arnold tapped as ahca secretary

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Arnold tapped as AHCA Secretary

In October, Governor Charlie Crist appointed Thomas W. Arnold as Secretary of the Agency for Health Care Administration (AHCA) after Holly Benson stepped down to pursue her candidacy for Florida’s Attorney General. As Secretary, Arnold oversees the operations of the Florida Medicaid Program, the Division of Health Quality Assurance and the Florida Center for Health Information and Policy Analysis, along with managing an $18 billion budget. Prior to his appointment as Secretary, Arnold served as Chief of Staff and Deputy Secretary for Medicaid, overseeing the country’s fourth largest Medicaid program.

Update

FHCAFLORIDA HEALTH CARE ASSOCIATION

DECEMBER 2009Florida Health Care AssociationP.O. Box 1459Tallahassee, FL 32302-1459

PRESRT STDU.S. POSTAGE

PAIDTallahassee, FL

Permit No. 1007

A Long Term Care Monitor of Nursing Home and Assisted Living Issues

InsideProtecting Florida’s Most Vulnerable Citizens .............................................. 8

Respirators and Surgical Masks in H1N1 Protection ........................... 9

Visiting a Step III QualityAward Winner ................................. 10

Five Star Rating System Staffing Measures ......................................... 16

continued on page 21continued on page 6

In November, 14 FHCA members selected for their exceptional commitment to leadership gathered in Orlando to begin the 2010 Florida Health Care Association Florida Leaders program. The session kicked off a year-long program that offers training and guidance for long term care professionals who have demonstrated leadership potential and an aptitude for representing the interests of the profession and the residents served within Florida’s long term care community. The program covered the latest theories in effective leadership and strategic planning, a spokespersons training and group discussions surrounding quality management, customer satisfaction and other current trends impacting long term care.

“By participating in this program, members of our 2010 Florida Leaders class will be better prepared to serve vital roles within the Association and on behalf of the entire profession,” commented FHCA President Deborah Franklin. “By honing their knowledge and leadership skills,” continued Franklin, “these future leaders will surely help to advance quality and promote the goal of providing the highest quality, resident-centered care for frail elders and people with disabilities in Florida.”

An Associate Member’s Perspective on Grassroots

FHCA kicks off 2010 Florida Leaders Program

FHCA December 2009 Pulse 3

FROM the PRESIDENT

by Deborah Franklin

FHCA President

Deborah Franklin,President

J. Emmett Reed, CAE,Executive Director

Nina Willingham,Senior Vice President

Scott Bell,Secretary

Scott Allen, Treasurer

Joe Mitchell, Member At Large

FHCA PulseDecember 2009

FHCA Pulse is a monthly publication of the Florida Health Care Association, P.O. Box 1459, Tallahassee, FL 32302-1459. To contact FHCA, call (850) 224-3907.Editorial – To submit information, guest articles, press releases, etc., contact Kristen Knapp, APR, Director of Communications, at (850) 224-3907 or via e-mail [email protected]. Fax information to (850) 681-2075 and include your name, telephone number and e-mail address. Advertising – For information on Pulse advertising rates and availabilities, contact Ian Cordes at Corecare Associates at (561) 659-5581 or via e-mail at [email protected] articles and advertising are subject to editorial review.

A new beginning. . .with the end in mind

I have always believed that the role of association board members should be to lead the organization. They must continuously evaluate all that the organization does and examine how the organization does it. Planning is fundamental to success—always has been and always will be.

For the last year of my term, I have spent time communicating with members about what they perceive as the value of their membership in the Florida Health Care Association. From those responses, it became clear that it was necessary to reinvent what we do—to realign ourselves toward meeting true market needs and toward our real purpose of promoting the interests of our members.

In July, I convened a strategic thinking group which represented FHCA Board members, nursing home owners, a nonmember and our executive director. This group of volunteers worked intensely over two days to assess our strengths and weaknesses, challenges and opportunities. It became clear that FHCA must be visionary if we are going to move forward and continue to succeed.

The Florida Health Care Association does not simply exist to “associate.” We exist to promote the interests of our members, and those member dynamics, as well as their needs, are constantly evolving. Simply “bringing people together” -which, coincidentally enough, is basically what meetings and newsletters and trade shows do - is what most associations have become. But this is not why FHCA was founded and not how we will exist in the future.

A plan in placeThat became evident when FHCA’s Board of Directors convened last month to build upon

the work of the strategic thinking group. Armed with the original planning document, input from Association staff and valuable feedback that you, the member, provided me throughout this process, we dug deep and created and APPROVED Florida Health Care Association’s 2010 Strategic Plan. We address strategic goals in four major areas: Member Benefits and Services, Leadership and Public Image, Proactive Legislative and Regulatory Advocacy, and Financial Growth and Stability of the Association.

What was exciting in this final process was the fact that this planning session also included members of the 2010 class of FHCA’s Florida Leaders. These individuals represented members who are already involved in a leadership role – some district presidents and committee chairs – and others who aspire to be leaders but have not yet taken that next step. Collectively, the planning session was an excellent representation of owners, administrators, front-line caregivers and staff members helping to build this impressive final document.

The plan revamps the Association’s Mission Statement:

Our mission is to advance the quality of services, image, professional development and financial stability of our members

As well as our Vision Statement:

To be recognized as the national leader in shaping health care

The plan also requires FHCA to look beyond the obvious to find ways to make our members thrive. It begins with the end in mind and may involve completely different products, completely different services, completely different membership models—or even business models—than any other association offers. It also includes an accountability feature, so we can track not just how we’re doing what we’re doing, but who is taking ownership to ensure that the goals that we have developed are met.

It would be much easier to face the revolutions and evolutions of our profession and the environment in the same way as we have always done. But that’s not how the world really works, though it’s tempting to pretend that it is. We could have continued operating business as usual at FHCA and achieved a standard level of comfort, even competence, on behalf of our members. But we would never truly have the chance for that seat at the table to shape how the nation views the long term care continuum as a significant piece of the health care system, which is what we envision for ourselves. With a plan now in place and the passion behind it, I believe we are finally well on our way.

FHCA December 2009 Pulse4

by J. Emmett Reed, CAE

FHCA Executive Director

FROM THE DIRECTOR’S DESK

FHCA Web SiteEmergency Preparedness • Legislative • Membership Press Center

Quality Improvement • Regulatory Reimbursement • Seminars/Events

www.fhca.org

‘Tis the season

Educating your lawmakers is a gift that will keep on giving

The holiday season is upon us, and with that, brings numerous celebrations in nursing homes throughout the state.

One gift that you could give your residents is to invite your local legislator to tour your facility.

“How is that a gift,” you ask?

For starters, nursing home residents will feel the brunt of historic cuts to providers if the federal cuts contained in health care reform (over $23 billion contained in the U.S. House and over $14 billion in the U.S. Senate) and state cuts (over $281 million presented to the Florida Legislature by the Agency for Health Care Administration during recent committee meetings) are implemented. It appears that the question is not “will there be cuts?” but rather, “how deep will these cuts be?”

Like it or not, the news media has done a poor job of touting the virtues of nursing homes. Headlines like “Sally Smith Loves Nursing Home Activity Center” or “Billy Jones Rehabbed and Back Home from Nursing Home in 20 Days” just do not sell newspapers. We are saddled with the few and far between bad apples that spoil the public’s view, and in some cases, legislators’ views of the quality care and services Florida’s long term care facilities provide.

It is no doubt that nursing homes get a bad rap. There are so many high quality

facilities in Florida, with loving, caring staff. It is imperative for your lawmaker to see that, and it is our responsibility as professionals to ensure that it happens – no one else will spread our message for us.

I am convinced that if a legislator tours a facility in his or her district, that lawmaker will leave with a positive perception of the care your residents receive.

Make it personalHosting a legislator turns the term

“nursing home” into more than just a building – they see faces of and recall stories about your residents and staff, so that when they are voting on legislation that affects you, they will remember the resident, CNA, DON, etc. and not some salacious headline-grabbing hatchet job.

The visit will also open the door to a much more comfortable experience when you travel to Tallahassee for FHCA’s Lobby Wednesdays, which begin in February. It will give your legislator a reference point of discussion, and I bet it will make you more comfortable when you meet them on their turf.

Setting up a visit is as easy as calling Peggy Rigsby or Teresa Hamlin of our staff. We already have the dates set for our 2010 Lobby Wednesdays, which you can read more about on page 7. FHCA covers the cost of your hotel room on Tuesday evening and arms you with the information

and resources you need to have a successful visit.

FHCA District VIII President and Hawthorne Health and Rehab of Ocala administrator David Minnici has capitalized on building relationships with his legislators throughout the year and understands the value of what those facility tours can do to open doors when he needs to speak with his lawmakers when the issues are on the line. “Touring a legislator is no different than touring family members for a prospective resident,” David said. “You want them to see the many quality services you have to offer, build a relationship that you can continue throughout the year and let them know you are a resource to them on long term care issues. The contacts I make over the summer make it so much easier when I head to Tallahassee in March, when my Representative is hearing from so many other folks on an abundance of topics. He remembers me and has a much stronger understanding of the work I do in caring for my residents. It definitely makes a difference.”

Don’t sit idle and assume someone else from the Association will get the job done. Be proactive and build those relationships with your legislators today to ensure your message is heard when it counts in the months ahead.


LTC LEGAL ISSUES and TRENDS by Karen Goldsmith

Goldsmith &, Grout, PA

FHCA Legal Consultant

Investigating sexual abuse in the long term care setting

continued on page 18

With the exploding population of the elderly and their increasing use of drugs like Viagra, sexual abuse in the nursing home has reached new levels.

Background screening of more employees may help. Most likely, this scope of screening will become law in the near future. But with more sexual abuse being seen in the long term care setting, it seems that resident-to-resident abuse is much more likely to occur than employee-to-resident abuse.

Illegal sexual activity may take many forms. It may be inappropriate touching, or it may be actual rape. It may be playful banter, or it may be outright inappropriate comments.

Protecting the residentResidents have the right to be free from

any type of abuse. Policies and procedures are required by law. While the scope of those policies and procedures is within your discretion, certain issues should be addressed, or at least considered, in all facilities.

Sexual abuse may take a form other than touching. Verbal sexual abuse is also not permitted, and residents should be protected from it, whether the abuse comes from employees or other residents. Watch for inappropriate comments in the guise of humor. A resident may take offense and has the right not to be subjected to such comments.

Sexual touching without a person’s permission is often a crime, but always inappropriate. No resident should fear being touched or feel the threat of being touched by another. And remember, the offense need not cross genders.

If a resident objects to receiving care from a staff member, take the resident seriously. If you get more than one complaint about an individual, be sure to look closely at that employee and his/her behavior. The person may not even be aware that his/her behavior is offensive, having acted in a certain way for a number of years with no complaints. Oftentimes, it is enough for the

individual to be told that his/her comments are offensive or that the particular way he/she is handling a resident makes that resident uncomfortable. Changing caregivers may be worth the effort if the ramifications are significant to the resident or the facility.

Sexual touching may take a number of forms, from casually brushing a person’s breast to actually touching sexual organs. If a person objects, than that person must be protected. Individuals that lack the mental capacity to consent to sexual activity must always be protected.

Any allegation must be investigated

The case law is clear that any allegation of sexual abuse must be investigated, and the residents (and others) must be protected. No matter how absurd the allegation, it must be considered reasonably truthful to be in compliance with the law.

We once represented a facility in which a resident, whose room was close to the nurses station, claimed to have been raped. Given all of the factors, including staff on the floor, time of night, the resident’s appearance, etc., staff believed that the resident had just had a bad dream. While they did investigate the incident, it was not until the next day when a complete investigation occurred. They were cited at a high scope and severity.

If a resident complains, there are a few things you should do immediately. Of course, the scope of the steps you take will depend on the circumstances and what you discover as you go through your investigation.

You must protect that resident and all others. If the resident is a woman and claims to have been raped by a man, it would be best if male staff did not approach female residents without the presence of a female staff person. Even better, take the male staff people off the female wing and have them care for male residents until cleared from suspicion.

Identify possible perpetratorsEven if the resident believes that she

was raped by a male staff person, consider the possibility that the perpetrator was an outsider and came into the building from the community. Secure all possible means of getting into the building; locking doors, securing windows, screening visitors. Consider that another resident could potentially be the perpetrator. Verify as much information as you can, determining where possible perpetrators were at the time of the alleged incident.

Interview everyone who may have information, and be imaginative in expanding this list. The case law is very clear that a thorough investigation may not necessarily involve all staff members, but the “Monday morning quarterbacks” will be very critical if you do not interview certain employees without a good reason to eliminate them.

When there is an allegation of rape, an examination of the resident must be conducted as soon as practicable. If the resident is her own decision-maker, it should be with her permission. If she is not, a family member should be involved. The person conducting the examination should be someone trained and knowledgeable in protecting evidence. Therefore, it is important to involve law enforcement immediately whenever an allegation of rape occurs so that a forensic examination can be conducted. The police or sheriff ’s office can compel an examination if the resident balks.

Once law enforcement is involved, keep them advised of the progress of your internal investigation. Merely involving them does not relieve you of the duty to investigate.

Be proactive with staffImmediately in-service staff on the

problem, being sure to protect the resident’s identity as much as possible. They are going to be talking anyway, so try to keep that to


The following members represent the 2010 Florida Leaders Class:

Michael Allen, Englewood HealthcareJane Armitage, Page Rehabilitation & Healthcare CenterRB Bridges, Lakeshore Villas Health Care CenterAlicia Brown, JH Floyd Sunshine Manor, Inc.Melissa Fijalkowski, Emerald Coast Rehabilitation Center, LLCTimothy Kimes, Martin Nursing & Restorative CenterRay McCall, Port Orange Nursing & Rehab CenterLisa McGinley, Brynwood CenterJennifer Mikula, Palm Garden of OcalaKathryn Smith, LTC Consulting, Inc.Patricia Spears, Dove Healthcare at Lake WalesSamuel Tate, Hampton CourtPat Ward, Lutheran Haven

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Regina Weilbacker, Advanced Rehabilitation & Health Center of Clearwater

“The overall quality of long term care will continue to improve as we cultivate strong, skilled leaders within the profession. Each participant certainly exemplifies what our members strive for in providing the highest quality care for our state’s frail elders,” said Emmett Reed, Executive Director for the Florida Health Care Association.

As a follow-up to the November program, FHCA’s Florida Leaders will develop personal and professional goals that align with the Association’s 2010 Strategic Plan, and they will track the progress of those goals throughout the coming year. In addition, they will participate in quarterly conference calls, read selected materials on leadership development and take part in FHCA’s Lobby Wednesday activities during the 2010 Legislative Session. The program will commence with a graduation ceremony and reunion with the 2009 Florida Leaders class at FHCA’s Annual Conference in July.

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2010 Florida Leaders Program, continued from page 1


goals for the state of Florida, I rely on the advocacy of citizens especially from within my Florida House District.” Representative Aubuchon is a member of the Health and Human Services Policy Committee.

These are the simple steps that I use to deliver my message:

Get to know your legislators. Know who represents you. Visit http://www.myfloridahouse.gov/ for a list of legislators in your district.Join FHCA’s Lobby Wednesdays in Tallahassee. Invite legislators to your facility.

Lobby WednesdaysOne of the most powerful tools we have

as FHCA members is Lobby Wednesdays, which traditionally take place every Wednesday just prior to and during the Legislative Session (March through May). FHCA staff has done an excellent job laying the groundwork for these lobbying visits so the process is easy to understand, focused and fun.

Facility and associate members who take part in Lobby Wednesdays typically arrive in Tallahassee on Tuesday evening and stay in a downtown hotel, for which your lodging expenses are reimbursed by FHCA. Wednesday morning begins with a hearty breakfast at the FHCA headquarters, which includes a brief but informative meeting on the Association’s legislative issues, followed by a virtual tour of the Capitol and overview of the legislative process.

The entire experience goes smoothly because the information shared by FHCA staff prepares you for your appointments with your legislators and/or their aides. You are equipped with position papers, talking points, a legislative handbook and the knowledge required to help you be successful. In between appointments, you can tour your state Capitol and see plenty of exhibits that will give you valuable insight into Florida’s political history.

1.

2.

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by Violet Acuna-Parker, PT, MBA

In an article from Rehab Perspectives (Fall 2006 Issue), Senator Blanche L. Lincoln (D-AR) commented, “The wheels of Congress turn on the hopes and dreams of most Americans. That’s why I rely on my constituents to identify small problems before they become big problems. In fact, many of the best solutions to our nation’s problems come from ordinary citizens who bring commonsense approach to problem solving.”

Sometimes, we just don’t know how to get involved. We may have taken some courses in political science, but, most of us did not learn how to communicate effectively with our elected officials. To be fair, we cannot expect the individuals we elect to represent us in Tallahassee to instantly become experts in the care of the elderly and people with disabilities. As caregivers in the long term care setting, we need to use our knowledge to help our legislators understand the needs of those we represent.

According to Representative Gary Aubuchon (R-District 74), “Input from an active and involved constituency is an invaluable resource for legislators as we make policy decisions about issues facing our state. In order to achieve good policy

Advocacy and Lobby WednesdaysAn associate member’s perspective on grassroots

“It is our responsibility to help our legislators

understand issues vital to seniors

and people with disabilities.”

Some companies participate by sponsoring part of the trip to Tallahassee. Others allow their employees to travel to Tallahassee at their own expense. At Aegis Therapies, we believe in active participation. According to Cindy Susienka, President and CEO of Golden Innovations and 2008-2010 Board of Directors President for the National Association for the Support of Long Term Care (NASL), “Caring extends beyond working directly with patients. We encourage active participation by our Aegis Therapies employees in associations and other organizations whose goals are to improve care for the elderly and disabled. Working with these organizations enables us to be advocates for our patients, our clients and our industry.”

I believe that I can make a difference, and I know you can, too.

Violet Acuna-Parker, PT, MBA, is Regional Sales Manager at Aegis Therapies in Bradenton and an associate member of FHCA. She can be reached at [email protected].

Get Involved and Make a Difference

FHCA’s 2010 Lobby Wednesdays are scheduled for February 3, 10 & 17; March 10, 17 & 24 and April 7, 14, & 21. For more information or to secure your date to participate, contact Teresa Hamlin at FHCA at [email protected] or (800) 771-3422.


by Andy McCumber

Unlike baseball, when it comes to protecting the most vulnerable among us, the rules should provide for one strike and you’re out. Recent media reports of convicted abusers, molesters and other specifically identified felons obtaining employment at child care facilities, home health agencies, assisted living facilities and in other positions where they are providing care to the Florida’s most vulnerable citizens have given rise to proposed legislation known as “Protecting Florida’s Most Vulnerable Citizens Act,” which seeks to make it more difficult for known abusers or molesters to have an opportunity to strike again.

The Florida Health Care Association fully supports these initiatives (HB 201/SB 428) and will be working with the Florida Legislature to develop legislation to best accomplish its goals as efficiently and cost effectively as possible. In this endeavor, private providers must partner with the state and federal law enforcement and regulatory agencies that collect and maintain the background information necessary to obtain thorough and comprehensive background screening as quickly, efficiently and inexpensively as possible. Many providers of care to children or the elderly receive some level of funding from various state or federal entities. Ideally, this legislation will not ultimately increase this cost to taxpayers or unfairly pass this cost burden on to conscientious providers without reimbursement. In addition, although these jobs are crucial to the well-being of the citizens served, many of these positions are at pay levels where these potential employees cannot afford to wait to take an available job until extensive screening can be completed. It is also important that providers of care to the state’s children and elderly be able to maintain staffing levels sufficient to provide the very best care to these populations.

Protecting Florida’s most vulnerable citizensFinal background screening legislation should be comprehensive, efficient and cost-effective

Nursing homes proactive in screening employees

Despite implications in some media reports to the contrary, Florida’s nursing homes have been obtaining Level 1 background screening as a condition of employment for over 10 years. Additionally, employees who have not continuously resided in Florida for the five years immediately prior to employment must obtain Level 2 background screening. Assisted living facilities (ALF) have also required Level 1 background screening since 1998, although the statute is not specific regarding whether this screening must be obtained prior to employment. Both nursing homes and ALFs are required to obtain Level 2 background screening on licensees who are individuals, administrators and financial officers before hire.

Despite implications in some media reports to the

contrary, Florida’s nursing homes have

been obtaining Level 1 background

screening as a condition of

employment for over 10 years.

Level 1 background screening is obtained through the Florida Department of Law Enforcement (FDLE) and costs providers $24.00 per search, with the results of the screening generally obtained within five working days. This proposed legislation requires that, like nursing homes, child care

and assisted living facilities obtain Level 1 background screening on employees prior to hire. It seems to me that if lawmakers truly want an outcome that ensures the protection of our residents, more stringent screening is needed than that required by the pending legislation. Individuals who will be granted the extraordinary privilege of caring for the state’s children or elderly in a child care or assisted living facility should not only complete Level 1 background screening, but should additionally be required to complete Level 2 background screening. In order to ensure that assisted living and child care facilities are able to maintain necessary staffing levels, the results of this higher level of screening should be required within six weeks of employment.

In addition to the state criminal background check that constitutes Level 1 screening, Level 2 background screening includes fingerprint analysis of the FBI’s national databank. Level 2 screening costs $54.25 for a mail-in fingerprint card that takes 2-6 weeks to process or $43.25 for an electronic submission, which takes only 2-3 working days. Assisted living and child care facilities will continue to bear significant administrative costs processing these checks, but as this is essentially a crime prevention initiative, the cost of the screening required should be borne by FDLE.

Anyone who has had the experience of receiving calls or mail immediately upon establishing a new address or obtaining a new phone understands that this technology is available. Though the media reports perhaps exaggerate the frequency with which these events have occurred, even one time is too many. Let’s work to get this legislation right from the outset to accomplish the established goals.

Andy McCumber is a partner with McCumber, Daniels, Buntz, Hartig & Puig, PA and an associate member of the Florida Health Care Association. He can be reached at [email protected].


by Lee Ann Griffin

FHCA Director of Quality and Regulatory Services

The latest inject into the debate surrounding the use of fit-tested respirators or surgical masks by health care workers in the care of persons with influenza-like illnesses comes from an ABC News story (11/01/2009) reporting that the authors of an Australian study that found N95 respirators better than surgical masks at preventing flu retracted their findings. The original study, presented earlier this year, influenced the Centers for Disease Control and Prevention’s (CDC) recent interim guidance on the use of masks in health care settings and was cited in the recent Institute of Medicine’s Respiratory Protection for Healthcare Workers against Novel H1N1.

The original findings of the Australian study surprised many experts because they conflicted with other studies and with clinical experience. For example, a recent Canadian study published in the Journal of the American Medical Association in October found no difference between fit-tested N95 masks and surgical masks. Further, University of Pennsylvania’s Dr. Neil Fishman told reporters that clinical experience suggests that flu is spread by large droplets and should be blocked by even a simple barrier such as a surgical mask. Authors of the Australian study reanalyzed their findings after prompting by reviewers and concluded they were no longer significant.

Since August, the Florida Department of Health has recommended the use of surgical masks by health care personnel who enter the room of patients with confirmed, suspected or probable novel H1N1 influenza. Fit-tested respirators are recommended for aerosol-generating procedures, such as open suctioning of airway procedures or resuscitation involving emergency intubation or CPR. Read more about the Department’s Interim Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Heath Care Setting (8/10/09) at the Bureau of Epidemiology’s Web site.

Respirators and surgical masks in H1N1 protectionAn unexpected controversy

What this means for Florida providers

Florida’s long term care providers are familiar with infection control standards and take an active role in offering seasonal flu vaccinations for both residents and staff. However, the unexpected recommendations connecting flu management with fit-tested respirators initiated new questions and some confusion about conflicting standards of practice.

FHCA staff recently met with representatives of the Agency for Health Care Administration (Agency) and asked if surveyors will be expecting nursing home staff to utilize fit-tested respirators rather than surgical masks in the routine care of residents with influenza-like illness. The Agency raised the question with the Centers for Medicare and Medicaid Services Regional Office in Atlanta which responded:

“There is no mandate; however, each facility needs to be aware of their staff ’s needs dependent upon the situation in their facility. This guidance is clear that personal protective equipment is the last level of protection, dependent upon the situation to prevent the spread of the disease. Providers should monitor their situation and check the CDC Web site, as noted in the Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Health care Settings, Including Protection of Health care Personnel, for updates. Also, they should know what recommendations and monitoring are coming from their own public health departments.”

Remember, too, that the Occupational Safety and Health Administration (OSHA) will inspect health care institutions upon worker request to verify they are following CDC guidance and may issue citations under the Respiratory Protection Standards, as well as the General Duty Clause. OSHA is expected to issue a compliance document for inspectors by December.

Responding to Novel H1N1 has felt a bit like participating in an international tabletop exercise in preparing for and managing a pandemic outbreak. This unwelcome opportunity has challenged nursing home providers to reevaluate their response to federal infection control standards, to think about hospital surges and airborne precautions, and to assess how vulnerable residents would be cared for with a depleted workforce and scarce supplies. It seems the Centers for Disease Control and Prevention recognize the learning curve involved in responding to a new threat, which is why their best recommendations continue to be referred to as interim guidelines.

KNOW WHAT TO DO

For updates on H1N1,

hurricane preparedness,

evacuation planning

and other emergency

preparedness topics,

remember to visit the

Emergency Preparedness

link on the FHCA Web

site at www.fhca.org.



by LuMarie Polivka-West

FHCA Senior Director of Policy

Visiting a Step III Quality Award winner: ElderWood at Lakewood, New York

The American Health Care Association’s (AHCA) Board of Quality Overseers recently visited one of the 2008 Step III Quality Award winners, ElderWood Health Care at Lakewood. This 166-bed residence provides skilled care, subacute care, rehabilitative care and long term care in Hamburg, New York. The Board of Overseers, which was led by Chair Bernie Dana and included the AHCA staff support of Tim Case and Courtney Krier, met with the Lakewood team, which included the administrative leaders of clinical, rehab, housekeeping, dietary, maintenance, business and finance, volunteer services and admissions. Yes, everyone was represented, and they all communicated the facility’s mission of quality services and its vision for continuous quality improvement. The ebullient maintenance director, who has been with Lakewood for 12 years, called the Step III award their “Super Bowl.”

Residents enjoy outstanding care in a beautiful, park-like setting. Comfortable rooms, spacious common areas, dining areas within the unit, outdoor patios and flower gardens provide an attractive, enjoyable setting for recreation and social activities. The physical plant is 25 years old, but the camaraderie of the staff, families and residents makes it seem ageless. There is a warm and inviting feeling about Lakewood that you experience when you enter, from the whiff of baking cookies and coffee to the administrative team offices located just off the living room where residents, families and other guests gather.

ElderWood Health Care at Lakewood was the first skilled nursing and rehabilitation facility in New York State to receive the American Health Care Association Step III Quality Award. Since the award was created in 1996, only six out of the nearly 17,000 skilled nursing facilities nationwide have earned this award. When the facility was awarded the highest AHCA Quality Award, the administrator, Deborah Urbank responded, “As proud as we are of this

award, what’s significant is what it says about us – that ElderWood Health Care at Lakewood makes quality care our top priority. Residents and families place enormous trust in us. By striving to be the best skilled nursing facility in the country, we’re always working to keep that trust.”

The award processThe AHCA Quality Award program

is based on criteria adopted from the Malcolm Baldrige National Quality Award, the nation’s premier recognition for quality achievement. It is a progressive, three-step award process, where facilities must receive the first level award before moving on to the next. Step III, or more recently renamed as the Gold Award, is the highest achievement.

ElderWood Health Care at Lakewood began the commitment to excellence in 1998 and submitted their first Step I award application in 2003, earning that award in 2004. They were the first facility in New York State to win the Step II Award in 2005. According to Mrs. Urbank, there was a “huge learning curve going to the Step II. We had the essence, but it can’t be dependent on one person or happenstance, we had to look at our data systematically, set a plan and follow through.”

To earn the Step III Quality Award, ElderWood Health Care at Lakewood submitted a 44-page application demon-strating superior performance in health care, customer satisfaction, financial, market, workforce, process and leadership outcomes over time.

A site visit by AHCA examiners confirmed that quality procedures are carried out in the daily operation of the facility. As part of the application process, ElderWood Health Care at Lakewood monitored patient, resident and family satisfaction using surveys administered by My InnerView Inc., a leading health care research organization. Lakewood’s satisfaction survey results far exceed national averages.

Surveys administered from July 2007 through June 2008 show that 100 percent of patients were satisfied with the quality of rehabilitation therapy at Lakewood. The national average is 89 percent satisfaction. While 76 percent of rehab patients nationwide would recommend their rehab facility to others, 97 percent of Lakewood patients would recommend that facility to family and friends. “Our satisfaction survey results are strong, and they validate the hard work of our entire staff,” said Urbank. “But, achieving quality is a continuous process. We’re always evaluating the needs of our residents and patients and making positive changes.”

The Elderwood CEO, Bob Chur, met with our visiting group and fully supported the facility taking the corporate strategic plan and turning it into a facility-specific strategic plan for improvement. The Lakewood team adopted the following areas as the mainframe of their strategic plan: 1) health care; 2) operations (controlling expenses); 3) human resources (14.9% turnover achieved); and 4) organizational sustainability. The Lakewood team took four months of weekends and night work on the Step III application and each day, after the morning meeting, a question was read from the application for the team to think about during the work day. According to Mrs. Urbanek, there is no longer a “Quality Management” team; it is a continuous quality improvement focus.

The next stepWhen asked what the next step is for

Lakewood in their quality improvement journey, many on the team responded at the same time: “culture change.” Lakewood has begun their culture change journey through “Elderbridge,” where each staff member is aligned with three residents they visit once a week and contacts the family representative once a month to develop a more in-depth relationship. The Lakewood team said that


primary care focus is culture change, and they are focused with a systemic approach to improve the relationships.

The team strongly supported the AHCA Quality Awards program and said that “you are learning as you go through the different stages of the application process. We had to learn how to drive quality improvement, get the systems in place, change the attitudes of staff and get all the different parts to work together.” ElderWood at Lakewood has succeeded, but they continue moving forward with the mission of quality improvement.

The AHCA/NCAL

National Quality

Award is a great way to

showcase your facility’s commitment

to continuous quality improvement

and to achieve performance

excellence. The 2010 Quality Award

information, instructions, criteria

and applications are now available

and can be found on the FHCA

Web site at www.fhca.org. New in

2010 are award level name changes,

including Bronze – Commitment

to Quality (formerly Step I); Silver

– Achievement in Quality (formerly

Step II); and Gold – Excellence in

Quality (formerly Step III).

In addition, participation in a

National Quality Award educational

program is required in order for

an application to be considered

by Examiners. This includes the

free webinars for each award

level held by the National Quality

Award program in December and

January of each year, and any other

educational program that focuses on

the National Quality Award process.

Changes have also been made to

the Bronze and the Silver criteria,

so facilities should be sure they

are working from the 2010 criteria

when writing their application.

Art from the Heart calendarThis year’s Art from the Heart

program drew nearly 65 artwork submissions from nursing home and assisted living residents in FHCA member facilities across the state. A volunteer group of judges from the Tallahassee artist community selected 14 entries for the 2010 Art from the Heart calendar, which will be available for sale this month. FHCA members will each receive a complimentary calendar and can purchase additional copies for just $7 each or $5 when you order more than 20 copies. Proceeds from sales of the calendar benefit FHCA’s Quality

Credentialing Foundation, which sponsors a number of quality initiatives to help facilities improve quality of care provided to residents.

These calendars make excellent gifts for your residents, their families or your staff. The calendar also serves as an awareness tool to promote the long term care sector, particularly the value activity programs have on improving residents’ quality of life. Administrators can also turn the calendar into a valuable promotional tool by including facility-specific information and sharing the calendar with hospital discharge planners or other members of their local community.

Artwork submissions from this year’s Art from the Heart program will be on display next year at the Florida Museum History in Tallahassee, as well as throughout the state as part of FHCA’s traveling Art from the Heart tabletop exhibit.

For more information about FHCA’s Art from the Heart program, contact Tracy Achey at [email protected].


A Worthwhile Investment Renew Your FHCA Membership Today

FHCA members benefit from a strong, unified presence in the state Capitol, up-to-date information, continuing education opportunities and access to LTC experts who can help with your operational effectiveness. Below are a few examples of how your investment in FHCA will reap valuable returns.

Representing your legislative interests: FHCA works diligently on your behalf to preserve essential funding and ensure fairness in regulatory matters. FHCA’s national affiliate, the American Health Care Association, also serves as your advocate in Washington in supporting favorable legislation.

Survey and regulatory help: FHCA Quality Unit staff is available to answer your state and federal regulatory questions or provide support when surveyors are in your facility. In addition, FHCA works effectively on your behalf with state and local emergency response desks during hurricane season.

Continuing education and professional development: FHCA members choose from a full schedule of continuing education opportunities at reduced member rates. FHCA promotes career advancement for LTC nurses, nurse leaders and other professionals through the annual Nurse Leadership Program and through scholarships awarded through the Florida Health Care Education and Development Foundation.

Information and networking: An extensive Web site, weekly (Focus on Florida) and monthly (Pulse) newsletters and issue-specific alerts keep members apprised on topics that affect facility operations and as situations warrant. Annual Conference, meetings and seminars keep LTC professionals informed and in touch with their colleagues.

Experts: FHCA maintains reimbursement, regulatory, clinical and media/public relations experts on staff and makes its legal, business and labor consultants available to all members.

For more information about membership in Florida Health Care Association, contact Dawn Segler at (850) 224-3907 or [email protected].

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Value. Trust. Performance. The foundations of a rewarding relationship.

The challenge of assuring that your patients receive the highest quality of pharmacy service is growing ever more complex. Medicare Part D, new drug therapies and emerging technologies make choosing the right pharmacy more important than ever before.At PharMerica, we help you care for the health and well-being of some of our most vulnerable populations. With over 20 years of experience in long-term care, we know what it takes to meet the needs and expectations of facilities and patients.

Make the Better Choice.

PharMerica is a leading institutional pharmacy services provider. We satisfy the complete pharmacyneeds for nursing centers, assisted living facilities, hospitals & specialized care centers.

We’ve developed a variety of cost containment programs and clinical services, as well as technology options in areas such as computerized order entry, real-time medical records, admissions and billing.Call us at 866-577-3784 to learn why PharMerica is the better choice for pharmacy service.

866.577.3784 www.pharmerica.com


LTCBUSINESS

NEWS

by Steven R. Jones, CPA and Lorne Simmons

Moore Stephens Lovelace

Want to stay up-to-date on FHCA news, events and activities?

Follow FHCA on Twitter at http://twitter.com/FHCA or join our Florida Health Care Association Group

on Facebook at www.facebook.com.

2010 Medicare premiums and deductibles announced

The Centers for Medicare & Medicaid Services (CMS) recently released the Medicare Part A and Part B premiums and deductibles for the calendar year 2010. The Notices indicate that the daily coinsurance for days 21-100 in a skilled nursing facility (SNF) will increase to $137.50 in 2010, an increase of $4.00 per day compared to 2009. CMS announced the standard Medicare Part B monthly premium will increase from $96.40 in 2009 to $110.50, a 15 percent increase. The MMA requires beneficiaries with higher incomes to pay a higher percentage of costs for Medicare Part B, so, depending on their income level and tax status, these beneficiaries will see monthly premiums ranging from $154.70 to $353.60.

Nursing home costs on the riseThe retail pricing deflation experienced in many sectors of the US economy haven’t yet applied

to long term care services. According to the annual study by the MetLife Mature Market Institute, the price for spending a day in a skilled nursing facility in 2009 rose approximately 3.3 percent in 2009 compared to 2008 nationwide. The national average rate for a private bed increased by $7 to $219, as did the price for a semi-private bed which also increased $7 to $198 per day. In Florida, the cost for a private bed averaged $225 per day with daily rates running as high as $320 and as low as $135. A semi-private room averaged $204 per day. Depending on when the Florida survey was done, those prices may not include the full impact of the SNF Quality Assessment.

MDS 3.0 releasedOn October 29, CMS released the MDS 3.0. This will give long term care providers a year to

prepare for the implementation of the new assessment tool, which is slated for implementation October 1, 2010. The Item Set includes a number of files designed to assist in implementation, such as an item matrix identifying information required for each type of assessment along with how each item is used. Other information includes:

MDS 3.0 data submission specifications.RUGs IV SAS code for RUGs IV classification with documentation and test data.A RUGs III MDS 3.0 mapping specifications file, which presents logic that can be used to produce RUGs III classifications using assessment items contained on the MDS 3.0.MDS 3.0 Care Area Triggers (CATS) providing specifications for the MDS 3.0 items used in triggering the care area. The CATS are replacing the MDS 2.0 Resident Assessment Protocol (RAP)

Publication of the MDS 3.0 RAI manual has been delayed. It is expected that chapters one through six will be published in November, except for chapter four (Care Area Assessments), which will be released in December. This should include descriptions and instructions for the types of assessments and tracking documents, each MDS 3.0 item, submission and correction of MDS 3.0 records and last but certainly not least, the RUGs IV classification system. To download the MDS 3.0 Item Set, visit the CMS Web site at www.cms.hhs.gov/.

1.2.3.

4.


LABOR RELATIONS

COUNSEL

by Mike Miller

Kunkel, Miller & Hament FHCA Labor

Relations Consultant

FMLA amendment regarding military leave

President Obama recently signed into law the National Defense Authorization Act for 2010, which amends the Family & Medical Leave Act (FMLA) with regard to military leave. Specifically, qualifying exigency leave is now available to a regular or reserve member of the Armed Forces (it formerly was available only to the latter) who is being deployed to a foreign country (the requirement that the call up be in support of a “contingency operation” has been deleted). In addition to providing for “caregiver leave” to those caring for injured members of the Armed Forces, the amended FMLA also now extends to those needing such leave to care for “veterans” (i.e., those who formerly were on covered active duty within a five-year period preceding treatment) who have the need for leave related to medical treatment, recuperation or therapy for a serious injury or illness. The law also has been expanded so that “serious injury or illness” now encompasses medical conditions that existed prior to the covered active duty for a regular or reserve member of the Armed Forces if such condition was aggravated by service in the line of duty. Veterans are covered by the same circumstances, regardless of whether the condition manifested itself before or after the former service member became a veteran. Obviously, any leave situation that involves an active or former member of the Armed Forces or their covered caregiver should be scrutinized closely, and you may want to seek the advice of legal counsel.

Twelve-hour shift at lower base pay did not violate FLSA A federal appeals court (Court) recently held that the maintenance of two different shifts (an eight-

hour shift and a 12-hour shift) with different base rates for nurses at a hospital (the 12-hour shift paid slightly less per hour) did not violate the Fair Labor Standards Act (FLSA). The hospital had an 8/80 plan in effect when it learned that some of the nurses would prefer a 12-hour shift because it gave them greater flexibility in scheduling. The 12-hour shift plan (which paid double overtime for work beyond the 12 hours) was optional when first proposed and later was ratified by the employees as part of a collective bargaining agreement. However, one of the nurses decided to challenge the 12-hour shift because it allegedly resulted in less overtime exposure for the employer and allowed the hospital to pay two different rates to nurses performing the same work (those on the eight-hour shift earned a slightly higher base rate). The Court rejected the challenge, finding no intent to evade the minimum wage or overtime requirements of the FLSA and holding that an employer can pay employees two different rates when they work different shifts where the evidence does not show that the rates are set so artificially low that the apparent intent by the employer was to avoid paying overtime (the double overtime after 12 hours was a significant deterrent, held the Court, to avoid the evil of underpaying and overworking nurses). Here, the employer merely put into place what the nurses were requesting.

Employee fired three minutes after returning from FMLA leave entitled to trial

This was the holding of a federal judge in Florida in a recent case involving claims of age discrimination and alleged violations of the FMLA. The Plaintiff, who was 56 years old when she was terminated, had worked for the company for seven years and had good performance evaluations and a good work record. While she was on FMLA leave, the company decided to cut costs statewide, but only cut one position in the Plaintiff ’s office (it did retain a 57-year old administrative employee who had more seniority than the Plaintiff). Even before the termination, the company decided to create a new administrative position but did not tell the Plaintiff about it or offer it to her. The Plaintiff returned from FMLA leave and clocked in at 8:00 a.m., and she was terminated three minutes later. However, she discovered the job (which was posted on the company’s Web site) and applied for it, but the new job was given to a 34-year old. On motions for summary judgment filed by both sides, the Court held that there were disputed issues of fact on both the age and FMLA claims that required resolution by a jury. While acknowledging that the company was under no obligation to reinstate the Plaintiff for any specific duration after her leave expired, the Court opined that returning an employee to her old job only long enough to fire her was not a meaningful reinstatement under FMLA. Employers who want to include just- returned employees in layoffs or reductions in force must be sensitive to the types of issues identified by the Court in this case.


Advancing Excellence in America’s Nursing Home campaign started Phase II in October 2009, with launching of new goals and a revamped Web site at www.nhqualitycampaign.org. Nursing homes that were part of the Advancing Excellence Phase I need to re-enroll by updating their facility profile and selecting new goals.

Why join? Nearly half of the nation’s nursing homes joined the Campaign during its first phase and the results have been very promising. Campaign participants that chose to focus on reducing use of physical restraints, reducing the prevalence of pressure ulcers and controlling symptoms of pain, improved at a significantly faster rate than other nursing homes. There are tangible benefits for nursing homes as well: improving staff retention and maintaining staff stability saves money, improves efficiency as well as outcomes and contributes to better relationships between residents and their caregivers.

In Phase II, Advancing Excellence sets eight goals that help nursing homes make a difference in the lives of residents and staff.

Goal 1 Staff Turnover: Nursing homes will take steps to minimize staff turnover in order to maintain a stable workforce to care for residents.

Goal 2 Consistent Assignment: Being regularly cared for by the same caregiver is essential to quality of care and quality of life. To maximize quality, as well as resident and staff relationships, the majority of nursing homes will employ “consistent assignment” of CNAs.

Goal 3 Restraints: Nursing home residents are independent to the best of their ability and rarely experience daily physical restraints.

Goal 4 Pressure Ulcers: Nursing home residents receive appropriate care to prevent and appropriately treat pressure ulcers when they develop.

Goal 5 Pain: Nursing home residents will receive appropriate care to prevent and minimize episodes of moderate or severe pain. Objectives for long stay and short stay are slightly different.

Goal 6 Advance Care Planning: Following admission and prior to completing or updating the plan of care, all NH residents will have the opportunity to discuss their goals for care including their preferences for advance care planning with an appropriate member of the healthcare team. Those preferences should be recorded in their medical record and used in the development of their plan of care.

Goal 7 Resident/Family Satisfaction: Nursing home staff will assess resident and family experience of care and incorporate this information into their quality improvement activities.

Goal 8 Staff Satisfaction: Nursing home administrators will assess staff satisfaction with their work environment at least annually and upon separation and incorporate this information into their quality improvement activities.

Both new and existing participants will benefit from being part of the “new” Advancing Excellence campaign, which neither duplicates nor conflicts with existing QI requirements or other QI initiatives. Please go to www.nhqualitycampaign.org and explore the free resources the Campaign offers and enroll.

Advancing Excellence sets eight goals


by Larry R. Vinson, PhD

Moore Stephens Lovelace-Broussard Healthcare Consultants

An overview of the Five Star Rating System Staffing Measures

Facility ratings on staffing are based on two case-mix adjusted measures: 1) Registered Nurse (RN) hours per resident day; and 2) total staffing hours (RN+ LPN+ nurse aide hours) per resident day. Other types of nursing home staff (clerical, administrative, or housekeeping, for example) are not included in these staffing numbers. These staffing measures are derived from the Centers for Medicare & Medicaid Services (CMS) Online Survey and Certification Reporting (OSCAR) system and are case-mix adjusted based on the distribution of MDS assessments by RUG-III group.

The source data for the staffing measures is CMS form CMS-671; resident census is based on the count of total residents from CMS form CMS-672. Many facilities fill these forms out incorrectly, often leaving out valuable hours from qualified staff. The specific fields that are used in the RN, LPN and nurse aide hour calculations are:

RN hours: Includes registered nurses, director of nursing and nurses with administrative duties.

LPN hours: Includes licensed practical/licensed vocational nurses.

Nurse aide hours: Includes certified nurse aides, aides in training, and medication aides/technicians

Keep in mind you are not credited with your actual hours staffed, but rather with adjusted hours based on acuity. We have seen adjustments as high as 50 percent based on acuity. The formula used is Hours Adjusted = (Hours Reported/Hours Expected) * Hours National Average. Hours Reported are taken directly from form 671 discussed above, while Hours Expected are based on the distribution of residents by RUG-III group in the quarter closest to the date of

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the most recent standard survey (when the staffing data were collected) and measures of the expected RN, LPN and nurse aide hours that are based on data from the CMS 1995 and 1997 Staff Time Measurement Studies. You can find the specific multipliers for each RUG category on page 18 of the Five Star Quality Rating System: Technical User’s Guide. The distribution of residents by RUG-III group is determined using the most recent MDS assessment for current residents of the nursing home on the last day of the quarter.

Hours National Average is the mean across all facilities of the reported hours per resident day for a given staff type. In practice, these numbers are:

Total Nursing Staff: 3.83862 National average hours per resident day.

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Registered Nurses: .63989 National average hours per resident day.

Hours Adjusted tells you how many hours are being used to create your Five Star Staffing Rating. CMS compared your adjusted hours for RN only and for total staffing with Table 3 shown on page 16. CMS then compares the combined rating levels for RN only and total staffing with Table 4 shown above to get your final staffing star rating. Notice that there are multiple ways to receive each star rating.

Remember a one star staffing rating costs you a star and a four or five star staffing rating can add a star. Also, keep in mind it is the mix of RN hours and total hours that produces your rating. There are many cases where a facility does not need more hours to raise their rating; they simply need to balance the hours so that they most effectively meet the CMS criteria.

•Grads Made Good

In October, a crowd gathered in the Oak Activity Center at the Palms of Sebring to watch four residents receive their honorary high school General Equivalency Diplomas (GED). The graduation ceremony included a commencement speech given by Dr. Roger Wild and diplomas given out by the Palms administrator Brent Montgomery (at left). Wild, in his commencement address, reminded the audience that “Life is continuing for all of us, these people are not sitting around waiting to die. We acknowledge what they’ve done, what they’ve accomplished”

The four graduates included Mary Thornburg (from left), 87; Evelyn A. Roberts, 94; Herbert Ouellette, 83; and Evelyn Smallman, 94. Roberts children, grandchildren, great-grandchildren and great-great-grandchildren all came to see her graduation ceremony. Smallman described how she left school at 17 and married at 18. Thornburg described herself as always curious. Oullette

received a special award for tackling an intense physical therapy program that helped him overcome his inability to walk when he arrived at the Palms and resulted in him walking to his wife’s apartment from the therapy center without help.

“These people made something of their lives,” said Brent Montgomery. “The residents of Palms of Sebring and all of our long term care facilities across Florida are treasured elders, and we need to continue honoring them for the contributions they have made and continue to make.”

continued from page 16


a minimum by being proactive. Remind them that they have a responsibility to protect the residents’ privacy. I say residents (plural) because the perpetrator may be a resident as well.

Tell them of any safeguards that you have established to protect both the residents involved and the others. You most likely will put some safety measures in place until the investigation is concluded that may or may not continue afterwards. Staff must be aware of what is required of them and that you will enforce the procedures. Several cases discuss implementing protective measures and then applying them inconsistently.

Ask all staff to be your eyes and ears and alert you to any suspicious or unusual behavior. Assure them that all information will be taken seriously and their identity kept confidential. Take their information to heart when they do report something. After all, it is your goal to find the perpetrator if

one exists and protect staff and residents.

Extra special attention must be given to residents whom you have identified as particularly at risk. A good example would be the resident on a ventilator or a young resident with dementia who may be susceptible to the attention of an abuser. Alert staff of the needs for additional attention to these people, and document monitoring or whatever is done for these individuals. Move particularly susceptible residents to an area near the nurses station if practicable.

The treating physician also needs to be alerted to the issue of the alleged rape so that he can send his patient for the proper consults or treatment of injuries, etc. Keep him informed of the resident’s progress even when there is no significant change.

Remember to be sure and file your investigative reports with the Centers for

Medicare & Medicaid Services (CMS) and the Agency for Health Care Administration (AHCA) just as you would any other incident in the building.

The key to a successful outcome is organization. One person should be in charge, and “in charge” is the operative word here. This investigation and the protection of the residents should be that person’s priority until the facts are gathered and decisions made. If the investigator is not the administrator or director of nursing, be sure to keep those two people involved and informed. Decisions will have to be made all along the way as to the best protection for all involved.

THANKS, Train-the-Trainer sitesSpecial thanks to the FHCA member facilities that graciously hosted the popular CNA Train-the-Trainer program for member facility RNs. This was the tenth year FHCA hosted these successful programs across the state.

Life Care Center of Orange Park

Pines of Sarasota

Hawthorne Village of Brandon

The all-day training sessions introduce RNs to FHCA’s CNA Test Prep Course and provide a step-by-step walk-though of the curriculum, as well as tips for the testing and certification process. Test Prep Course completers are prepared to challenge the state’s CNA exam. The next CNA Train-the-Trainer session will be held in conjunction with FHCA’s 2010 Nurse Leadership Program, which will take place September 8-10, 2010 at the Hilton Clearwater Beach Resort.

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Investigating sexual abuse in the long term care settingcontinued from page 5


FHCA Welcomes New Associate

Members

Medical Nutrition USA, Inc., Boca Raton

Weekes & Callaway, Inc, Delray Beach

iSure Insurance Brokers, Miami

Allied Health Resources,

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Last year, I was quickly corrected by the State Fire Marshal when I wrote about being able to use cut Christmas trees in sprinklered nursing homes. The 2006 edition of NFPA 1 - The Uniform Fire Code - chapter 10.14.2 states that in any occupancy, limited quantities of combustible vegetation shall be permitted where the Authority Having Jurisdiction (AHJ) determines that adequate safeguards are provided based on the quantity and nature of the combustible vegetation.

Artificial vegetation and artificial Christmas trees shall be labeled, identified or certified by the manufacturer as being fire retardant (10.14.3.1). Such fire retardance shall be demonstrated by each individual decorative vegetation item, including any decorative lighting, in an approved manner (10.14.3.2).

Vegetation and Christmas trees shall not obstruct corridors, exit ways, or other means of egress (10.14.4). Only listed (UL approved) electrical lights and wiring shall be used on natural or artificial combustible vegetation, natural or artificial Christmas trees and other similar decorations (10.14.5). The suggested, recommended life for a string of incandescent Christmas tree lights is three years; older lights should be replaced. Electrical lights are prohibited on metal artificial trees (10.14.6).

Non-sprinklered nursing homes

When talking to the Agency for Health Care Administration’s Office of Plans and Construction (AHCA-OPC), it is understood that there are a number of facilities that have not had or requested to have a final inspection of their newly-installed sprinkler system.

Section 633.022(4) (a), F.S. requires that nursing homes licensed under Part ll of Chapter 400, F.S., be protected throughout by an approved, supervised automatic fire sprinkler system in accordance with Chapter Nine of the Florida Edition of NFPA 101,

by Max Hauth

NHA, CRCHere come the holidaysWhat to know regarding your Christmas trees, sprinkler systems and other news

the Life Safety Code adopted in Rule 69A-3.012, F.A.C., pursuant to the following:

Each nursing home, in its entirety, shall be protected by an approved supervised automatic fire sprinkler system by no later than December 31, 2010.

Final document (Plan) approval should have been received from AHCA–OPC.

Be sure to keep the Office of Plans and Construction informed of your progress or any difficulties that you may be experiencing on these projects.

Changing timesOn February 12, 2010, Mr. James R. (Skip)

Gregory will be retiring as the Bureau Chief of AHCA’s Office of Plans and Construction. Skip joined the Agency’s Office of Plans and Construction in December 1986 as an architect plan reviewer under the direction of Mr. Richard Rosenvold. In December 1993, Skip assumed the OPC’s Bureau Chief Position with the announced retirement of Mr. Rosenvold.

Mr. Gregory has been supportive of growth and changes in the health care industry. Special attention has been given to the welfare and life safety of the patients and staff working within the industry. He has worked with the various associations in making building code and life safety changes that promote health care to Florida’s residents. He has provided continuing education on building and life safety code changes and how to best prepare a health care facility to meet these needs during surveys.

While directing his department, Skip has also served on a number of state and national committees, including the NFPA’s Life Safety 101 Committee. His willingness to work with and support Florida’s health care industry has been appreciated. We certainly hope he will enjoy his retirement.

Max Hauth is President, Hauth Health Care Consultants, in Lakeland and a frequent contributor to FHCA Pulse on life safety issues. Contact him at (863) 688-0863.


NEWS FROM ACROSS FLORIDA

FHCA Pulse welcomes news items, photos, or guest articles of up to 500 words or less. For information, call (850) 224-3907 or e-mail [email protected].

Giving BackAt right, volunteers from Village on the Isle in Venice helped raise money and renovate a kitchen for Prospect House, a project of the Mental Health Community Centers in southwest Florida. The staff at Prospect House shared the message with administrator Tom Kelly that “tis the season to recognize those who are so important with our gratitude...thank you so much for everything you do for some of our most vulnerable citizens who attend and rely on the services...”

Spooktacular SupportHouse Speaker Larry Cretul sent this hand-carved pumpkin to Hawthorne Health and Rehab of Ocala to help residents with their Halloween celebrations.

Leadership DinnerDuring the FHCA Florida Leaders program in November, Signature Health Care CEO Joe Steier (right center) and FHCA Secretary and Delta Health Group President Scott Bell (far right) both gave the group an inspiring presentation on executive leadership. They’re shown here from left with FHCA Treasurer Scott Allen, Executive Director Emmett Reed, Senior Vice President Nina Willingham and President Deborah Franklin.

Black CaucusMiracle Hill Nursing & Convalescent Center in Tallahassee recently hosted a facility tour to nearly 25 legislators who are members of the Black Caucus.

Honoring Our Heroes

Above, Health Central Park (HCP) hosted their 4th Annual “A Day at the Park.” This community event included Winter Garden Mayor John Rees and Rep. Steve Precourt, who took part in the Commemoration Ceremony which honored 24 veterans that reside at Health Central Park and eight veterans that are either staff or volunteers.

Above right, Hawthorne Village of Brandon also hosted a celebration which included presentations to their local veterans and a display of military vehicles.


continued from page 1Update

Architects and engineers learn about Culture Change design conceptsThe 25th Annual Innovations for Health Care Facility Design and Construction Conference, held in Orlando in October, presented architects and engineers with first-hand experiences in adopting household based models for long term care organizations. The general sessions emphasized design’s role in culture change, noting that culture change is bigger than design and encompasses both the physical environment and organizational change. Two presentations exploring the household model for nursing homes were presented and can be found under the Tools and Resources link on the Quality Improvement section of the FHCA Web site: “The Case for Culture Change” and “Culture Change: A Journey that Does Work.”

NOTICEABLY DIFFERENT.Knowledgeable, accessible, responsive. You’ll develop a personal connection with our senior living team—people dedicated to using their skills and resources to create a noticeably different client experience.

Audit, accounting, and tax | Reimbursement | Internal auditStrategic capital planning | Feasibility studies Operations and performance improvement | Market researchLong-term care demand analysis

Contact Gregory Hathorne at 407-802-1200

© 2009 LarsonAllen LLP

2010 AIA guidelinesThe 2010 American Institute of Architects Guidelines for the Design and Construction of Health Care Facilities is expected to be available for purchase by December. Florida references the 2006 Guidelines as a design code and standard when reviewing and approving plans for new construction of health care facilities. During the above-mentioned Innovations for Health Care Facility Design and Construction Conference, presenters explained that the Health Guidelines Revision Committee rejected a strong push to go to single-bedded rooms for nursing homes in the 2010 Guidelines and offered a series of recommendations based on research from the University of Minnesota. To learn when the 2010 AIA Guidelines will be available for purchase, visit www.fgiguidelines.org.

National fundraiser to benefit CNAs and caregivers The National Association of Health Care Assistants (NAHCA) will launch their 1st annual premier fundraising event, “Stepping Up for Quality”, on February 1, 2010. The nationwide walkathon will benefit certified nursing assistants (CNA) and caregivers across the country by providing continuing education and allowing for professional development. The walkathon will run throughout the month of February, and participants will monitor their steps while in the workplace using a pedometer provided by NAHCA. “Stepping Up for Quality” registration information can be found by visiting the NAHCA website at http://www.nahcacares.org/sufq.htm.


American Health Care Association and National Center for Assisted LivingAHCA/NCAL offer hundreds of long term care professional development resources. Categories include Care Practice, Compliance & Regulation, Staffing & Retention, Consumer Resources, Nurse Aid Training, Assisted Living and many more. Go to www.ahcapublications.org or call (800) 321-0343 Monday - Friday, 9 am - 6 pm to place an order.

Edge Information Management Inc.Since becoming an approved service corporation company for FHCA in 1993, Edge has helped over 250 FHCA members meet their background screening requirements and kept them informed of pertinent legislative issues. Edge offers a variety of background checks including: drug screening, fingerprints, criminal, sexual offender, license verifications and references. Call (800) 725-3343.

FMS Purchasing & ServicesFMS has a full line of products and services in our Group Purchasing Program. Through our six area managers and twenty auditors, we ensure maximum savings, prompt response and unparalleled service throughout the state. In addition to our Group Purchasing Program, we also offer the Manufacturers Value Incentive Program. Contact FMS today to receive a free cost analysis and learn how we can put these powerful programs to work for you. Visit us at www.fmspurchasing.com , or call (800) 456-2025.

Hamilton Insurance AgencyHamilton Insurance Agency has 25 years experience, with an emphasis on the healthcare industry, and is proud to provide the best and most economical services available in the industry to its customers. Offering commercial, health, personal and a variety of specialty services like Risk Management consulting, COBRA and Workers’ Compensation. Contact Geoffrey Shisler at (877) 260-9468 or via e-mail, [email protected].

HealthScreen Disease ManagementHealthScreen Disease Management works with self-insured employers to manage those employees and dependents covered under the employer’s health plan diagnosed with chronic illnesses such as asthma, diabetes, hypertension, etc. The expertise we have developed in working with the chronically ill has allowed us to successfully stabilize the healthcare costs of these individuals, which translates into identifiable direct dollar savings to the employer. Unlike many vendors in this industry, HealthScreen is strictly a Pay for Performance organization. HealthScreen will provide employers with 1,000 or more covered employees a Net Guaranteed Return on Investment (ROI) of 125 percent at the end of the first twenty-four (24) months of the program. HealthScreen will put up to twenty-five (25) percent of fees at risk to support this guarantee. HealthScreen also provides one of the most unique and successful smoking cessation programs available today. For more information contact Mack Bryson at [email protected] or call 877-223-4325. Visit our website at www.ehealthscreen.com.

MED-PASS, Inc. (Heaton Resources)MED-PASS is a nationally known company specializing in the research and development of documentation solutions, policy and procedure manuals, regulatory guides and in-service training programs for the longterm care professional. Our manuals and guides are comprehensive, easy-to-use and continuously updated. Our forms and resources offer peace of mind and quality and better than competitive prices. Visit us at www.med-pass.com, or call (800) 438-8884.

Office DepotOffice Depot offers Florida Health Care Association members extra discounts and services due to the cooperative purchasing power of FHCA. We offer a wide variety of benefits, including 50 items which have been reduced based on volume ordering up to 80 percent off the list prices (the “High Use Item List”); next-day delivery on everyday office products; an award-winning Web site which links you to your pricing and into the warehouse and keeps 12 months of tracking information at your fingertips. Call (800) 422-2654 for information or to set up an account; call (800) 386-0226 to place an order.

RXPERTS PharmacyRXPERTS is Florida’s premier pharmacy providing pharmaceuticals and infusion services to nursing homes and assisted living facilities. We are the only pharmacy to print the patient/resident’s digital photo on the Rx label, POS, MAR and all other forms. RXPERTS participates in all third party billing, including all approved Medicare Part D PDPs. Call Jeff Wilkes, Director of Sales and Marketing at (813) 579-7042.

Senior CrimestoppersThe Senior Crimestoppers program is a proven, effective, proactive crime prevention system that combines proven components to help provide safe, crime-free facilities for residents, staff, visitors and vendors. Personal lock boxes for use by residents and/or family members, an around-the-clock, completely anonymous “tip line” call center, cash rewards of up to $1,000 posted on any and all incidents that occur and educational materials for residents, families, management and staff members are a few of the components that make up the program. More details can be found at www.seniorcrimestoppers.org or contact Kay Joest at (800) 529-9096 for more details.

FHCA SERVICE CORPORATION SAVES YOU MONEYWe are proud to recommend these fine vendors who provide quality goods and services.

They help keep you and FHCA on top!


Some meetings noted herein may also carry CE credits. Additional information and registration can be found at www.fhca.org. Click on “Seminars/Events”

Classified Ads“Help wanted” and “situations wanted” classified ads are free to FHCA members. You can also post your ad on the FHCA Web site at www.fhca.org. Click on “Job Board.”

Interim Administrator/Prudent Manager – Available statewide. Successful companies need prudent management in difficult economic times as they strive toward operational effectiveness; namely, focus and accountability. As a seasoned professional who has both management and consulting experience in the operation of health care facilities, you will get both a licensee and an opportunity to “fine tune” your operation. Contact Doug Eitel at (813) 843-6250, or via e-mail, [email protected].

Interim Administrator/Executive Director or RVP – Excellent problem solver and communicator. Knowledgeable on LTC regulations (state and federal). Given excellent evaluations for management and leadership. Licensed in Florida. For your needs, call Fred Taylor at (727) 534-0726, or via e-mail, [email protected].

2010 Continuing Education/TrainingMark your calendar now for the months of February, May, September and November, when FHCA will offer top-notch, regional education programs that address topics related to the Five Star Rating System, quality care initiatives, MDS 3.0, life safety issues and more. Check the FHCA Web site at www.fhca.org for details soon.

2010 Meetings/EventsFHCA Legislative MeetingJanuary 27, 2010Combination Web cast and in-person meetings in various locations across Florida. Topics include updates on reimbursement, legislative priorities, grassroots and effective communications.

FHCA Annual Conference & Trade ShowTuesday, July 6 – Friday, July 9, 2010Orlando World Center MarriottOrlando, FL

FHCA Nurse Leadership ProgramWednesday, September 8 – Friday, September 10, 2010Hilton Clearwater Beach ResortClearwater Beach, FL

Visit www.fhca.org for more information.

In addition to all FHCA members and associate members, FHCA Pulse is also mailed to legislators, opinion leaders, reporters and state/federal regulators in Florida. The wider distribution allows others to better understand long term care and the daily challenges faced by the long term care providers we represent.

Note to FHCA Pulse readers

American Health Care Association EventsVisit www.ahcancal.org for details.

AHCA/NCAL Quality SymposiumTuesday, February 9 – Wednesday, February 10, 2010Marriott Baltimore WaterfrontBaltimore, MD

Independent Owner Leadership ConferenceThursday, March 11 – Friday, March12, 2010Doubletree Paradise Valley ResortScottsdale, AZ

arnold tapped as ahca secretary

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