Governor names advocate for Kansans in long-term care facilities
Cruz named as advocate

      As part of her commitment to residents of long-term care facilities and
      Kansas seniors, Governor Kathleen Sebelius has appointed Gilbert Cruz, to
      serve as Acting State Long-Term Care Ombudsman.

      The State Long-Term Care Ombudsman advocates for residents of long-term
      care facilities across the state, and oversees the efforts of volunteer
      long-term ombudsmen.

      “Gilbert has experience working with Kansas seniors and their families
      through his work in long-term care and assisted living facilities,”
      Governor Sebelius said. “It’s essential Kansans have someone like Gilbert
      they can count on, someone who is on their side.”

      Cruz, Garden City, has eight years of experience as a long-term care
      facility administrator. Currently, he is the administrator of Terrace
      Gardens Care Center, a 60-bed skilled nursing facility specializing in
      long-term care.

      Since 2003, he has been the president and chief executive officer of Cruz
      Enterprises L.L.C., a health consulting and property management company.
      In addition, Cruz has been executive director at Homestead Assisted Living
      and administrator at Richmond Care Center. He is co-owner of Fiesta
      Courtyard L.L.C. in Garden City.

      Currently, Cruz is the vice-chair member of the Garden City Chamber of
      Commerce. He also served as a Kansas Health Care Association independent
      owners representative, was co-founder of the Indigent Transportation
      Program for Community Health Coalition, and founded the Coalition of
      Hispanic Organizations and Professionals.

      Cruz received his undergraduate degree from the University of Kansas
      Medical Center in respiratory therapy. In 1998, he received his master’s
      degree in public administration from the University of Missouri-Kansas
      City.
        

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  National Nursing Home Week --Event begins on May 14

National Nursing Home Week began in 1967, and we are gearing up to celebrate the 40th year recognizing the critical role that nursing homes play in the health care industry.  National Nursing Home week starts on Mother's  Day, May 14-20th, 2006.

AHCA's website has a planning and product catalogue (this was also mailed out to all facilities) on their National Nursing Home Week website at http://www.nnhw.org/. This has some new ideas on how to celebrate the occasion, as well as some community outreach tips. 

Staff will be attending as many member events as possible, so as you are planning, do not hesitate to contact Phyllis Gish at 785-267-6003 or pgish@khca.org  with your events so that we can begin planning the staff schedule.  If you have any questions or need any assistance on planning your event please contact KHCA.

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  Disaster Preparedness Tip of the Week

AHCA/NCAL's Life Safety and Disaster Planning Committee will bring you tips designed to help you prepare for all disasters.  TIP • In the event of an impending disaster, move all computer systems and hardware to a safe location such as an interior area in the facility to prevent damage from water or debris.  It's also a good idea to keep — offsite — a current inventory of hardware and software, related instructions (e.g., backup procedures), and a backup copy of critical data ("offsite" can mean your IT staff takes a backup copy home to place in a fire-proof safe that would be accessible if you lost data at the facility).  You also may want to maintain a list of equipment and software — include serial numbers, technical specifications, version numbers, licensing agreements, websites, and contact information for technical contractors/assistance. •

Tornadoes Remind Us of the Importance of Preparedness
When a string of tornadoes and violent weather ripped across Arkansas, Illininois, Iowa, Kentucky, Missouri, Ohio, and Tennessee earlier this week, we were reminded that natural disasters can happen at anytime.  AHCA is working to help long term care facilities prepare to meet challenges from weather-related or other types of emergencies.  Check out a few of our disaster preparedness resources like the ones below by going to www.ahcapublications.org

•  Disaster Planning Guide: A Resource Manual For Developing
   A Comprehensive Preparedness Plan
•  Disaster & Recovery Planning: A Guide for Facility Mangers
•  Dietary Disaster Plan
•  Fire Safety in Long Term Care Facilities

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  KHCA Nursing Advisory Committee Elects Executive Board

The Nursing Advisory Committee members held their annual meeting during the 14th Annual LTC Nurses Conference in Manhattan last week. Elections were held for the executive officers. The term is for two years and individuals are eligible for two consecutive terms. The member at large positions are elected during odd numbered years and the executive board is elected on even numbered years.

Executive Committee
President                      Judy Bagby  Medicalodges, Inc.
Vice President              Lucille Holderman Golden Heights Living Center Garnett
Secretary                       Amy Higgins  Medicalodge of Eureka
Treasurer                      Wilda Lemon  Medicalodge of Wichita

Members at Large include
Sharon Mulqueen         Lexington Park Nursing and Post Acute Topeka
Lydia Field                      Medicalodge of Atchison
Sheila Locke                  Highland Healthcare & Rehab Highland

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  Calling all Caring Hearts…

Deann Behring, Community Liason for Heart of America Hospice, fell ill while traveling in Paris with her daughter in March. She has been diagnosed with a malignant brain tumor. She is currently in back in Topeka at Kansas Rehab Hospital.

The road ahead for Deann is one full of uncertainty and great expense. Agroup to Topeka organizations are coordinating a Bar-B-Q fundraiser to keep with medical costs.

On Friday, April 21, 2006 from 10:00 – 2:00pm Manor Care Health Center 2515 SW Wanamaker Road will host the event. Call Tina Potter at 271-6808 for drive thru or delivery service.

Please call Heart of America Hospice at 785-228-0400 for other ways to help.

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  SAVE THE DATES

May 9, CNA Conference featuring Lori Porter

Topeka, Ramada Inn

June 13-15 KHCA Spring Conference Wichita Airport Hilton
June 13   Pre-Conference Day
        KHCA Board of Directors Meeting

June 14-15         Spring Conference
June 14   KHCA WCIT Annual Meeting

July 19-20 Joint Provider Training- Life Safety Code Issues

September 25           KHCA PAC golf
                                     Falcon Ridge Golf Course

September 26  Pre-Convention Education
                            KHCA Annual Meeting

September 27-28  56th Annual Convention and Trade Show
                                  Overland Park Convention Center

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  KHCA Workers Compensation Safe-Lift Program

The Kansas Health Care Association Workers' Compensation Insurance Trust and Thomas McGee L.C. are proud to announce the acceptance of the following facilities as SAFE-LIFT facilities.

This honor is granted to member locations that consistently provide a risk free environment for residents and staff and meet the stingent requirements of the SAFE-LIFT program.

As of April 12, the following facilities met the requirements.

Lexington Park Nursing and Post Acute Center, Topeka

Countryside Health Center, Topeka

Homestead of Lenexa Assisted Living, Lenexa

Homestead of Topeka Assisted Living, Topeka

Hilltop Lodge Nursing Center, Beloit

Brookside Retirement Community, Overbrook

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  Kansas Center for Assisted Living News

NCAL Releases 2006 State Regulatory Review
NCAL has released the 2006 edition of its annual Assisted Living State Regulatory Review. The 171-page report summarizes assisted living regulations across 20 categories in the 50 states and District of Columbia and is available free of charge. The report also includes phone numbers, e-mail addresses, and Web site information for state agencies that oversee assisted living regulation.

NCAL produces the annual Regulatory Review as a service to its members, policymakers, and the public.  It is widely used by assisted living professionals, policy makers, aging organizations, and consumers. 
“In 2005, assisted living regulations continued to evolve, in some states reflecting a trend toward rising resident acuity levels,” says Karl Polzer, senior policy director for NCAL and editor of the report. “While a few states overhauled their regulations, many implemented targeted reforms or made minor adjustments.”
Assisted living is regulated primarily at the state level.  While it can be difficult to identify national regulatory patterns due to wide variation in state regulatory approaches and market conditions, according to Polzer’s analysis, some of the regulatory trends in the past year include the following:

* Some states implemented or strengthened standards for facilities housing residents with Alzheimer’s disease or dementia. States also continued to increase training requirements for staff delivering care to this population.
* Several states added requirements for facilities to disclose information to prospective residents or increased disclosure requirements.
* A few states increased staff training requirements, resident assessment requirements, and made changes allowing facilities to admit residents with increased health care needs.
* States continued adding or refining Medicaid programs designed to serve low-income people in assisted living facilities.

Areas of state assisted living regulation covered in the 2006 review include licensure term, definition, scope of care, move-in/move-out criteria, requirements for resident assessments, Alzheimer’s unit requirements, Medicaid waiver policy, and requirements for medication management, physical plant, staff training, and disclosure.

An electronic copy of the report is available on the NCAL Web site at www.ncal.org/about/statsum.htm. 

To obtain a printed copy, call Martece Yates at (202) 898-2855 or send an e-mail to myates@ncal.org. Be sure to include your name, address, and phone number.

Extended Part D Transition Period Ends; CMS Warns Plans To Honor Appeals Procedures

With the extended transition period ending March 31 for millions of Part D enrollees, the Centers for Medicare & Medicaid Services (CMS) officials are concerned that the number of exceptions and appeals requests could rise significantly as prescription drug plans (PDPs) begin imposing pre-authorization requirements and trying to shift beneficiaries to preferred drugs on their formularies. 

To forestall possible problems, CMS officials last week warned PDPs and other Part D sponsors to follow appeals procedures and to make sure beneficiaries’ transitions to new drug regimens go smoothly.   

In a memorandum restating an earlier policy, CMS instructed Part D sponsors to continue supplying beneficiaries with the drugs their doctors prescribe them until the conclusion of exceptions and appeals procedures.  According to CMS:  “Until (a) transition is actually made . . .  either through a switch to an appropriate formulary drug, or resolution of an exception request, continuation of drug coverage is necessary, other than for drugs not covered under Medicare Part D.” 

CMS also told the PDPs: “We would expect that in situations where plans are unable to meet established timeframes for decision-making or forwarding cases or files to MAXIMUS [CMS’ Part D appeal contractor], affected enrollees should be given a temporary supply of the requested prescription drug (where not medically contraindicated) until the case is fully resolved or MAXIMUS issues a reconsideration decision.”  (The CMS memorandum can be found at www.ahca.org/members/finance/medicare/part_d/transitionappeals060330.pdf.)

CMS issued the warning to Part D plans after NCAL and AHCA staff brought it to CMS’ attention—both in weekly Part D teleconferences and in a face-to-face meeting with CMS Administrator Mark McClellan, M.D., and other top CMS officials last Wednesday—potential weaknesses in the Part D coverage and appeals process, including making sure that plans honor timeframes for processing coverage determinations and appeals. 

CMS also warned PDPs that it is monitoring whether they are adhering to the timeframes for processing exceptions and appeals and may sanction plans that do not.  CMS highlighted the following possible problem areas:

* Failure to meet the decision-making timeframes for coverage determinations or redeterminations.
* When these timeframes are not met, failure to forward these requests in a timely manner to CMS’ Part D appeal contractor (MAXIMUS).
* Extended delays in sending case files to the CMS appeals contractor when an enrollee requests a reconsideration of a plan’s decision.
 
“Where plan performance in these areas is interfering with enrollees’ rights to obtain the drugs they need on a timely basis, we will take prompt action,” the CMS memorandum stated. “That action could include imposing corrective action plans to achieve immediate improvements but also, when necessary, employing stronger sanctions, including civil monetary penalties.”  CMS also said that it did not anticipate the need for such sanctions as long as plans provide the recommended temporary supplies of prescription drugs to mitigate short-term difficulties with processing exceptions and appeals and take immediate action to implement any needed improvements in procedures.

Although the extended transition period ended last week, beneficiaries who enroll in a Medicare drug plan beginning in April will continue to have access to the original 30-day transition policy (90 days for beneficiaries in long-term care facilities).  Under the original transition policy, plans provided at least a 30-day supply of non-formulary drugs for people transitioning to Part D coverage, and a 90-day supply in long term care facilities.  After many implementation problems arose during the first month of the program, this policy was extended from 30 days to 90 days for any beneficiary that had enrolled effective Jan. 1, 2006, and to 60 days for beneficiaries enrolled effective Feb. 1.  Under the Part D program, assisted living/residential care facilities are not considered long term care facilities. 

General information on Part D coverage determination and appeals procedures, and the Part D grievance process can be found on NCAL’s Web site at        
http://www.ahca.org/members/assisted/part_d/index.htm.

CMS Begins Placing More Low-Income Medicare Beneficiaries In Part D Drug Plans

To ensure that certain Medicare beneficiaries with limited incomes and resources receive extra financial assistance available to them, the Centers for Medicare & Medicaid Services (CMS) has begun facilitating their enrollment in Medicare Part D prescription drug plans.  CMS has begun mailing letters to approximately 1.2 million people who are enrolled in other federal assistance programs such as Supplemental Security Income (SSI) and Medicare Savings Programs, as well as low-income beneficiaries who have applied for and been approved for the extra financial help.

The letters let the beneficiary know which Medicare prescription drug plan CMS will enroll them in if they take no action before April 30.  Unless they enrolled on their own during March, these beneficiaries will have their prescription drug coverage begin on May 1.  CMS is enrolling this group of beneficiaries one month earlier than planned to make sure that they receive the benefit of the extra help as soon as possible—and without having to pay a penalty for enrolling after May 15. 
These beneficiaries can still decline the enrollment before it becomes effective. 

CMS officials say that Part D is a good deal for many seniors, particularly those that qualify for low-income subsidies.  However, Part D coverage is not advantageous for everyone.  For example, many Medicare beneficiaries have existing drug coverage, usually from employers or unions that is as good as or better than Medicare Part D coverage.  Under the Medicare Part D program, drug coverage that is as good as or better than Part D’s standard benefit is called “creditable coverage.”  People with creditable coverage who lose it for some reason can sign up for a Medicare Part D plan after May 15 without paying the premium penalty (if they enroll within 63 days of losing their creditable coverage).

One reason beneficiaries assigned to Part D plans need to check whether they have existing coverage is that enrolling in a Part D plan can trigger the loss of existing drug or major medical coverage for both beneficiaries and their dependents who may rely on that coverage.  This is because some employers have said they will drop people from retiree drug or medical plans if they enroll or are auto-enrolled in a Part D plan.  In some cases, this might affect not only residents of assisted living and nursing facilities but also their community spouses and other family members.

All of the plans that qualify for the upcoming automatic enrollment process must meet Medicare’s standards for access to medically necessary drugs at a convenient local pharmacy.  Beneficiaries also have the option to change plans if they are unhappy with the plan into which CMS has placed them.  The letters make it clear to beneficiaries that they can choose a different approved plan in their area.  The facilitated enrollment letter will list all the prescription drug plans available in their region with premiums at or below the low-income premium subsidy amount.  It also recommends calling 1-800-MEDICARE to find out more about these plans. 

A fact sheet with more information about facilitated enrollment and copies of the facilitated enrollment letters is available on-line at http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1806. 

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  KCAL Leadership

Bev Blassingame President

Board Members

                   Ruth Channels
                   Rachel Storm
                   Marilyn Zieg
                   Jolene Klausman

District VP’s

 District 1 Joe Perkin
 District 2 Connie Everson
 District 3 Trish Schleicher
 District 4 Kathy Dieball
 District 5 Kim Flory/Kim Ludlum
 District 6 Vicki Frohling

 Past-President  Ed Schulte

Let us know if you would like the contact information for any of the KCAL Board Members.

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  New CMS Guidance, but not Related to any F-Tags

Psychosocial Severity Guidance is Released
The Centers for Medicare and Medicaid Services (CMS) has released the advance version of its new psychosocial severity guidance.  The guidance is not "tied" to any particular F-Tag or deficiency; the purpose of the guidance is to help surveyors determine the psychosocial effects on residents when there are findings of noncompliance.  The guidance presumes that all situations of noncompliance potentially cause psychosocial outcomes.

The following links provide more detailed information on this subject:
* Click below to view the American Health Care Association's summary of the guidance (3 pages). http://www.ahca.org/members/operate/survcert/survey/wu060331-1.htm

* Click here to view the CMS announcement of this guidance (2 pages).

* Click here to view the CMS changes to Appendix P (9 pages).

The CMS date of enforcement is June 1, 2006. 

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  Updated CMS Quality Measure Manual

Available for download online

The Quality Measures Resource Manual has recently been updated.  Click here and enter "Quality Measures Resource Manual" in the search box at the top of the webpage to view and download chapters from the manual.  This manual contains detailed information on the enhanced set of quality measures that are being implemented by the Centers for Medicare & Medicaid Services (CMS) as part of the Nursing Home Quality Initiative (NHQI).  The manual contains chapters on a variety of topics, such as risk adjustment, quality measures calculation, resident MDS assessment selection for measures calculation, pain, pressure sores, UTI, delirium, and more.

http://www.medqic.org/dcs/ContentServer?pagename=Medqic/MQPage/Homepage

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  New Citizenship Documentation Requirements for Medicaid Are on the Way

Deficit Reduction Act of 2005 implements new documentation requirements

States will no longer be able use self-declaration of citizenship to satisfy the citizenship requirement.  The provision is mandated and has a July 1, 2006 date for implementation.

DHS has not received guidance from the Centers for Medicare and Medicaid Services (CMS) on how to implement this provision.  Obviously, DHS has concerns about the mandate as this is clearly a new administrative burden that will be complicated by a Medicaid Applicant’s need for a birth certificate and/or photo identification to document citizenship.

According to the Kaiser Family Foundation, “the Congressional Budget Office estimates that this provision will result in a loss of coverage for 35,000 Medicaid enrollees.  Many low-income Americans do not have such documentation in their possession and may find their Medicaid coverage delayed or denied altogether while they attempt to obtain it from the state agency that maintains vital records.  Research consistently shows that increased documentation requirements are a barrier to Medicaid enrollment.”

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  Power Mobility Device Regulation and Payment Finalized

Final Federal Regulations in Effect June 2006

The Centers for Medicare & Medicaid Services (CMS) is issuing a final rule implementing provisions in the Medicare Modernization Act (MMA) affecting Power Mobility Devices (PMDs), which include power-operated vehicles (or scooters) and power wheelchairs.  This final rule finalizes payment and documentation policies established in an interim final rule published in August.  One change from the interim final rule is that this final rule gives physicians and treating practitioners 45 days, rather than 30 days, after the date of the face-to-face examination to provide pertinent parts of the medical record to the durable medical equipment (DME) supplier.
CMS will also pay physicians and other treating practitioners (a physician’s assistant, nurse practitioner, or clinical nurse specialist) an add-on payment for the work involved in compiling and transmitting the required documentation to the DME supplier.  This payment, which was authorized in the interim final rule, has been held in abeyance until April 1, 2006 by the fiscal year appropriations legislation, enacted by Congress last December.  This final rule is part of a comprehensive overhaul of Medicare policies affecting PMDs that encompasses coverage, prescribing, coding, payment, and claims documentation for these devices.  The goals are to ensure that beneficiaries who need assistance with mobility have access to appropriate technologies and that Medicare pays appropriately for these devices.

Specifics Of The Final Rule:
This final rule delineates the responsibilities of physicians and other treating practitioners, as well as suppliers of PMDs, to ensure that each beneficiary receives the type of power wheelchair or power scooter most suited to his or her needs.  It also implements the MMA provision eliminating a requirement that a power scooter could only be prescribed by a specialist in physical medicine, orthopedic surgery, neurology or rheumatology.  This new regulation will be effective sixty days from the date of publication in the Federal Register, or early June. (This final rule went on public display at the office of the Federal Register on March 31, 2006 for publication on April 5, 2006.)  This new process provides opportunities for a broader range of health professionals to be more actively involved in deciding whether a beneficiary needs a PMD, and, if so, the appropriate type of PMD.  It also gives physicians, other treating practitioners, and suppliers greater certainty regarding Medicare payment by providing more extensive guidance for how PMD claims can be supported with well-documented findings by physicians and other treating practitioners.

Further, the new process includes specific payments to physicians and other treating practitioners for providing documentation, and it eliminates the burden for physicians and other treating practitioners to provide potentially duplicative information on multiple forms.  In particular, the interim final rule announced the elimination of the need for a physician or other treating practitioner to complete and sign a Certificate of Medical Necessity (CMN) to accompany the order for a PMD.  CMS’ experience has been that the CMN did not work as well as originally hoped because it did not accurately reflect the contents in the medical record.  The beneficiary’s physician or treating practitioner is in the best position to evaluate and document the beneficiary’s clinical condition and medical needs, and good medical practice requires that this evaluation be adequately documented.  Thus, to minimize the documentation requirements for providers while assuring that documentation is adequate, physicians and treating practitioners will now submit copies of relevant existing documentation from the beneficiary’s medical record, rather than having to transcribe medical record information onto a CMN.

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  Register Now for the AHCA/ NCAL Congressional Briefing

Event takes place June 27-29

AHCA/NCAL’s Congressional Briefing will be held in Washington, DC June 27-29.  The Congressional Briefing not only provides the educational sessions you need to stay abreast of long-term care legislative issues pending at the federal level, but also the opportunity to meet with your senators and representatives to discuss your concerns and propose solutions.  Do not miss this opportunity to network with your peers and acquire the knowledge you need to successfully impact Congress on the most compelling issues facing our profession.

Tuesday, June 27, begins with a welcoming reception at the Marriott Crystal Gateway in Arlington, Virginia.  On Wednesday morning, June 28, you will promptly commence to the Briefing Session.  AHCA will arm you with talking points, lobbying tips and information.

You are encouraged to register and make your lodging arrangements now.  AHCA/NCAL has negotiated discounted room rates at the Marriott Crystal Gateway in Arlington, Virginia, just minutes from Washington, DC.  The hotel offers a complimentary shuttle to and from Reagan National Airport and on-site access to Washington’s Metro rail system.  It is also within walking distance of many fine restaurants and terrific shops.  Space is limited, so make your reservations early!

The registration and hotel deadline for the conference is Tuesday, June 6, which will be here soon.  To register, please click on the following link:  http://www.ahca.org/events/cb.html.  For more information, feel free to contact AHCA’s registration office at meetings@ahca.org.

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  New Sales Associates

Penner Patient Care is a leading provider of bathing systems to the healthcare industry for
25 years.  The Cascade Spa, side-entry system with optional Reservoir and Transfer.  The Cascade
Bariatric Spa, designed for the larger resident.  The Pacific Spa, a height adjustable recumbent
system with Stretcher and Chair.  The Superior, a time-tested concept.  All are proudly made in
the USA.

Penner Patient Care
PO BOx 523
Aurora, NE 68818

800-732-0717

Please contact us at sales@pennercareinc.com

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  Accu-Med Services

 
Accu-Med Services’ wide stable of products includes: clinical, financial and enterprise software, bedside MDS, pharmacy order entry, therapy management, quality/outcomes tools and management portals.

Accu-Med Services, Inc.
300 TechneCenter Drive, Suite A
Milford, OH  45150
Phone: (800) 777-9141 Fax: (513) 831-1370
Web sites: www.accu-med.com
      www.pro-tracking.com

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  Coastal Administrative Services

Please Help us welcome the Newest KHCA Sales Associate Member: 

            Coastal Administrative Services, LLC
            10210 Highland Manor Drive, Suite 250
            Tampa, FL  33610

            Jim Culp
            Vice President of Reimbursement

            (813) 744-2827 – Office
            (813) 744-2805 – Fax

            jculp@coastaladm.com

Coastal Administrative Services, LLC provides an array of back office and other support services to skilled nursing facilities and other companies.  Our services are designed to help facilities effectively operate in the continually changing environment of post-acute and long-term care.  Coastal’s team of professionals provides expertise in the areas of information technology, finance and accounting, employee payroll and benefits, accounts payable, regulatory affairs, risk and insurance, reimbursement, treasury and communications.

The Company currently provides services to 127 facilities located in 17 states and the District of Columbia.

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  Updates
By Kathy Achor, CMS

Fire Marshal Updates…

Sprinkling of Freezers

If a building is required to be sprinklered by virtue of the construction type, then it is to be completely sprinklered. Complete means all spaces will be covered, regardless of size.  2000 NFPA 101, Table 19.1.6.2

Fire Alarm strobe synchronization

It is not required that existing systems have the strobes synched, unless they have replaced the alarm system - then they will need to comply with new requirements. 2000 NFPA 101, 9.6.3.6
Notification signals for occupants to evacuate shall be by audible and visible signals in accordance with NFPA 72, National Fire Alarm Code, and CABO/ANSI A117.1, American National Standard for Accessible and Usable Buildings and Facilities, or other means of notification acceptable to the authority having jurisdiction shall be provided.
Exception No. 1:  Areas not subject to occupancy by persons who are hearing impaired shall not be required to comply with the provisions for visible signals.
Exception No. 2:  Visible-only signals shall be provided where specifically permitted in health care occupancies in accordance with the provisions of Chapters 18 and 19.
Exception No. 3:  Existing alarm systems shall not be required to comply with the provision for visible signals.

Alcohol Based Hand Rubs - Foam canisters
 
ABHR – Foam                                            
Alcohol gels are okay so long as they meet the requirements in the Code (per the TIA). Liquids are okay in pump bottles, so long as they meet the requirements for amounts and distances in the Code. Foam based or aerosol sprays (under pressure) are not acceptable. JCAHO is currently enforcing this restriction as well.
The requirements from the corrected version of the June 9, 2005 S&C letter 05-33:
Installation:
* Where ABHR dispensers are installed in a corridor, the corridor shall have a minimum width of 6 ft (1.8m).
 
* The maximum individual dispenser fluid capacity shall be: 
 

      0.3 gallons (1.2 liters) for dispensers in rooms, corridors, and areas open to corridors. 
      0.5 gallons (2.0 liters) for dispensers in suites of rooms.
* The dispensers shall have a minimum horizontal spacing of 4 ft (1.2m) from each other.
 
Not more than an aggregate 10 gallons (37.8 liters) of ABHR solution shall be in use in a single smoke compartment outside of a storage cabinet.

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  Terrace Garden Care Center, Garden City

 
Nursing Home Administrator: Vetter Health Services is looking for an enthusiastic motivated individual to serve as an Administrator for a 60-bed facility in Garden City Kansas. This position is responsible for the day-to -day operations of the facility. The duties of this position will be performed in accordance with current federal and state regulations. The successful candidate must have a State of Kansas Nursing Home Administrator's license, a Bachelor's degree and at least three years successful administrative experience in a skilled nursing facility. Interested applicants should e-mail/mail a resume with cover letter and salary requirements to: Robyn O'Driscoll Vetter Health Services,5020 South 118th Street, Omaha,Ne 68137, rodriscoll@vhsmail.com.

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