Associations Announce Joint Effort to Improve Survey and Enforcement

The Kansas Health Care Association, The Kansas Association of Homes and Services for the Aging, and the Kansas Adult Care Home Executives all support strong, outcomes-focused regulatory oversight as one important means to protect Kansans who reside in long-term care facilities. At the same time we believe that the current long-term care survey and enforcement system all too often pits regulators and providers against each other in an adversarial, punishment-focused rather than quality improvement focused process. Over the next year we will work together to gather and analyze information and to advocate for improvements in the long-term care survey and enforcement process.

Information Gathering and Analysis

The associations will:

1. Implement a process to identify surveyor conduct patterns that is user-friendly and
protects provider anonymity. This information will be shared with KDOA-KDHE to
incorporate into their internal quality improvement activities.

2. Collect and provide examples of G+ deficiencies that do not rise to actual harm in a real sense to CMS Region VII for analysis and follow up.

3. Analyze survey results for key finding patterns within specific F-tags, regional and other differences and for advocacy and member education efforts.

4. Implement a system to quantify the impact of Denial of Payment for New Admissions on elders, communities and providers.

5. Analyze Informal Dispute Resolution participation and disposition, and solicit feedback from panelist and providers about their experiences and recommendations for
improvement in the process.

Advocacy

The associations will work together to advocate for:

1. A third party post-survey provider feedback process to identify issues that need to be
addressed by KDOA and KDHE quality improvement systems.

2. Revise the state enforcement protocol so that H rather than G is the threshold for
automatic Denial of Payment for New Admissions.

3. KDHE long-term care facility surveyor participation in joint provider-surveyor trainings and KDOA surveyor conferences.

4. Explore options and advocate for modifications in structure and or administration of the informal dispute resolution process.

5. Advocate for passage of HR 3437 with our members of Congress.

Representing KHCA are Tim Allin, Resident Satisfaction Chair and KHCA staff.

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  Health Survey Trends 2006

According to the KDOA Licensure, Certification & Evaluation Commission, the first three quarters of CY 2006 present a changing picture of deficiency trends. Compared to CY 2005 as a whole and to the 6 year average of 2000-2006, the combined period shows an even blend of positive and negative trends. However when the current period is broken down into quarters, most of the trends become positive.

(Resurvey Data charts) In the first three quarters of CY 2006 there were 270 resurveys conducted of which 94 were G+. This cumulative rate of 34.8% was down slightly from the 35.5% rate for CY 2005 but was somewhat above the 6 year average of 32.1 %. The third quarter rate of 26% was moderately down from the second quarter rate of 33% and substantially down from the 46% rate of the first quarter being the best rate of the last four quarters.

(Deficiency Data charts) During the period, 7.4% of all deficiencies were G+, slightly lower than in 2005 and moderately below the 6 year CY 2000 -- CY 2005 rate of 8.7%. The average number of G+ deficiencies per resurvey was .73 slightly higher than the rates for 2005 (.68) and the 2000-2005 period (.66). The number of all deficiencies per survey was 9.8, up 1.0 deficiency per survey from CY 2005 and up 2.2 deficiencies from the 6 year average. The 3rd quarter of this period however showed improvement from the 2nd quarter in all 3 of these measures similar to the improvements that the second quarter showed over the first. The third quarter rates were the best of the last four quarters.

(N0TC Data charts) Data regarding Double G facilities continues to be drawn from CMS' pilot PDQ reporting system. During the period, 68 facilities were in Double G status which surpasses the entire yearly total for CY 2004 (57). Nine of the 68 facilities were in Double G status more than once during the period. The Double G rate for the third quarter of this period was about half of the rate of the 1st quarter.

(Zero Deficiency charts) 'There were 11 zero deficiency resurveys during the period which is a rate of 4.1 %. This rate is the lowest so far during the CY 2000 - CY 2005 period being about 40% below the 6 year average rate of 9.7%. The third quarter rate of 5.7% was considerably above the 2.2% rate for the 2nd quarter and tied for highest among the last 4 quarters.

Resident Satisfaction and KHCA staff look at this same information: zero deficiencies, total number of deficiencies, number cited at A-F, and number cited at G+ by survey region by quarter.  Click on the following links to view this summary information. 1st quarter 2006, 2nd quarter 2006, 3rd quarter 2006.

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  Resident Satisfaction Committee Meeting

The next Resident Satisfaction Committee meeting is scheduled for November 21, 2006 at 10am.  Agenda items for discussion include 2006 health survey deficiencies and informal dispute resolution.  New members are welcome.  Please contact Nancy at npierce@khca.org for more information.

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  Informal Dispute Resolution Update

Click on each of these links to view information on the informal dispute resolution panel, process, current numbers, and statute.

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  Year 3 Summary of the Kansas Nursing Facility Project

The Kansas Department on Aging has released Year 3 of the Kansas Nursing Facility Project.  This report is the final report for this project.  To view the entire report click on the following link at www.nursingoutcomes.org/knfp.htm.  Click here to view a summary of the report.

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  KHCA Online Registration

Remember to use the online registration found on the KHCA website at www.khca.org.

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  A Punchlist for Smart Pre-Retirement Planning
David Landwehr

I am an expert in Long Term Care (LTC) Planning, and LTC insurance. I work with the Wichita Independent Business Association WIBA, the Kansas Health Care Association KHCA, the Community Bankers Association and other associations as their long term care insurance specialist. My monthly LTC E-lert provides entertaining, timely, short articles on the subject of LTC planning – of interest to your baby boomer members and their parents.

My wife and I have experienced firsthand the stresses of long-term care. My mother-in-law lived with us for the last 4 ½ years of her life, enduring 29 surgical operations before she passed away. You are welcome to use the free LTC Elerts to educate your members. If you would like to investigate providing a discount for your members and their families or sponsor an Educational Seminar, please call 316-945-2011 or contact us at DLandwehr@LTCareSolutions.com www.LTCareSolutions.com educational website. *Designations held: CSA is Certified Senior Advisor, CLTC is Certified in Long Term Care

It has been said that no one plans to fail, but most people fail to plan. This is certainly true when considering financial and insurance planning for retirement. A recent report published by the Library of Congress included this shocking statistic: for 40% of elderly recipients, Social Security contributes more than 90% of their income, and for one-quarter of recipients, it is their only source of income.

Statistics like this steel the resolve of those Americans who do take retirement planning seriously. However, planners need to know that in addition to saving and investing for retirement, there are other important steps that are critical to successful aging. Dubbed 6 by 60, these steps were outlined by author and speaker Marilee Driscoll on Comcast Cable’s Money Matters Today show September 28. It’s best to check off these items by age 60, but if you’re already 60+, this is your wake- up call!

1. Find a trustworthy financial advisor (in addition to a lawyer) who knows your situation, your future plans, and what is and isn’t important to you. This is important even for married couples, especially those who do not share equal interest in financial matters.
2. Simplify your finances. You don’t need your money in five different mutual fund companies, for example. You don’t need to carry six credit cards. Simplicity makes everything easier as you age.
3. Know your Plan B for LTC. If you need long term care in the future, what will that care look like, and how will you pay for it? Many of the most attractive options are private pay only. Look into purchasing long term care insurance. This is the only insurance designed to cover home-based or facility-based care. Protect your independence, dignity, and nest egg with this insurance.
4. Advance Care Directives. Do you want extraordinary treatments done if you are unable to communicate your wishes? Without a valid advance care directive (usually a health care proxy), it can be very difficult to have your care wishes fulfilled. Inquire at your doctor’s office, lawyer’s office or even your hospital for information and valid forms.
5. Distribution Planning – double check the titling of all your assets, and the beneficiaries on all your insurance policies and accounts (including qualified retirement plans and IRAs). Many assets are passed along to stated beneficiaries, regardless of what your will states. Make sure that you have a valid will, and with HIPPA privacy laws consider a durable power of attorney, which authorizes someone to act on your behalf if you are mentally incapacitated. Estate planning sounds like something that’s only for rich people, but it is for everyone.
6. De-clutter! Many people downsize in retirement, and some want to but are overwhelmed with an abundance of stuff. Down the road, it has to go somewhere! Who will get your prized possessions? Consider giving cherished items to your loved ones now, when you can explain their value and hear their thanks. Have valuables that you are keeping appraised so that relatives don’t sell valuable items at a tag sale.
   

LT Care Solutions, Inc. specializes in LTC planning for both companies and individuals since 1992. We believe that dabbling is dangerous and LTC is an important decision best made in consultation with an experienced advisor.
Website: http://www.LTCareSolutions.com
LT Care Solutions
David Landwehr CSA, CLTC
President
email: dlandwehr@ltcaresolutions.com
phone: 316-945-2011

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  2006 Tradeshow Pictures

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  Household Matters Toolkit

Through funding of the Commonwealth Fund, Sunflower Foundation and the Kansas Department on Aging, Meadowlark Hills has worked with Action Pact, Inc. to create an integrated toolkit of materials and systems for use by long-term care providers (and others) with a stake in transforming the culture of long-term care in a sustainable fashion.  The developers have generously given the toolkit to the Pioneer Network to distribute, with all proceeds going to further our unique mission as a non-profit organization dedicated to serving the culture change movement.

There are several potential audiences for the toolkit, the principle ones being organizations such as nursing homes and assisted living facilities.
In addition, the toolkit of products will greatly benefit consultants in long-term care, enabling them to enhance their services and effectiveness in helping organizations reshape themselves.

The toolkit has four major parts:

1) In Pursuit of the Sunbeam - A Practical Guide to Transform Institution to
Home: A leadership book by Steve Shields & LaVrene Norton that assists providers by providing a change framework based on the Norton/Shields Change
Matrix: Self, Leadership, Organizational and Environmental Transformation.

2) Daybreak - Creating Home: A set of policies and procedures shaped for household life.

3) Midday - Living & Working in Harmony: An integrated human resource system that reflects the values of the new model.

4) Evensong - Reflecting on Quality: A system of team-based continuous quality improvement.

Taken together, the toolkit's components provide an explicit roadmap for how an organization can shape itself to become a resident-directed service model with a well trained, empowered, and satisfied workforce.  It's really a one of a kind resource, and we are very excited at the prospect of reaching those decision-makers who can put these tools into practice and help us transform the world of long-term care.  Order yours today!

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  LTC Survey Manual June 2006 Update

Copies of the June 2006 LTC Survey update were mailed this week to the attention of your state executive. Please update your binders! AHCA will continue to provide each state affiliate with an update as we make the various changes released by CMS.

A product order form for the LTC Survey is also attached to the email. No facility should be without this manual so please help AHCA get the word out regarding the NEW June 2006 edition.

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  "FIRE" SALE

Disasters Can Happen At Any Time.
Have You Developed Your Emergency Plan?
Hurricanes, tornadoes and fires are natural disasters that can happen at any time. Make sure your facility has a plan to respond to natural and other types of disasters. The American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) offer several resources that can assist you and your staff in preparing emergency action plans.

Disaster Planning Guide: A Resource Manual For Developing A Comprehensive Preparedness Plan
This manual was developed as a reference tool to assist in the development and implementation of a disaster procedure and an emergency operations plan for your facility. It also contains information on disaster plans, with or without evacuation; transportation; housing; insurance; finance; and legal and legislative issues. Order your copy toady from KHCA/KCAL by downloading the order form or you may contact kendra Poole at 785-267-6003, kpoole@khca.org.

Member Price:
$67.50 + tax & S/H

Non - Member Price:
$90.00+ tax & S/H

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  Book Order Form

Click here for KHCA's book order form.

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  Nursing Home Quality Campaign

Advancing Excellence materials continue to be developed.  Be sure to visit the Campaign’s Web site (http://www.nhqualitycampaign.com/) frequently as new material is posted weekly.  AHCA staff is working on a “Toolkit” similar to ones AHCA produced to launch NHQI (2002) and the enhanced NHQI quality measures (2004).  Below is an outline of the Toolkit, which will include a power point presentation.  If you have a suggestion(s) on an item that should be included in the Advancing Excellence Toolkit, please let me know.  For now, here is the outline:

I.  Description of the major national quality initiatives – Quality First, National Nursing Home Quality Initiative, Culture Change
II. Advancing Excellence Campaign
o How & why it was developed
o Describe and explain the eight goals and the measures for each goal
o What is a LANE and how to participate
o Role of consumers
o Ideas for states
o Talking points on the goals and measures
o Sample media release to announce participation
o General tips for the facility on how to promote Advancing Excellence

If you have any questions, please contact Cindy Luxem, cluxem@khca.org.

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  CMS Guidelines for Surveyors Using Photography During Surveys

The use of photography during the survey process is not required by the Centers for Medicare & Medicaid Services (CMS) although State Survey Agencies may choose to do so CMS recently provided State Agencies with basic principles to assist states if they do use photographic evidence. A brief summary of the principles follows.

* The camera and film used must be sole property of the State
* The State Agency should develop guidance for using photography during the survey process and train staff in the proper use of the camera.
* Photographs can be used as a tool to supplement written documentation, to assure accurate and effective records of observations made during surveys, with the intent to produce photographs that are relevant to possible deficiencies.
* Photographs cannot stand alone without written documentation.
* Photographs should not be included as part of the Form CMS-2567
* Photographs should not be referenced in the statement of deficiencies, only in surveyor notes.

The surveyor must request the resident/patient/client's or hislher surrogate's written permission prior to photographing himlher.

There should be a complete series of photographs - at least three providing an overview, a mid-range and a close-up.  Photographs are to be handled with as much confidentiality as a medical record An original photograph must not be modified The memorandum (PDF. opens in new window) provides additional information.  Contact Lyn Bentley at AHCA for more information. Ibentley@ahca.org

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