July 11, 2018
Featured
Care Center Staffing Ratings Under Scrutiny
On July 10, 2018 by Jodi Boyne
The New York Times recently published an article (‘It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years. July 7, 2018) that calls into question staffing levels in nursing homes. The article cites data analyzed by Kaiser Health News that nursing homes submit to the Centers for Medicare & Medicaid Services (CMS) each quarter via the Payroll-Based Journal (PBJ) system, as well as staffing data that facilities previously submitted annually using the CMS-671 form.
Among other information, the article links to a map of the U.S., with data showing ratios of residents-per-aide and residents-per-nurse at high and low points, in order to show that staffing can fluctuate at an individual facility over time.
While Minnesota nursing homes are staffing higher on average than facilities nationwide and on average are earning more than 4 of 5 possible stars for staffing, the article could raise questions and concerns regarding staffing levels. We are monitoring media outlets in Minnesota to see whether they NY Times story or Kaiser Health News assessment will get additional coverage.
LeadingAge Minnesota Response
The NY Times has helped raise awareness of an issue we are acutely aware of in Minnesota – workforce challenges in nursing homes.
Minnesota, on average, rates higher than other states in its staffing ratings, and we are proud of the quality care we provide to aging Minnesotans. Quality and safe care requires a person-centered approach that allows for adjustment in staff levels based on the needs of people being served. Every day, aging services providers work in collaboration with doctors, nurses, residents and families to appropriately staff their settings based on individual needs of the residents and the training, experience and capabilities of the care team.
The greater challenge we face in ensuring access to quality care is the ongoing shortage of professional caregivers. There are currently 2,800 open direct care positions in nursing homes across the state, and many nursing homes have made the difficult but necessary choice to decline admissions at certain times due to shortages in essential staff.
LeadingAge Minnesota and its members are actively pursuing many solutions to address our workforce challenges. However, we alone cannot resolve this challenge. With the 65+ population set to double in the next decade, it will take a lot of us working together to serve the needs of our growing senior population. We look forward to continued collaboration with regulators, lawmakers and other stakeholders to elevate the profession of caregiving and ensure quality care and services that seniors deserve and families expect.
Members can download Staffing Concerns in Care Centers for key takeaways from the NY Times article, the LeadingAge Minnesota response, key facts on our workforce challenges, and a summary of activities we are developing and implementing to resolve our workforce challenges.
PBJ TIPS AND RESOURCES:
We also encourage members to refresh their understanding on this important change in how CMS calculates staffing ratings via the PBJ system. Here are two tips and a few resources to help you:
Tip: Review Nursing Home Compare and Check for This Icon --
CMS has added an icon to Nursing Home Compare for facilities that reported 7 or more days in a quarter with no RN hours through the PBJ system. Check your Nursing Home Compare rating to see if the icon appears. If it does, review your Payroll Based Journal submission to confirm that CMS has not made an error in its application of the data for your site.
TIP: Timely & Accurate Reporting
Submitting timely and accurate data is important as CMS will continue to calculate the staffing measures posting to the Nursing Home Compare website to use in the 5-Star Quality Rating System. In an April 2018 memorandum announcing the transition to use of PBJ data for staffing ratings, CMS identified some common errors in PBJ data submission. See the first item in the resource list below to access that memo.
Resources:
CMS Tags Nursing Home Compare Ratings to Reflect On-Site Nurse Coverage (Advantage, June 5)
PBJ Now Being Used to Set Staffing 5-Star Measure (Advantage, May 1)
Care Center Staffing Measures and Ratings to Reflect PBJ Data (Advantage, April 11)
Care Centers: Improve Your 5-Star Rating with Quality Apex
On July 10, 2018 by Julie Apold
Are you looking for ways to boost your organization’s performance or 5-Star rating? Quality Apex is an affordable, secure, web-based analytics tool that translates your most current MDS 3.0 data into actionable information to improve quality and outcomes.
Quality Apex comes to you from the team that developed the 5-Star Analysis Report and Quality Metrics. The knowledge, accuracy and power provided by the tool will enable your staff to:
- Measure Quality Metrics (QM) rates based on your recent MDS 3.0 data;
- Analyze performance against user-defined goals;
- Identify areas for improvement using dashboards and drill-down capability; and
- Report quality improvement plans and accuracy.
Other features include:
Easy to Use: Quality Apex uses your current MDS 3.0 data, which means there is no additional tracking and inputting required by your staff to access these resources.
Accuracy: The scrubbing feature in Quality Apex helps with clinical accuracy of MDS data that you submit to the Centers for Medicare & Medicaid Services (CMS).
Timely: While public data is delayed 4-6 months, Quality Apex is based on your most current MDS 3.0 data upload and offers the greatest chance for successful care planning, reimbursement and quality outcomes.
Power: Quality Apex shows your organization where you need to improve to receive or maintain your highest 5-Star rating by drilling down to resident level detail and supports your QAPI projects by ensuring that staff are on the same page and that improvements are sustained.
Affordable: The annual subscription is $850 for LeadingAge members and $1250 for non-members.
In the evolving healthcare marketplace where reimbursement systems are based on a deepening connection between quality and outcomes, data is power. Quality Apex is the right tool to help you analyze your performance, show you where you need to improve and compare your outcomes with other nursing homes.
To learn more, visit the Quality Apex at www.qualityapex.com and watch the demo videos. You can also contact Julie Apold.
Regulatory Resources and Updates for Care Centers
On July 11, 2018 by Jonathan Lips
The Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Health (MDH) issued a number of regulatory updates in the two weeks since we last published Advantage. Care centers will want to take note of these items:
MDH to Host Statewide Call on July 16
MDH will sponsor a statewide Nursing Home Regulatory telephone conference call on Monday, July 16 from 11 a.m. to Noon. An agenda will be posted here when available. MDH is pleased to offer a new statewide call system that does NOT require any registration. There is no limit to the number of participants. This new system enables MDH to archive a recording of the call, which will be posted on MDH website for 90 calendar days. To participate, call 844-302-0362 and use event number 793733705.
CMS Addresses Legionella Testing Questions
In welcome news, CMS has updated its Quality, Safety & Oversight memorandum concerning Legionella. Ever since CMS established the requirement last year for care centers to have water management programs addressing Legionella, there has been uncertainty about whether providers must test their water for the presence of the pathogen itself.
This memorandum states clearly that “CMS does not require water cultures for Legionella or other opportunistic water borne pathogens. Testing protocols are at the discretion of the provider. … LTC surveyors will expect that a water management plan (which includes a facility risk assessment and testing protocols) is available for review but will not cite the facility based on the specific risk assessment or testing protocols in use.”
For additional guidance about when a facility might choose to conduct testing, see this Centers for Disease Control and Prevention Frequently Asked Questions page.
Liquid Oxygen Update
As anticipated (see our June 19 Advantage article), CMS has provided written guidance to MDH clarifying that existing care centers may store and use liquid oxygen in resident rooms without having to meet a fire-resistance enclosure rating.
What follows is a communication from the CMS Region V office in Chicago to MDH:
“CMS recently had a meeting between central office and the regional offices to discuss the applicability of NFPA 99 Section 11.7.4, 2012 Edition. During that meeting, it was pointed out that part of the requirements at 11.7.4 are separation requirements that include fire barriers that have a minimum of a 1 hour fire resistance rating. Therefore, this code section only applies to new construction after CMS adopted the LSC, 2012 Edition and NFPA 99, 2012 Edition. As a reminder, the regulation was published and effective July 5, 2016. Details were provided in S&C 16-29-LSC. Furthermore, it was stated in that memo that NFPA 99, 2012 Edition adopted only TIA 12-2, 12-3, 12-4, 12-5 and 12-6. NFPA recently released TIA 12-8 that pertains to NFPA 99 Section 11.7.4, but it is not enforceable by CMS, because that TIA was not one that was adopted on July 5, 2016. CMS would need to formally adopt that TIA before it is enforceable as a Federal requirement. To summarize, NFPA 99, 2012 Edition, Section 11.7.4 only pertains to new construction after the adoption of that edition on July 5, 2016. Also, TIA 12-8 that pertains to this code section has not been adopted through the rulemaking process and is not enforceable during a Federal survey. You will receive something from CMS if there are any changes to this guidance in the future.”
Frequently Asked Bed Rail Questions
CMS has prepared a Frequently Asked Questions document concerning bed rails, which addresses questions arising under F604, F700 and F909. CMS intends to post the document on its website within the next month; meanwhile, members may access the document by clicking here.
Immediate Jeopardy Removal Process
MDH has developed a document that surveyors will use any time they identify an Immediate Jeopardy situation. This one-page summary describes the process by which a care center submits a removal plan and MDH verifies the facility has implemented the plan.
Consistent with the CMS State Operations Manual Chapter 7, the MDH guidance emphasizes that a plan of correction should be deferred until after the immediate jeopardy has been removed and the facility receives its 2567 Statement of Deficiencies.
55 Organizations Using OnTrack Nursing Assistant Training
On July 10, 2018 by Jenna Kellerman
OnTrack Nursing Assistant Training has been available for seven months and now has 55 organizations enrolled. Of those 55 organizations, 16 have been approved by the Minnesota Department of Health and 39 are in the application process.
OnTrack has enrolled 125 students to date. Based on student outcomes, OnTrack is providing quality training: State Exam results are trending 6 percent higher than the statewide average, with a 94% overall pass rate.
Find out what everyone is raving about – call 651.425.1110 to schedule your OnTrack demo today.
PROGRAM DETAILS:
OnTrack brings Nursing Assistant training to a new level. There are no class size minimums and no wait time. This hybrid curriculum, supported by the LeadingAge Minnesota Foundation and powered by EduCare, combines the modern conveniences of online training with the interactive and hands-on approaches of a Skills Lab and Clinical Experience.
Why choose OnTrack?
- Anytime enrollment
- Available online 24/7
- No cohort or class size requirements
- Local assistance from OnTrack staff
- Compliance guarantee
- Affordable student registration fees only, no hidden costs
- Adult learning best practices
- Unique character storylines, instilling the importance of person-centered care
- Resources, links, and search features
- More than 40 videos from real staff in the field
- Interactive curriculum with activities, optional games, and quizzes
OnTrack is your Comprehensive Solution. The program offers four components:
- Getting Started Guide to help organizations implement OnTrack
- Media Kit to help organizations recruit students
- Complimentary Train-the-Trainer with easy access online and on-demand!
- Student Experience to teach the Nursing Assistants of today how to care for the people we serve today.
Questions? Call us at 651.425.1110 or visit www.OnTrackNATraining.Com.
State News
What Happens after DHS Completes a Site Visit for HCBS Settings Rule Compliance?
On July 10, 2018 by Bobbie Guidry
The Minnesota Department of Human Services (DHS) is well underway with conducting site visits to Home and Community-Based Services (HCBS) providers who are “presumed not to be HCBS settings.” As some of these site visits have now been completed, we are able to provide information on what happens once DHS completes its visit.
As a reminder, the purpose of the DHS visit is to check that providers are meeting the HCBS standards or to assist the provider in determining how they can meet the standards.
If they find the setting in compliance, information about the setting will be posted on the DHS website for public comment for a period of 30 days. The provider will be notified several days before the posting and is invited to share the opportunity for comment with residents, families, staff and the broader community.
If the setting is not in compliance with the standards, the provider will receive a notice that they need to complete a transition plan to reach compliance. DHS has provided information what to expect after an on-site assessment.
For any setting found in compliance, the comments from the public comment period and documentation from DHS supporting their finding that the setting functions as a HCBS setting will compiled into an “evidentiary package” that will be sent to CMS for its final decision.
DHS reports that the biggest challenge for providers is meeting the community integration standard. DHS has provided examples of ways to comply with that standard in their Provider’s Guide.
For those still working to comply with the initial attestation requirements, DHS is preparing a template to assist you. Use of the template will allow providers not to resubmit the full attestation. We will provide providers with the template once it is approved by DHS.
If you are new to a setting that is working on HCBS Settings Rule compliance, you can find information about the Rule, Standards and Minnesota’s State Transition Plan on the LeadingAge Minnesota HCBS Settings Rule webpage.
We are in the process of scheduling a webinar with DHS to provide updates on this process and to answer your questions. A session with DHS is also planned for August at Senior Living NOW on Aug. 16.
HIE Grants Available from Health Department
On July 11, 2018 by Jonathan Lips
The Minnesota Department of Health (MDH) is seeking proposals for the Minnesota Health Information Exchange (HIE) Grant Program. The program provides financial assistance to Minnesota health care providers to encourage implementation of admission, discharge and transfer alerts and care summary document exchange transactions.
Eligible applicants include home care agencies (including hospital/health system-based, independent Medicare-certified home health agencies and home care agencies) and long-term and post-acute care facilities (including skilled nursing facilities and assisted living settings that provide health or medical services).
Approximately $500,000 is available for these grants. MDH anticipates awarding between five and 25 grants ranging from $10,000 to $100,000. The grant period will be one year, estimated to be from Nov. 1, 2018 – Oct. 31, 2019.
Potential applicants must submit a letter of intent to apply by 4 p.m. on July 20. Grant applications are due by 4 p.m. on Aug. 24.
View the complete RFP, required forms and additional documents on the HIE Grant Program webpage. Questions may be submitted by email to mn.ehealth@state.mn.us.
Federal News
Supreme Court Dumps Public Sector Union Fees
On July 10, 2018 by Guest Contributor
The U.S. Supreme Court in a 5-4 decision issued a long-awaited opinion holding that the First Amendment prevents public sector unions from forcing government employees to pay union dues. While the decision applies only to public sector workers (and not private sector union employees), the decision will have an immediate impact in states like Minnesota where compulsory dues are required by law.
In 2017, 15.2 percent of Minnesota workers (or about 411,000) belonged to a union. Public sector unions account for at least one-third of Minnesota’s total union representation and the state’s largest public unions include: Education Minnesota (70,000 members), AFSCME (56,000 members), and the Minnesota Association of Professional Employees (14,500 members).
Background
Many states, including Minnesota, have passed laws permitting public employees to unionize. Under these laws, the union may engage in collective bargaining; individual employees may not be represented by another agent or negotiate directly with their employer (i.e., the state).
Individuals who do not wish to join the union can still be required to pay what is generally called an “agency fee,” a percentage of full union dues under a Supreme Court decision called Abood v. Detroit Board of Education, 431 U. S. 209 (1977). This fee may cover union expenditures attributable to those activities “germane” to the union’s collective-bargaining activities (such as negotiations and grievance processing) but may not cover the union’s political and ideological projects (such as supporting political candidates). The union sets the agency fee annually and then sends nonmembers a notice explaining the basis for the fee and the breakdown of expenditures.
In Minnesota, for example, state law provides that government employees who refuse to join the union can be forced to pay a “fair share fee” of up to 85 percent of full union dues. While there is a process for challenging the fees assessed by the union, it is convoluted and cumbersome.
The Supreme Court Decision
In Illinois, state employee Mark Janus objected to the “agency fee” charged by the union representing his colleagues. The fee was 78.06 percent of full union dues. Janus objected to the payment of any union dues because he claimed that fees constituted “coerced political speech” in violation of the First Amendment.
The Supreme Court agreed, overruling its decision in Abood. The 5-4 majority concluded that “public-sector agency-shop arrangements violate the First Amendment.” The court dismissed the union’s “free-rider and “labor peace” arguments, noting that neither were sufficient to overcome the free speech concerns.
Bottom Line
The result of today’s decision is that public sector workers who refuse to join the union can no longer be forced to pay any dues or fees to the union.
In Minnesota, this likely means that any “fair share fee” assessed by a union on a public sector employee violates the First Amendment. While current public-sector union members would need to resign their membership before their dues obligation could cease, non-members could likely cease paying dues immediately.
Public sector employers that are deducting fair share fees from non-members should seek immediate legal counsel to avoid potential legal liability as continuing to withhold and pay such dues may result in litigation and damages.
Thank you to Grant T. Larsen, Attorney and MSBA Certified Labor & Employment Law Specialist, Fehlhaber Larsen for contributing this commentary.
No Significant Changes in Medicaid on Congressional Agenda before November Elections
On July 10, 2018 by Jodi Boyne
As Congress broke for it July 4 recess, LeadingAge provided an update on where our legislative and regulatory issues stand on Capitol Hill and in the federal agencies.
There are no significant changes in Medicare or Medicaid are on the congressional agenda before the November midterm elections.
Most of our current legislative activity on Capitol Hill is focused on housing and home- and community-based services appropriations for 2019. House and Senate appropriations committees are marking up legislation and the congressional leadership wants to get individual spending bills done before the new fiscal year begins on Oct. 1. However, time is relatively short. It appears that once again there will be some sort of continuing resolution.
On the regulatory front, LeadingAge filed comments on the proposed Medicare payment rules for skilled nursing facilities and hospice that include provisions on value-based purchasing, quality reporting, and reform of the payment system. We also continue our advocacy on reform of the nursing home oversight system.
Get Up to Speed on HUD Rent Proposals in 7 Minutes
On July 10, 2018 by Bobbie Guidry
A new, seven-minute QuickCast from LeadingAge is a fast way for members to get up to speed on HUD and Congressional proposals to change how rents of HUD-assisted residents, including older adult residents, would be calculated.
As part of its fiscal year 2019 budget proposal, HUD has proposed to eliminate medical expense deductions for older adults, change the definition of what it means to be an "eldery household" for purposes of rents and work requirements, and shift from calculating rents at 30 percent of adjusted income to 30 percent of gross income, among other changes.
Congressman Dennis Ross (R-FL) has also proposed changes to rents for HUD-assisted residents. The QuickCast reviews the HUD and Ross proposals, both of which LeadingAge strongly opposes.
Watch Proposed Rent Reform for HUD-Assisted Residents in LeadingAge's Learning Hub, under Hub Products.
Notable News
Fore! Deadline to Register for Foundation Golf Tournament is July 16
On July 11, 2018 by Jenny Prosser
This year’s LeadingAge Minnesota Foundation Golf Tournament on Aug. 8 is nearly sold out! Don’t delay. Register today for a day of golf on the championship-style Keller Golf Course, networking and – most importantly – raising money to fund essential caregiver scholarships!
Our sixth annual golf fundraiser is a can’t miss event. It all takes place at the Keller Golf Course in Maplewood (located near the intersection of Hwys. 36 and 61). Watch this video to get a sneak preview of this great course.
Our valued business partners have already contributed more than $22,500 in sponsorship dollars. We are challenging our members to raise another $25,000. We are well on our way, but need your support to reach this goal.
Join us on Wednesday, Aug. 8! If you can’t make it for the whole day, plan to have lunch or dinner with us. You’ll be in the best company for a great day of networking.
Registration deadline is Monday, July 16. Register Today!
Member News
Benedictine Health System Names Steven Przybilla as Senior Vice President, Operations/COO
On July 10, 2018 by Jodi Boyne
Steven Przybilla is the new senior vice president, operations/chief operating officer, for Benedictine Health System effective July 1.
Przybilla has served as the interim SVP/COO since March 2018 while also serving his current position as BHS vice president operations of the north region, where he oversees long-term care and housing operations across North Dakota and Minnesota.
Przybilla has more than 20 years of leadership experience in the long-term care industry and extensive experience in construction management and business development. He joined BHS in July 2009 as administrator/CEO at St. Gabriel’s Community in Bismarck. His responsibilities now include focusing on operational efficiencies within the System and enhancing alignment of functions supporting BHS communities across the Midwest.
For more information, see Benedictine Health System Names Steven Przybilla as Senior Vice President, Operations/COO.
Erin Hennessey Named CEO of Health Dimensions Group
On July 10, 2018 by Jodi Boyne
Health Dimensions Group announced that Erin Shvetzoff Hennessey has been named the company’s next chief executive officer. She takes over the top leadership position from Sergei Shvetzoff, who has served in that capacity since October 2015. Shvetzoff will continue as chairman of the board of directors.
“We are in a time of rapid change in our field; these changes, combined with the increase in demand for the senior services our partners provide, creates opportunity for us to provide our clients with the expertise and customized solutions that our many talented employees provide each day,” said Erin Shvetzoff Hennessey.
Hennessey has been a leader, advisor, and executive director of skilled nursing, assisted living, and senior living communities located in several states. She is active in acute, post-acute, and senior services professional organizations providing educational resources, industry information, and support for members. Hennessey is a sought-after speaker at national and state meetings on a variety of topics, including senior health care, acute/post-acute integration, health care reform, value-based transformation, and planning for aging populations. Recently, she was named senior fellow with the BDO Center for Healthcare Excellence & Innovation.
For more information, see Introducing Health Dimensions Group’s New CEO.
Education Solutions
Earn CEUs: Learn Strategies for Effective, Systematic Approach to Strategic Planning
On July 10, 2018 by Julie Apold
Register your team by July 16 for a workshop where you will discover new tools and approaches to your strategic planning process. As part of LeadingAge Minnesota’s Performance Excellence in Aging Services platform, the July 19 workshop A Systematic and Effective Approach to Strategic Planning unfolds the strategic planning process from preparation and prioritization to deployment and sustaining the plan.
Discover how to structure the planning process, how to gather, interpret and use data, develop short- and long-term action plans, and identify key performance and review measures. It’s a day packed full of great information and practical application. This program is open to all LeadingAge Minnesota members whether participating in the Performance Excellence in Aging Services program or not.
Details and registration here. For more information, contact Julie Apold.
Sign Up for Live Demo of New Job Board
On July 10, 2018 by Jenna Kellerman
The new AgingServicesJobs.Org platform has launched! Sign up for a live webinar demo on July 31 from 9 a.m. - 10 a.m. to learn how to post a job.
If you’d like to try posting a job today, email Jenna Kellerman – the first 10 members to email Jenna will get a free promo code to post their next open position!
A recorded webinar on How to Create an Account and How to Post a Job is available here. Download written instructions here: Posting Guide, Connecting with Candidates, Promote on Social Media.
The sophisticated technology, thanks to new vendor WorkFountain/RealTime Talent Exchange, includes blindmatching algorithms to connect candidates and employers based on skills, interests and job requirements. The data-driven technology sorts and ranks matched candidates based on alignment with job characteristics.
HOW IT WORKS:
Go to AgingServicesJobs.org.
Create an employer account.
Answer specific questions about your position.
Meanwhile, candidates answer correlated questions about their unique skills and interests.
Reach out to candidates that match to your open position!
COST:
To help build a robust job board that is attractive to job seekers, LeadingAge Minnesota Foundation is subsidizing the cost for providers to post open positions on AgingServicesJobs.Org when the new system launches.
The total cost per job posting will be $50 for a job and $30 for an internship, discounted to $25 for a job posting and $15 for an internship thanks to the Foundation’s generosity. This discount will be available to all members for a limited time.
Questions can be directed to Jenna Kellerman.
Last Chance for Adult Day Conference
On July 10, 2018 by Heidi Simpson
Thursday, July 12 is the last day to pre-register for the July 17 Adult Day Conference. Join more than 100 of your adult day colleagues at the summer’s one-stop event to learn, share and connect.
Find details and registration here.
Billing University for Care Centers is Aug. 8-9
On July 10, 2018 by Heidi Simpson
Care center billing office staff are encouraged to attend the annual Billing University on Aug. 8 and 9. Content is reviewed and updated each year to stay current with the business environment, so it is applicable to both new and seasoned staff.
This two-day intensive learning workshop is specifically designed to improve the financial health of the care center by equipping staff with the essential knowledge, skills and resources to capture appropriate reimbursement for services provided.
Find details and registration here.