New CMS Survey & Certification Letter: Discharge Assessments

          This memo clarifies the steps facilities must take to address MDS 3.0 discharge assessments that have not been completed and/or submitted as required under 42 CFR §483.20(g) and 42 CFR §483.20(f)(1).

o   42 CFR §483.20(g)-Accuracy of Assessment, requires that assessments “accurately reflect the resident’s status.”

o   42 CFR §483.20 (f)-Automated Data Processing, requires facilities to encode the following information for each resident in the facility within 7 days from completion of a resident’s assessment: (i) Admission assessment. (ii) Annual assessment updates. (iii) Significant change in status assessments. (iv) Quarterly review assessments. (v) A subset of items upon a resident’s transfer, reentry, discharge, and death. “A ‘subset of items upon…discharge…’ means discharge assessment.”

Shortage of PPD for Washington State TB Screening

The Department of Health and ALTSA recognize that there is a current shortage of PPD for required TB testing in community based and state licensed facilities. 

Please remember that licensing requirements include both the PPD and blood test options.  Providers should work closely with their licensing staff and/or field managers in the event questions arise about any delays in testing.

Please contact Bonnie Blachly at bblachly@leadingagewa with questions.   

 

 

Focus on QAPI: The Second Element

QAPI (Quality Assurance Performance Improvement) has 5 elements that you must include in your program.  The second aspect of QAPI is Governance and Leadership.   This aspect deals with who is going to take responsibility for the QAPI process and how are they going to do it?  Those of you in Administration need to take the lead in QAPI.  Use your staff, residents and families to get input that will help you to decide how to proceed.  You need to provide the necessary training and equipment for the staff as you select projects to work on.  When you think about establishing policies around QAPI, you need to make sure they will stand up in the face of changes in personnel and turnover.    Set your priorities for improvement.  Your QAPI program must have at least one person accountable with adequate resources to ensure the success.  It is important to set expectations from the start.  As you set these expectations, keep in mind safety, quality, rights, choice and respect.  Finally, create an organizational culture and climate that holds staff accountable, where systems are evaluated through root cause analysis rather than punishing individuals and creating fear of retaliation.  Very often identified problems are due to a system failure rather than an individual making a mistake. 

 

For assistance, contact Bonnie Blachly at bblachly@leadingagewa.org.

 

QAPI (Quality Assurance Performance Improvement) Update

QAPI (Quality Assurance Performance Improvement) has 5 elements that you must include in your program.  The first aspect of QAPI is Design and Scope.  Your QAPI process must measure how you are doing in every department and against every part of the regulation.  It is more than a one- time look but is on-going.  It should include your clinical care, quality of life, resident choice and care transitions.  When looking at design and scope, you need to make sure you are using the best available evidence to define and measure your goals.  Nursing Homes must have a written QAPI plan.  As you consider how you will craft design and scope, use your quality indicators and quality measures.  They can give you a retrospective look at how you did which is the QA part of QAPI.  Then use that data to determine what changes you will implement, monitor and measure in the coming months.  That is the PI part of QAPI.  Be sure you are monitoring your outcomes related to the newly implemented changes you make.

Stay tuned for next week's QAPI update.  Contact Bonnie Blachly with questions or for assistance.

 

Nursing Homes Randomly Selected to Be Focus of an Evaluation Related to Abuse

         The Office of Inspector General, Office of Evaluation and Inspections has begun sending out letters to a number of nursing facilities to notify those providers that "OIG is conducting an evaluation that will determine whether nursing facilities complied with Federal requirements related to reporting allegations of abuse and ensuring that covered individuals report reasonable suspicions of crimes", and that they have been selected to participate. 

Health Care Reform: DELAY in Employer Shared Responsibility Provisions

The White House and US Department of the Treasury (Treasury) have announced that it will delay the Affordable Care Act mandatory employer shared responsibility provisions and insurer reporting requirements for one year.  Thus, the reporting requirements and any potential penalties will not be collected in 2014. 

Here is a summary with more information and links to the White House blog and Treasury release.

 

LeadingAge Innovations Fund Open for Applications

The LeadingAge Innovations Fund is designed to catalyze innovation among our members to develop programs that have the potential for demonstrable impact on residents, clients, families, employees or the broader community and have the potential for replication. Up to 8 grants will be awarded for a maximum amount of $25,000 per grant. This is twice as many grants as were awarded in 2012.

The 2013 round seeks to identify promising strategies for linking health and supportive services with congregate housing settings to help low-income residents meet their needs and safely age in their home and community. Projects may include services in any area and be delivered through any mechanism.

Read more here.  Grants from the Innovations Fund are made possible through the generosity of LeadingAge members and a matching grant from the NewCourtland Foundation.

Seeking Pilot Program Participants for INTERACT Tools in Assisted Living Environments

Care Transitions programs are coming to Assisted Living, finally.

Florida Atlantic University (FAU) seeks Assisted Living Facilities to pilot test the INTERACT (Interventions to Reduce Acute Care Transfers) Quality Improvement Program for Assisted Living. 

The pilot test will run for a 3-6 month period, beginning in July 2013, and requires participating agencies to: 

1. Implement the INTERACT Quality Improvement Program using the PAPER ONLY version of the draft Version 1.0 Tools for Assisted Living.
2. Provide routine feedback to the project team via brief online surveys and brief telephone interviews.

The application requires you to select the Quality Improvement Program tools you will use during the pilot. 
To make the selection please review the Version 3.0 tools and Quality Improvement Program.  Applications should be completed online by July 12, 2013.

Please contact Dr. Henry at henryn@fau.edu if you have any questions. Thank you

CMS Opens Round Two of Health Care Innovation Awards

The Centers for Medicare & Medicaid Services (CMS) has released a Funding Opportunity Announcement for round two of the Health Care Innovation Awards. Under this announcement, CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

The second round of the Health Care Innovation Awards will support public and private organizations in four defined areas that have a high likelihood of driving health care system transformation and delivering better outcomes. Specifically, in this second round, CMS is seeking proposals in the following categories:

• Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings.
• Models that improve care for populations with specialized needs.
• Models that test approaches for specific types of providers to transform their financial and clinical models.
• Models that improve the health of populations – defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class – through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting.

In this round, CMS specifically seeks new payment models to support the service delivery models funded by this initiative. All applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model that they propose.

Construction Review Services to Offer Assistance During LeadingAge Washington Annual Conference

This opportunity allows you to meet with their professional staff to discuss questions about rules and regulations, future plans for your facility, review of active projects and/or get advice on quick resolution.

Timeslots are available at 30 minute intervals to discuss topics of your choice!

Reserve your time now by contacting Marlei' Brenna at 360-236-2944 or emailing requests to dohfslcrs@doh.wa.gov.

Contact Paul Montgomery for more information.

HB 1629 Signed by Governor - Changes LTC Worker Training Requirements

The Governor signed HB 1629 on Thursday, May 16.  The bill goes into effect on July 28.  Of note, LeadingAge Washington was able to secure an exemption from DSHS continuing education requirements for licensed nurses.  Additionally, long term care workers now have 200 days from the date of hire in which to become certified as a home care aide, and there is time-limited provisional certification allowed for those with English proficiency challenges.

Contact jmartin@leadingagewa.org for more information.

Death Results in DSHS' Dear Administrator Letter re: Safety Risks of Medical Devices

With a recent fatal incident involving the use of bed rails, DSHS is issuing an updated Dear Provider letter to Nursing Homes and Assisted Living communities regarding the use of medical devices by or for your residents.  This letter replaces one issued in 2009 on the same subject.

Among other things, IF you are using or considering the use of a medical device for a resident, review the following carefully:

• The resident assessment will include the resident's strengths and any needs for which a medical device might be considered.  NOTE:  The assessment identifies the resident's needs.  Do not use the assessment to justify the use of the device.
• Ensure the resident's negotiated service agreement includes both the resident's needs and provides alternative interventions that support the needs of the resident and how best to keep the resident safe.  Less restrictive alternatives are safer and should be implemented before using any medical device.
• Residents and/or family members must be provided with enough information about the significance and level of the safety risk of using the medical device to enable them to make an informed decision about whether or not to use the device.

For information, contact Julie Martin.

Technology at Work: Empowering Staff to Improve Care for Dementia Residents

The Mather LifeWays Institute on Aging developed a measure, called “Observing Quality of Life in Dementia” or OQOLD, which enables professional caregivers in a variety of settings to assess the quality of life of persons with dementia based on their observations of those individuals during a variety of activities.

Quality-of-life scores, which range from a low of -3 to a high of +3, are based on the person’s level of engagement and/or emotional reaction during the activity.

Through a partnership with Benten Technologies, and thanks to a grant from the National Institute on Aging, Mather LifeWays staff members currently record their OQOLD scores on an iPod Touch. Data are wirelessly transferred from the iPod Touch to a website where the scores are organized into a variety of reports that staff can download and use to maximize both the quality of care provided and the quality of life of participants with dementia.

LeadingAge: Empowering Staff to Improve Care for Dementia Residents

Seattle HUB Office To Close? How HUD Plans to Restructure the Office of Multifamily Housing

The U.S. Department of Housing and Urban Development (HUD) on April 24 announced a series of restructuring and systemic changes within its Office of Multifamily Housing Programs and the Office of Field Policy and Management (FPM).

The changes include:

• Consolidating multifamily business to 5 hubs nationwide.
• Closing 16 smaller offices altogether.
• Consolidating multifamily staff to no more than 10 offices nationwide.
• A redesign of multifamily office structures and plans for workload sharing.

LeadingAge: How HUD Plans to Restructure the Office of Multifamily Housing

Center for Aging Services Technology Clearinghouse A Resource Open to All

CAST Clearinghouse is a dynamic resource that contains information about cutting-edge research, pilot projects, and products designed to support independence, quality of care and quality of life for older adults. This free tool is open and available to everyone.

Information can be submitted directly by:

• Aging Services Providers - Let your peers know what you're pilot testing.
• Companies/Vendors - Share details about your existing and emerging products and services.
• University Researchers - Disseminate information about your research projects and prototypes.

New I-9 Form Published

On March 8, 2013, the U.S. Citizenship & Immigration Services released a new version of the I-9, the Employment Eligibility Verification form. Follow this link to their website and a click-through to the new form. 

Apply Now for a LeadingAge Washington Award of Excellence

The Awards of Excellence recognize those individuals and organizations who have made an outstanding contribution in the fields of aging, health care, housing and community-based services. It is our way of saying thank you, to those who do more than what is merely expected of them, who do the right things for the right reasons.

Apply today.

Book Your Lodging Now For The Annual Conference

LeadingAge Washington will be in Vancouver, Wa. for our 62nd Annual Conference.  Join us June 10-13 & reserve your lodging now.

Legislation Introduced: Fix Medicare Observation Days

Both the House and the Senate have bills before them which specify that any hospital stay under observation would count towards the three-day hospitalization requirement for Medicare coverage of post-acute care.

Take action to request support from your congressional leaders now by Contacting Congress.

DSHS Issues Clarification on Regulatory Authority

DSHS issued the following notice to Nursing Homes, Adult Family Homes and Assisted Living Facilities on March 5, 2013:

"We would like to clarify the role of our licensors as a regulator and not as a consultant. We understand that applicants and providers want to know what to do to meet the requirements. In an effort to be helpful, Department staff have sometimes provided information that is not strictly regulatory based but may instead be a best practice.

The Department's role is to develop, establish and enforce standards for the maintenance and operation of assisted living facilities. The health, safety, well-being and quality of life of vulnerable adults have always been and will continue to be the paramount concern in determining whether to issue a license to an applicant, whether to suspend or revoke a license, or whether to take other licensing actions.

As a regulator, Department staff can and will continue to tell applicants and providers when they are in compliance with the regulations and when they have not met the requirements. Department staff may also tell applicants and providers if something that they plan to do would appear to help them meet the regulations or not. However, Department staff will not provide information on how to implement the regulations."