Pulse December 2005

FHCA FLORIDA HEALTH CARE ASSOCIATION

Update

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Pulsec DECEMBER 2005 ce

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

Adios, 2005 hurricane season

While not as devastating as the four hurricanes that rocked Florida last year, the four storms that made landfall in Florida (Dennis, Katrina, Rita and Wilma) in 2005 caused widespread damage and forced numerous facility evacuations in advance of each storm. For more on hurricanes and emergency preparedness, see "From the President's Desk," page 3, and "News from Across Florida," page 12.

Special session convenes

At press time, Florida legislators were scheduled to meet in a one-week special session December 5th to consider giving the final go-ahead to Medicaid managed care pilot programs recently approved by the federal government.Two of the demonstration projects that relate to managed elder care will be set up in the Orlando and Pensacola areas. See January 2006 FHCA Pulse for a complete report.

Thanks, Train-the-Trainer sites

FHCA extends its thanks to Orlando Regional Lucerne Hospital; Regency House in Daytona Beach; Palm Garden of Tampa; and Baptist Manor in Pensacola, the hosts for this year's FHCA CNA Train-the-Trainer sessions. FHCA member facility RNs attended the all-day training sessions in order to obtain the curriculum and learn how to implement the two-week CNA Test Prep Course in their facilities.

CONTINUED ON PAGE 19

YEARin REVIEW

Major quality gains mark 2005 for nursing homes

Will Medicaid reform and HMOs be able to maintain quality?

The quality of care in Florida's nursing "What we predicted would happen has indeed homes steadily improved over 2005, contin- come to pass," FHCA President Dion Sena said of

uing a trend that began with the passage of the good news. "By any standard, our facilities

landmark elder care legislation in 2001. For deliver a better standard of care than ever before."

the fourth year in a row, the total

Despite the dramatic improvement,

number of deficiencies cited during RUG 53 nursing homes continue to face challenges

annual and complaint surveys fell, and Update finding adequate and affordable liability

the number of adverse incidents declined See Page 15 insurance, even though the number of

by more than a third over a three-year

nursing home lawsuits tapered off slightly.

period. The number of facilities on Florida's Medicaid reform, a busy hurricane season and

Watch List steadily declined as well, and the numerous regulatory changes marked a challeng-

federal Quality Measures -- the indicator of ing year for long term care providers.

how patients progress in nursing homes -- From the pages of FHCA Pulse, a month-by-

show Florida care to be among the nation's month review of some of the major events

best.

shaping long term care:

CONTINUED ON PAGE 6

SEASONS GREETINGS FROM IRAQ

That's FHCA lobbyist Bob Asztalos in a pre-mission photo taken with his U.S. Marine Corps unit stationed in Iraq. Asztalos is a Senior Chief Medical Corpsman who's due home in March. At right, Asztalos models the unit's "good luck" bandana.

Florida Health Care Association

P.O. Box 1459 Tallahassee, FL 32302-1459

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Inside

Speaking Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Posting Staffing. . . . . . . . . . . . . . . . . . . . . . . . 11 Labor News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Christmas Trees . . . . . . . . . . . . . . . . . . . . . . . . 17

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FROM the PRESIDENT'S

DESK

What about the 2006 hurricane season?

Lawmakers should focus attention on the vulnerable elders who live at home, not just those in nursing homes

by Dion Sena FHCA President

Florida Health Care Association

Dion Sena, President

Bill Phelan, Executive Director David Sylvester, Senior Vice President Deborah Franklin,

Secretary Nina Willingham, Treasurer

FHCA Pulse

DECEMBER 2005 FHCA Pulse is produced monthly for the Florida Health Care Association, P.O. Box 1459, Tallahassee, FL 32302-1459, by Ed Towey & Associates, Inc. Editorial ? To submit information, guest articles, press releases, etc., contact Ed Towey at (850) 224-6242 or via e-mail at etowey@. Fax information to (850) 224-9823 and include your name, telephone number and e-mail address. To contact FHCA, call (850) 224-3907. Advertising ? For information on Pulse advertising rates and availabilities, contact Ian Cordes at Corecare Associates at (561) 6595581 or via e-mail at icordes@. All articles and advertising are subject to editorial review.

Acouple of months ago, a friend of mine sent me one of those humor pieces that bounces around the Internet.This one was "37 Signs That You Live In Florida." A few examples:

s You have more than 300 "C" and "D" batteries in your kitchen drawer s You are on a first-name basis with the cashier at Home Depot s At cocktail parties, women are attracted to the guy with the biggest chain saw s You can recite from memory whole portions of your homeowner's insurance policy s Your child's first words are "hunker down" and you didn't go to Ole Miss s You catch a 13-pound redfish ? in your driveway

I for one am thankful that the 2005 hurricane season is behind us. What pride our members can take in knowing that over four hurricanes and thousands of patient evacuations, not one precious life was lost! I hope lawmakers keep this compelling accomplishment in mind when considering any legislation that would call for more micromanagement of nursing homes before, during and after a storm.

In fact, their attention ought to be focused more on those seniors who don't live in elder care facilities, for it is they who seem to be most at risk, judging by recent experience. I pointed out last year that the storms revealed just how threadbare our system of home- and community-based elder care is. One year later, we still see otherwise independent seniors trapped in high-rise condos because the elevators don't work. We see otherwise independent seniors unable to fill prescriptions and who later show up in hospitals and special needs shelters. Let me be very clear.We fully support the state's "aging in place" strategies, but those strategies ought to include being certain the place where people age is safe and that needs are covered during an emergency.

Special thanks

One of the reasons our nursing homes were able to weather the storms so well was because of outstanding FHCA member volunteers and the way nursing home helped nursing home, regardless of company affiliation. FHCA Disaster Preparedness Committee chair Robin Bleier again was invaluable. Tim Gregson stepped up to the plate and hit another home run. In Dade, Broward and Palm Beach counties, FHCA members Robbie Williams, Tracy Greene, Pat Feeney, Frank Buxton, Rob Yandek, Ben Jelsema, Brenda McKenzie, Deb Williams, Karla Conway and Jose Perez manned the ESF-8 desks at their local emergency response centers. FHCA staff members LuMarie Polivka-West, Debbie Afasano and Lee Ann Griffin took turns at the state Emergency Operations Center in Tallahassee. Staff member Koko Okano worked out of Broward County with the statewide response team comprised of the Agency for Health Care Administration and Department of Health. Our many other Associate Member companies came through for us again, and I thank you on behalf of all the very many and very grateful nursing homes you helped.

A holiday message

Last month I had the privilege of attending the very moving memorial service for Luke Rigsby, the 20-year-old son of FHCA Government Services Director Peggy Rigsby. Luke died following an 18-month battle with cancer. One of Luke's many eulogizers that day recounted giving him the Mitch Albom book, "Tuesdays with Morrie," and how much it meant to Luke. The book's central message -- that we should love and serve others in our communities -- is a powerful truth, one well worth remembering this holiday season. Luke may be gone, but as Albom notes, "death ends a life, not a relationship."

Cathy and I wish you and your family a most blessed Christmas, a joyous holiday season and a prosperous and happy new year.

FHCA DECEMBER Pulse 3

LTC LEGAL ISSUES and TRENDS

Oh, frustration!

by Karen Goldsmith

Goldsmith, Grout & Lewis FHCA Legal Consultant

Ever since the state began issuing its own deficiency report rather than adding its identifiers onto the federal report, we have received many complaints from providers. First, of course, is that deficiency reports are now longer and appear to have more cites than the previous system. This is because the state report may totally reiterate the language in the federal report where before the "N" number was simply added onto the end of the federal tag.

Second, providers are finding that IDR (informal dispute resolution) may not be available to them if the citation is state only. In fact, technically, the state tag need not be changed through IDR even if the federal tag is, although the underlying facts may be identical. This, however, would lead to absurd results with the Agency for Health Care Administration state office (acting on behalf of the feds) overturning a federal tag while keeping the same fact pattern as a state tag. From a practical standpoint, that should not happen if the state and federal regulations are identical. Either the tag exists or it does not. To say it does exist for state reasons but not federal, would make no sense.

However, if the tag is only a violation of a state requirement or the state requirement

New CMS and AHCA policies are making life difficult for nursing homes

differs from the federal one, then IDR is not available to dispute the tag.

Federal CMPs

At the time that you get your 2567, you typically get a letter from the Centers for Medicare & Medicaid Services, advising you of the AHCA's recommendation for sanctions, if any. This letter is faxed and a receipt is requested. If you do not send the receipt you will likely get a call from CMS looking for same.

Unless you have had serious deficiencies, the CMS letter will tell you of sanctions that may be imposed if you do not achieve substantial compliance on your resurvey. If this occurs, you will receive no further communication from CMS until they send you a bill for civil money penalties, if such are imposed.This letter will arrive long after the time for challenging the sanctions has passed. Providers have even been in denial of payment for new admissions and not known it because they waited for a letter telling them that, in fact, sanctions have been

Letters from across Florida

Capable and attentive

"My family and I want to thank you and your impressive staff for all your careful and thorough attention to our mother, Edith Cherry, during her stay at Quality Health.We could not have asked for better or more thoughtful care...Mother's CNAs were always capable and attentive...You have built a strong health care team.We cannot imagine a better place for our mother to find the warm and gentle care she needed and the peace that she sought.We admire your leadership of this fine organization, and we will always be grateful to you."

-- Kelli Cherry, to Quality Health of Fernandina Beach administrator Debbie Daniels

Love and caring

"(S)ince I have been here I have been surprised at what I have experienced. That is the love and caring that the employees reflect toward the residents. Yes, I know they get paid for what they do, but not for their attitude. Money can't buy that! From Matt Triplett, the administrator down, all of his employees reflect the fact that all the residents receive their love and attention... In my five years here, I have gone through four storm seasons. People here go on 24-hour shifts or longer and were ready to move everyone and everything at anytime.They have moved before and will again because we live on the Gulf Coast and believe me, it is no easy feat."

-- Carlton Williams, a patient at Delta Health Care Center in Destin, in a letter to the editor published in the Northwest Florida Daily News, September 25, 2005

imposed.That letter is rarely sent -- you are expected to rely on the initial letter.

What to do

If you get a civil money penalty you have three options:

1. Ignore it and pay the fine

2. Challenge the deficiencies (in some cases you must challenge all of them, not just the ones driving the fine)

3.Take the 35 percent reduction. In order to get the 35 percent reduction you must waive the right to a hearing in writing within the same 60 days in which you can file a challenge. You need not admit the tags, simply waive the right to the hearing while including language that documents your opposition to them

Petitions filed with the Departmental Appeals Board, challenging your survey report, must be filed within 60 days of the letter. Filing means that it is actually received by DAB so some sort of receipt should be obtained (overnight or certified mail). Your waiver however must be sent to CMS and received by them by the deadline. Unfortunately, providers have lost the chance to get the discount on their fine because they let the deadline slip by.

Accumulated surveys

In counting the days which trigger a denial of payment or even termination, providers tend to focus on the annual survey and forget the impact of other surveys (e.g., complaint surveys). You will be denied payment for new admissions if you are out of substantial compliance for 90 days. The days are not necessarily counted from the annual recertification survey.

For example, you may have a complaint survey on January 1st and receive one citation. Your annual survey may occur on February 10th. If the tag found on the complaint survey is not corrected, then at the time of the survey you are already out of substantial compliance for 40 days. If on resurvey (30 days after the annual) you have a single deficiency at the scope and severity of "D," even though the tag found on the complaint survey is corrected, you will not be in substantial compliance. You are now out of substantial compliance for 70 days and that 90-day milestone is fast approaching.

The moral of the story: Keep an eye on that calendar!

4 FHCA DECEMBER 2005 Pulse

Speaking Out

A good investment?

(Editor's note: The following was published October 28, 2006 in the Naples Daily News, written in response to an earlier editorial.)

The Daily News' lack of understanding of how nursing homes function as businesses is apparent in the editorial that suggests nursing homes purchase expensive backup power plants as "a good investment."

In a free market, businesses purchase new equipment with the expectation that it will generate increased business and increased revenue, which both pays for the cost of the equipment and generates additional capital for future needs. Nursing homes, however, do not operate in a free market. The typical nursing home receives 80 percent or more of its total annual revenue from Medicare and Medicaid, whose payments are determined by formula, are fixed and are already insufficient.

Increased business? There has been a moratorium on new nursing home bed construction since 2001. So how or from whom are the nursing homes to recover this huge cost?

If the Legislature wishes to require all nursing homes to purchase, install and maintain expensive near-megawatt generators,

it should bear the huge cost of compliance. It should also consider a much more reasonable and much less costly alternative: installing transfer switches in all facilities to which portable power plants could be trucked in and readily connected when power fails.

Finally, nursing homes already regularly receive evacuees from nearby facilities, along with the staff necessary to care for them. They do this because during times of crisis, nursing homes stick together to protect the frail elderly entrusted to their care.

William J. Phelan

Executive Director Florida Health Care Association

FHCA DECEMBER Pulse 5

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