One resident said, ‘These kids are so special, and they treat me like I am special,’” said Jodi Burroughs, Porthaven activities director, in her nomination. </div>
<div> </div>
<div>“This resident has developmental disabilities and a serious seizure disorder, which presented some challenges. After he began participating in activities with [the students], he not only developed confidence in himself, but his behaviors improved!”</div>
<div> </div>
<div>“It’s so exciting to watch our student volunteers connect with Porthaven residents,” said Kris Persson, principal at Helensview High School. “We hope that this program inspires students to continue volunteering throughout their lifetimes.” </div>
<div><span id="__publishingReusableFragment"></span></div>
<div> </div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Robin Moran</span><br>Noble Caregiver in Assisted Living</h2>
<div><em>Lisa Gluckstern</em></div>
<div> </div>
<div><img width="184" height="202" class="ms-rtePosition-1" alt="Robin Moran" src="/Monthly-Issue/2013/PublishingImages/1013/RobinMoran.jpg" style="margin:5px 10px;" /><br>Robin Moran, recreation assistant for The Chelsea at Tinton Falls, N.J., makes it her life’s purpose to get to know each resident as well as possible. That desire is one of many factors that led to Moran being named the recipient of the 2013 NCAL Noble Caregiver In Assisted Living Award. </div>
<div> </div>
<div>She loves getting to know each resident and becomes a trusting friend to the residents. In one recent instance, a resident confided to Moran about his memory lapses and asked if his repetitive questions annoyed her. Moran reassured him that they did not, explaining that he wasn’t the only person with this condition and telling him, “This could be me some day, and I hope people will be kind when that day comes.”</div>
<div>Moran’s kindness is demonstrated through visits to residents who have been hospitalized. She reaches out to residents who are shy or unhappy and is often rewarded with a smile and newfound friendship. </div>
<div> </div>
<div>She recruits her own friends and acquaintances to give talks to the residents on a variety of subjects. For example, she convinced her husband to give a lecture on the Hindenburg event and then a 10-week series on “The Pacific.” She arranged for people to arrive in costume on Halloween to deliver treats to residents. She runs the book club, bakes cookies, brings her pets in, and takes residents to monthly events at her church. </div>
<div>Moran was hired by the community four years ago.</div>
<div> </div>
<div>“She took to the role like a duck takes to water,” wrote Kathie Deak, executive director of The Chelsea at Tinton Falls. “Her outgoing personality, love of people, strong nurturing skills, and a positive outlook on life had an immediate effect on residents, families, and co-workers alike.” </div>
<div> </div>
<div>Whenever anyone in the community is going through a rough patch, she uses her spirituality to give them strength, and she has set up a quiet area in the community’s sun room where someone can go to reflect, said Deak. </div>
<div> </div>
<div>“She is a very modest unsung hero who loves what she does and makes what she does look easy,” Deak wrote.</div>
<div> </div>
<div><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Julie Taylor</span><br>NCAL Administrator of the Year</h2>
<div><em>Lisa Gluckstern</em></div>
<div> </div>
<div><img width="190" height="257" class="ms-rtePosition-1" alt="Julie Taylor" src="/Monthly-Issue/2013/PublishingImages/1013/JulieTaylor.jpg" style="margin:5px 10px;" /><br>Julie Taylor, administrator of Gilman Park Assisted Living located in Oregon City, Ore., is not afraid to clean, dig, paint, or do anything she asks of others. </div>
<div> </div>
<div>The pride she takes in the assisted living community is contagious to her staff members. She encourages them to make their own decisions and trains them to take care of resident issues in a timely fashion. Those are just a few of the accomplishments of Taylor, who is the recipient of the 2013 NCAL Administrator of the Year Award. </div>
<div> </div>
<div>Her support of staff members encourages the delivery of person-centered care to residents. In her five years at Gilman Park, she created an awards program for the community’s volunteers and reduced staff turnover while increasing census. Last year, Gilman Park won four company awards at Frontier’s annual meeting, among them was having the highest average occupancy. In 2012, Taylor was named Frontier Management’s Executive Director of the Year.</div>
<div> </div>
<div>But that’s not all. Taylor also raised the profile of Gilman Park Assisted Living to the surrounding community. For example, she created the ABC Award pencil program for the local elementary school. Every quarter, 500 pencils with the words “I AM Brilliant” or “I am Awesome” are distributed to students who earn good grades or do good deeds. </div>
<div> </div>
<div>Then, once a month, Gilman Park residents go over to the school and become lunch buddies to a group of school children. </div>
<div> </div>
<div>Four years ago, Taylor created the Volunteer of the Year Award for Oregon City, which recognizes a senior who worked on behalf of others in the city. Every year the assisted living community hosts an award ceremony. The mayor attends and makes the presentation.</div>
<div> </div>
<div>Taylor stays busy with projects. She is currently designing and planning to build a koi pond for the community after designing, planning, and building Gilman Park’s dog run, which allows residents to be outside while their dogs roam freely without their leashes. </div>
<div> </div>
<div><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Cheryl Hopkins</span><br>NCAL Assisted Living Nurse of the Year</h2>
<div><em>Lisa Gluckstern</em></div>
<div> </div>
<div><img width="204" height="228" class="ms-rtePosition-1" alt="Cheryl Hopkins" src="/Monthly-Issue/2013/PublishingImages/1013/CherylHopkins.jpg" style="margin:5px 10px;" /><br>Cheryl Hopkins, RN, resident care manager at the Kansas community Vintage Park at Paola, personifies the community’s mission: Make a difference, every day, every time. </div>
<div> </div>
<div>The 2013 NCAL Assisted Living Nurse of the Year is described as compassionate and committed. Hopkins’ leadership inspires staff and conveys concern and great care to the residents and their family members. </div>
<div> </div>
<div>For an example of her dedication and personal commitment, her nominator Christina (Tina) Dick, Vintage Park director, cited how Hopkins works long hours to make sure a resident who is close to the end of life is “not alone” and is comfortable. “Cheryl displays integrity and a high standard of ethical behavior by leading staff to standards, which she sets above and beyond expectations. She rolls up her sleeves and works side by side with the staff, teaching and reviewing their skill competencies,” she said.</div>
<div> </div>
<div>Hopkins has led the community to deficiency-free surveys for the past five years. In 2010, she guided staff to achieving Silver in the AHCA/NCAL National Quality Award program. </div>
<div> </div>
<div>Not resting on her laurels, she helped reduce resident hospital readmission rates, and employee satisfaction ratings of excellent rose to 70 percent. </div>
<div> </div>
<div>She has been resident care manager for the past six years and has a total of 25 years of experience in long term care.</div>
<div> </div>
<div>“Cheryl takes great pride in the communication between her and the physicians, family members, and other stakeholders,” said Dick. “She will not leave until she is satisfied that all is going well with the residents, staff, and family members.”</div>
<div><span id="__publishingReusableFragment"></span></div>
<div> </div>
<h2 class="ms-rteElement-H2"><span class="ms-rteThemeForeColor-8-4">Summer’s Landing of Warner Robins</span><br>NCAL National Assisted Living Week Programming Award</h2>
<div><em>Lisa Gluckstern</em></div>
<div> </div>
<div><img class="ms-rtePosition-1" alt="Summer's Landing of Warner Robins" src="/Monthly-Issue/2013/PublishingImages/1013/Summerlanding.jpg" style="margin:5px 10px;" /><br>The team at Summer’s Landing of Warner Robins in Georgia planned events based on the 2012 National Assisted Living Week theme, Art for the Ages, with the Spiritual, Physical, Intellectual, Creative, and Emotional (SPICE) needs of the residents at the forefront of their programming design.</div>
<div> </div>
<div>This was a winning strategy that created engaging and fun events for residents, staff, families, and the surrounding neighborhood community. The Summer’s Landing team: Kim Pitsenbarger, executive director, Allison Gatliff, senior living advisor, Melissa LaFave, human resources, and Lany Puckett, dietary director, are recipients of the 2013 National Assisted Living Week Programming Award. </div>
<div> </div>
<div>These four individuals designed programming that celebrated the creativity of everybody, inside and outside the assisted living community, such as a nearby daycare center, a local elementary school, and experts who conducted interactive presentations that helped empower residents to create art either collectively as a group or individually. </div>
<div> </div>
<div>The highlight of the week was the Summer’s Landing Art Gallery, which contained work created by residents, family members, and staff, who displayed their ceramics, needlework, woodworking, oil paintings, and puzzle art in the dining rooms and the halls of the community. The team also posted various creative works of art from across the globe, along with facts about them, throughout the community. User-friendly cameras were available for residents and staff to take candid photos of life in the community, which were then displayed in the lobby. </div>
<div> </div>
<div>One of the residents taught a class on the Art of Flower Arranging. And a local expert taught residents about Japanese Ikebana—the art of creating elegant beauty with ordinary objects found in nature. </div>
<div> </div>
<div>The Art of the Spoken Word was celebrated by having a resident recite from memory the Frank Stanton poem, “Keep A Goin’ ” during a wine and cheese social. The Landing’s food and beverage team shared their knowledge of wine production, and a local bluegrass band performed original music, as well as country and Western music.</div>
<div> </div>
<div>The Art of Dining Well included four dining rooms decorated with flower and Ikebana arrangements and filled with carefully drizzled plates of julienned vegetables and Atlantic salmon; for dessert, flaming peaches jubilee. </div>
<div> </div>
<div>A local photographer instructed residents about the composition elements of taking photos and shared his stories and prize-winning photos taken while traveling.</div>
<div> </div>
<div>The Art of the Everyday featured a rotating art gallery of puppets made by the daycare center children. </div>
<div>Finally, The Art of Thankfulness featured a photo contest and a Tree of Gratitude. The residents and staff members each wrote one good thought on a paper leaf and attached it to a tree drawn on an oversized poster board. One leaf contained the following touching thought:</div>
<div> </div>
<div>“Thank you to all of you who keep us going and make us feel like we belong.”</div>
<div> </div>
<div> </div> | The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) have announced the individual and group winners of their annual awards. | 2013-10-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/1013/special_thumb.jpg" style="BORDER:0px solid;" /> | Quality;Caregiving | Column | 10 |
| The QIS Expert: Can QIS Methods Help Providers Comply With QAPI’s Systematic Analysis And Action Regs? | https://www.providermagazine.com/Issues/2013/Pages/1013/Can-QIS-Methods-Help-Providers.aspx | The QIS Expert: Can QIS Methods Help Providers Comply With QAPI’s Systematic Analysis And Action Regs? | This is the final column in A series of five addressing how QIS methods can be used for Quality Assurance & Performance Improvement (QAPI). The previous four columns (in <a target="_blank" href="/Monthly-Issue/2013/Pages/0213/The-QIS-Expert.aspx">February</a>, <a target="_blank" href="/Monthly-Issue/2013/Pages/0413/Can-QIS-Help-Providers-Comply-With-New-QAPI-Regs.aspx">April</a>, <a target="_blank" href="/Monthly-Issue/2013/Pages/0613/The-QIS-Expert.aspx">June</a>, and <a href="/Monthly-Issue/2013/Pages/0813/Can-QIS-Methods-Help-Providers-Comply_4.aspx">August</a> 2013 issues) have shown the parallels between QIS methods and the first four of the Five Elements of QAPI.<br><br>These first four columns showed that QIS is consistent with where the Centers for Medicare & Medicaid Services is heading on QAPI from a regulatory standpoint. More importantly, QAPI is a voluntary means to continuously improve care. (See <a target="_blank" href="http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-05.pdf">www.cms.gov/Medicare/ Provider-Enrollment-and-Certification/Survey CertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-05.pdf)</a>.<br><br>Element 5: Systematic Analysis and Systemic Action provides the framework that providers can use to voluntarily conduct QAPI. <br><br>CMS says that Systematic Analysis involves the following: “The facility uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, its causes, and implications of a change. The facility uses a thorough and highly organized/structured approach to determine whether and how identified problems may be caused or exacerbated by the way care and services are organized or delivered.” <br><br>Just as surveyors use the multifaceted Stage 1 investigation of the QIS process to determine when in-depth analysis is needed, providers can use those same assessments, but with a different type of reporting. “Understanding the problem, the causes, and the implications for change” involves drilling deeper into the QIS data than is required for the survey process. <br><br>For example, it is not sufficient for QAPI to determine that a resident’s preferences are not being honored by staff. Instead, staff must understand specifically what choices are not being honored; whether it is just a single resident, a unit, or the facility as a whole; and what must be done to improve accommodation of resident preferences. <br><br>Thus, provider QAPI systems that use QIS methods must go beyond the work of surveyors in Stage 1. Staff must go beyond the typical questions on resident satisfaction surveys. Fortunately, the QIS questions can provide much of the necessary drill-down when broken down and structured in a QAPI tool. <br><br>Element 5 also says that, “Systemic Actions look comprehensively across all involved systems to prevent future events and promote sustained improvement. This element includes a focus on continual learning and continuous improvement.” <br><br>Once again, QIS contains tools, when properly restructured, that take aspects of the surveyor investigation process and “look comprehensively across all systems.” This involves advancing the investigation that surveyors conduct a step further—to correcting system failures that are identified. It also requires that providers do not use the QIS methods in a “mock survey” or external consulting model; rather, they use the methods continuously for “learning and continuous improvement.”<br><br>In recent years, working with providers, I have observed numerous examples of staff using these QIS tools for QAPI with extraordinary success. So what are you waiting for? <br><br><em>Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey (QIS).</em><br> | Just as surveyors use the multifaceted Stage 1 investigation of the QIS process to determine when in-depth analysis is needed, providers can use those same assessments, but with a different type of reporting | 2013-10-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/headshots/AndyKramer.jpg" style="BORDER:0px solid;" /> | Policy;Survey and Certification;Management | Column | 10 |
| Climbing The Mountain Of Health Care Reform | https://www.providermagazine.com/Issues/2013/Pages/1013/Climbing-The-Mountain-Of-Health-Care-Reform.aspx | Climbing The Mountain Of Health Care Reform | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a></div><p>When the Treasury Department announced in early July that employer penalties under the Affordable Care Act (ACA) would be delayed for a year, until 2015, the news came as a relief to long term care providers, regardless of how prepared they were for the transition.<br><br>“Delay of the employer mandate meant the delay of both uncertain and actual cost increases,” says Phil Fogg Jr., president and chief executive officer of Marquis Cos. in Milwaukie, Ore. <br><br>Marquis had already begun offering an ACA-compliant health plan when the announcement was made. By July, the self-insured organization was preparing its initial communications with employees and was on the brink of offering reduced cost-sharing in the health plan as an incentive for employee participation in wellness initiatives targeting obesity and other costly health problems. </p>
<p><img width="430" height="175" class="ms-rtePosition-2" alt="Variable Affecting Employer Costs" src="/Monthly-Issue/2013/PublishingImages/1013/coverstory_employercosts.jpg" style="margin:5px 20px;" />Marquis has about 3,500 employees and operates skilled nursing facilities, assisted living communities, and other long term care services in 26 locations, mostly in Oregon. With a qualifying plan in place, “we are 98 percent of the way there,” Fogg says of Marquis’ readiness for ACA compliance. <br><br>He’s less certain, however, about the number and cost of employees who will opt into the health plan, especially as they face the ACA’s individual mandate requiring all adults to obtain insurance for themselves and their children in 2014, or pay a penalty.</p>
<p></p>
<div>Some workers are expected to choose to pay the individual penalty of $95 or 1 percent of household income rather than incur the cost-sharing required by the health plan. Nevertheless, participation in Marquis’ insurance program is expected to spike, adding an estimated $1.5 to $2.5 million a year to benefit costs, Fogg says. </div>
<div> </div>
<div>“That’s a big hit for us,” he adds.</div>
<div> </div>
<div>Despite the delay in ACA penalties, Marquis’ health coverage will remain intact, along with its commitment to the wellness goals of reducing costs and promoting a healthy workforce. The company has taken a step back, however, from linking wellness participation with financial incentives in the health plan. </div>
<h2 class="ms-rteElement-H2">Cost Tops List Of Provider Concerns</h2>
<div>The ACA requires businesses that are deemed “large employers” to provide health coverage to full-time staff. The coverage must be “affordable” for employees, whose share of premium payments cannot exceed 9.5 percent of their household income. It must also offer “minimum value,” by achieving at least 60 percent actuarial value, meaning the plan can be expected to pay 60 percent of an insured’s health expenses.</div>
<div> </div>
<div>Projections of exorbitant cost increases tied to ACA compliance, as well as uncertainty about the magnitude of the increase, and the inability to offset costs by raising prices in a profession dominated by government payers, top the list of long term care providers’ concerns about the ACA.</div>
<div> </div>
<div>There are no estimates of how much ACA implementation is likely to cost the profession. Financial exposure will vary based on factors unique to each provider and organization, experts say. These include the level of baseline coverage, staff composition and wages, and the number of employees who choose to participate in their employer’s plan.</div>
<div> </div>
<div>Providers’ concerns are driven by “two recurring themes,” says Emmett Reed, executive director of the Florida Health Care Association. “It’s going to cost more money, and in some cases a lot more money, to continue operating.” </div>
<div> </div>
<div>The second theme is the unknown, he says. Providers don’t know who is going to join the plan and how much more it’s going to cost. As a result, organizations “can’t properly plan their business strategy.” </div>
<div> </div>
<div>Some large organizations have estimated as much as a $7 million cost increase, Reed says. “That’s a big number and a huge concern given nursing facilities’ razor-thin margins.” Smaller providers are even more fearful of the impact, he adds. “It’s a frightening time.”<br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">The California Experience</h2>
<div>In California, providers are “stepping back and seeing what’s reasonable and what they can afford,” says James Gomez, president and chief executive officer of the California Association of Health Facilities. Unlike Florida, California is integrating the ACA’s optional Medicaid expansion, to 138 percent of the federal poverty level, which will result in the addition of more than 1 million beneficiaries, Gomez says. In addition, the state is running its own Health Insurance Exchange, as opposed to defaulting to the federal government for that function. The Web-based portal could be deluged by 3 million to 4 million registrations for insurance coverage, Gomez says.<br></div>
<div><br>“This is a very rapid program that we’re trying to do. It will be difficult everywhere in the nation.”</div>
<div> </div>
<div>From providers’ perspective, the effort is draining state and federal resources from quality improvement and the payment of adequate Medicaid rates, he adds.</div>
<div> </div>
<div>“We lose money every time we serve a Medicaid participant,” Gomez says. As more people gain eligibility, there is widespread fear across all provider types of further rate erosion.</div>
<div> </div>
<div>Under California law, federal and state mandates must be reimbursed, he says. “We’ve let [lawmakers] know this is an issue.”</div>
<div> </div>
<div>Craig Robinson, president of Gulf Coast Health Care in Pensa-cola, Fla., says the ACA compounds the uncertainty that long term care providers face from perpetual reimbursement and regulatory changes.</div>
<div> </div>
<div>“The [ACA] penalties are being put off, but we need to move forward with health insurance as if it’s going to happen,” he says. “We need to do what we have to by law.” But it’s difficult to do that with “unknown costs” that have to be budgeted, he adds.</div>
<div> </div>
<div>“There’s uncertainty in our environment all the time,” stemming from potential payment cuts and regulatory changes, Robinson says. </div>
<div> </div>
<div>“The ACA is just like that.”</div>
<h2 class="ms-rteElement-H2">Gearing Up For Compliance</h2>
<div>The year-long reprieve from penalties gives providers additional time to get their arms around the complexities of the ACA, develop health coverage that best fits their organization, and test out their programs before they are exposed to penalties for compliance failures, experts say. </div>
<div> </div>
<div>“We’re recommending that employers proceed as if the ACA is going into effect in 2014 and that they use the transition time to work out the kinks, while there are no financial implications from penalties,” says Tiffany Downs, a partner and head of the employee benefits group in the Atlanta law office of Ford Harrison. This gives businesses time to develop Plan B if their initial program isn’t compliant, she adds.</div>
<div> </div>
<div>“If you don’t offer coverage at all [during the transition], it takes more time to get up and running.” </div>
<div> </div>
<div>Most importantly, the delay should not be mistaken for the demise of the ACA, say legal and health benefits professionals who, like Downs, are advising clients to use the transition time to plan for implementation.</div>
<div> </div>
<div>Next year should be treated as “the dry run for employers to see whether the benefits they intend to provide, are going to be compliant in 2015, when ACA penalties kick in,” says Toni Fatone, member services liaison with the American Health Care Association (AHCA), who has worked with insurers and a broker to create the AHCA/National Center for Assisted Living Insurance Solutions Program, which gives members of the organization access to discounted health plans.</div>
<div> </div>
<div>“It’s really important that [providers] don’t take their foot off the gas” next year, says Nicole Fallon, a health care consultant at CliftonLarsonAllen (CLA), a national consulting firm based in Minneapolis. </div>
<div> </div>
<div>“Employers should use 2013 employee data to simulate how the 2015 requirements will impact their organization, because we believe 2014 data will be used as a measurement period to determine which employees are full-time and which employers are considered ‘large’ and subject to the law,” she says.</div>
<div> </div>
<div>It is not clear if the federal government will offer employers the same flexibility in 2015 as it did in 2014, to synchronize the launch of new ACA plans with the start of their existing health plan year or use shorter measurement periods to determine full-time status of employees, says Fallon. If they do not get the same leeway, employers will have to hit the ground running with a compliant plan on Jan. 1, 2015. </div>
<div> </div>
<div>“The ACA is not going to go away,” says Nancy Taylor, an attorney with the Miami-based law firm Greenberg Traurig and co-chair of the firm’s health and FDA business practice. “It’s wishful thinking to believe it could be delayed forever.” </div>
<div> </div>
<div>Providers wrestling with ACA compliance must also wrestle with math. The law is stacked with formulas and measurements that determine whether a provider is subject to penalties for failing to offer health coverage, whether workers are counted as full-time and must therefore be offered coverage, whether health benefits meet value and affordability tests, and whether a provider and its workforce would be better served by compliance or penalty payment.</div>
<div> </div>
<div>These often dizzying calculations are staples of ACA webinars, workshops, and presentations being conducted nationwide for long term care and other employers, by legal and benefits experts who are steeped in details of the law. </div>
<div> </div>
<div>ACA calculus begins with staffing. Only businesses with 50 or more full-time employees and “equivalents” are deemed to be large employers, subject to the ACA’s health coverage requirements and at risk of penalties for failing to comply.</div>
<div> </div>
<div>Counting staff, however, is not as simple as it sounds. The ACA defines full time as 30 hours per week, measured as 130 hours of service in a month, says Taylor, who also serves as legal counsel to AHCA and has conducted several ACA webinars and presentations for the organization and its state affiliates. </div>
<div> </div>
<div>For the purpose of determining whether a business is a large employer, however, the count includes the total hours worked by all part-time staff in a month, up to a maximum of 120 hours per employee, divided by 120, Taylor explained in a July webinar for AHCA. The sum of that equation is the number of “full-time equivalents,” which must be added to the number of actual full-time workers. If the final tally is 50 or more, the business meets the definition.<br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">Look-Back Period</h2>
<div>For staff whose full- or part-time status is unclear due to their variable or seasonal schedule, the ACA creates a “look-back” period. <br><br></div>
<div>This measurement tool allows employers to track an employee’s hours over a three- to 12-month period to determine whether they average 30 hours per week/130 hours per month, says Downs. If so, the person is deemed full time and must be offered health coverage during a “stability period” of six months, or the duration of the look-back, whichever is greater, Downs says.</div>
<div> </div>
<div>Employers may designate an administrative period up to 90 days between the look-back and stability periods, in which they “crunch numbers and offer enrollment,” Downs says. At the end of 90 days, the stability period must start immediately, and employers must provide health coverage to those workers deemed full-time, even if their hours no longer rise to the level of full-time status, Downs says. </div>
<div> </div>
<div>A look-back period can only be used when “it’s not clear that an employee works 30 hours a week,” Downs says. “It cannot be used to delay coverage. There has to be a determination that hours really are variable.” </div>
<h2 class="ms-rteElement-H2">The ACA And Quality Care </h2>
<div>As employers develop strategies for managing ACA costs and meeting compliance challenges, one of the available options is to create more part-time positions, reducing the number of staff to whom insurance coverage must be offered. </div>
<div> </div>
<div>While the approach might be useful in retail or other settings, long term care providers are not embracing part-time employment as a solution.</div>
<div> </div>
<div>At Mission Health Services in Ogden, Utah, the philosophy of care is rooted in the belief that “the resident has to be well-known,” says Gary Kelso, president and chief executive officer. “That means we have to have consistent staffing.”</div>
<div> </div>
<div>By having “the same individuals caring for people every day, even if there is a slight change in condition, the employee will see it,” Kelso says. </div>
<div> </div>
<div>The need for consistency and familiarity means that reducing work hours to create more part-time staff who don’t have to be offered health coverage under the ACA is not an option for Mission Health, a nonprofit with four facilities and 375 employees. The organization, which is partially self-insured, put an employee insurance plan in place five years ago. It covers 100 percent of employees’ premium cost, has a small copay after the deductible is met, and needs no modifications to comply with the ACA. </div>
<div> </div>
<div>Since the plan was implemented, Mission Health’s workers’ compensation costs have dropped dramatically, and staff turnover has plummeted from 60 to 70 percent, which is typical in the long term care sector, to under 10 percent for the past three years, Kelso says. All facilities have four or five stars from the Centers for Medicare & Medicaid Services, and two have had deficiency-free surveys for the past 18 months.</div>
<div> </div>
<div>Other factors have likely contributed to these trends, including the fact that all Mission Health facilities are Eden-registered, Kelso says. While he believes the ACA is “bad policy” that will lead to “losses in business and losses in the economy,” he’s not expecting to reduce employees to part time.</div>
<div> </div>
<div>“I don’t think that’s a valuable or good policy,” he says.</div>
<div> </div>
<div>Kelso says he’s not stressed about the ACA, as there’s nothing the organization needs to change to be compliant. The acquisition of 12 facilities, with 475 employees, is on the horizon, however, and the move may add as much $1 million a year to the health benefits rate structure. </div>
<div> </div>
<div>“That’s significant,” Kelso says. “We may have to ask employees to pay a small amount” for their premiums, though it would probably not be as much as the ACA’s benchmark for affordability, which is 9.5 percent of household income.</div>
<div> </div>
<div>“That’s still too high in my perspective when you have lower-paid employees,” he says.</div>
<h2 class="ms-rteElement-H2">Creating A Workable Plan</h2>
<div>At Opis Management Resources in Tampa, Fla., the company is working closely with a health insurance broker to understand the ACA, the changes that it would have to make to come into compliance, options for redesigning the current benefit program, and the associated costs.</div>
<div> </div>
<div>“We’ve always provided coverage and have a generous plan,” which is “extremely affordable” and has a good participation rate, says Jennifer Ziolkowski, senior vice president of finance. Adding staff who work 30 hours a week, as opposed to the current 32-hour threshold for full-time status, will be the biggest cost, she says.</div>
<div> </div>
<div>Opis manages 10 Florida skilled nursing facilities and one assisted living community. With about 2,300 employees, the company recognizes the need to remain competitive, and that means keeping up with the benefits that other providers and other types of businesses are offering. Opis plans to come into ACA compliance, and doing so will require closer management of staff hours, Ziolkowski says.</div>
<div> </div>
<div>In looking closely at monthly reports on “flex staff,” who are supposed to be part-time, for example, Opis found that some of those employees were in fact working 40 hours a week.</div>
<div> </div>
<div>“We were calling them as needed, but we needed them all the time,” Ziolkowski says. “Our mindset isn’t on having more flex-time workers, but on having permanent staff,” she says. </div>
<div> </div>
<div>As the organization focuses more closely on hours, it will have to be vigilant about defining full-time, part-time, and flex staff, she says. <br><br></div>
<div>“We need to make sure that if we have flex staff working more than what we consider flex time, we address that by approaching staff to become full time, or by spreading the hours over more people,” she says. </div>
<div> </div>
<div>Next to managing the cost of ACA compliance, the greatest challenge faced by long term care providers will be the time and effort it takes to track employee hours and other data required by the ACA, says CLA’s Fallon. </div>
<div> </div>
<div>“A large organization with a couple of hundred employees and on-call staff now has to closely track all those hours.” <br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">Pay Or Play: That Is The Question</h2>
<div>Among the most critical ACA calculations employers have to make is the decision to offer health coverage or pay a penalty.<br></div>
<div><br>Many factors go into this consideration, says Fallon, including staff composition and wage levels, premiums charged by the Health Insurance Exchange, and the cost of providers’ options.</div>
<div> </div>
<div>Under the ACA, providers that don’t offer any health coverage to full-time workers are subject to a $2,000 penalty for every full-time worker in their employ, excluding the first 30. </div>
<div> </div>
<div>Employers that offer insurance that fails to meet the ACA’s affordability or minimum value test are subject to a higher penalty of $3,000, but it applies only to full-time employees who receive subsidies through the Health Insurance Exchange, as opposed to the entire full-time staff.</div>
<div> </div>
<div>To be affordable, employees’ share of the premium cannot exceed 9.5 percent of their modified adjusted gross household incomes. Alternatively, IRS regulations provide employers three affordability safe harbors: 9.5 percent of the employee’s W-2 wages, 9.5 percent of the federal poverty level, or 9.5 percent of their monthly wages based on 130 hours of service and their hourly rate of pay.</div>
<div> </div>
<div>Employers incur no penalties unless a full-time employee applies to the Exchange for coverage and is deemed eligible for subsidies. <br></div>
<div><br>“A penalty is tied to a full-time person,” Fallon says. “You only trip the trigger on a penalty if a person goes to the Exchange and purchases insurance with sudsidies.”</div>
<div> </div>
<div>A Health Insurance Exchange is an ACA-created entity designed to function as a Web-based marketplace for individual and small-group health plans. </div>
<div> </div>
<div>The Exchange is also a portal where individuals with incomes up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four) may apply for sliding-scale premium tax credits and cost-sharing subsidies. </div>
<div> </div>
<div>Employees who earn more than 400 percent of poverty are not eligible for subsidies and therefore will not trigger employer penalties, even if they purchase insurance via one of the Exchanges, says Fallon.</div>
<h2 class="ms-rteElement-H2">States Choose Exchange Type</h2>
<div>Exchanges can be unilaterally created and controlled by the state, or run solely by the federal government, or operated through a partnership between state and federal agencies.</div>
<div> </div>
<div>According to the Kaiser Family Foundation, as of late May 2013, 17 states had announced plans to create their own exchanges, retaining control over all activities, including selection of health plans. Twenty-six states had defaulted to a federal exchange, while another seven were planning a partnership exchange.</div>
<div> </div>
<div>Insurance plans sold through the Exchange must meet one of four “actuarial value” tiers, designated by the ACA as bronze, silver, gold, and platinum, the Kaiser Family Foundation reported in a 2011 analysis of ACA actuarial values. </div>
<div> </div>
<div>An actuarial value is the percentage of health care expenses a health plan is expected to pay, based on a standard population, Kaiser said. The ACA requires minimum-level bronze plans to meet a 60 percent actuarial value, meaning consumers can expect to pay 40 percent of their health expenses out-of-pocket, through deductibles, copays, and coinsurance. </div>
<div> </div>
<div>The ACA requires at least a 60 percent actuarial value, which is referred to as the “minimum value,” for any health plan purchased by individuals through the Exchange, or offered by employers to full-time staff.</div>
<div> </div>
<div>The highest tier platinum plans, for people with incomes from 100 percent to 150 percent of poverty, have a 94 percent actuarial value, according to Kaiser.</div>
<div> </div>
<div>Insurance subsidies will be administered through the Exchange via federal payments to insurers for reducing premium costs and, in some cases, cost-sharing for low-income purchasers, CLA says. Households with incomes up to 200 percent of poverty, for example, are eligible for a two-thirds cost-sharing reduction, while those between 200 percent and 250 per-cent may receive a 50 percent subsidy to reduce out-of-pocket costs, according to materials prepared by CLA. </div>
<div> </div>
<div>The premiums, benefits, and provider networks available through Exchanges will vary from state to state, sometimes dramatically, says Fallon. Employers should be aware of what their Exchange is offering to understand how it compares with what they can afford to offer employees, Fallon says. Low-income workers might find more affordable coverage through the Exchange with or, in some cases, even without subsidies, though they would only be eligible for financial assistance, if their employer did not offer coverage, or failed to offer an affordable, minimum-value plan, she adds.</div>
<div> </div>
<div>To help providers determine the most cost-effective option, AHCA offers its membership a free comparison of their penalty and coverage costs. The service is part of a larger AHCA/NCAL Insurance Solutions Program, which gives members access to national carriers that have agreed to offer members discounted coverage for their workforces, including options for providers that want to self-insure, says Fatone.</div>
<div> </div>
<div>AHCA has also partnered with Benefit Focus, a human resources software firm that can manage much of the employee data collection and reports required for the ACA, Fatone says. While the cloud-based service isn’t free, it creates tremendous efficiencies for employers. </div>
<div> </div>
<div><em>Lynn Wagner is a freelance writer based in Shepherdstown, W.Va.</em></div>
<p></p> | The ACA requires businesses that are deemed “large employers” to provide health coverage to full-time staff. The coverage must be “affordable” for employees, whose share of premium payments cannot exceed 9.5 percent of their household income. It must also offer “minimum value,” by achieving at least 60 percent actuarial value, meaning the plan can be expected to pay 60 percent of an insured’s health expenses. | 2013-10-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/1013/coverstory_thumb.jpg" style="BORDER:0px solid;" /> | Quality;Policy | Cover Story | 10 |
| Delivering Large Quantities Of Quality | https://www.providermagazine.com/Issues/2013/Pages/1013/Delivering-Large-Quantities-Of-Quality.aspx | Delivering Large Quantities Of Quality | <div>“I have measured out my life in coffee spoons,” Prufrock says in one of the great poetic kvetches of all time. </div>
<div> </div>
<div>And there is surely a reason that our culture makes a cliché of the line that quality is more important than quantity. </div>
<div> </div>
<div>But for Neil Pruitt Jr., there’s a revolution in the measurements, and quality vs. quantity is a false antithesis. “We’ve always been delivering quality, high-quality care in America’s long term care facilities,” Pruitt says. “The problem is you had so many initiatives… but nobody had said that we’re going to have some specific measures.”</div>
<div> </div>
<div>Pruitt, leader of the long term care company that bears his family name, UHS-Pruitt Corp., headquartered in Norcross, Ga., is wrapping up two years as chairman of the American Health Care Association’s Board of Governors. In most cases, it would be sloppy to refer to a mere two years as an “era,” but Pruitt’s time comes the closest to deserving the term. </div>
<div> </div>
<div>“Neil deserves enormous credit for bringing AHCA and the Alliance together and for making the delivery of quality care our core mission,” says AHCA board Secretary/Treasurer Leonard Russ.</div>
<div>Group Launches Quality Initiative Under his direction, AHCA/National Center for Assisted Living launched its Quality Initiative. The group set specific, measurable targets to improve care by safely reducing hospital readmissions, cutting back on staff turnover, increasing customer satisfaction, and cutting back on the off-label use of antipsychotic drugs. </div>
<div> </div>
<div>“When we started that initiative, we decided that if we truly were going to be in partnership with CMS [the Centers for Medicare & Medicaid Services], quality truly had to be a concern,” Pruitt says. While there has been tension between CMS and the profession, Pruitt says that he and his colleagues recognized that, whatever differences they may have with regulators, they ultimately share the same goal—quality care. The idea is not just to meet regulators’ expectations, but to surpass them, thereby building up the credibility of the profession. </div>
<div> </div>
<div>The regulators seem to have understood the effort. When the association launched its Quality Initiative, only 37 percent of its members were rated 4 stars or higher by CMS’ Five-Star Quality program. Now, it’s an even half. Perhaps even better, the 2-Star facilities decreased from 40 percent to 27 percent in just two years. </div>
<div> </div>
<div>“None of us likes the Five-Star system, per se,” Pruitt says. “But we wanted our partners at CMS to know—if you give us a system, we can exceed it. Our members really started to move the ratings.”</div>
<div>It’s not just in the rating system. In July, CMS announced that long term care facilities had cut down on the improper use of antipsychotic drugs for those suffering from dementia by about 9 percent nationally. AHCA members had cut their uses by 10.5 percent. </div>
<div> </div>
<div>“In fact, what we saw across the nation is that the state execs started aligning their quality initiatives with the national ones. And they started competing with one another,” Pruitt says. </div>
<div> </div>
<div>AHCA President and Chief Executive Officer Mark Parkinson says Pruitt deserves a mountain of credit for his focus on data-driven quality. </div>
<div> </div>
<div>“Neil has been a leader for our profession on many levels and in many respects,” Parkinson says. “And in each of them, he has stressed not just a broad vision, but specific, measurable goals with defined timelines to achieve and succeed. From our landmark Quality Initiative to new advances in LTC Trend Tracker, Neil has been truly transformational as he has shepherded these efforts during his tenure.”</div>
<h2 class="ms-rteElement-H2">Patients First</h2>
<div>Pruitt’s intervention comes at the best possible time for the profession: An aging population virtually guarantees that long term care is going to be in the public’s eye. </div>
<div> </div>
<div>“Obviously, we have some work to do in getting the story out,” he says. “But if we take care of the patient, the story will take care of itself, time and time again… </div>
<div> </div>
<div>“Not only have we said we want to move these markers of quality. We have AHCA dedicated staff; they’re out on the road, making sure they’re disseminating the best, evidence-based practices. If an AHCA member is serious about making improvements, they go to our website, they can check with our state affiliates, and it virtually is self-propelling.”</div>
<div> </div>
<div>Pruitt renounces his formal title, but it’s doubtful that he’ll walk away from the work. In the meanwhile, he’s also serving on the Long Term Care Commission, which is charged with advising Congress on the best ways to care for an aging America. </div>
<div> </div>
<div>“I will say that I have enjoyed the commission,” he says. “We do need to improve coordination and efficiency in the system. We don’t need to do it because of good government or saving money, but we need to do it because it’s good for the patient.” </div>
<div> </div>
| Pruitt, leader of the long term care company that bears his family name, UHS-Pruitt Corp., headquartered in Norcross, Ga., is wrapping up two years as chairman of the American Health Care Association’s Board of Governors. In most cases, it would be sloppy to refer to a mere two years as an “era,” but Pruitt’s time comes the closest to deserving the term. | 2013-10-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/dr_staff.jpg" style="BORDER:0px solid;" /> | Quality;Management | Column | 10 |
| Technology And Readmissions | https://www.providermagazine.com/Issues/2013/Pages/1013/Technology-And-Readmissions.aspx | Technology And Readmissions | <div><div>A key element of health reform is introducing new ways to reward hospitals for good outcomes and penalize hospitals for poor outcomes. In this new environment, hospital strategies may influence referral patterns and significantly impact the business of post-acute providers. </div>
<div> </div>
<div>Two of the most impactful changes to a hospital’s bottom line—30-day readmission penalties and bundled payments cov<span></span>ering the entire continuum of care—are significantly affected by what happens to patients when they leave the hospital. These market forces will demand that hospitals develop stronger relationships with long term and post-acute care organizations that provide effective and efficient care post-discharge. </div>
<div> </div>
<div>This is especially true for preventable conditions such as fall-related injuries and complications from undetected urinary tract infections (UTIs). </div>
<h2 class="ms-rteElement-H2">Improving Relationships With <span></span><span></span>Hospital<span></span>s</h2>
<div>Accountable care requirements are causing shifts in the industry, making collaboration and partnership across the spectrum of care more prevalent. This trend is already affecting long term and post-acute care providers. </div>
<div><span> <div><span><span><span><span><span><span><img width="409" height="153" class="ms-rtePosition-2" alt="Falls and Hospitalizations" src="/Monthly-Issue/2013/PublishingImages/1013/tech_falls.jpg" style="margin:5px;width:495px;height:185px;" /></span></span></span></span></span></span>The traditional business model of long term care facilities focuses on providing a place of residence for someone who needs support with daily living. In the future, that model will not lead to market leadership. Already, long term care facilities are shifting the way they operate to provide services for those older adults who want to age in place. </div>
<div> </div></span></div>
There is greater appetite for innovation, including long term care providers that distinguish themselves with new approaches and services to become a provider of choice when hospitals look to develop patient referral networks. <div> </div>
<div>Providers may be hesitant to rewire a business model that has been successful, yet those that do not take a new approach will almost certainly lose market share.</div></div>
<h2 class="ms-rteElement-H2"><span><span><span><span><span><span></span></span></span></span></span></span>Standing Out</h2>
<div>There are a few key characteristics hospitals will most likely assess when deciding which long term or acute-care providers should be part of their preferred network for referrals. Hospitals will choose long term care facilities that have some level of clinical services to provide support for residents who leave the hospital. <span><span><span><span><img width="471" height="282" class="ms-rtePosition-2" src="/Monthly-Issue/2013/PublishingImages/1013/tech_cautionarytale.gif" alt="" style="margin:10px;" /></span></span></span></span></div>
<div> </div>
<div>Facilities that are <span><span><span></span></span></span>innovative in how they care for residents, show an expertise in understanding the needs of newly discharged patients, and provide 360-degree care will be in a good position to succeed.</div>
<div> </div>
<div>Technology can be a useful tool as long term and post-acute care providers develop strategies to differentiate and make themselves more attractive to hospitals. </div>
<div> </div>
<div>For example, smart sensor technology provides information to staff that can help facilitate the right care at the right time and help improve patient health and well-being. The technology, which is already being used in senior living communities, can help mitigate potential readmission risks, such as falls and UTIs, to improve quality of care and safety. </div>
<div> </div>
<div><span><img width="263" height="305" class="ms-rtePosition-1" alt="A Mutual Benefit" src="/Monthly-Issue/2013/PublishingImages/1013/tech_benefit.jpg" style="margin:5px 10px;" /></span>UTIs are the second leading cause for hospitalization in seniors age 65 and older. Detecting a UTI early can be the difference in being hospitalized or treated as an outpatient, which could potentially save a hospital from financial penalties. <br></div>
<div>Early signs include frequent urination at night. Long term or acute-care facilities that have smart sensor technology can detect if a resident used the restroom an unusually high <span></span>number of times in one night, and the technology sends an alert to a staff member. That staff member could check on the resident, test for a UTI, and, if it came back positive, treat it before it becomes more serious and requires hospitalization.</div>
<div> </div>
<div>Falls are another example of where smart sensor technology may help prevent hospital admissions. </div>
<div> </div>
<div>Thirty-three percent of seniors fall every year, causing 662,000 hospitalizations. Additionally, the rate of falling after a hospitalization is four times as likely within the first two weeks after discharge, compared with the first three months.</div>
<div> </div>
<div>Smart sensor technology can detect when there is a different pattern or inactivity in a patient room and will send an alert to a staff member. If a resident falls in the bathroom and smart sensor technology recognizes that there has been no movement for 30 minutes, a caregiver is alerted to check on him. </div>
<div> </div>
<div>While smart sensor technology cannot detect a fall, it can measure the activity within a patient’s room and help detect differences. </div>
<div> <span><em><img class="ms-rtePosition-2" src="/Monthly-Issue/2013/PublishingImages/1013/tech_sources.gif" alt="" style="margin:5px;" /></em></span><br>Helping a patient after a fall within the golden hour increases the patient’s survival rate and may allow the long term or acute-care facility to care for the patient before complications arise that require hospitalization. </div>
<h2 class="ms-rteElement-H2">Moving The Industry Forward</h2>
<div>Strong partnerships between hospitals and long term care providers are a relatively new idea, and there is no set formula for success. What will this shift in care look like? What amount of care should be provided at a nursing home, and what role should it play in coordinating care? How can long term and acute-care facilities shift their business models to partner with hospitals? These questions have yet to be answered, but they will be in time. And first movers will have the most influence and reap the biggest rewards as hospitals and health systems look for dependable and innovative partners. </div>
<div> </div>
<div><em>Julie Cheitlin Cherry, RN, MSN, director of clinical services, Intel-GE Care Innovations, can be reached at <span class="baec5a81-e4d6-4674-97f3-e9220f0136c1" style="white-space:nowrap;">(408) 835-8716<a title="Call: (408) 835-8716" href="#" style="border-width:medium;border-style:none;border-color:-moz-use-text-color;margin:0px;width:16px;bottom:0px;display:inline;white-space:nowrap;float:none;height:16px;vertical-align:middle;overflow:hidden;right:0px;top:0px;left:0px;"><img title="Call: (408) 835-8716" alt="" style="border-width:medium;border-style:none;border-color:-moz-use-text-color;margin:0px;width:16px;bottom:0px;display:inline;white-space:nowrap;float:none;height:16px;vertical-align:middle;overflow:hidden;right:0px;top:0px;left:0px;" /></a></span> or at </em><a title="Email Julie!" href="mailto:julie.cherry@careinnovations.com" target="_blank"><em>julie.cherry@careinnovations.com</em></a><em>. </em></div>
<span></span><span></span><span></span><span></span><span></span><span></span> | Two of the most impactful changes to a hospital’s bottom line—30-day readmission penalties and bundled payments covering the entire continuum of care—are significantly affected by what happens to patients when they leave the hospital. | 2013-10-01T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/1013/tech_thumb.jpg" style="BORDER:0px solid;" /> | Technology;Management;Quality Improvement | Column | 10 |
| Nominations Now Open For 20 To Watch 2014 | https://www.providermagazine.com/Issues/2013/Pages/1013/20-To-Watch-Nominations-Now-Open.aspx | Nominations Now Open For 20 To Watch 2014 | <p>It's time again to nominate someone for <span class="ms-rteForeColor-2"><strong><a href="/Monthly-Issue/2013/Pages/0113/Stars-In-Their-Own-Right.aspx">20 To Watch</a></strong></span>—the featu<img width="151" height="163" class="ms-rtePosition-2 ms-rteImage-1" src="/news/PublishingImages/20toWatch/20toWatch_2014.jpg" alt="" style="height:247px;margin:10px;width:266px;" />re that recognizes <br>committed, compassionate, and caring people in long term and post-acute care. </p>
<h2 class="ms-rteElement-H2" dir="ltr" style="text-align:left;"><strong>Recognize Someone You Know</strong></h2>
<p>Nominations are open! Help us identify men and women who have both the compassion and the vision to make a lasting impact on the profession. We want individuals who are the profession’s “up-and-comers”—those who are worthy of “watching.”</p>
<p>Nominees may include, but are not limited to, anyone who works in the profession, including those who work for supporting companies, such as suppliers, medical directors, or consultants.</p>
<h2 class="ms-rteElement-H2"><strong>How To Nominate</strong></h2>
<div>Send a message to Managing Editor Meg LaPorte at <a href="mailto:mlaporte@providermagazine.com">mlaporte@providermagazine.com</a> with the following information:</div>
<div> </div>
<div>1. The <strong>candidate’s name, title, company, and location</strong>.**</div>
<div> </div>
<div>2. A <strong>brief explanation</strong> of how the candidate has helped (or is currently helping) residents and/or staff achieve their potential.</div>
<div> </div>
<div>3. A <strong>statement </strong>about how the candidate has the potential to become a leader within the profession.</div>
<div> </div>
<div>4. A <strong>description </strong>of how the candidate has successfully implemented an innovative program that positively impacted residents and/or staff.<br></div>
<div>The honorees will be featured in the January, February, and March 2014 issues, and a page on <em>Provider's </em>website will be dedicated to them.<br> <br><strong class="ms-rteForeColor-2">Deadline for nominations: Nov. 14, 2013</strong></div>
<div><strong><font color="#ff0000"></font></strong> </div>
<div><div>Questions? Call Meg at <span class="baec5a81-e4d6-4674-97f3-e9220f0136c1" style="white-space:nowrap;">(202) 898-2845<a title="Call: (202) 898-2845" href="/news/Pages/0913/20.aspx#" style="overflow:hidden;border-top:medium none;height:16px;border-right:medium none;vertical-align:middle;white-space:nowrap;right:0px;border-bottom:medium none;float:none;left:0px;margin:0px;border-left:medium none;display:inline;top:0px;width:16px;bottom:0px;"><img title="Call: (202) 898-2845" alt="" style="overflow:hidden;border-top:medium none;height:16px;border-right:medium none;vertical-align:middle;white-space:nowrap;right:0px;border-bottom:medium none;float:none;left:0px;margin:0px;border-left:medium none;display:inline;top:0px;width:16px;bottom:0px;" /></a></span>. </div>
<div> </div>
<div><strong>**</strong>Please note that all nominees who are staff members at a nursing home or assisted living community must be working for a current AHCA or NCAL member.</div></div> | It's time again to nominate someone for 20 To Watch—the feature that recognizes committed, compassionate, and caring people in long term and post-acute care. | 2013-10-03T04:00:00Z | <img alt="" height="150" src="/Monthly-Issue/2013/PublishingImages/0213/20towatch2.jpg" width="150" style="BORDER:0px solid;" /> | 20 to Watch | Column | 10 |
| Percolating In Seattle | https://www.providermagazine.com/Issues/2013/Pages/1013/Percolating-In-Seattle.aspx | Percolating In Seattle | <p><br>Provider’s<em> </em><a target="_blank" href="/Monthly-Issue/2013/Pages/0113/Stars-In-Their-Own-Right.aspx"><font color="#0072bc"><em>20 To Watch </em></font></a><em>feature, first published in our January 2013 print issue, highlights some of the most caring, committed, and compassionate up-and-coming leaders in long term and post-acute care. </em><em>In order to bring further—and much deserving—attention to these individuals, we are posting discrete profiles of honorees on this site throughout the year. They include informative links and additional background on the individuals.</em></p>
<div><strong><img src="/Monthly-Issue/2013/PublishingImages/0113/KavanPeterson.jpg" class="ms-rtePosition-2 ms-rteImage-3" width="239" height="214" alt="" style="margin:15px;width:224px;height:201px;" /></strong></div>
<div class="ms-rteForeColor-2"><strong>Kavan Peterson </strong></div>
<div><strong>Creative Consultant, www.kavanpeterson.com </strong></div>
<div><strong>Editor, ChangingAging.org </strong></div>
<div><strong>Seattle</strong></div>
<div> </div>
<div>Rumor has it that Seattle is positioning itself to be among the most aging-friendly, dementia-friendly, and pro-aging cities in America, and Kavan Peterson, 2013 20 To Watch honoree and editor of <a target="_blank" href="http://www.changingaging.org/">ChangingAging.org</a>, is working hard to <a target="_blank" href="http://changingaging.org/blog/building-an-elder-friendly-future/">make that happen</a>. </div>
<div> </div>
<div>Having recently moved cross-country with his family, from Baltimore to Seattle, Peterson is already immersed in the city’s aging services community. In his new neighborhood, which is part of the national <a target="_blank" href="http://www.vtvnetwork.org/">Village to Village </a>movement, he has jumped in feet first as a volunteer and newly appointed member of their board of advisors. His goal is “to help shape the direction of the Village movement to become more intergenerationally engaging.”</div>
<div> </div>
<div>Peterson has also joined a newly founded (and Seattle-based) Alzheimer’s Services Coalition, working to launch “a groundbreaking initiative” aimed at making Seattle “the most dementia-inclusive city in America.” </div>
<div> </div>
<div>The coalition, which includes Seattle Parks and Recreation, the <a target="_blank" href="http://whf.org/">Washington Health Foundation</a>, <a href="http://www.phinneycenter.org/gsc/">Greenwood Senior Center</a>, <a target="_blank" href="http://www.elderwise.org/">Elderwise</a>, <a href="http://www.fulllifecare.org/">Full Life Care</a>, King County Senior Services, the Alzheimer's Association, ChangingAging.org, and others, is focused on “working with people living with dementia to empower them to create exponentially increasing opportunities for meaningful living and engagement,” Peterson says. </div>
<div> </div>
<div>“For too long the dementia story we’ve been telling ourselves has been one of loss, decline, isolation and shame,” Peterson said. “It’s time for a new dementia story, a story about living and growing and learning from the many strengths people living with dementia can offer, like living in the moment.” </div>
<div> </div>
<div>Peterson is helping launch the coalition’s website and support efforts to provide “meaningful experiences for people living with dementia as well as a full buy-in from businesses, museums, theaters, cafes, and community partners.” </div>
<div> </div>
<div>In addition to the many local enterprises, one of Peterson’s biggest projects is with <a href="http://www.ncbcapitalimpact.org/">NCB Capital Impact</a>, on a “comprehensive social media strategy covering their numerous projects, ranging from <a target="_blank" href="http://www.greenhouseproject.org/">The Green House Project</a> and the Village to Village Network, to charter schools and home-ownership programs.”</div>
<div> </div>
<div>Looking ahead, he says 2014 will be a big year for him as he works with Bill Thomas, MD, to launch his next book, “Second Wind: Navigating the Passage to a Slower, Deeper, and More Connected Life,” to be published in March by Simon & Schuster. </div>
<div> </div>
<div>Back in Washington, D.C., Peterson is also contributing to AARP’s latest initiative, the <a target="_blank" href="http://institute.lifereimagined.org/">Life Reimagined Institute</a>, where Thomas is a Senior Fellow and spokesperson. “The institute is tasked with providing thought leadership and innovation to create new programs, products, and services,” says Peterson. </div>
<div> </div>
<div>Rock on, Kavan, you’re in Seattle now—and there’s plenty of coffee.<img src="/Monthly-Issue/2013/PublishingImages/0213/20towatch2.jpg" class="ms-rteImage-1 ms-rtePosition-2" width="215" height="180" alt="" style="margin:5px;width:108px;height:90px;" /><br><br></div>
<div><strong>Do you know someone in long term care who is doing amazing things to help residents and/or staff? Click </strong><a target="_blank" href="/Monthly-Issue/2013/Pages/1013/20-To-Watch-Nominations-Now-Open.aspx"><strong><font color="#0072bc">HERE</font></strong></a><strong> to nominate him or her for the 2014 20 To Watch list. </strong></div>
<div><strong></strong> </div>
| Having recently moved cross-country to Seattle with his family, Kavan Peterson is already immersed in the city’s aging services community. | 2013-10-24T04:00:00Z | <img alt="" src="/Monthly-Issue/2013/PublishingImages/0113/KavanPeterson.jpg" style="BORDER:0px solid;" /> | 20 to Watch | Column | 10 |
| What’s Delayed…And What’s Not | https://www.providermagazine.com/Issues/2013/Pages/1013/What’s-Delayed…And-What’s-Not.aspx | What’s Delayed…And What’s Not | <p></p>
<div>The delay of ACA employer penalties, along with some of the law’s reporting requirements, was announced July 2 in the government blog, Treasury Notes. A week later the Internal Revenue Service (IRS) issued a formal notice of transition relief.</div>
<div> </div>
<div>Specifically, the delay affects annual reporting under sections 6055 and 6056 of the Internal Revenue code by large employers and other entities required to file certain information on employees and their health coverage.</div>
<div> </div>
<div>The delay gives the administration time to “simplify” reporting and “adapt health coverage and reporting systems,” said Mark Mazur, assistant secretary for tax policy, who wrote the Treasury Department’s announcement.</div>
<h2 class="ms-rteElement-H2">Penalties</h2>
<div>Penalties, or “employer-shared responsibility payments” in ACA parlance, were also delayed. Under the ACA, penalties are triggered when large employers fail to offer “affordable” and “minimum value” coverage to full-time workers and one or more of their employees applies to a Health Insurance Exchange and is deemed eligible for subsidized coverage. </div>
<div> </div>
<div>Since penalties are linked to the information provided by the delayed reports, it would be “impractical” to try to assess whether employers owed penalties in 2015 and in what amount, Mazur said. He urged businesses to voluntarily comply with both the reporting and health coverage requirements in 2014, even though they won’t pay penalties for failing to do so. </div>
<div> </div>
<div>Federal officials are making it clear that the delay is not a “pass to drop coverage,” says Ford Harrison's Tiffany Downs. While some employers are putting a hold on coverage expansions to avoid the cost, others are moving forward with ACA compliance so that if they experience “hiccups,” they “have a year to work it out before the penalty kicks in,” she says.</div>
<div> </div>
<div>While the impact of the delays on employer costs and decision making is significant, a multitude of other requirements remain on schedule and can’t be overlooked, experts say. </div>
<div> </div>
<div>“Employers should keep preparing for the implementation of other requirements,” says CLA’s Nicole Fallon.</div>
<h2 class="ms-rteElement-H2">Notifications Due</h2>
<div>Among the most immediate measures is the notification that all businesses must provide to every employee by Oct. 1, 2013, and to all new hires after that date. The notices must:</div>
<div><ul><li>Indicate whether or not employees will be offered coverage;</li>
<li>Provide contact information for the Health Insurance Exchange;</li>
<li>Describe services offered through the Health Insurance Exchange and the possibility that an employee may be eligible for insurance subsidies; and</li>
<li>Disclose the risk of losing employer contributions to health benefits when employees who are offered affordable, minimum value coverage through the workplace purchase it instead through the Exchange. </li></ul></div>
<div>The Department of Labor has posted two model notices on its website, at <a href="http://www.dol.gov/ebsa/healthreform/" target="_blank">www.dol.gov/ebsa/healthreform/</a>. One form is for businesses that offer coverage to full-time workers and one for those that do not. <br><br>Employers may use the model forms or create their own, as long as they include the requisite information, says Greenberg Traurig's Nancy Taylor. Either way, this is “an opportunity to educate staff about the benefits you’re offering or the benefits of the exchange,” she says.</div>
<p></p> | | | | | Column | 10 |