-
Thursday January 5, 2012
Influenza can spread quickly and have serious consequences in
long-term care facilities, putting residents - especially those
with certain medical conditions at greater risk of developing
complications like pneumonia and bronchitis. The flu also can make
chronic health problems worse and may result in hospitalization and
sometimes even death.
The January 6, 2012 Morbidity and Mortality Weekly Report
includes a report that highlights the importance of having and
following an influenza outbreak management strategy.
CDC has posted consolidated influenza outbreak management
guidance for long-term care facilities at: www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
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Wednesday January 4, 2012
Federal Requirements for the Independent Informal
Dispute Resolution Process
New regulations have been added at 42 CFR, Sections 488.331 and
488.431 as required under section 6111 of the Patient Protection
and Affordable Care Act of 2010 enacted on March 23, 2010. This
memorandum provides interim advanced guidance regarding the Federal
requirements for the Independent IDR Process for nursing homes.
The Centers for Medicare & Medicaid Services (CMS) is in the
process of updating the SOM to reflect the new regulations found at
42 CFR Sections 488.331 and 488.431. An advance copy of the interim
guidance is attached to the memorandum.
IDR S&C Letter Dec 2011
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Wednesday January 4, 2012
CMS Issues New Guidance for 2012 Medicare S&C
Budget
The Centers for Medicare and Medicaid services (CMS) issued a
new S&C memorandum on December 9, 2011 related to the Survey
and Certification Budget for Physical Year 2012. The memorandum
states that CMS is exploring methods to increase the focus on
certain high priority areas. To make possible such increased focus
and to accommodate the budget constraints, they are examining ways
to reduce surveyor time in areas of lower risk. Particular areas in
which they seek to increase the focus include:
- Poorly Performing Nursing Homes
- Inappropriate Anti-Psychotic Use
- Avoidable Falls
The effective date of this material is January 1, 2012.
For more details see attached memorandum.
FY 2012
Medicare S&C Budget
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Wednesday January 4, 2012
Smoking Safety in Long Term Care
The Centers for Medicare and Medicaid Services (CMS) issued a
Survey & Certification (S&C) Memorandum November 10, 2011
reminding both surveyors and facilities of the importance of
smoking safety for residents who smoke. The S&C memo reviews
some of the information contained in the Surveyor Guidance for F323
- Accidents & Supervision.
Smoking Safety in Long Term Care
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Wednesday January 4, 2012
Pioneer Network Announces New Dining Practices
Standards
The Pioneer Network announced that its Food and Dining Clinical
Standards Task Force: A Rothschild Regulatory Task Force has
finalized new Dining Practice Standards agreed to by twelve
national clinical standard-setting associations. These nationally
agreed upon new food and dining standards of practice support
individualized care and self-directed living versus traditional
diagnosis-focused treatment for people living in nursing home. The
New Dining Practice Standards document reflects evidence-based
research available to-date as well as current thinking.
The Pioneer Network stated that the importance of these new
agreed upon clinical standards cannot be overstated as food and
dining are an integral part of individualized care and
self-directed living for people living in nursing homes.
Pioneer Network plans to submit the new Dining Practice
Standards to CMS, FDA,
CDC and the long-term care community at
large. It is anticipated that CMS
will refer to these new agreed-upon standards of practice within
long term care interpretive guidance where they fit as
CMS usually refers to the current standards of
practice set by the clinicians who work within the long term care
field. It is the goal of the Task Force that surveyors, clinicians
and interdisciplinary team members will put these new standards
into practice in order to continue their efforts to improve quality
of life for those living in nursing homes across the country.
New
Dining Practice Standards 8-26-11
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Wednesday January 4, 2012
OSHA to Focus on
Nursing Home
The Occupational Safety and
Health Administration will soon launch the National Emphasis
Program on Nursing Homes and
Residential Care Facilities. This is in response to what
OSHA sees as higher than
average incidents of occupational injuries and illnesses among
health care support
workers. Through this initiative, they
will increase inspections of these facilities, focusing on back
injuries from resident handling or lifting patients; exposure to bloodborne pathogens and
other infectious diseases; workplace violence; and slips, trips and
falls.
See OSHA Press Release 2011 for
more details.
OSHA
Publishes New and Updated Materials on Worker Safety and
Health
The Occupational Safety and Health
Administration (OSHA) recently published new and updated educational brochures on a
number of topics including workers' rights, employers' rights following an OSHA inspection,
as well as how to protect workers from hazards in the construction, general and maritime
industries. OSHA's Worker' Rights booklet describes
the rights to which
workers are legally entitled under the Occupational Safety and
Health Act. The booklet,
Employer Rights and Responsibilities Following an OSHA
Inspection, reviews what happens after an inspection and is
provided to employers during an OSHA inspection. The agency also recently published an
updated Construction Industry Digest, and a new Small
Entity Compliance Guide for Respiratory
Protection Standard, Laboratory Safety Guidance, a
series of new QuickCards
and new publications to help protect construction, general industry
and shipyard workers.
Please call 1-800-321-OSHA or (202) 693-1999 to order copies or
visit OSHA's
Publications page: http://www.osha.gov/pls/publications/publication.AthruZ?pType=AthruZ)
to order online.
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Monday February 27, 2012
Once an outbreak has been identified, it is important the
facility take the appropriate steps to contain
it. State, local and county health departments
offer guidance and regulations regarding responding to and
reporting outbreaks. This information is often
received in advance of an outbreak and included in the infection
prevention and control program. Plans for containing outbreaks
usually include efforts to prevent further transmission of the
infection while considering the need of all residents and
staff.
We suggest that you review the Regulations in Assisted Living
and Specialty Care Assisted Livings to ensure Regulatory
Compliance. This information can be found in: Alabama Assisted
Living Rules and Regulations 420-5-4-.05 Records and
Reports andAlabama Specialty Care Assisted Living Rules
and Regulations 420-5-20-.05 Records and
Reports.
It is important that all infection prevention and control
practice reflect current Centers for Disease
Control guidelines.
Each facility should refer to their specificState:
- Rules and Regulations; and
- State and local health departments for reporting guidelines and
recommendations.
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Monday February 27, 2012
Due to the recent reported cases of the Norovirus in nursing
homes and assisted living facilities it is important that we
remember what the facility's role and responsibility is regarding
infection control.
Under the guidance for Surveyors in the State Operations Manual,
F-441Infection Control, states; Recognizing and
Containing Outbreaks An outbreak is typically one or more of the
following:
- One case of an infection that is highly communicable;
- Trends that are 10% higher than the historical rate of
infection for the facility that may reflect an outbreak or seasonal
variation and therefore warrant further investigation; or
- Occurrence of three or more cases of the same infection over a
specified length of time on the same unit or other defined
areas.
Once an outbreak has been identified, it is important the
facility take the appropriate steps to contain it. State
health departments offer guidance and regulations regarding
responding to and reporting outbreaks. This information is
often received in advance of an outbreak and included in the
infection prevention and control program. Plans for containing
outbreaks usually include efforts to prevent further transmission
of the infection while considering the need of all residents and
staff.
It is important that all infection prevention and control
practice reflect current Centers for Disease
Controlguidelines.
Component of an infection Prevention and Control Program
- Policies and procedures
- Infection Preventionist
- Surveillance( process and outcome)
- Documentation
- Monitoring
- Data Analysis
- Communicable Disease Reporting
- Education
- Antibiotic Review
Facilities should review the complete guidance under CFR ยง483.65
Infection Control F441 for more details.
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Tuesday February 21, 2012
As part of President Obama's commitment to reducing regulatory
burden, Health and Human Services Secretary Kathleen G. Sebelius
announced that HHS will initiate a process to postpone the date by
which certain health care entities have to comply with
International Classification of Diseases, 10th Edition
diagnosis and procedure codes (ICD-10).
The final rule adopting ICD-10 as a standard was published in
January 2009 and set a compliance date of October 1, 2013 - a delay
of two years from the compliance date initially specified in the
2008 proposed rule. HHS will announce a new compliance date
moving forward.
"ICD-10 codes are important to many positive improvements in our
health care system," said HHS Secretary Kathleen Sebelius.
"We have heard from many in the provider community who have
concerns about the administrative burdens they face in the years
ahead. We are committing to work with the provider community
to reexamine the pace at which HHS and the nation implement these
important improvements to our health care system."
ICD-10 codes provide more robust and specific data that will
help improve patient care and enable the exchange of our health
care data with that of the rest of the world that has long been
using ICD-10. Entities covered under the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) will be required
to use the ICD-10 diagnostic and procedure codes.
All HHS press releases, fact sheets and other press materials
are available at: http://www.hhs.gov/news.
-
Tuesday February 21, 2012
Healthcare facilities, including nursing homes and hospitals,
are the most commonly reported settings for norovirus outbreaks in
the United States. The virus can be introduced into healthcare
facilities by infected patients/residents--who may or may not be
showing symptoms--or by staff, visitors, or contaminated food
products. Outbreaks in these settings can be quite long-sometimes
lasting months-and illness can be more severe, occasionally even
fatal, in hospitalized or nursing home patients than for otherwise
healthy persons.
Noroviruses are responsible for about half of all reported
outbreaks of gastroenteritis (vomiting, diarrhea, and stomach
cramping caused by inflammation of the stomach and intestines).
While the vast majority of norovirus illnesses are not part of a
recognized cluster, outbreaks provide important information on how
the virus is spread and, therefore, how best to prevent
infection. Norovirus outbreaks occur throughout the year, but
over 80% of them occur during November-April. In addition,
norovirus outbreaks tend to increase periodically when new strains
of the virus appear. The virus can be spread through food, water,
by touching things that have the virus on them, as well as directly
from person to person. There is no long-lasting immunity to
norovirus; thus, outbreaks can affect people of all ages and in a
variety of settings
Due to the recently reported outbreaks of the norovirus in Long
Term Care and Assisted Living facilities we have attached several
CDC norovirus related documents.
For more information we encourage you to visit the CDC web
site at: http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm
Norovirus-Guideline for Healthcare Settings-2011
Norovirus Worksheet
Norovirus Poster
Norovirus Comm Framework
Norovirus Case Fact Sheet
NoroVirus-Management of Outbreaks in Healthcare Settings
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Wednesday February 15, 2012
Healthcare providers could get some regulatory deadline relief
soon. The acting head of the Centers for Medicare and Medicaid
Services said today the agency is considering extending its
timeline for ICD-10 code conversion compliance.
Under current ICD-10 rules, healthcare providers, payers, and
others have until Oct. 1, 2013 to switch over their claims,
billing, and other systems from current ICD-9 to ICD-10 codes for
medical diagnosis and inpatient procedures. The transition from
ICD-9 to ICD-10 involves expanding medical diagnosis codes from the
current 14,000 to more than 67,000, and procedure codes from 13,000
to 85,000.
Marilyn Tavenner, the acting administrator of the Centers for
Medicare and Medicaid Services, told a conference of the American
Medical Association (AMA) that her agency could delay adoption of
the ICD-10 system. Current law calls for physicians to adopt the
new codes next year.
"I'm committing today to work with you to re-examine the pace at
which we implement ICD-10," she said to loud applause. "I want to
work together to ensure that we implement ICD-10 in a way that
[meets its] goals while recognizing your concerns."
Critics - including the AMA - say switching to ICD-10 coding
will require doctors' offices to deal with some 68,000 codes, more
than five times the current 13,000. The change, according to the
AMA, would cost medical practices anywhere between $83,290 and more
than $2.7 million, depending on size.
Speaking to reporters after her prepared remarks, Tavenner said
her office would formally announce its intention to craft new
regulations "within the next few days."
LTC Provider University will provide updates when they
become available.
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Monday February 13, 2012
On January 13, 2012 CMS published a
pair of transmittals that revise Chapter 8, section 40.1 of the
Medicare Benefit Policy Manual to add physician assistants to the
list of practitioners that can perform the
required initial certification and periodic recertifications of the
need for skilled nursing facility (SNF) level of
care.
On January 13, 2012 CMS issued Transmittal
153,
entitled -"Allowing Physician Assistants to Perform Skilled Nursing
Facility (SNF) Level of Care Certifications and
Recertifications". The transmittal provides guidance
on the ability of physician assistants to perform level of care
certifications and recertifications in skilled nursing facilities.
The guidance implements Section 3108 of the Affordable Care
Act. According the guidance, a physician assistant may
now perform the certification or recertification if the physician
assistant collaborates with the physician but does not have a
direct or indirect employment relationship with the facility.
Please review the following two
attachments for details.
Physician Assistants
January 13, 2012
Physician Assistants
Flyer
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Monday February 13, 2012
The Centers for Medicare and Medicaid Services (CMS) has
recently issued an updated S&C memo on reporting the reasonable
suspicion of a crime.
This memorandum informs SAs of the new section 1150B of the Act,
which was established by section 6703(b)(3) of the Affordable Care
Act and is entitled "Reporting to Law Enforcement
of Crimes
Occurring in Federally Funded Long-Term Care Facilities." In
order to promote timely application of the protections offered by
section 1150B of the Act for LTC facility residents, CMS is
explaining now the current obligations of LTC facilities to comply
with the law as it is plainly written, without any delay that might
be occasioned by waiting for any administrative rule-making process
that might further clarify application of the law.
The updates appear in the Definitions and Questions and Answers
sections.
In the definitions, the terms "agent" and "contractor" are
further defined in Appendix One. These definitions will assist
providers in determining who is included in "covered individuals."
In the Q&A section of the memo, additional clarity is
provided regarding the role of the facility in reporting the
suspicion of a crime. It should be noted that this memo
specifically states that a facility may report of a reasonable
suspicion of a crime directly to the state survey agency and law
enforcement on behalf of covered individuals. Additionally, the
Q&A section provides clarity about the impact of this
requirement on ICFs/MR.
Please see the attached S&C letter for more
detailed information.
Reporting Suspicion of Crime 20Jan2012 update
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Friday March 16, 2012
According to F500, if the facility does not employ a qualified
professional person to furnish a specific service to be provided by
the facility, the facility must have that service furnished to
residents by a person or agency outside the facility under an
arrangement, agreement or contract. The arrangement,
agreement, etc. pertaining to services furnished by outside
resources must specify in writing that the facility assumes
responsibility for obtaining services that meet professional
standards and principles that apply to professionals providing
services in such a facility and the timeliness of the
services.
Therefore the facility is required to have contracts with all
third party vendors that provide contract services. Contracts
should include at a minimum:
- Clarification of services/scope of work
- Timeliness of the services
- Payment arrangements of the services/compensation
- Clarification of reporting/documentation requirements, if
applicable
- Staff training requirements, screening, licensure, etc., if
applicable
- Contract terms
- Period of agreement
- Termination of agreement
From the risk management perspective, the following terms should
be included in the contract:
- Independent Contractor provision - this agreement clarifies
that the contractor is not a facility employee and therefore not
subject to the facility's worker's compensation benefits or
professional liability insurance coverage.
- Hold Harmless/Indemnification provision - this agreement
clarifies that one or both parties agree to not hold the other
responsible for damages. This agreement indemnifies one or
both parties by agreeing to not hold the other responsible for any
legal liability or looses as a result of a specified incident or
action.
- Insurance coverage by both parties - this clause states that
each entity will carry their own general/professional liability
insurance. This provision without a hold harmless/indemnification
clause is only helpful if both the facility and the 3rd
party contractor are co-defendants. In other words, if the
3rd party contractor is not a party to a claim against
the facility, the 3rd party contractor's liability
insurance will not hold harmless or indemnify the facility.
In the event an incident/event occurs in which a vendor employee
is involved and a claim arises, the outcome may depend upon the
terms of the contract.
The facility may want to consult with Corporate Counsel on the
appropriate wording for contracts.
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Wednesday April 25, 2012
Federal regulations require that Medicare and Medicaid certified
nursing homes have written emergency plans and provide employees
with emergency preparedness training. In a 2006 report about
nursing homes that experienced hurricanes, the Office of Inspector
General (OIG) found that emergency plans lacked many provisions
recommended by experts. In response, CMS issued guidance checklists
for emergency planning of health care facilities, long-term care
(LTC) ombudsman programs, and State survey agencies (SA). The OIG
conducted this study released April 2012 to assess emergency
preparedness and response of nursing homes that experienced more
recent disasters.
For this study, the OIG analyzed national survey data to
determine compliance with Federal regulations. They also conducted
site visits to 24 selected nursing homes that experienced floods,
hurricanes, and wildfires in 2007-2010. They interviewed nursing
home administrators and staff, local emergency managers, and
representatives from State LTC ombudsman programs and SAs. They
also compared the emergency plans of each selected nursing home to
the CMS checklist for health care facilities.
The OIG found that most nursing homes nationwide met Federal
requirements for written emergency plans and preparedness training.
However, they identified many of the same gaps in nursing home
preparedness and response that were found in the 2006 report.
Emergency plans lacked relevant information including only about
half of the tasks on the CMS checklist. Nursing homes faced
challenges with unreliable transportation contracts, lack of
collaboration with local emergency management, and residents who
developed health problems. LTC ombudsmen were often unable to
support nursing home residents during disasters; most had no
contact with residents until after the disasters. SAs reported
making some efforts to assist nursing homes during disasters,
mostly related to nursing home compliance issues and ad hoc
needs.
The OIG made three recommendations to CMS and one recommendation
to Administration on Aging (AoA). CMS agreed with their
recommendations to revise Federal regulations to include specific
requirements for emergency plans and training, update the State
Operations Manual to provide detailed guidance for SAs on nursing
home compliance with emergency plans and training, and promote use
of the checklists. AoA also agreed with their recommendation to
develop model policies and procedures for LTC ombudsmen to protect
residents during and after disasters.
The top 10 disaster prone states, as ranked by historical
statistics on disaster declarations are Texas, California,
Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas
and Missouri.
Sources: Department HHS Office of Inspector General; CMS;
Long Term Care Ombudsman
The National Long Term Care Ombudsman Resource Center link: http://www.ltcombudsman.org/issues/emergency-preparedness
Office of Inspector General April 2012 Report:
Nursing Home Emergency Preparedness and Response Report
2012
OIG Memo to CMS April 13, 2012:
OIG Emergency Memo April 13-2012
CMS Emergency Preparedness Checklist:
CMS Emergency Preparedness for Every Emergency checklist revised
Sept 2009
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Monday April 23, 2012
It has been recently noted after review of numerous medical
records a common trend has been identified. Residents with
impaired cognition are exhibiting behaviors i.e. screaming out,
resisting care, removing clothes etc. The residents are being
assessed for behavioral interventions and some resident are being
placed on psychoactive medications while pain is the cause of the
resident's behaviors. Residents were not consistently assessed for
pain during the behavioral assessment phase to rule out pain.
Facilities may want to review current systems and processes to
ensure there is an evaluation of the resident for pain with the
onset and/or increase in behaviors. This will also help
in the prevention of unnecessary drugs. See article
below.
Management of Pain In Persons With Dementia
Pain is a common medical condition in older persons; especially
residents in long term care (LTC) settings. Pain is defined as a
sensory and emotional experience associated with actual or
potential tissue damage. Chronic persistent pain occurs in 24% of
LTC residents while only 29% are free of all pain. Most, i.e., 74%,
demented nursing home residents have some pain and the majorities,
i.e., 70%, are untreated
or under-treated.
Pain can have multiple origins; however, discomfort produced by
musculoskeletal disease is the most common problem in the older
person, e.g., arthritis 42%, bone fracture 12%. Untreated or
under-treated pain can produce significant suffering as well
as agitation and
behavioral
problems in persons with dementia. Regular administration of
acetaminophen can reduce agitation in more than one-half of
agitated, demented patients with pain.
Assessment and management of pain is an important responsibility
of any clinical management team. Dementia patients are less likely
to receive analgesics despite the fact that they experience
suffering equal to cognitively intact individuals.
Source: Richard E. Powers, MD (2008) - Bureau
of Geriatric Psychiatryhttp://www.alzbrain.org/
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Monday April 23, 2012
April 30, 2012 is the new deadline for nearly all nursing
facilities and assisted living communities to display posters
informing employees of their rights under the National Labor
Relations Act (NLRA), according to the National Labor Relations
Board. The notice should be posted in a conspicuous place,
where other notifications of workplace rights and employer rules
and policies are posted. Employers also should publish a link to
the notice on an internal or external websites if other personnel
policies or workplace notices are posted
there.
You may download and print the notice using the links below. You
may also call 202-273-0064 and copies will be mailed to you free of
charge.
IMPORTANT INFORMATION ABOUT POSTERS
The poster is required to be 11 x 17 inches, in color or
black-and-white. When printing to full size, be sure to set your
printer output to 11 x 17. Or you may print the two 8.5 x 11 pages
and tape them together.
English Posters
English
Employee Rights Poster 11 x 17 English
Employee Rights Poster 8-5 x 11
Spanish Posters
Spanish
Employee Rights Poster 11 x 17
Spanish
Employee Rights Poster 8-5 x 11
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Wednesday April 11, 2012
On January 4, 2011, President Barack Obama signed into law the
National Alzheimer's Project Act (NAPA), requiring the Secretary of
the U.S. Department of Health and Human Services (HHS) to establish
the National Alzheimer's Project. The law also establishes the
Advisory Council on Alzheimer's Research, Care, and Services and
requires the Secretary of HHS, in collaboration with the Advisory
Council, to create and maintain a national plan to overcome
Alzheimer's disease (AD).
Building on the preliminary work on this plan, on February 7,
2012, the Obama Administration announced a historic $156 million
investment to tackle Alzheimer's disease.
The draft of the National Plan is being submitted to the
Advisory Council for consideration and input. It was also be open
for public comment through March 30, 2012.
To read the draft in its entirety click on the following
link:
Draft
National Alzheimer's Plan 2012
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Monday April 9, 2012
The National Certification Council of Activity Professionals has
implemented an examination that all NEW applicants must complete in
order to apply for national certification at the ADC or ACC
level(s) effective January 1, 2012. Please note that is will not
affect those individuals already certified at any level with NCCAP
prior to December 31, 2011.
The test consists of questions from the nine topic areas and the
163 competencies defined in the MEPAP curriculum. Completion of the
Modular Education Program for Activity Professionals,
2nd Edition will prepare the applicant for the exam.
There will be 50 questions on the test and applicants will have one
(1) hour to complete the test. Applicants must make a 70% to pass
the exam. Comira and ACT testing centers will administer the
examination and they are located throughout the United States and
Canada.
For additional information regarding the new testing policy and
procedure please contact the NCCAP office or visit their web site
at www.nccap.org
Source: National Certification Council for Activity
Professionals
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Monday April 9, 2012
The average flu vaccination rate among nursing home residents
nationwide was 72 percent during the 2005-2006 flu season. This was
well below the Healthy People 2010 goal of 90 percent. A new study
found that black nursing home residents have lower flu vaccination
rates than their white counterparts. It found that over three
consecutive flu seasons (2006-07, 2007-08, and 2008-09), the odds
of being vaccinated were 14-16 percent lower for blacks than for
whites within the same facility.This difference persisted even
after excluding residents who were either offered but declined
vaccination, or were vaccinated outside the facility.
The Brown University researchers also found that nursing homes
with high proportions of black residents had lower vaccination
rates for both blacks and whites than did facilities with lower
proportions of black residents. These facilities generally have a
high proportion of Medicaid residents. Therefore, they have less
revenue and fewer opportunities to cross-subsidize care with income
from more profitable Medicare and private-pay patients.
The researchers suggest that low revenue, insufficient staffing,
and poor-quality performance may all contribute to the lower
vaccination rates in these facilities. They also point out that
blacks are consistently more likely than whites to refuse flu
vaccinations when offered. To completely eliminate racial
differences in flu vaccination rates, educational programs that
focus on elderly blacks and their families may be necessary,
suggest the researchers. Their study was supported in part by the
Agency for Healthcare Research and Quality (HS16094).
Source: Agency for Healthcare Research and
Quality http://www.ahrq.gov/research/apr12/0412RA23.htm
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Tuesday April 3, 2012
The Registered Nurses Association of Ontario (RNAO) and the
guideline development panel have compiled a list of implementation
strategies to assist health-care organizations or health care
providers that are interested in implementing this guideline.
According to the RNAO, this nursing best practice guideline is a
comprehensive document, which provides resources necessary for the
support of evidence-based nursing practice. The document must be
reviewed and applied, based on the specific needs of the
organization or practice setting/environment, as well as the needs
and wishes of the client. This guideline should not be applied in a
"cookbook" fashion, but rather as a tool to enhance decision-making
in the provision of individualized care. In addition, the guideline
provides an overview of appropriate structures and supports
necessary for the provision of best possible care.
The purpose of this best practice guideline is to provide
evidence-based recommendations for Registered Nurses and Registered
Practical Nurses on best nursing practices for end-of-life care
during the last days and hours of life. The guideline does not
replace consultation with palliative care specialists, who can
support nurses to provide quality end-of-life care. The guideline
is intended to be a resource to nurses who may not be experts in
this practice area. It is acknowledged that individual competencies
vary between nurses and across categories of nursing professionals.
The inclusion of recommendations on clinical, education,
organization and policy topics makes this guideline applicable to
nurses in all domains and settings of practice
Source: Agency for Healthcare Research and Quality
End of Life Care During the Last Days and Hours
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Monday April 2, 2012
WEDNESDAY, March 28 (HealthDay News) -- Antipsychotic drugs can
raise the risk of heart attack in older patients with dementia, a
new study suggests.
It's common to prescribe antipsychotics to older patients with
dementia to control symptoms such as agitation, hallucinations and
aggression. Previous studies have found that this use of the drugs
may be linked to an increased risk of stroke and death from all
causes.
But until now, the risk of heart attack associated with the use
of antipsychotic drugs in older people with dementia had been
"poorly examined," wrote study author Dr. Antoine Pariente, of
Universite Bordeaux Segalen in France, and colleagues.
They looked at nearly 11,000 patients, aged 66 and older, in
Quebec who were being treated with cholinesterase inhibitors for
dementia and were also prescribed antipsychotics.
Within a year of starting treatment with the antipsychotics, 1.3
percent of the patients had a heart attack. Compared to those not
taking antipsychotics, the risk of heart attack among those taking
them was 2.19 times higher for the first 30 days, 1.62 times higher
for the first 60 days, 1.36 times higher for the first 90 days, and
1.15 times higher for the first year.
"Our study results indicate that the use of [antipsychotic
medications] is associated with a modest increase in the risk of
[heart attack] among community-dwelling older patients with treated
dementia," the researchers wrote. "The increased risk seems to be
highest at the beginning of treatment and seems to decrease
thereafter, with the first month of treatment accounting for the
highest period of risk."
The study, which found an association between antipsychotic use
and heart attack but did not prove cause-and-effect, appeared
online March 26 in the Archives of Internal Medicine.
"Because [antipsychotic] use is frequent in patients with
dementia ... the increased risk of [heart attack] may have a major
public health effect, which highlights the need for communicating
such risk and for close monitoring of patients during the first
weeks of treatment," the authors concluded in a journal news
release.
Further research is required to learn more about why the use of
antipsychotic drugs in dementia patients may increase the risk of
heart attack, Dr. Sudeep Gill and Dr. Dallas Seitz, of Queen's
University in Kingston, Ontario, Canada, wrote in an accompanying
editorial.
"Meanwhile, physicians should limit prescribing of antipsychotic
drugs to patients with dementia and instead use other techniques
when available, such as environmental and behavioral strategies, to
keep these patients safe and engaged," they suggested.
While the study found an association between antipsychotic drugs
and heart attack risk, it did not prove a cause-and-effect
relationship.
SOURCE: JAMA/Archives journals, news release, March 26, 2012
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Wednesday May 30, 2012
The purpose of Enforcement Procedures for Investigating or
Inspecting Workplace Violence Incidents is to provide general
policies and procedures that apply when workplace violence is
identified as a hazard while conducting an inspection under a
national, regional or local emphasis program and when responding to
incidents of workplace violence, especially when conducting
inspections at worksites in industries with a high incidence of
workplace violence.
Workplace violence is recognized as an occupational hazard in
some industries and environments which, like other safety issues,
can be avoided or minimized if employers take appropriate
precautions. At the same time, it continues to negatively impact
the American workforce. Workplace violence has remained among the
top four causes of death at work for over fifteen years, and it
impacts thousands of workers and their families annually.
Research has identified factors that may increase the risk of
violence at worksites. Such factors include working with the public
or volatile, unstable people. Working alone or in isolated areas
may also contribute to the potential for violence. Handling money
and valuables, providing services and care, and working where
alcohol is served may also impact the likelihood of violence.
Additionally, time of day and location of work, such as working
late at night or in areas with high crime rates, are also risk
factors that should be considered when addressing issues of
workplace violence.
Click the link below for the complete report:
Enforcement Procedures for Investigating or Inspecting Workplace
Violence Incidents
-
Tuesday May 29, 2012
The Falls Management
Program (FMP) is an interdisciplinary quality improvement
initiative. It is designed to assist nursing facilities in
providing individualized, person-centered care, and improving their
fall care processes and outcomes through educational and quality
improvement tools. Many nursing facilities have fall programs in
place, but recognize that there is always room for improvement.
While not all falls and injuries can be prevented, it is critical
to have a systematic process of assessment, intervention and
monitoring that results in minimizing fall
risk.
Source: Agency for
healthcare Research and Quality
(AHRQ)
-
Friday May 25, 2012
For
more than 20 years, the Beers Criteria for
Potentially Inappropriate Medication Use in Older
Adults has been the leading source of
information about the safety of prescribing drugs for older people.
To help prevent medication side effects and other drug-related
problems in older adults, the American Geriatrics Society (AGS) has
updated and expanded this important resource. The
expanded AGS Updated Beers Criteria for
Potentially Inappropriate Medication Use in Older
Adults identifies medications
with risks that may be greater than their benefits for people 65
and older.
This summary is from the
full report titled,
AGS Updated Beers Criteria for Potentially Inappropriate Medication
Use in Older Adults. It is in the March
2012 issue of the
Journal of the American Geriatrics Society
(JAGS). The report is authored
by the American Geriatrics
Society
Click Link
Below for Summary:
Beers Criteria -
Updated 2012
-
Thursday May 10, 2012
Free Online Training for MDS 3.0 Section M: Skin Condition
This FREE video and handouts of the pressure ulcer assessment
and coding training session for MDS 3.0 Section M: Skin Condition
was delivered in Las Vegas on August 10, 2010. It was posted
online by the Centers for Medicare and Medicaid Services (CMS) on
January 20, 2011. This lecture was part of the CMS
sponsored introduction to MDS 3.0. If you still want
access to the information it is posted on YouTube! The link is
posted below with the slides/handouts.
You can view the slides/handouts, watch the video, and get free
in-depth training on this important topic for resident assessment
in long-term care. The lecture is 1 hour and 42 minutes
long and reviews all aspects of prevention, wound identification,
staging, and coding, including sample coding challenges and wound
quiz.
You Tube link to video:
http://www.youtube.com/watch?v=7km6NHbVxHs
Handouts/slides:
MDS 3.0
Training Slides 2 Section M
MDS 3.0
Section M Study Aid
MDS
3.0 Training Slides Section M
-
Friday June 29, 2012
Dementia Incidences to Triple Says World Health
Organization
The World Health Organization has released data on the
current state of dementia care worldwide and the prevalence of the
disease, both currently and in the future. Among other findings,
researchers predict the number of people with dementia worldwide to
triple by 2050.
The World Health Organization compiled the results of a number
of studies in a new report about the prevalence, effects, and
implications of dementia. According to the report, in 2010 35.6
million people worldwide had dementia, a number expected to nearly
double every 20 years. In 2010 the worldwide costs of dementia were
estimated to be 604 billion US dollars, a number also expected to
grow over the coming years. Despite the high social and financial
costs, only eight countries have national programs to address
dementia.
The report emphasizes that a variety of services, including
caregiver support programs, residential care communities, and
palliative care options, are needed to serve those with dementia.
High-income countries are generally able to provide more options
for citizens, but the report makes it clear that even high-income
countries have room for improvement. For example, seven out of
eight survey respondents from high-income countries report that
their country provides support for residential care, but many of
these countries do not provide sufficient care. Poland, for
instance, only reported one community specifically designed for
individuals with dementia.
Read the full report: Dementia: A Public Health
Priority
-
Monday June 18, 2012
Current guidance in Appendix PP of the State Operations Manual
for Tag F 492, 42 CFR ยง483.75(b) and (c) States that this tag
should be cited only when the authority having jurisdiction has
both made a determination of noncompliance and has
taken a final adverse action as a result. There has been confusion
as to whether this requirement may be cited when a facility simply
does not meet a State regulation. This memorandum clarifies and
revises the Centers for Medicare & Medicaid Services (CMS)
guidance to Surveyors in Appendix PP of the SOM regarding citations
under Tag F492.
June 1, 2012 CMS issued a revision and clarification to the
Interpretive Guidance for F492. The effective date of this memo is
immediately. These changes will be incorporated into the next
revision of Appendix PP of the SOM. Please read the attached
document for details.
Revised Guidance for
F492
-
Tuesday June 5, 2012
All long term care providers and operators have an obligation to
prepare for potential disasters. Each facility is unique with
regard to the types of residents/clients served, geographical
location, types of disasters to plan for and proximity to local
assistance. Preparation, education, and practice are the keys to a
well-managed event involving a catastrophic occurrence that comes
with little or no warning.
We have recently added numerous documents, forms, and guides to
assist health care facilities in this planning process. These forms
are located behind the "Risk Management Resource Center" door. We
remind all facilities that any workable disaster plan must be
tailored to the individual facility. It is advised that a committee
be formed to develop and analyze all material for the manual, as
well as provide regular reviews and updates. The following
documents posted are:
- Nursing Home Incident Command System (NHICS)
- Guidebook
- Incident Management Team
- Position Crosswalk
- Quick Guide to Job Responsibilities
- Incident Briefing & Operational Log
- Incident Objectives
- Organization Assignment List
- Incident Communications Plan
- Staff Injury Plan
- Organizational Chart
- Incident Message Form
- Facility System Status Report
- Personnel Time Sheet
- Volunteer Staff Registration
- Master Emergency Admit Tracking Form
- Master Resident Evacuation Tracking Form
- Procurement Summary Report
- Resource Accounting Record
- Facility Resource Directory
- Master Facility Casualty Fatality Report
- Resident Evacuation Tracking Form
- Incident Action Safety Analysis
- Emergency Water Supply Planning Guide
- National Criteria for Evacuation Decision - Making in Nursing
Homes
- Caring for Vulnerable Elders During A Disaster - Hurricane
Summit
Listed below are links to also assist you in locating additional
information that you may require:
FEMA:
http://www.fema.gov/
Homeland Security:
http://www.dhs.gov/files/prepresprecovery.shtm
American Red Cross Preparedness Fast Facts:
http://www.redcross.org/portal/site/en/menuitem.86f46a12f382290517a8f210b80f78a0/?vgnextoid=92d51a53f1c37110VgnVCM1000003481a10aRCRD
Kentucky All Hazards Long Term Care Planning & Resource
Manual:
http://www.kahsa.com/Kentucky-All-Hazards-Long-Term-Care-Planning-%26-Resource-Manual-p-373.html
California Association of Health Facilities - Disaster
Preparedness Program: http://www.cahfdisasterprep.com/PreparednessTopics.aspx
Florida Health Care Association - Emergency Preparedness Tools:
http://www.fhca.org/facility_operations/emergency_preparedness_tools/
http://www.fhca.org/emerprep/index.php
National Nurse Emergency Preparedness Initiative:
http://www.nnepi.org/index.htm
Texas Health Care Association-Disaster Preparedness Tools: http://www.txhca.org/disasterpreparedness.htm
-
Friday June 1, 2012
The Centers for Medicare & Medicaid Services (CMS) has
recently received reports of use of insulin pens for more than one
patient, with at least one 2011 episode resulting in the need for
post-exposure patient notification. These reports indicate that
some healthcare personnel do not adhere to safe practices and may
be unaware of the risks these unsafe practices pose to patients.
Insulin pens are meant for use by a single patient only. Each
patient/resident must have his/her own. Sharing of insulin pens is
essentially the same as sharing needles or syringes, and must be
cited, consistent with the applicable provider/supplier specific
survey guidance, in the same manner as re-use of needles or
syringes.
The Centers for Disease Control and Prevention (CDC) has also
become increasingly aware of reports of improper use of insulin
pens, which places individuals at risk of infection with pathogens
including hepatitis viruses and human immunodeficiency virus (HIV).
This notice serves as a reminder that insulin pens must
never be used on more than one person.
Follow the link to visit the CDC page on Injection
Safety:
http://www.cdc.gov/injectionsafety/clinical-reminders/insulin-pens.html
CDC Insulin Pen Poster:
Clinical Reminder for Use of Insulin pen
CMS Survey & Certification letter on Insulin pens:
Use of Insulin Pens May 18 2012
-
Wednesday July 11, 2012
Suicide is tragic. It cuts a life short, and it devastates the
family, friends and loved ones left behind. Those who survive a
suicide attempt might end up with severe disability or other
injuries. The children of people who die by suicide are more likely
to later die by suicide themselves. With such extreme consequences,
why would anyone make the dire decision to choose death over
life?
That's a question scientists have been struggling to answer for
decades. "When you're in a suicidal state, you're kind of closing
down your options. You see it as the only solution. You're not
really able to entertain other ideas," says Dr. Jane Pearson, who
heads a suicide research consortium at NIH. "What's the science
behind that? What's happening in the brain that leads people to
think so dysfunctionally?"
Recognizing those at risk is essential. Suicide is the
10th leading cause of death nationwide, and it's the 3rd leading
cause of death among adolescents. Nearly 37,000 Americans died by
suicide in 2009, according to the U.S. Centers for Disease Control
and Prevention. More than half of those deaths were from
firearms.
People of all genders, ages and ethnicities are at risk for
suicide. Women are more likely than men to attempt suicide, but men
are more likely to die by suicide. That's because men often choose
deadlier methods, such as firearms or suffocation.
"The highest risk groups are older men," says Pearson.
"In fact, white men who are 85 and older have a rate of suicide
that's 4 times the national average."
To read the entire NIH report in this
attachment.
-
Monday July 9, 2012
Memorandum Summary
- Quality Assurance and Performance Improvement (QAPI)
Activities: Section 6102(c) of the Affordable Care
Act mandates the Centers for Medicare & Medicaid Services (CMS)
to establish standards and provide technical assistance to nursing
homes on the development of best practices relating to QAPI. The
CMS put forth several initiatives to implement these provisions
that include:
- Refinement of QAPI Tools and Resources:
Ongoing development of QAPI tools and resources that nursing homes
may use to design and implement an effective QAPI program.
- Launch of a QAPI Demonstration:
Demonstration project in 17 nursing homes in 4 States to test tools
and resources and provide technical assistance to nursing homes in
QAPI implementation.
- Rollout of QAPI materials: CMS will
release materials later this calendar year that will support
nursing homes in QAPI implementation.
- Draft of the QAPI Regulation: CMS is in
the process of drafting a new QAPI regulation.
- Launch of the Nursing Home Quality Improvement
Questionnaire: The CMS has launched a nursing home
quality improvement questionnaire using an independent
contractor. The data collection period is from June 25
through September 28, 2012.
-
Tuesday July 24, 2012
This study used a random sample of records from a previous
Office of Inspector General (OIG) study of elderly nursing facility
residents with Medicare claims for atypical antipsychotic drugs
between January and June 2007. They reviewed the records for
evidence of compliance with Federal requirements for resident
assessments and documentation of decision-making. They also
reviewed the records for evidence of compliance with Federal
requirements for care plan development and implementation.
Nearly all records reviewed (99 percent) failed to meet one or
more Federal requirements for resident assessments and/or care
plans. The resident assessment and care plan process involves four
steps. One-third of records reviewed did not contain evidence of
compliance with Federal requirements regarding resident
assessments, the first step. Further, for 4 percent of records,
nursing facility staff did not document consideration of the
Resident Assessment Protocol for psychotropic drug use as required,
the second step. Ninety-nine percent of records did not contain
evidence of compliance with Federal requirements for care plan
development, the third step. Finally, 18 percent of records
reviewed did not contain evidence to indicate that planned
interventions for antipsychotic drug use-the fourth step-actually
occurred.
Please read the following attachments for more details and
CMS response to the report.
OIG Report Care Plans for Residents Receiving Atypical
Anitpsychotic Drugs
-
Tuesday August 14, 2012
INTERACT
(Interventions to Reduce
Acute Care
Transfers) is a quality improvement program that
focuses on the management of acute change n resident condition.
The INTERACT
program is designed to improve the early identification,
assessment, documentation, and communication about changes in the
status of residents in skilled nursing facilities.
The INTERACT goal
is to improves care and reduce the frequency of potentially
avoidable transfers to the acute hospital. Transfers to the
hospital can be emotionally and physically difficult for residents,
and result in numerous complications of hospitalization, and they
are costly.
In the plans for health care reform, Medicare may financially
reward facilities with lower hospitalization rates for certain
conditions. By improving the identification, evaluation, and
communication about changes in resident status, some, but not all
acute care transfers can be avoided.
The attached pdf Transitions and Long-Term Care:
Reducing Preventable Hospital Readmissions Among Nursing Facility
Residents explains what INTERACT is and how to use
the quality improvement tool.
Reducing Preventable Hospital Readmissions Among Nursing Facility
Residents
TheINTERACT web
site; www.interact2.net is
a free web site for facility use in decreasing acute care
transfers. The web site contains information about INTERACT,
INTERACT II Tools, Educational Resources, and Links to Other
Resources.
-
Wednesday September 5, 2012
Please read the following reminder regarding the Medicare
Secondary Payer Act. Medicare
Secondary Payer Act Reminder
-
Wednesday September 5, 2012
On August 28, 2012 the Centers for Medicare and Medicaid
Services (CMS) released their 2012 Nursing Home Action Plan. The
plan is organized into 5 actionable strategies:
- Enhance Consumer Engagement.
- Strengthen Survey Processes, Standards, and Enforcement.
- Promote Quality Improvement.
- Create Strategic Approaches through Partnerships.
- Advancing Quality through Innovation and
Demonstration.
Details include planned updates to Nursing Home Compare, improving
fire safety, revising surveyor guidance, QIS, civil money
penalties, culture change activities, QAPI, Care Transitions,
Health Facility Acquired Infections (HAIs), and initiatives for
reducing re-hospitalizations and use of anti-psychotics. The
plan is based on a 3-part plan created by the agency to improve the
U.S. health care system:
- Improving the individual experience of care.
- Improving the health of populations.
- Reducing the per-capita cost of care of populations.
Complete 2012 Nursing Home Action Plan: 2012-Nursing-Home-Action-Plan
-
Wednesday September 5, 2012
In 2012, CMS launched the Partnership to Improve
Dementia Care in Nursing Homes to promote comprehensive dementia
care and therapeutic interventions for nursing home residents with
dementia-related behaviors. The goals of this initiative include a
focus on person-centered care and the reduction of unnecessary
antipsychotic medication use in nursing homes and eventually other
care settings as well.
CMS is using several approaches to successfully implement
this initiative. CMS is developing and conducting trainings for
nursing home providers, surveyors, and consumers. We are conducting
research, raising public awareness, using regulatory oversight, and
public reporting to increase transparency.
-
Friday September 7, 2012
Registration is now open for the 2012 CQRMS Training
Program. If you would like more information about this
program please contact Nancy Lee (contact information listed in the
brochure).
Seating is limited, early registration is recommended.
Registration brochure: 2012 CQRMS web
brochure
-
Friday September 14, 2012
Hand Hygiene (HH) has always been a concern in long term care
facilities and recently, in some states, there has been an increase
in the number of citations being written related to HH. A recent
article published in the Journal of Applied Gerontology,
titled "Hand Hygiene Deficiency Citations in Nursing
Homes" addresses this area of concern.
Click on the link below to take you to the article.
http://jag.sagepub.com/content/early/2012/08/01/0733464812449903.abstract
-
Friday September 14, 2012
The healthcare industry faces enormous pressure to
transform the delivery system from acute centric care into more
cost effective care across the preventative, chronic, acute, and
long-term continuum. The marketplace is demanding that providers
align, and that change is implemented aggressively. The current
industry backdrop is an environment where the cost of drugs,
supplies, technologies and staffing are increasing, competition
from entrepeneurs who capture opportunities in attractive niches is
intensified, and consumer interest in public scorecards on hospital
and physician safety, quality, and satisfaction has risen. All the
while reimbursement rates from third party payors (Medicare,
Medicaid, and Commercial Health Plans) is trending
downward.
To continue reading this article, click the link below:
Transition to
ICD 10
-
Tuesday September 18, 2012
Please see the two attachments regarding a recent lawsuit
involving alleged off-labeled use of an antipsychotic and a press
release from the U. S. Department of Justice in which a company
maintained specialized sales force to market drug for off label
purposes; Targeted elderly dementia patients in nursing homes.
Alert-CMS Initiative for the Use of Antipsychotics
subject of lawsuit
U.S. Department of Justice Press
Release
-
Tuesday April 26, 2011
Our analysis of
criminal history records maintained by the Federal Bureau of
Investigation (FBI) revealed that 92 percent of nursing facilities
employed at least one individual with at least one criminal
conviction. Overall, 5 percent of nursing facility employees had at
least one criminal conviction.
Federal
regulation prohibits Medicare and Medicaid nursing facilities from
employing individuals found guilty of abusing, neglecting, or
mistreating residents by a court of law, or who have had a finding
entered into the State nurse aide registry concerning abuse,
neglect, or mistreatment of residents or misappropriation of their
property. Interpretive guidelines from CMS for this regulation
state that "[nursing] facilities must be thorough in their
investigations of the past histories of individuals they are
considering hiring." Despite this guidance, Federal law does not
require that nursing facilities conduct FBI or statewide criminal
background checks. Although FBI maintained criminal history records
provide a comprehensive source of criminal histories, the records
do not contain information on whether the victim of a crime was a
nursing facility resident and therefore cannot be used by
themselves to determine whether a conviction disqualifies an
individual from nursing facility employment.
Most often,
criminal convictions were for crimes against property (e.g.,
burglary, shoplifting, and writing bad checks) and occurred prior
to employment. We also found that despite the lack of a Federal
requirement for nursing facilities to conduct criminal background
checks, most States required, and/or nursing facilities reported
conducting, some type of background check.
In light of the
National Background Check Program that the Patient Protection and
Affordable Care Act created, we recommended that CMS develop
background check procedures. In developing those procedures, CMS
should (1) clearly define the employee classifications that are
direct patient access employees and (2) work with participating
States to develop a list of convictions that disqualify an
individual from nursing facility employment under the Federal
regulation and timeframes in which each conviction bars the
individual from employment.
In its written
comments on the report, CMS agreed with our recommendation. CMS
stated that in its solicitation to States for the National
Background Check Program, the definition of "direct patient access
employee" is broad and outcome based, which in nursing facilities
should include all staff. CMS stated that it will work with the
States through the National Background Check Program to assist them
in developing lists of convictions that disqualify individuals from
employment, as well as defining whether any of those conviction
types can be assumed to be mitigated because of the passage of time
and which convictions should never be considered mitigated or
rehabilitated.
Click here for the full report
-
Wednesday May 4, 2011
Report: OEI-07-08-00150
05-04-2011
For the period January 1 through June 30, 2007, we determined
using medical record review that 51 percent of Medicare claims for
atypical antipsychotic drugs were erroneous, amounting to $116
million.
A member of Congress requested that OIG evaluate the extent to
which elderly nursing home residents receive atypical antipsychotic
drugs and the associated cost to Medicare. Specifically, this
member expressed concern with atypical antipsychotic drugs
prescribed to elderly nursing home residents for off-label
conditions (i.e., conditions other than schizophrenia and/or
bipolar disorder) and/or in the presence of the condition specified
in the Food and Drug Administration's (FDA) boxed warning (i.e.,
dementia). Medicare requires that drugs be prescribed for
"medically accepted indications" for reimbursement. Further, CMS
sets standards to ensure that nursing home residents' drug therapy
regimens are free from unnecessary drugs.
We also found that 14 percent of the 2.1 million elderly (i.e.,
age 65 and older) nursing home residents had at least 1 claim for
these drugs. We determined using medical record review that 83
percent of Medicare claims for atypical antipsychotic drugs for
elderly nursing home residents were associated with off-label
conditions and that 88 percent were associated with the condition
specified in the FDA boxed warning. We further determined through
medical record review that 22 percent of the atypical antipsychotic
drugs associated with the claims were not administered in
compliance with CMS standards regarding unnecessary drugs in
nursing homes, amounting to $63 million. Nursing homes' failure to
comply with these standards may affect their participation in
Medicare. However, nursing homes' noncompliance with these
standards does not cause Medicare payments for these drugs to be
erroneous.
To ensure that Medicare correctly pays for atypical
antipsychotic drugs and that elderly nursing home residents are
free from unnecessary drugs, we recommend that CMS (1) facilitate
access to information necessary to ensure accurate coverage and
reimbursement determinations, (2) assess whether survey and
certification processes offer adequate safeguards against
unnecessary antipsychotic drug use in nursing homes, (3) explore
alternative methods beyond survey and certification processes to
promote compliance with Federal standards regarding unnecessary
drug use in nursing homes, and (4) take appropriate action
regarding the claims associated with erroneous payments identified
in our sample.
In its written comments on the report, CMS shared our concern
and that of Congress over whether atypical antipsychotics and other
drugs are being appropriately prescribed for elderly nursing home
residents. CMS concurred with the second, third, and fourth
recommendations; however, CMS did not concur with the first
recommendation and expressed several general concerns with the
report.
CMS did not concur with the first recommendation, stating that
diagnosis information is not a required data element of pharmacy
billing transactions nor is it generally included on prescriptions.
OIG recognizes that the industry has not developed a standardized
way of collecting diagnosis information for prescription drugs.
However, without access to diagnosis information, CMS cannot
determine the indications for which drugs were used. For this
reason, CMS is unable, absent a medical review, to determine
whether claims meet payment requirements.
Although CMS concurred with the second recommendation, we
further recommend that CMS use its authority through the survey and
certification processes to hold nursing homes accountable when
unnecessary drug use is detected.
Although CMS concurred with the third recommendation, it did not
believe some of the examples of alternative methods to promote
compliance provided in the report to be practicable. We suggest
that CMS either use its existing authority or seek new statutory
authority to prevent payment and hold nursing homes responsible for
submitting claims for drugs that are not administered according to
CMS's standards regarding unnecessary drug use in nursing
homes.
Click Here for Full Report
-
Thursday June 23, 2011
A summary and suggestions regarding the Office of
Inspector General's Report on billing practices in
Skilled Nursing Facilities
In December, 2010, the OIG issued a report on Medicare Part A
services provided in the SNF setting. This summary addresses the
findings along with suggestions.
In the recent past the OIG has found a number of issues with SNF
billing for Part A services. One such report analyzing claims from
2006-2008, found that 26% of claims submitted were not
supported by the medical records resulting in over $500
million in potential overpayments. Along with these findings, the
Medicare Payment Advisory Commission indicated that SNFs may be
improperly billing for therapy in order to obtain
additional Medicare payments.
Summary
- SNFs were increasingly billing for higher paying RUGs, even
though the beneficiary characteristics remained almost the
same.
- For-profit SNFs were more likely to bill higher paying RUGs
than nonprofit and government SNFs.
- Some SNFs had questionable billing in 2008, frequently
billing for higher RUGs and having longer length of stays (LOS)
than other SNFs.
OIG Conclusions
These findings raised concerns about the potentially
inappropriate use of higher paying RUGs, especially the Ultra High
category and deduced that the payment system offered incentives to
place beneficiaries into these categories when that level of care
was not needed. The report acknowledged that a new payment system
was being introduced but felt that more needed to questionable
billing practices.
Recommendations
If you are not sure if you are up to date with the Medicare
guidelines and documentation standards or whether your SNF would
pass a RAC Audit or other OIG or CMS review, then consider looking
for related regulations, guidelines, MDS analysis on LTC Provider
University's website.
Click
here for a copy of the Full Report
-
Friday June 17, 2011
Section 1150B of the Social Security Act (the Act), as
established by section 6703(b)(3) of the Patient Protection and
Affordable Care Act of 2010 (Affordable Care Act), requires
specific individuals in applicable long-term care facilities to
report any reasonable suspicion of crimes committed against a
resident of that facility. Reports must be submitted to at least
one law enforcement agency of jurisdiction and the state survey
agency (in fulfillment of the statutory directive to report to the
Secretary).
This memorandum discusses applicability of this provision to the
following Medicare and Medicaid participating long-term care
provider types that are collectively referred to as "facilities" or
"LTC facilities" in this memorandum:
- Nursing facilities (NFs),
- Skilled nursing facilities (SNFs),
- Hospices that provide services in LTC facilities, and
- Intermediate Care Facilities for the Mentally Retarded
(ICFs/MR).
Click here for the report:
June 17, 2011 Reporting Reasonable Suspicion of a Crime
-
Friday July 1, 2011
July 1, 2011 Changes to MDS 3.0 Assessment Modification &
Formatting Policies & Nursing Home Compare website.
The purpose of this CMS memorandum is to describe changes that
the Centers for Medicare & Medicaid Services (CMS) has made to
the MDS 3.0 assessment modification and formatting policies, as
well as changes to the Nursing Home Compare website as a result of
MDS 3.0 implementation.
Click here for full report
-
Monday August 29, 2011
The Centers for Medicare and Medicaid Services has announced
it will cut Medicare payments to skilled nursing facilities by $3.9
billion next year to recover overpayments it made to companies that
inflated their costs. CMS says its newly recalibrated
classification system, known as "Resource Utilization Groups
Version 4," or RUG-IV, will eliminate skilled nursing facilities'
ability to bill for a higher level of care than they actually
provide to patients. According to a July 29 statement ...
http://money.msn.com/retirement/article.aspx?post=a6d41859-804e-49f4-9568-e4cf43be63b3
-
Thursday August 11, 2011
Click on the link below to download the QIS documents:
QIS Brochure
April 2011
QIS
Checklist Final July 2011
QIS
Implementation Map April 2011
QIS
Memo Checklist Changes July 2011
-
Monday August 8, 2011
The purpose of this letter is to ensure that States are
informed of the existing options and flexibilities regarding the
application of Medicaid liens, transfer of assets, and estate
recovery. Specifically, this letter is intended to advise States of
existing choices and options regarding spousal and domestic partner
protections related to liens, transfer of assets, and estate
recovery.
Same Sex Partners MCD Liens Transfers Estate Rec 06 11
-
Friday August 5, 2011
A federal audit of Medicare hospice spending for nursing home
residents has revealed that spending has jumped nearly 70 percent
since 2005, as some for- profit hospices gained higher enrollment
and reimbursement rates at long-term- care facilities. The Office
of the Inspector General issued recommendations that the Centers
for Medicare and Medicaid Services reduce Medicaid payments for
hospice care provided in nursing facilities and closely monitor
hospice agencies.
-
Wednesday August 3, 2011
Due to a recent event and in an effort to keep our customers
informed of risk management issues, we wanted to communicate
potential risk factors regarding mechanical lifts and slings.
There are numerous brands of lifts (Hoyer, Invacare, Reliant,
EZ-Access, etc.) There are also numerous brands of slings and in
most cases, each sling will contain a warning label that states to
utilize the sling only with the same brand of lift.
Therefore, please look at your lift program to determine if the
appropriate slings are being utilized with the appropriate
lifts. (Note: Some distributers may sell some slings as
universal slings but the warning labels may still have a disclaimer
to only utilize with the same brand of lift.) Also, each lift
manufacturer may have their own fit guide to determine how to
measure residents for the appropriate size of sling.
Therefore, if your facility has several different brands of lifts
then your staff may have to be knowledgeable of the different fit
guides to determine the appropriate size of sling. Also, your
staff should be knowledgeable on guidelines to determine what type
of sling should be utilized for the resident, i.e. bathing,
transfers, etc. Will your staff be able to answer questions
on how to measure residents for the appropriate fit of a sling for
each brand? Will your staff be able to communicate how they
assess a resident to determine which type sling is appropriate for
the resident? How will your facility be able to show how you
communicate to your staff the correct size sling and type of sling
for each resident?
-
Tuesday August 2, 2011
Only the resident signed the arbitration provisions contained
in the admission agreement. Suit was filed before her death and
later amended to include wrongful death. Although currently on
appeal before the 11th circuit, the trial court ruled
that a personal representative of a resident's estate cannot be
compelled to arbitration. They opined that Alabama courts have
consistently held that wrongful death claims do not belong to a
decedent (Ala. Code ยง 6-5-462). As such, her wrongful death claim
belongs to the person representative because as a survival action,
the claim would have belonged to the decedent through her estate.
The outcome is currently pending on appeal but may have far
reaching results. Stay tuned.
-
Tuesday August 2, 2011
The redesign of the federal Nursing Home Compare website, which
lets consumers file complaints more easily and compare facilities
based on quality measures, is complete.
www.medicare.gov/nhcompare/
-
Tuesday August 2, 2011
A federal court in the Western District of Kentucky recently
provided much awaited clarification on one of many troubling
dilemmas faced by defendants, insurers and their attorneys
who are working to adhere to the requirements of Medicare Secondary
Payer ("MSP") law. Despite the challenges associated with
complying with MSP law, all of those involved in the settlement of
a claim that involves personal injury damages must be diligent to
avoid the post-settlement potential for liability to the Centers
for Medicare & Medicaid Services ("CMS").
-
Tuesday August 2, 2011
A federal audit of Medicare hospice spending for nursing
home residents has revealed that spending has jumped nearly
70 percent since 2005, as some for- profit hospices gained
higher enrollment and reimbursement rates at long-term-care
facilities. The Office of the Inspector General issued
recommendations that the Centers for Medicare and Medicaid
Services reduce Medicaid payments for hospice care provided in
nursing facilities and closely monitor hospice agencies.
-
Tuesday August 2, 2011
Inpatient rehab facilities will see a 2.2% payment rate increase
under the IRF Prospective Payment System in fiscal year 2012. The
system will also establish a new quality reporting system
authorized by the Affordable Care Act.
-
Tuesday August 2, 2011
Shares of major skilled nursing facility operator stocks took
a nosedive Monday morning following Friday's announcement that
the Centers for Medicare & Medicaid Services are cutting
Medicare reimbursements to SNFs by 11.1%, starting Oct. 1.
Operators Sun Healthcare, Skilled Healthcare and Kindred Healthcare
lost more than a quarter of their market value on Monday, according
to published reports.
-
Wednesday October 19, 2011
Article from Thirdage.com- by Caitlin
Bronson
http://www.thirdage.com/news/nursing-home-hospitalization-influenced-by-payer-status_10-04-2011
A nursing home often decides whether or not to send an ill
resident to the hospital or treat them on-site depending on their
insurance status, a new study from the University of Rochester
Medical Center found. As reported by ScienceDaily, residents
enrolled in Medicaid are 27 percent more likely to be taken to the
hospital than residents with private insurance.
And that often mean higher health care costs and poorer
outcomes, said lead author Shubing Cai of Brown University.
"Nursing homes, in many instances, have discretion in whether to
keep a patient in the facility and expend additional resources, or
transfer the resident to the hospital," Cai said. "While we know
that nursing homes tend to provide similar quality of care to all
residents, hospitalization decisions are often different from the
decisions involved in the provision of daily care and have a
significant impact on the long-term health of residents."
According to the same publication, hospitalization of elderly
patients is often linked with poor outcomes leading to further
physical and psychological decline. Patients are more vulnerable to
infections while in the hospital, experience a disruption in care
and have been show to decline more quickly in functional status and
become more confused.
The study authors recommend aligning incentives with Medicare
and Medicaid, so that nursing homes are paid based on quality
measures, including hospitalization rates.
ScienceDaily noted that Medicaid often reimburses nursing homes
at a lower rate for treatment than does private pay insurance, and
often below the necessary cost to provide onsite intensive care.
That means nursing homes have a strong financial incentive to send
ill residents on Medicaid to the hospital, where they know the cost
will be taken care of by Medicare.
-
Monday April 1, 2013
The Office of the Inspector General (OIG) released a report
February 2013 (OEI-02-09-00201) stating they found, "For 37 percent
of stays, SNFs did not develop care plans that met requirements or
did not provide services in accordance with care plans. For 31
percent of stays, SNFs did not meet discharge planning
requirements. Medicare paid approximately $5.1 billion for stays in
which SNFs did not meet these quality-of-care requirements.
Additionally, reviewers found examples of poor quality care related
to wound care, medication management, and therapy. These findings
raise concerns about what Medicare is paying for. They also
demonstrate that SNF oversight needs to be strengthened to ensure
that SNFs perform appropriate care planning and discharge
planning."
The OIG made the following recommendations; "We recommend that
the Centers for Medicare & Medicaid Services (CMS): (1) strengthen the
regulations on care planning and discharge planning, (2)
provide guidance to
SNFs to improve care planning and discharge planning,
(3) increase surveyor
efforts to identify SNFs that do not meet care planning and
discharge planning requirements and to hold these SNFs
accountable, (4) link payments to meeting
quality-of-care requirements, and (5) follow up on the SNFs
that failed to meet care planning and discharge planning
requirements or that provided poor quality care. CMS concurred with
all five of our recommendations."
You may read the entire OIG Report by clicking on the link
below.

-
Monday April 1, 2013
The Alabama Supreme Court decided on a nursing home arbitration
case on 3/22/2013 that has restricted somewhat the enforceability
of our arbitration agreements, SSC Montgomery Cedar Crest Operating
Company v. Linda Bolding, as attorney in fact and next friend of
Norton Means. The decision specifically indicates that in the case
of an incompetent resident, arbitration agreements will be enforced
only if the person who signs the agreement has been appointed by
the resident as durable power of attorney (DPOA) or has some other
valid legal authority to act on the resident's behalf other than
simply being the next of kin or being appointed as the
sponsor.
What appears to be missing from the decision is whether the
resident was competent when the arbitration agreement was
signed. Unless a resident has been adjudicated to be
incompetent by a probate judge, having a diagnosis of dementia or
Alzheimer's diagnosis may not necessarily mean a resident is
considered incompetent. If unsure whether the resident may or may
not be competent to sign, we would suggest that you have the
resident sign along with the power of attorney(POA) or the
signature of someone with valid legal authority to act on the
resident's behalf such as a guardian, conservator, or health care
proxy.
It available, you may wish to review a copy of one of the three
cognitive tests that was or has been given to the resident shortly
before or after the resident signed the arbitration agreement.
Although not officially guaranteed, the score could give you a clue
as to whether the resident has or had the capacity to consent and
sign the arbitration agreement on their own behalf.
-
With a SLUMS score of 20-21 or less consistently, the resident
probably should not consent or make their own decisions
unilaterally. With a score of โค21, it would be helpful to have the
legally authorized representative sign too.
-
With a BIMS score of 10 or less consistently, the resident
probably should not consent or make their own decisions
unilaterally. With a score of โค10, it would be helpful to have the
legally authorized representative sign too.
-
If the mini mental status score was less than 15, we presumed
that they probably could not consent or make their own decisions
unilaterally. With a MMSE score of โค15, it would be helpful to have
the authorized representative sign and consent too.
In conclusion, the Alabama Supreme Court decision does seem to
indicate that an arbitration agreement is enforceable against
the resident and the resident's estate if it is signed by:
1. A competent resident;
2. By a family member on behalf of a
competent resident; or
3. By an attorney in fact under a
durable power of attorney.
The decision does seem to say that an arbitration
agreement is not enforceable if it is signed by:
1. An incompetent resident; or
2. A family member of an
incompetent resident that has not been
appointed as the holder of the DPOA
or appointed as another
authorized legal representative on
behalf of the resident.
If you would like a copy of the decision or to discuss this
case further, please contact Lavonya below:
Lavonya K. Chapman, Esq., RN.|Director of
Claims/Litigation
Arthur J. Gallagher Risk Management Services, Inc.
2200 Woodcrest Place, Suite 250
(:205.414.2649 (direct) | 7:205.414.2632 (fax)
(:205.542.2771 (mobile)
-
Tuesday April 2, 2013
Mandatory Corporate Compliance is Here:
Are you Ready?
Approved for 1 hour NAB credit
April 16, 2013
12:00 - 1:00 Eastern
Register Today: $79
Under the Sections 6102 and 6401 of the Affordable Care Act
(ACA), Medicare and Medicaid certified nursing homes are required
to have in place a compliance and ethics program that is effective
in preventing and detecting criminal, civil, and administrative
violations and in promoting quality care. To date, however, the
Centers for Medicare & Medicaid Services (CMS) has yet to
promulgate regulations governing the statutory requirement.
Regardless, facilities must have a plan in place effective March
23, 2013. Is your facility ready?
This webinar will:
-
Review
the essential structure and elements of an effective nursing home
corporate compliance program based on existing guidance and the
provisions of the ACA;
-
Offer
practical information to create a meaningful corporate compliance
program. Provide understanding regarding how CMS guidance necessary
to implement the ACA's compliance mandate is likely to impact
providers.
To
register for this seminar go to www.care2learn.com
-
Monday April 22, 2013
Amgen, Inc., a California-based biotechnology company, has
agreed to pay the United States $24.9 million to settle allegations
that it violated the False Claims Act for marketing Aranesp to
treat anemia in nursing home residents. Aranesp may be
indicated in residents who have anemia associated with conditions
such as renal failure, dialysis or chemotherapy but not necessarily
anemia from other causes. The government alleged that Amgen
distributed materials to consultant pharmacists and nursing home
staff encouraging the use of Aranesp for patients who did not have
anemia associated with chronic renal failure.
Please see the attached release from the U. S. Department of
Justice for additional details.

-
Wednesday April 24, 2013
Care2Learn has recently posted a White Paper addressing the
issue of avoiding unnecessary rehospitalizations. The paper states
that roughly 40% of Medicare beneficiaries leaving the hospital are
discharged to a post-acute setting, where the risk for
rehospitalization begins, and the role of the skilled and assisted
living facility and home health agency becomes critical in
prevention. Effective October 2012, The Affordable Care Act
instituted the Hospital Readmission Program, requiring the Centers
for Medicare and Medicaid to reduce payments to hospitals with
excessive 30-day readmissions. Read Out of the Penalty Box to learn
about what you can do to implement evidence-based care processes
and effective training, while partnering across the healthcare
continuum to deliver better patient care and reduce unnecessary
costs to your organization as well as CMS. Explore CMS' new payment
and service delivery models of care that leverage both penalties
and incentives for all healthcare providers.
For more information click on the attachment below or visit
their web site at www.care2learn.com

-
Wednesday April 24, 2013
Medicare Audit Improvement Act of 2013 (H.R. 1250)
Legislation has been introduced that would make much-needed
improvements to the Recovery Audit Contractor (RAC) program and
other Medicare audit programs. Representatives Sam Graves (R-MO)
and Adam Schiff (D-CA) introduced the Medicare Audit Improvement
Act of 2013 (H.R. 1250), which, among other measures, would:
- Establish a consolidated limit for medical record requests
- Improve auditor performance by implementing financial penalties
and by requiring medical necessity audits to focus on widespread
payment errors
- Improve recovery auditor transparency
- Assure due process appeals for claims reopenings
- Allow accurate payment for rebilled claims
- Require physician review for Medicare denials
In a separate move, the Centers for Medicare & Medicaid
Services (CMS) issued a proposed rule on March 13, 2013, that would
allow hospitals to be paid full Part B (outpatient) payment for
inpatient claims denied during a RAC audit, when the care is found
to be appropriate at the outpatient level, if the claim is one year
old or less. This time limitation is particularly problematic to
hospitals considering RACs audit claims for services provided
during the previous three years. The Medicare Audit Improvement Act
of 2013 (see above) would fix this Part B underpayment policy.
-
Monday March 18, 2013
The Centers for Medicare and Medicaid Services have made
additional revisions to Surveyor Guidance at F Tag 155 in Appendix
PP of the State Operations Manual.The attached document below
includes the Memorandum, F155, and the Surveyor Training slides
which include Interpretive Guidance and Investigative Protocol.
Revised F155 attached below.
Revised Advanced
Directives - F Tag 155
-
Tuesday March 12, 2013
The Centers For Medicare & Medicaid Services have revised
F322 - Naso Gastric Tubes. The memo date March 8, 2013 stated that
since the release of S&C 12-46-NH, CMS conducted further review
of the interpretive guidelines for F tag 322 in Appendix PP of the
SOM. Based on the additional internal and external stakeholder
feedback the guidance and related training materials have been
revised to provide additional clarification when determining
compliance.
The memo, revised F322, and training material are attached
below.
F322 Naso-Gastric Tubes
Revised
-
Tuesday March 19, 2013
Recently
at St. Peter's Hospital in Albany, U.S. Senator Charles E. Schumer
joined Capital Region senior citizens and hospital executives to
push his plan to change the Medicare law, so that elderly patients
are not charged unfairly for receiving needed nursing home care
after being hospitalized. Schumer noted that "observation" stay
cases in hospitals, when the elderly individual is not technically
an inpatient, have been on the rise in recent years, costing
America's seniors thousands of dollars in medical bills. Currently,
Medicare will only cover post-acute care in a skilled nursing home
facility if a beneficiary has three consecutive days of
hospitalization as an inpatient. Under Schumer's plan,
the Improving Access to
Medicare Coverage Act, "observation" stays will be
counted toward the 3-day mandatory inpatient stay for Medicare to
cover rehabilitation post-hospital visit.
For
example, Mr. Ike Cassuto recently broke his pelvis and spent four
days at St. Peter's Hospital. In accordance with current law, St.
Peter's listed him under "observation status" because no operation
or procedure was performed. The consequence of this meant that
Medicare will not pay for his 3-weeks in rehab that followed his
hospital stay. Schumer emphasized it is the flawed Medicare law
which is costing Capital Region seniors thousands of
dollars.
"In
recent years, there's been a huge uptick in elderly patients under
'observation status' at Capital Region hospitals - and it's leaving
seniors high and dry and hospitals no better off. A flawed Medicare
law is to blame, and I have a plan to change that, so hundreds of
thousands of seniors, like Mr. Cassuto, are not hit with huge
rehabilitation bills after a lengthy hospital visit. This
new Improving Access to
Medicare Coverage Act would allow senior citizens
to count time spent under this 'observation status' towards
Medicare-covered rehabilitation. If you are holed up in a hospital
bed for days on end, it shouldn't matter what your billing status
is, and this plan will save Capital Region seniors
thousands."
Schumer
was joined by James K. Reed, President & CEO of St. Peter's
Heath Partners; Mr.& Mrs. Ike Cassuto; James Barba, CEO of
Albany Medical Center; Gail Myers of Statewide Senior Action and
representatives from AARP. Schumer highlighted Mr. Cassuto's recent
case, and explained that this is one example of hundreds of
thousands. The number of observation cases has been on the rise in
recent years, a consequence of policies meant to reduce
Medicare expenditures. According to the Albany Times
Union, St. Peter's Hospital, serving the Albany
community since 1930, has reported that observation cases have
nearly doubled in the past three years, with 2,560 cases in 2009
and 5,000 in 2012. This can lead to massive bills - in the tens of
thousands of dollars - that senior citizens must pay for
rehabilitation and nursing home care post-hospital
visit.
Schumer
vowed to fight for the bipartisan Improving Access to
Medicare Coverage Act to address the flawed
Medicare law. Currently, Medicare will only cover post-acute care
in a skilled nursing facility if a patient has three consecutive
days of hospitalization as an inpatient, not counting the day of
discharge. Because of the uptick in observation
cases, patients are enduring lengthier hospital stays in
observation status and may unknowingly be treated under outpatient
observation status for the entirety of their hospital
visit. Under Schumer's legislation, observation stays will be
counted toward the 3-day mandatory inpatient stay for Medicare
coverage of skilled nursing facility services after a hospital
visit. The Improving Access to Medicare Coverage Act of 2013 would
amend title XVIII of the Social Security Act. Without being
involved in billing technicalities between the hospitals and
Medicare, Schumer's plan would ensure that patients 65 and older
are eligible for coverage for their rehabilitation services, as
long as they are in the hospital for three days.
"Observation
stays" are specific, clinically appropriate services that treat and
assess a patient in a hospital while a decision is being made as to
whether patients will require further treatment as hospital
inpatients, or if they are able to be discharged from the hospital.
Hospitals, like St. Peter's, are following a flawed Medicare law in
their treatment of many patients above 65 years old. In fact,
Schumer noted, that hospitals are reimbursed less from Medicare for
the treatment of patients under "observation" status than those
that are inpatient. Hospitals also devote a significant amount
of time and money to assuring that patients are properly classified
as inpatients or outpatients.
Isadore
"Ike" Cassuto's case is among the hundreds of thousands of elderly
Americans who have been placed under "observation" status during a
hospital stay, and who now face medical bills that Medicare refuses
to cover for rehabilitation services. Mr. Cassuto came to St.
Peter's Hospital after breaking his pelvis and was a patient for
four days, but the hospital had him under observation without
admitting him as an inpatient. Mr. Cassuto then underwent three
weeks of rehabilitation, which was not covered under his Medicare
plan, leaving him with $6,000 in medical bills.
"We
thank Senator Schumer for his leadership on legislation that will
promote fairness for Medicare patients who need rehabilitation
following a hospitalization. Because of the uptick in the number of
Medicare observation status billing codes throughout our state, NY
StateWide Senior Action Council has developed a Patients' Rights
Toolkit, available at 1-800-333-4374.
We encourage Medicare patients to ask about their status so that
they can make informed decisions regarding their discharge plan,
and uphold their rights to care through the appeals process when
needed. Patients should not be forced to pay out of
pocket for otherwise covered Medicare services due to institutional
billing issues," said Gail Myers of the NY StateWide Senior Action
Council.
SCHUMER:
MEDICARE'S 'OBSERVATION STATUS' FORCES SENIORS TO PAY THOUSANDS
EXTRA FOR REHAB THAT ARE NOT REIMBURSED - SENIORS ARE LEFT HIGH
& DRY, UNABLE TO PAY HUGE BILLS POST-HOSPITAL
STAY
Schumer's
New Plan Would Change Three-Day Requirement & Allow Time Spent
In 'Observation' To Count Toward Medicare-Covered Rehabilitation -
Saving Seniors Huge Costs
Schumer Highlighted That 'Observation' Stay Cases Are Skyrocketing
In Hospitals Across the Capital Region And Country, As Hospitals
Comply With Flawed Medicare Law
Schumer Will Join Ike Cassuto Who Was Put Under 'Observation
Status' At the Hospital- For Days-After Breaking His Pelvis,
Meaning Medicare Won't Cover Nursing Home Recovery Care, Which Can
Cost Thousands
-
Tuesday March 19, 2013
The U.S. Supreme Court case of Marmet Health Care Center v.
Brown, decided on Feb 21, 2012, shows the advantage of a properly
written and signed arbitration agreement in order to keep claims
out of court where jurors decide and instead allow an arbitrator to
decide the outcome.
Before Marmet, several states completely prohibited nursing
homes from compelling residents to give up their right to a jury
trial and declared all arbitration agreement in nursing home
admission contracts to be unconscionable.
After Marmet Health Care Center v. Brown, nursing home owners
and operators can have confidence that properly drafted and
executed arbitration agreements will keep inevitable claims away
from jurors.
Litigating claims in court can lead to unexpectedly high awards.
Arbitration of claims is generally seen as offering significantly
less potential for runaway jury awards by eliminating the emotions
that fuel them. More predictable losses should result in lower
overall claim payments, safeguarding funds that are better spent
caring for residents. For these reasons, many long-term-care
facilities have sought to use arbitration agreements when
contracting with their residents upon admission. Plaintiffs often
seek grounds to avoid the enforcement of arbitration agreements, in
order obtain for themselves the potential of a much larger jury
award.
The U.S. Supreme Court noted that in Marmet, arbitration
agreements signed predispute, were enforceable and not void as a
matter of public policy. That Court went on to say "Congress
did intend for the federal arbitration act (FAA) to take precedent
over state law.
Properly drafted and executed arbitration agreements between
facilities and their residents are generally enforceable. The
impact that arbitration has on dispute resolution is so important
that we expect to see it used routinely. Of course, care must be
taken to avoid unenforceability, as is the case with any
contract.
The most significant of these are a lack of mental capacity to
consent, fraudulent inducement to sign, duress and
unconscionability. Long term care facilities who choose not to
utilized arbitration agreements will be well-advised to
reconsider.
Arbitration agreements will go a long way toward reducing
inappropriate and huge jury awards, allowing for better provision
of care for nursing home residents.
For information on the provisions needed in arbitration
agreements to increase the likelihood of being enforced or how the
train your facility in getting them signed by the appropriate
person(s), please contact:
Lavonya K. Chapman, Esq., RN.|Director of
Claims/Litigation
Arthur J. Gallagher Risk Management Services, Inc.
2200 Woodcrest Place, Suite 250
-
Wednesday March 20, 2013
Occupational safety and health concerns are not limited to the
construction and general industries anymore. Over the past four
years, OSHA has become increasingly aggressive in its enforcement
practices in every employment sector, rejecting collaborative
efforts with employers, such as partnerships, to enhance workplace
safety in favor of enforcement with higher citation classifications
and enhanced penalties. With the reelection of President Obama and
the understanding that Dr. David Michaels, Assistant Secretary of
Labor, will remain the head of the OSHA for another four years,
employers across the board can expect the agency to continue its
aggressive enforcement tactics in 2013 and beyond.
To read more about OSHA enforcement, click on the link
below.

-
Thursday March 21, 2013
The U.S. Court of Appeals for the 10th Circuit rendered an
opinion that not only altered the agency's burden of proof for OSHA
citations but effectively reduced that burden to little more than a
semantic impediment. The Court declared that OSHA, or the
Secretary of Labor need not establish the elements of the long
established four-part Atlantic Battery test to prove a violation
but instead must only prove that a "reasonably prudent employer"
would have anticipated the hazard at issue and done more to prevent
it. Further, the Court found this burden met where the Secretary
had simply asserted that the employer at issue failed to act as a
reasonably prudent employer without offering any evidence regarding
whether a reasonably prudent employer in the same industry would
have even recognized the hazard and, if so, what protective
measures, if any, would have been taken.
In effect, the employer's liability is viewed
in a vacuum with no reference to some recognized norms of safety
recognition in the employer's industry. According to the Court, the
Secretary only need to allege and prove that the specific
employer's actions were "imprudent" and the violation will
stand.
For more details please read the following
attachment:

-
Thursday March 21, 2013
The patient/resident medical record is the best evidence in a
medical malpractice lawsuit. It is the medical record
documentation, not the physician recall of details, which can most
effectively defend a physician against a malpractice claim.
Why?
-
Friday March 22, 2013
The prompt reporting of claims is one of the easiest ways to
lower your total cost of risk; the sooner we learn about the claim
the quicker we can engage in medical and disability management.
The results of this study emphasize the importance of
reporting claims as soon as possible.
Below is a link to view the Liberty Mutual Study.

-
Tuesday March 26, 2013
On March 19, CMS issued in the Federal
Register, a final rule that outlines steps that long-term care
facilities need to take if they decide to cease business
operations.
๏ปฟ
In the case of a facility closure, any
individual who is the administrator of the facility must
provide written notification of the closure and the plan for
the relocation of residents at least 60 days prior to the impending
closure or, if the Secretary terminates the
facility's participation in Medicare or Medicaid, not later
than the date the Secretary determines appropriate, according to
the rule.
๏ปฟ
It also identifies penalties for
non-compliance and clarifies the responsibility of the
administrator of the facility to ensure that no new residents are
admitted after written notice is submitted and that the notice of
closure must include a plan for transfer and adequate relocation to
another facility.
See the attachment below for details
for: Medicare and Medicaid Programs; Requirements for
Long Term Care (LTC) Facilities; Notice of Facility
Closure
๏ปฟ
-
Sunday March 31, 2013
Megace: Potential Liability and Regulatory Impact
Par Pharmaceutical Co., has agreed to pay $45 million to settle
allegations it improperly
labeled and marketed its prescription drug Megace ES to elderly
patients, the U.S. Department of Justice said.
Among other things, the company was accused of criminally
misbranding Megace, which was approved by the FDA to treat weight
loss tied to AIDS, as a treatment for non-AIDS-related geriatric
wasting.
Despite being aware of harmful side effects, Par also targeted sales to nursing home
residents with weight loss, and launched a sales force specifically
for this market, according to the Justice Department.
A representative from the company didn't immediately respond to
a request for comment. On behalf of Par, Chief Executive Paul V.
Campanelli pleaded guilty to criminal misdemeanor charges in a New
Jersey federal court on Tuesday, the Justice Department said. The
company was fined $18 million and ordered to pay $4.5 million in
criminal forfeiture, and agreed to pay $22.5 million to resolve its
civil liability. "Today's resolution emphasizes the importance of
the U.S. government's coordinated efforts to combat health care
fraud," said Stuart F. Delery, of the Justice Department's civil
division. "We expect companies to make honest, lawful claims about
the drugs they sell."
Megace, a megestrol acetate drug, lacked adequate directions for
use in the treatment of geriatric wasting unrelated to AIDS,
a use that wasn't approved by the FDA, the Justice Department said.
The civil allegations against the company were related to claims
submitted to federal
health-care programs for uses that weren't approved by the
FDA. U.S. officials alleged that Par was aware that
megestrol acetate carried potentially fatal risks for
elderly patients, including a heightened potential for deep
vein thrombosis and toxic reactions in patients with impaired
kidney function.
Please see the attached release from the U. S. Department of
Justice for additional details.
We wanted you to be aware of the above information as you
continue to review all medications in conjunction with your
Pharmacist and physician and work with your physician on providing
documentation in the event medications are used for off-labeled
use.

-
Friday May 17, 2013
The Centers for Medicare & Medicaid
Services (CMS) is publishing this article to provide clarification
of Federal guidance regarding Section 3108 of the Affordable Care
Act (ACA), related to physician delegation of certain tasks in SNFs
and NFs to NPPs (NPPs are formerly "physician extenders") such as
nurse practitioners (NPs), physician assistants (PAs), or clinical
nurse specialists (CNSs).
This article addresses the authority of NPs,
Pas, or CNSs to perform certain tasks such as conducting physician
visits and writing orders, and to sign certifications and
re-certifications.

-
Wednesday May 8, 2013
This updated Special Advisory Bulletin describes the scope and
effect of the legal prohibition on payment by Federal health care
programs for items or services furnished (1) by an excluded person
or (2) at the medical direction or on the prescription of an
excluded person. For purposes of Office of Inspector General (OIG)
exclusion, payment by a Federal health care program includes
amounts based on a cost report, fee schedule, prospective payment
system, capitated rate, or other payment methodology. It describes
how exclusions can be violated and the administrative sanctions OIG
can pursue against those who have violated an exclusion. The
updated Bulletin provides guidance to the health care industry on
the scope and frequency of screening employees and contractors to
determine whether they are excluded persons.

-
Friday May 17, 2013
In an arbitration ruling in December 2011 in case of The Estate
of Jane Doe versus ABC Health & Rehabilitation Center the terms
specified in the Medical Director Agreement played a significant
role in the Arbitration Panel ruling in favor of the defendant ABC
Health and Rehab. The Arbitration Panel members found there
had been no showing that any act or omission by the nurses at ABC
Health and Rehabilitation Center constituted a breach of the
applicable standard of care or caused the medical problems
culminating in the resident's death. A significant
factor in the favorable outcome of this case for the facility was
the terms of the Medical Director Agreement. The Medical
Director Agreement stated that the Medical Director was an
independent contractor; the roles of the medical director were
clearly stated and did not include a responsibility to diagnose or
treat patients. Rather, the agreement clearly stipulated that
any services the physician was to provide in that regard were to be
in his independent role as an attending physician and the facility
was not liable for the acts or omissions of the attending
physician.
Are the roles of your Medical Director in your Medical Director
Agreement clearly defined and separate from any acts he/she may
engage is as attending physician who has a responsibility to
diagnose and treat patients? If not you may wish to review
your contract with your corporate counsel and decide if
clarification is needed to this area or any other areas of the
agreement.
A sample Medical Director Agreement for your review is
available from the American Medical Director Association at the
link below. We do not recommend any changes to your agreement
without review and discussion with your corporate
counsel.
-
Thursday May 30, 2013
The Patient Protection and Affordable Care Act (PPACA)
required all Medicare/Medicaid Skilled Nursing Facilities to have
an effective Compliance and Ethics Program in place by March 23, 2013.
The primary purpose of the Compliance and Ethics Program is to
prevent, detect, and correct any fraud, abuse, or waste, to promote
quality of care, and to have an operational Compliance and Ethics
Program in place to meet applicable federal, state, and local laws
and regulations. In order to avoid potential exposure nursing
facility providers should take steps to implement the required
Compliance and Ethics Program.
Robinson Adams - Arthur J. Gallagher has partnered with
Associated Long Term Care Insurance Company, Johnston Barton
Proctor & Rose and Care2Learn to assist you with the
development of your Compliance and Ethics Program and training
along with answering any questions you may have concerning this
program.
Information from Johnston Barton Proctor & Rose on how they can
help you develop your Corporate Compliance Program:
Long
Term Care - Corporate Compliance Management
Johnston Barton
Proctor & Rose
Our law firm, in partnership with Robinson Adams - Arthur J.
Gallagher, has developed a Corporate Compliance Program Template
(the "Template") to assist long term care facilities in meeting
this requirement.
Our Template includes a corporate compliance program, employee
manual, copies of the applicable statutes and
regulations, in-service log and
instructions, corporate compliance hotline
information, and corporate compliance log and
instructions. The charge for the Template is $500.00.
Our law firm is also available to assist you with customizing and
implementing the Template for your facility at a discounted
rate.
If your facility is interested in purchasing the Template or if
our firm can provide your facility with any other assistance in
meeting the compliance program requirements of PPACA, please
call Angie Cameron at (205) 458-9489.
Care2Learn
You may also contact Stu DeVust at Care2Learn at 941-465-4578
to find out how you can enroll in the following Corporate
Compliance Online Courses:
-
Corporate Compliance - What You Need to Know
(USS-11600)
-
Corporate Compliance - What You Need to Know for Assisted
Living (USS-11600A)
-
Corporate Compliance and the Deficit Reduction Act for
Management (USS-11200)
Please contact Russ Crouch at 205-414-1390, or our vendor
partners, if you need additional information or assistance.
-
Thursday June 20, 2013
Guidance - This memo conveys clarification to Appendices P and
PP related to nursing home residents with dementia and unnecessary
drug use. โข Training - Mandatory surveyor trainings are available
online at
http://surveyortraining.cms.hhs.gov
S&C 13-35

-
Thursday June 20, 2013
S&C: 13-34-ALL Memo
Release of Training Materials:The Survey and Certification
Group (SCG) is providing the third and final training program on
the care of persons with dementia and unnecessary antipsychotic
medication use. The first two programs were made available in
January 2013; the third program will be released after May 31,
2013.
Program Content and Design:The third program is a
video-streaming that discusses how to cite severity. The first
program provides survey basics related to care of persons with
dementia and unnecessary medications. The second program is an
interactive self-study with video clips that walks through portions
of an actual nursing home survey. โข Target Audience: These three
programs are mandatory for all State and Regional Office surveyors
and optional for other interested personnel. Surveyors have until
August 31, 2013 to view the final training. The deadline to view
the first two programs was April 30, 2013.

-
Friday June 21, 2013
AHCA has available and free to all AHCA members the 4 Key
Strategies to Retain New Hires and Reduce Employee Turnover
(toolkit and webinar) and the Clinical Considerations of
Antipsychotic Management (Toolkit and webinar):
http://qualityinitiative.ahcancal.org. This resource uses a process
framework, based on the Nursing Process, to identify care
objectives and expectations. It identifies tools and resources to
help providers successfully manage antipsychotic medication use at
the resident and facility level. The guide focuses on 7 critical
steps needed to ensure quality outcomes that are successful and
continuous.
Members will need to log-in to access the toolkits, as it is a
member-only
benefit. If log-in information is needed, please contact
your facility Administrator or State Association and they can give
you the information you need.
-
Friday June 21, 2013
June 2013 OEI-07-11-00010
In 2011, Medicare paid between 18 and 30 percent more than
other insurers for 20 high-volume and/or high-expenditure lab
tests. Medicare could have saved $910 million, or 38 percent, on
these lab tests if it had paid providers at the lowest established
rate in each geographic area. State Medicaid programs and 83
percent of FEHB plans use the Medicare CLFS as a basis for
establishing their own fee schedules and payment rates, although
most pay less. However, unlike Medicare, FEHB programs incorporate
factors such as competitor information, changes in technology used
in performing lab tests, and provider requests in their payment
rates. Some State Medicaid programs and FEHB plans required
copayments for lab tests, which, in effect, lowered the costs of
lab tests for the insurer.
The OIG recommend that the Centers for Medicare & Medicaid
Services (CMS) seek legislation that would allow it to establish
lower payment rates for lab tests and consider seeking legislation
to institute copayments and deductibles for lab tests. In its
comments, CMS stated that it is exploring whether it has authority
under current statute to revise payments for lab tests consistent
with OIG's recommendation and that a proposal to establish
"deductibles and coinsurance" for lab tests is not included in the
fiscal year 2014 President's Budget.
To read the complete report click on the pdf below.

-
Wednesday June 26, 2013
Tips to Control the Risk with Communication

-
Friday July 12, 2013
In Alabama,
one has the right to obtain a deceased resident's medical records
from an Alabama health care provider if the requester is the
personal representative (such as the executor or administrator) of
the deceased resident's estate.
The new
HIPAA privacy final rule passed 3/26/2013 with a compliance
deadline of 9/23/2013. The new final HIPPA rule says that those
family members, relatives, and others who had access to the health
information of the deceased prior to death, but had not qualified
as a "personal representative"(PR) of the decedent under HIPAA
Privacy Rule 164.502(g)(4) the final Privacy Rule allows covered
entities (facility) to disclose a decedent's protected health
information(PHI) to family members and others who were involved in
the care or payment for care of the descendent prior to death,
unless doing so is inconsistent with any prior expressed preference
of the individual that is known to the covered entity. Whether to
adhere to the new HIPAA final rule is now at the discretion of the
facility and is not mandatory.
We do not
plan to make any changes to our current procedure unless the
facility/covered entity directs us to do so. As such, we will still
require a written request for the deceased resident's medical
records signed by the personal representative of the estate on a
HIPAA compliant release form along with the accompanying legal
authority from the Probate court naming the requester as the
PR.
This recent
HIPAA amendment is addressed under number 2 below and authorizes
the covered entity to produce protected health information or
medical records to individuals who are not the PR, so long as those
individuals were involved in the decedent's care/payment, need the
PHI for that purpose and the decedent did not express a preference
(that was known to the covered entity) for his/her PHI to not be
released to the individual now seeking it. It will be interesting
to see how this new HIPAA amendment plays out. Under this new
amendment, the covered entity has the discretion to produce the PHI
or not; HIPAA does not require that the covered entity produce, but
rather permits the disclosure.
Under HIPAA,
the confidentiality of a resident's protected health information
continues after the resident's death. In general, the covered
entity is not required to disclose a decedent's PHI to anyone other
than the decedent's personal representative. The covered entity
must (1) verify the identity of the individual and (2) verify that
the individual has the legal authority to access the decedent's
PHI. Recent amendments to the HIPAA privacy rule limit the time
period for which the covered entity must protect a decedent's PHI
to 50 years after the person's death. See45 C.F.R. 164.502(f).
HIPAA provides for disclosure of a decedent's PHI as
follows:
(1)Disclosure of PHI
to Personal Representative- upon verification of identity and legal
authority, the personal representative must be treated as the
individual for purposes of disclosure
See 45 C.F
.R. 164.502(g)(1)Standard: Personal representatives.As specified
in this paragraph, a
covered entity must, except as provided in paragraphs (g)(3) and
(g)( 5) of this section, treat a personal representative as the
individual for purposes of this subchapter.
See 45
C.F.R. 164.502(g)(4)Implementation specification: Deceased
individuals. If under applicable
law an executor, administrator, or other person has authority to
act on behalf of a deceased individual or of the individual's
estate, a covered entity must treat
such person as a personal representative under this
subchapter, with respect to
protected health information relevant to such
personal representation.
(2)
Disclosure of PHI to family member, other relative, or close
personal friend of decedent - The covered entity is permitted, but
not required to disclose PHI to theseindividuals so long as the
individual was involved in the decedent's care or payment for
healthcare prior to death and the PHI is relevant to the family
member, other relative or close personal friend's involvement; the
disclosure also must not be contrary to the decedent's prior
expressed preference. [1]
See 45 C.F.R
164.510(b)Standard: Uses and disclosures for involvement in
the individual's care and
notification purposes-
(1)
Permitted uses and disclosures. (i) A covered entity
may, in accordance with paragraphs (b )(2), (b )(3), or (b )(5) of
this section, disclose to a family member, other relative, or a
close personal friend of the individual, or any other person
identified by the individual, the protected health information
directly relevant to such person's involvment with the individual's
health care or payment related to the individual's health
care.
See 45
C.F.R. 164.510(b)(5)Uses and disclosures when the individual
is deceased.If the
individual is deceased, a covered entity may disclose to a
family member, or other
persons identified in paragraph (b) (1) of this section who
were involved in the
individual's care or payment for health care prior to
the individual's death,
protected health information of the individual that is relevant to
such person's involvement, unless doing so is inconsistent with any
prior expressed preference
of the individual that is known to the covered entity.
(3)
Disclosure of PHI to law enforcement- if the covered entity has
suspicion that death may have resulted from a criminal act, then
disclosure is permitted.
See 45
C.F.R. 164.512 Uses and disclosures for which an authorization
or opportunity to agree
or object is not required. A covered entity may use or
disclose
protected health information without the written authorization of
the individual, as
described in ยง 164.508, or the opportunity for the individual
to agree or object as
described inยง 164.510, in the situations covered by this
section, subject to the
applicable requirements of this section. When the covered entity
is required by this
section to inform the individual of, or when the individual
may agree to, a use or
disclosure permitted by this section, the covered
entity's information and the
individual's agreement may be given orally.
See 45
C.F.R. 164.512(f)(4)Permitted disclosure: Decedents. A covered
entity may disclose
protected health information about an individual who has died to
a law enforcement
official for the purpose of alerting law enforcement of the
death of the individual if
the covered entity has a suspicion that such death may
have resulted from
criminal conduct.
(4)
Disclosure of PHI to Coroners and Medical Examiners
See 45
C.F.R. 164.512(g)Standard: Uses and disclosures about
decedents-(1) Coroners and medical
examiners. A covered entity may disclose protected
health information to a
coroner or medical examaniner for the purpose of identifying a
deceased person, determining a cause of death, or other duties as
authorized by law. A covered entity that also performs the duties
of a coroner or medical examiner may use protected health
information for the purposes described in this
paragraph.
(5)
Disclosure of PHI to Funeral Directors
See 45
C.F.R. 164.512(g)(2) Funeral directors. A covered entity may
disclose protected health
information to funeral directors, consistent with applicable
law, as necessary to carry
out their duties with respect to the decedent. If necessary
for funeral directors to
carry out their duties, the covered entity may disclose
the protected health
information prior to, and in reasonable anticipation of,
the individual's
death.
(6)
Disclosure of PHI for Research Purposes-The covered entity is
permitted to disclose PHI for research subject to various criteria
not set out fully herein
See45 C.F.R.
164.512(iii)Research on decedent's information. The
covered entity obtains from
the researcher:
(A)
Representation that the use or disclosure sought is solely for
research on the protected health
information of decedents;
(B)
Documentation, at the request of the covered entity, of the death
of such individuals;
and
(C)
Representation that the protected health infomation for which use
or disclosure is sought is necessary for the research
purposes.
Member may
login to review new and revised related forms.
Lavonya K. Chapman, Esq., RN, Claims Compliance Director
Arthur J. Gallagher Risk Management Services, Inc.
2200 Woodcrest Place, Suite 250
Birmingham, AL 35209
(205) 414-2649 (direct)
(205) 414-2632 (fax)
(205) 542-2771 (mobile)
To visit the
LTC Provider University website go to www.ltcpu.com
[1]Attached is an
excerpt from the Federal Register which discusses this new
amendment to the HIPAA Rule. It is helpful and explains in some
detail the rationale, concerns, etc. behind extending permissible
disclosures of PHI to family members, other relatives and close
friends of the decedent who would not qualify as a personal
representative and otherwise would not have access to the
decedent's PHI.
-
Tuesday August 6, 2013
LEGIONNAIRES' DISEASE
CAN AFFECT
RETIREMENT
COMMUNITIES
There have
been recent newspaper articles in the United States reporting
outbreaks of Legionnaires' disease in retirement communities.
Legionnaires' disease is not contagious but is contracted when
people breathe in tiny droplets of contaminated water from sources
such as showers, water fountains, whirlpool tubs, etc.
The Centers for Disease Control and Prevention have
many resources available on this topic for you to review relating
to symptoms, causes, prevention and surveillance. For
additional information, please reference CDC.gov. http://www.cdc.gov/legionella/about/
-
Tuesday August 6, 2013

Section 40-12-143 of the Alabama Code, made by Senate Bill 286,
permits employees to have guns in their vehicles on their
Employer's property. It may be a good time for facilities to
evaluate their current work place safety policies. Our
partner, Johnston Barton Proctor & Rose, developed a detailed
summary of this new amendment that went into effect on August 1,
2013. We have included the summary below. For additional
information on Section 40-12-143 of the Alabama Code you can
contact Angie C. Cameron or Sarah C. Blutter at Johnston Barton
Proctor & Rose LLP.

-
Thursday August 8, 2013
The Arthur J
Gallagher Loss Control Practice Group developed a webcast providing
an overview of OSHA's Globally Harmonized System mandatory
regulation that provides insight on how to be compliant with this
regulation. You can view this webcast by clicking on the following
link:
http://ajg.adobeconnect.com/p4l83ypg2l4/
Risk
Management Strategies Webcast Special Edition Series:

-
Monday August 12, 2013

Contract Requirements between Long
Term Care Facilities and Hospice Service Providers
On June 27, 2013 CMS released the final ruling on contract
requirements between long term care providers and Hospice
Services. This regulation will be effective on August 26,
2013. Because there are similar services provided by
both long term care facilities and hospice providers it is possible
for residents to receive the same services or conflicting services
from both companies. The rationale behind the final ruling
from CMS is to help ensure safe and quality care for residents by
requiring a written agreement between the long term care facility
and the hospice provider outlining the services that will be
provided by both entities.
When hospice services are provided in long term care facilities
then each facility is responsible for ensuring that the hospice
services meet professional standards and principles that apply to
individuals providing services in the facility, and to the
timeliness of these services. The long term care facility
must meet the requirements of the contract between the hospice
provider and the long term care facility and this contract must be
signed by an authorized representative of the hospice service
provider and the long term care facility before hospice care can be
provided to residents at the facility. The written agreement must
address issues such as:
- The services hospice will provide
- The hospice's responsibilities for determining the appropriate
hospice plan of care
- The services the long term care facility will continue to
provide, based on each resident's plan of care
- A communication process including how the communication will be
documented between the long term care facility and the hospice
service, to ensure that the needs of the resident are addressed and
met 24 hours per day
- A provision that the long term care facility will immediately
notify the hospice service about the following: 1) a
significant change in the resident's physical, mental, social or
emotional status; 2) clinical complications that suggest a need to
alter the plan of care; 3) a need to transfer the resident from the
long term care facility for any condition; and 4) the resident's
death
- A provision stating that the hospice service assumes
responsibility for determining the appropriate course of hospice
care, including the determination to change the level of services
provided
- An agreement that it is the long term care facility's
responsibility to furnish 24 hour room and board care, meet the
resident's personal care and nursing needs in coordination with the
hospice representative, and ensure that the level of care provided
is appropriately based on the individual resident's needs
- A delineation of the hospice's responsibilities, including but
not limited to, providing medical direction and management of the
patient; nursing; counseling; social work; providing medical
supplies, durable medical equipment, and drugs; and all other
services that are necessary for the care of the resident's terminal
illness and related conditions
- A provision that when the long term care facility personnel are
responsible for the administration of prescribed therapies,
including those therapies determined appropriate by the hospice and
delineated in the hospice plan of care, the long term care
personnel may administer the therapies whether permitted by State
law
- A provision stating that the long term care facility must
report all alleged violations involving mistreatment, neglect, or
verbal, mental, sexual, and physician abuse, including injuries of
unknown source, and misappropriation of patient property by hospice
personnel, to the hospice administrator immediately when the
facility becomes aware of the alleged violation
- A delineation of the responsibilities of the hospice and the
facility to provide bereavement services to the long term facility
staff
The final ruling also states that the long term care facility
must designate a member of the facility's interdisciplinary team to
be responsible for working with hospice representatives. This team
member must have a clinical background.
In addition to the CMS requirements in the agreement between the
long term care facility and the hospice provider that are outlined
above, from a risk management perspective, you should also consider
adding the following additional provisions to the contract between
your facility and the hospice provider:
- Independent Contractor provision - this agreement clarifies
that the contractor is not a facility employee and therefore not
subject to the facility's worker's compensation benefits or
professional liability insurance coverage
- Hold Harmless provision - this agreement clarifies that one or
both parties agree to not hold the other responsible for
damages. This agreement indemnifies one or both parties by
agreeing to not hold the other responsible for any legal liability
or losses as a result of a specified incident or action
- Insurance coverage by both parties - this clause states that
each entity will carry their own general/professional liability
insurance. This provision without a hold
harmless/indemnification clause is only helpful if both the
facility and third party contractor are co-defendants.
In other words, if the third party contractor is not a party to a
claim against the facility, the third party contractor's liability
insurance will not hold harmless or indemnify the facility
The facility may want to consult with its Corporate Counsel
before finalizing the language in the contract between the facility
and the hospice provider, or with any other third party.
To read the complete final rule, the Federal Register is
attached.

-
Friday August 16, 2013
CMS Manual System Transmittal 86
Revisions to State Operations Manual (SOM) Chapter 5
EFFECTIVE DATE: July 19, 2013
IMPLEMENTATION DATE: July 19, 2013
-
Friday August 16, 2013
Complying with Medicare Signature Requirements
The attached fact sheet describes common
Comprehensive Error Rate Testing (CERT) Program errors related to
signature requirements and provides information on the
documentation needed to support a claim submitted to Medicare for
medical services.
Click on the pdf below to read the entire
document from DHHS.

-
Friday September 13, 2013
Safety Seminar
Healthcare Forum
Friday October 4, 9am -3pm
Arthur J.
Gallagher
Robinson Adams Insurance
2200 Woodcrest Place, Suite 250
Birmingham, AL 35209
Click here to register!
Arthur J.
Gallagher, in partnership with Liberty Mutual Insurance, is
offering a complimentary Healthcare seminar to help recognize and
reduce risk in the healthcare industry. The training covers a
variety of safety and health topics specific to exposures faced by
healthcare workers.
As a result of this training, participants will be able
to:
- Evaluate slips
and falls and implement prevention strategies
- Modify internal
patient handling policies to include industry best
practices
- Develop methods
to track and measure safety performance
- Address the
challenges and impact associated with an aging
workforce
- Determine the
impact of shiftwork on employees
This seminar
is designed for Arthur J. Gallagher Risk Management Services and
their clients who want to help reduce risk within their operation.
Complimentary continental breakfast and lunch will be
provided.
Please register
early as seats are limited.
If you have
any questions email us at Risk Control Learning or contact
our Training Specialists
at 877-588-2016.


-
Wednesday October 2, 2013
A thorough
accident investigation procedure is an important part of any safety
program. It is essential that an employer understand what caused an
accident to happen and what can be done to prevent a recurrence.
This article provides you with information on when to begin the
accident investigation and the steps that should be followed during
the investigation process.
Click on the link to view the article: 

-
Monday October 21, 2013
ROGUE SUPERVISOR: FEDERAL COURT REJECTS OSHA'S ATTEMPT TO CREATE
STRICT EMPLOYER LIABILITY.
It is well recognized that employer knowledge is required for
OSHA to establish a violation. Under most circumstances, this
element can be satisfied when a supervisor, manager or foreman, who
are agents of the employer, witnesses an employee exposed to a
hazard, but does nothing about it. But what happens when the
supervisor, manager, or foreman is the individual violating OSHA's
regulations?
The article below examines a recent Federal Court of Appeal's
decision rejecting OSHA's interpretation, and how that decision may
affect OSHA's ability to prove a violation in the first place as
well as the employer's ability to prove unavoidable supervisor
misconduct affirmative defense.

-
Monday December 2, 2013
A Minute for Safety, by Arthur J. Gallagher
& Co.
You are responsible for fire prevention and the safety of your
coworkers in the event of a fire. The best way to prevent
workplace fires is to be aware of and on the lookout for potential
fire hazards. Employees should be trained about fire hazards
and about what to do in the event of a fire. This article
will review the steps to take to reduce the risks from fire
occurring in the workplace and what to do if one should
occur:

-
Thursday November 21, 2013
Alabama Medicaid Agency - Medicaid Alert
TO: Nursing Home Providers
The purpose of this alert is to clarify the procedures associated
with handling funds following the death of a Medicaid-eligible
nursing home resident. The Medicaid Administrative Codes
560-X-10-.14(3)(f) and 560-X-22-.25(5)(e) and the Social Security
Administration Guide for Representative Payees require that nursing
homes,upon the death of a resident, release any funds being held at
the facility in the resident's name to the administrator of the
deceased resident's estate. In the event that there is not a person
who has been appointed to act as the administrator of the estate,
the funds should be sent to the Alabama State Treasurer's Office,
Unclaimed Property Division. In an effort to ensure that all
Alabama nursing home facilities are in compliance with the rules
and regulations pertaining to the handling of the funds of deceased
residents, the following instructions are provided in the pdf
below.
-
Thursday December 12, 2013
In the regulations at42 CFR 409.32(c), the level of care
criteria for SNF coverage specifies that the "โฆ restoration
potential of a patient is not the deciding factor in determining
whether skilled services are needed." In addition, on January 24,
2013, the Court approved the settlement concerning the Jimmo v.
Sebeliuscase which has eventually resulted in new guidelines for
skilled care and skilled therapy.
The Centers for Medicare & Medicaid Services has now
revised the Medicare Benefit Policy Manual, Publication #: 100-02,
Chapter 8, ยง 20.1.2-Determination of Coverage, to clarify that
skilled care and skilled therapy may be covered even for conditions
that will not improve.
In the past many thought that Medicare coverage of skilled
nursing care or therapy required documentation that a resident or
Medicare beneficiary must have the potential for improvement from
the nursing care or therapy. The manual revisions, now
clarifies that skilled care may be needed to maintain a current
condition or prevent or slow a resident/patient's deterioration.
The manual also includes specific examples of documenting skilled
care.
Until theMedicare Benefit Policy Manualis updated, see the
attachedMLN Matters Number: MM8458 or Related CR Transmittal #:
R175BP. Effective Date: January 7, 2014,for guidance.
Please click on the MLN Matters article below:

-
Monday December 16, 2013
Prior to the arrival of emergency medical services (EMS),
nursing homes must provide basic life support, including initiation
of CPR, to a resident who experiences cardiac arrest (cessation of
respirations and/or pulse) in accordance with that resident's
advance directives or in the absence of advance directives or a Do
Not Resuscitate (DNR) order. CPR- certified staff must be available
at all times.
Please click on the article below to read the Memorandum
regarding CPR in Nursing Homes:

-
Thursday December 26, 2013
This Key
Cares article focuses on winter fire prevention, and highlights
methods to prevent the most common causes of home and workplace
fires. This article also features information about obesity and
body mass index. Please click on the link below to access the
article.
http://campaign.r20.constantcontact.com/render?ca=5ce4b51f-21eb-4b00-8a64-4758b3916472&c=bed96d40-4cec-11e3-bcea-d4ae5292bb50&ch=bf3fa920-4cec-11e3-bd14-d4ae5292bb50
-
Tuesday January 7, 2014
Active Shooter Preparedness - The potential for a shooting
incident by an active shooter exists, unfortunately, in every
workplace place throughout the United States. This article will
help you and your staff create an emergency action plan to respond
to an active shooter situation.

-
Tuesday January 28, 2014
This
Arbitration Signature Flowchart will guide you and your staff on
the signature options for your facility's arbitration agreement.

-
Monday February 3, 2014
The Long
Term Care Community is waiting for CMS to release the final Quality
Assurance and Performance Improvement (QAPI) regulations, but your
team should be preparing today to build a systematic,
comprehensive, data driven approach to care. This free webinar will
provide an overview of the eHealth Data Solutions CareWatch
features that can enhance your QAPI activities and will discuss
real life examples of the way CareWatch data can be used in the
Plan-Do-Study-Act Cycle and your performance improvement projects
(PIPs). See the link below on how to register for this free webinar
presented by eHealth Data Solutions:
https://www2.gotomeeting.com/register/602492442
-
Thursday February 6, 2014

With less than one year to go until the October 1, 2014,
ICD-10 compliance date, now is the time to assess your progress.
CMS continues to work with health care organizations to develop and
distribute a variety of resources to help you with your ICD-10
planning and preparation.
No matter where you are in your transition, there are
ICD-10 resources available to you. Check the
provider resources page on the CMS website
frequently for news and information to help you prepare, and visit
your professional organization's website for resources tailored
specifically to your needs. These resources can help
you:
- Plan your journey - Look at the codes you
use, prepare a budget, and build a team
- Train your team - Many options and
resources are available
- Engage your partners - Talk to your
software vendors, clearinghouses, and billing services
- Test your systems and processes - Test
within your practice and with your partners
2014 is the year of ICD-10. The
ICD-10 transition will affect every part of your practice, from
software upgrades, to patient registration and referrals, to
clinical documentation and billing. With everyone in health care
working toward a successful transition, now is the time to make
sure you are ready too.
Keep Up to Date on ICD-10
Visit the CMS
ICD-10 website for the latest news and resources to
help you prepare for the October 1,
2014, compliance date. Sign up for
CMS ICD-10 Industry Email Updates and
follow us on Twitter.


-
Friday February 28, 2014
The Centers
for Medicare & Medicaid Services (CMS) is alerting healthcare
facilities that they have revised current emergency preparedness
checklist information for health care facility planning. These
updates provide more detailed guidance about patient/resident
tracking, supplies and collaboration.
CMS has updated the
S&C Emergency Preparedness Checklist - Recommended Tool for
Effective Health Care Facility Planning. This updated checklist can
be found at their S&C Emergency Preparedness Websitehttp://www.cms.hhs.gov/SurveyCertEmergPrep/.
CMS has stated that
updates and new documents will be posted to the website as they
become available.
The S&C
letter is attached below.

-
Tuesday February 18, 2014
CMS-
February 18, 2014 - CMS is in the procurement process for the next
round of Recovery Audit Program contracts. It is important that CMS
transition down the current contracts so that the Recovery Auditors
can complete all outstanding claim reviews and other processes by
the end date of the current contracts. In addition, a pause in
operations will allow CMS to continue to refine and improve the
Medicare Recovery Audit Program. Several years ago, CMS made
substantial changes to improve the Medicare Recovery Audit program.
CMS will continue to review and refine the process as necessary.
For example, CMS is reviewing the Additional Documentation Request
(ADR) limits, timeframes for review and communications between
Recovery Auditors and providers. CMS has proven it is committed to
constantly improving the program and listening to feedback from
providers and other stakeholders. Providers should note the
important dates below:
โข February
21 is the last day a Recovery Auditor may send a postpayment
Additional Documentation Request (ADR)
โข February
28 is the last day a MAC may send prepayment ADRs for the Recovery
Auditor Prepayment Review Demonstration
โข June 1 is
the last day a Recovery Auditor may send improper payment files to
the MACs for adjustment
CMS will
continue to update this Website with more information on the
procurement and awards as information is available. Providers
should contact RAC@cms.hhs.gov for additional questions.
-
Saturday February 1, 2014
From
2008-2012, the OIG conducted a series of studies about hospital
adverse events, defined as harm resulting from medical care. This
work included a Congressionally mandated study to determine a
national incidence rate for adverse events in
hospitals. As part of this
work, they developed methods to identify adverse events, determine
the extent to which events are preventable, and measure the cost of
events to the Medicare program. This study continues that work by
evaluating post-acute care provided in
skilled nursing facilities (SNF). SNF post-acute
care is intended to help beneficiaries improve health and
functioning following a hospitalization and is second only to
hospital care among inpatient costs to Medicare. Although various
health care stakeholders have in recent years paid substantial
attention to patient safety in hospitals, less is known about
resident safety in SNFs.
Because many
of the events identified were preventable, our study confirms the
need and opportunity for SNFs to significantly reduce the incidence
of resident harm events. Therefore, the OIG recommends that the
Agency for Healthcare Research and Quality (AHRQ) and the Centers
for Medicare & Medicaid Services (CMS) raise awareness of
nursing home safety and seek to reduce resident harm through
methods used to promote hospital safety efforts. This would include
collaborating to create and promote a list of potential nursing
home events-including events we found that are not commonly
associated with SNF care-to help nursing home staff better
recognize harm. CMS should also instruct State agency surveyors to
review nursing home practices for identifying and reducing adverse
events. AHRQ and CMS concurred with our recommendations.
To read the
complete OIG report, click on the attachment below.

-
Wednesday March 26, 2014
UPDATE: On
Thursday, March 27, 2014, the US House of Representatives passed a
bill that would delay the implementation of ICD-10-CM/PCS to
October 1, 2015. Bill, H.R. 4302, Protecting Access to
Medicare, mainly adjusts the Sustainable Growth Rate (SGR) for
Medicare payments. The SGR outlines how much physicians get
paid for their services. However, the bill includes a seven
line section (Section 212) which delays the implementation of
ICD-10-CM/PCS to October 1, 2015.
Action on
H.R. 4302 now moves to the Senate for a vote. Senators are
expected to vote on the bill in the coming days.
The bill,
which would amend the Social Security Act to extend Medicare
Payments to physicians and change other provisions of the Medicare
and Medicaid programs and adjust the Sustainable Growth Rate (SGR),
also includes a section that would delay ICD-10 to October 1,
2015.
-
Monday March 31, 2014
On Monday, March 31,
2014, the Senate passed H.R. 4302, Protecting Access to Medicare
Act of 2014, which included a section delaying the implementation
of ICD-10-CM/PCS by at least one year. The bill will now go
before President Obama, who is expected to sign the bill into law.
The bill,
H.R. 4302 states that the Department of Health and Human Services
(HHS) cannot adopt the ICD-10 code set as the mandatory standard
until at least October 1, 2015. ICD-10 was originally set to
be implemented on October 1, 2014.
-
Monday May 19, 2014
In this video senior executives from OIG will discuss the
emerging trends in combating fraud, waste, and abuse in Federal
Health Care Programs and upcoming projects in the newly released
OIG Work Plan. OIG is a sister agency to the Centers for Medicare
and Medicaid Services within the Health and Human Services
Department. This podcast goes over how data is mined to direct
audit resources and conduct investigations such as RAC
Audits.
View the Video from the Office of Inspector
General
-
Tuesday May 20, 2014
In the attached documents you will find the issues that must be
addressed in contracts between Long Term Care Facilities and
Hospice Service Providers and the contract provisions that should
be considered for inclusion from a risk management
perspective.
View Contract Requirements between Long Term Care
Facilities and Hospice Service Providers
View
Federal Register - Long term care-hospice contracts
-
Monday June 2, 2014
Every contract has risks that must be reviewed from the
perspective of protecting your entity and assets. This
document is designed to provide you with guidelines and tools to
help you manage those risks and to consider the regulatory and
liability implications from contracted services.
To learn more about Third Party Contracts click on the icon
below.
Third Party
Contracts
-
Tuesday June 3, 2014
Adult Portable Bed Handles Recalled by Bed Handles Inc.
Due to Entrapment and Strangulation Hazards; Three Deaths
Reported
Description
WASHINGTON, D.C. - The U.S. Consumer Product Safety Commission
(CPSC) and Bed Handles Inc., of Blue Springs, Mo., are announcing
the voluntary recall of about 113,000 adult portable bed handles.
When attached to an adult's bed without the use of safety retention
straps, the handle can shift out of place creating a dangerous gap
between the bed handle and the side of the mattress. This poses a
serious risk of entrapment, strangulation and
death.
Three women died after becoming entrapped between the mattress
and the bed handles. They include an elderly woman, age unknown,
who died in an Edina, Minn. assisted living facility; a 41-year-old
disabled woman who died in a Renton, Wash. adult family home; and
an 81-year-old woman who died in a Vancouver, Wash. managed care
facility.
The recall involves adult portable bed handles sold by Bed
Handles Inc. from 1994 through 2007 that do not have safety
retention straps to secure the bed handle to the bed frame to keep
the bed handle from shifting out of place and creating a dangerous
gap. Recalled models include the Original Bedside Assistantยฎ
(BA10W), the Travel Handlesโข (BA11W) which is sold as a set of two
bed handles, and the Adjustable Bedside Assistantยฎ (AJ1).
For more information, including contact information and a photo
of the Bed Handles click on the attachment below.
Third
Party Contracts
-
Thursday June 12, 2014
Cyber and Privacy Liability Insurance provides coverage when
data is breached within your business. Traditional insurance
policies such as property and general liability generally have gaps
which may not cover losses from a data breach at your organization.
This article will introduce you to cyber and privacy liability
insurance and examples of coverage that it may provide.
Download the Cyber and Privacy Liability
Insurance Article
-
Wednesday July 23, 2014
The Office of the Inspector General recently released their
findings of a study they conducted from 2009-2011. In this study
they found an estimated 22 percent of Medicare beneficiaries
experienced adverse events during their SNF stays. An additional 11
percent of Medicare beneficiaries experienced temporary harm events
during their SNF stays. Physician reviewers determined that 59
percent of these adverse events and temporary harm events were
clearly or likely preventable. They attributed much of the
preventable harm to substandard treatment, inadequate resident
monitoring, and failure or delay of necessary care. Over half of
the residents who experienced harm returned to a hospital for
treatment, with an estimated cost to Medicare of $208 million in
August 2011.
Because many of the events that were identified were
preventable, their study confirms the need and opportunity for SNFs
to significantly reduce the incidence of resident harm
events.
Therefore, the OIG recommended that the Agency for Healthcare
Research and Quality (AHRQ) and the Centers for Medicare &
Medicaid Services (CMS) raise awareness of nursing home safety and
seek to reduce resident harm through methods used to promote
hospital safety efforts. This would include collaborating to create
and promote a list of potential nursing home events-including
events that were found that are not commonly associated with SNF
care-to help nursing home staff better recognize harm. The OIG
stated that CMS should also instruct State agency surveyors to
review nursing home practices for identifying and reducing
adverse events. AHRQ and CMS concurred with our
recommendations.

-
Tuesday July 29, 2014
Recently CMS proposed new rules combining F-250 Quality
Assurance (QA) with additional ACA provisions of Performance
Improvement (PI). In response, The Compliance Store developed the
QAPI Quick Start Tool Kit. The link below contains all of the
resources that you will need and outlines each step to help you get
your QAPI Program up and running quickly. Staff improvements
through QAPI equals decreased turnover, which leads to better
quality of care.
Read More
-
Friday August 1, 2014
CNA will be broadcasting a Webcast on Thursday August 7, 2014 at
12:00 Central Time on the admissions and transfer challenges facing
aging services facilities. Facilities work with residents and their
families on numerous sensitive issues that arise in this healthcare
delivery setting. Appropriate identification of those residents who
may be safely admitted and those who should be transferred poses a
significant challenge. This webcast will address the admission and
transfer issue, as well as resident behavior and health issues, and
resident assessment tools. To register for this webcast please view this
attachment.
-
Friday August 8, 2014
Healthcare is one of the most regulated industries in the U.S.
and healthcare providers are extremely vulnerable to allegations of
improper billing by both governmental payers and private commercial
payers. The Gallagher Billings E&O Program provides important
protection to healthcare providers against such
allegations.
Read more about the Gallagher Billings E&O
Program
-
Wednesday August 20, 2014
ALERT Nursing Home Providers
Regarding
Handling Funds Following the Death of a Medicaid -
Eligible Resident
The purpose of this alert is to clarify the procedures
associated with handling funds following
the death of a Medicaid-eligible nursing home resident. 42 CFR ยง
483.10(c)(6), the Medicaid Administrative Code 560-X-10.-14(3)(f)
and 560-X-22-.25(5)(e) and the Social Security Administration Guide
for Representative Payees require that nursing homes, upon the
death of a resident, release any funds being held at the facility
in the resident's name to the individual or probate jurisdiction
designated to administer the deceased resident's estate.
Attached to this alert is a newly developed Administrator of
Estate Designation Form which will provide a resident the
opportunity to designate who should receive the remaining personal
funds. Upon the death of the resident, the completed form in the
patient's record will allow a nursing home facility to turn over
any remaining funds to the designated Administrator of the
Estate.
See attached document for complete ALERT and Administrator of
Estate Designation Form.

-
Wednesday September 24, 2014
ASHRM Continuing Education Credits Available!
AHA Solutions' Signature Learning Series
Friday, September 26
- 1:30 p.m. - 2:30 p.m. Eastern
- 12:30 p.m. - 1:30 p.m. Central
- 11:30 a.m. - 12:30 p.m. Mountain
- 10:30 a.m. - 11:30 a.m. Pacific
SPEAKERS:
- Jim O'Brien, M.D., MSc
- Chairman, Board of Directors, Sepsis Alliance
- Vice President, Quality and Patient Safety, Ohio Health
Riverside Methodist Hospital
- Pamela Popp, MA, JD
- Executive Vice President & Chief Risk Officer
- Western Litigation, Inc.
- Tara Crockett, RN, BN, CHSE, Alumnus CCRN
- Director Clinical Delivery
- Medical Simulation Corp
REGISTER NOW!
Sepsis can arise from any underlying infection, affecting anyone
at any time. The symptoms can be easily missed, allowing the
disease process to move quickly through the body, resulting in
disability, loss of limbs or death.
Hospitals must move quickly and effectively to address this
complex condition. This webinar illustrates the risks of
misdiagnosis, the challenges of treatment, and provides practical
solutions that providers can undertake to increase early
recognition, response and recovery.
Discover the key elements of successful sepsis performance
improvement initiatives that improve patient outcomes, lower
mortality and reduce health care cost.
You Will Learn:
- The implications of sepsis to the health care industry
- The key challenges to sepsis identification and
management
- About a case study illustrating the difference between early
intervention and later intervention
- Recommended next Action Steps for a 'SuspectSepsis'
initiative
Click here to check out other live and online WLI
events!
-
Friday October 10, 2014
EBOLA(This information was obtained from the CDC website:
www.cdc.gov)
Ebola, previously known as Ebola hemorrhagic fever, is a rare
and deadly disease caused by infection with one of the Ebola virus
strains. Ebola can cause disease in humans and nonhuman primates
(monkeys, gorillas, and chimpanzees).
Ebola is caused by infection with a virus of the family Filoviridae,
genus Ebolavirus.
A severe, often fatal disease, Ebola can be spread in several
ways to others: through direct contact (through broken skin or
mucous membranes) with a sick person's blood or body fluids or
objects that have been contaminated with infected body fluids.
Ebola symptoms usually begin after an incubation period ranging
from 2 days to 21 days.
Symptoms of Ebola include:
- Fever (greater than 38.6ยฐC or 101.5ยฐF)
- Severe headache
- Muscle pain
- Weakness
- Diarrhea
- Vomiting
- Abdominal (stomach) pain
- Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to
Ebola, but the average is 8 to 10 days.
Recovery from Ebola depends on good supportive clinical care and
the patient's immune response. People who recover from Ebola
infection develop antibodies that last for at least 10 years.
Transmission
When an infection does occur in humans, the virus can be spread
in several ways to others. Ebola is spread through direct contact
(through broken skin or mucous membranes in, for example, the eyes,
nose, or mouth) with
- blood or body fluids (including but not limited to urine,
saliva, sweat, feces, vomit, breast milk, and semen) of a person
who is sick with Ebola
- objects (like needles and syringes) that have been contaminated
with the virus
- infected animals
- Ebola is not spread through the air or by water, or in general,
by food. However, in Africa, Ebola may be spread as a result of
handling bushmeat (wild animals hunted for food) and contact with
infected bats. There is no evidence that mosquitos or other insects
can transmit Ebola virus. Only mammals (for example, humans, bats,
monkeys, and apes) have shown the ability to become infected with
and spread Ebola virus.
Healthcare providers caring for Ebola patients and the family
and friends in close contact with Ebola patients are at the highest
risk of getting sick because they may come in contact with infected
blood or body fluids of sick patients.
During outbreaks of Ebola, the disease can spread quickly within
healthcare settings (such as a clinic or hospital). Exposure to
Ebola can occur in healthcare settings where hospital staff are not
wearing appropriate protective equipment, including masks, gowns,
and gloves and eye protection.
Once someone recovers from Ebola, they can no longer spread the
virus. However, Ebola virus has been found in semen for up to 3
months. People who recover from Ebola are advised to abstain from
sex or use condoms for 3 months.
Infection Prevention and Control Recommendations for
Hospitalized Patients with Known or Suspected Ebola Virus Disease
in U.S. Hospital
Standard, contact, and droplet precautions are recommended for
management of hospitalized patients with known or suspected Ebola
virus disease.
How do I protect myself against Ebola?
If you must travel to an area affected by the 2014 Ebola
outbreak, protect yourself by doing the following:
- Wash hands frequently or use an alcohol-based hand
sanitizer.
- Avoid contact with blood and body fluids of any person,
particularly someone who is sick.
- Do not handle items that may have come in contact with an
infected person's blood or body fluids.
- Do not touch the body of someone who has died from Ebola.
- Do not touch bats and nonhuman primates or their blood and
fluids and do not touch or eat raw meat prepared from these
animals.
- Avoid hospitals in West Africa where Ebola patients are being
treated. The U.S. Embassy or consulate is often able to provide
advice on medical facilities.
- Seek medical care immediately if you develop fever (temperature
of 101.5ยฐF/ 38.6ยฐC) and any of the other following symptoms:
headache, muscle pain, diarrhea, vomiting, stomach pain, or
unexplained bruising or bleeding.
- Limit your contact with other people until and when you go to
the doctor. Do not travel anywhere else besides a healthcare
facility.
For general information about Ebola, please use the
links below:
This information was obtained from the CDC website.
-
Wednesday November 12, 2014
You medical record is worth 10 times more to hackers than your
credit. The attachment below contains an article from the New York
Daily News that provides information on how cyber criminals are
breaking into healthcare computer networks to steal the personal
information of patients.
Click here to read more.
-
Monday December 1, 2014
Recently, the Gallagher Risk Management Services Claims
Department has seen an increase in allegations relating to a
facility's negligent hiring, training, and supervision of its
employees. Claims relating to the hiring, training, and
supervision of employees are often tied to incidents where an
employee of a facility has been accused of abuse / neglect of a
resident and terminated. While there is no requirement to
perform intermittent background checks, running a background check
once a year for every employee could potentially reduce the
likelihood that a facility may be susceptible to a claim of
negligent hiring, training, and supervision. Bullet Screening
Services provides comprehensive employment screening services.
Through a partnership with Bullet Screening Services, ALTC's
clients are able to purchase discounted special employment
screening packages, including a $7.00 per employee charge for a
background check. The investment of performing an annual
background check on each employee would be an investment in quality
control for residents and possibly reduce the significance of a
claim for negligent hiring, training, and supervision. You can
learn more about the services that Bullet Screening Services
provides tor the Senior Care Industry by going to their website at
www.bulletscreening.com
or calling them at 205-823-5551.
-
Tuesday December 2, 2014
It is the policy of the facility to safeguard the privacy and
security of protected health information (PHI) and to protect the
resident's right to confidentiality of clinical information by
releasing resident information or protected health information
(PHI) only to authorized persons/agencies, in compliance with state
and federal regulations covering treatment, payment, health care
operations and/or other mandatory reporting requirements and in
accordance with facility policy. The attached link is a sample
Release of Medical Records Policy that may help you and your staff
comply with these
requirements.
Click here for Release of Medical Records Policy
sample.
-
Wednesday December 3, 2014
Delirium will complicate a hospital stay for more than 2.2
million Americans this year, with estimated costs of as much as $8
billion annually. The attached white paper from Relias Learning
provides you and your staff with information on how to recognize
the role of delirium in preventing Rehospitalization.
View the Whitepaper
-
Thursday December 4, 2014
New insurance coverage for Disaster Management Services is
available through Arthur J. Gallagher and underwritten by Lloyds of
London. This coverage will respond in the event of a sudden,
unforeseen natural disaster or man-made catastrophe which affects
five or more lives, results in multiple fatalities and/or injuries,
and/or where the company is directly responsible for the population
which is directly affected by the event. To learn more about this
coverage and how to obtain a quote you can open the article in the
link below.
Read The Article
-
Thursday December 4, 2014
New insurance coverage for Violent Malicious Acts is now
available through Arthur J Gallagher and is designed to help you
and your facility move forward after a tragedy. Violent Malicious
Acts coverage insures the necessary Extended Loss of Revenue and
Extra Expense you incur in order to continue the normal conduct of
the facility's operations following a Violent Malicious Act. To
learn more about this coverage and how to obtain a quote you can
open the article in the link below.
Read The Article
-
Thursday December 18, 2014
This study from the Department of Health and Human Services
(OIG) found that even though most nursing homes met Federal
requirements for written emergency plans and preparedness training
there were many gaps in these plans. These emergency plans lacked
relevant information, including only about half of their tasks on
the CMS checklist. Nursing Homes faced challenges with unreliable
transportation contracts, lack of collaboration with local
emergency management, and residents that developed health problems.
The attachment below contains the entire study from the OIG.
Nursing Home Disaster Prepardness and Response
during Disasters 2007-201.pdf
-
Thursday December 18, 2014
This report was published by Advisen and sponsored by Ace
Insurance. Healthcare in the United States is in the midst of
unparalleled transformation, driven in large measure by the Patient
Protection and Affordable Care Act. Many of the environmental
exposures of healthcare organizations may fall under core EPA
programs or similar state regulations, making it important that
healthcare organizations maintain a sharp focus on environmental
compliance. Maintaining this focus and identifying emerging
environmental exposures while in a period of growth and rapid
change will be a continuing challenge for risk managers, compliance
officers, and administrators. The attachment below contains the
report on these merging environmental risks.
Advisen Emerging Healthcare Environment Risk
WhitePaper.pdf
-
Monday January 5, 2015
There are new OSHA Reporting Requirements now in effect.
Beginning on January 1, 2015, there is a change to what covered
employers are required to report to OSHA. Employers are now
required to report all work related fatalities within 8 hours and
all inpatient hospitalizations, amputations, and losses of an eye
within 24 hours of finding out about the incident. The attachments
below provide more information about the new Mandatory OSHA
Reporting and Record Keeping requirements for 2015.
Mandatory OSHA 300 Log Reporting and Recordkeeping
for 2015
OSHA in 2015 and beyond
-
Wednesday January 7, 2015
Recently, an incident was reported where a resident suffered a
fall. Unfortunately, after the incident the facility failed
to document the resident's overall status during the next 24
hours. As a result, it is difficult to determine
whether the change in status was related to the incident or another
event/condition. Attached is a resource for your facilities
as a reminder and guidance for documenting after an
incident.
Click here for file.
-
Wednesday January 7, 2015
The winter season is right around the corner and it is a good
time to plan for and mitigate the property damage, employee illness
and injury, and even business closures that can be caused by severe
winter weather.The following checklist will help you identify the
areas of your business that are most susceptible to winter
hazards.
Click here for Winter Weather Preparedness
Checklist
Disclaimer: I would like to emphasize that the discussions,
examples and templates set forth above are from an insurance/risk
management perspective and is NOT legal advice. We do not
provide legal advice as we are not qualified to do so. I
highly recommend that you seek the advice of legal counsel in order
to become fully apprised of the legal implications related to these
issues. The information contained herein was obtained from sources
which to the best of the writer's knowledge are authentic and
reliable. Arthur J. Gallagher makes no guarantee of results,
and assumes no liability in connection with either the information
herein contained, or the safety suggestions herein made.
Moreover, it cannot be assumed that every acceptable safety
procedure is contained herein, or that abnormal or unusual
circumstances may not warrant or require further or additional
procedures, resources or advice.
-
Monday January 12, 2015
Arthur J Gallagher put together a series of webcasts on risk
management strategies that included Generating a Culture Change
Mindset in Workplace Safety, Simple Steps for Creating a Strong
Safety Structure, and Safety Communication for Speakers of Spanish
and Other Languages.
View the three Risk Management Strategies
Webcasts.
Disclaimer: I would like to emphasize that the discussions,
examples and templates set forth above are from an insurance/risk
management perspective and is NOT legal advice. We do not
provide legal advice as we are not qualified to do so. I
highly recommend that you seek the advice of legal counsel in order
to become fully apprised of the legal implications related to these
issues. The information contained herein was obtained from sources
which to the best of the writer's knowledge are authentic and
reliable. Arthur J. Gallagher makes no guarantee of results,
and assumes no liability in connection with either the information
herein contained, or the safety suggestions herein made.
Moreover, it cannot be assumed that every acceptable safety
procedure is contained herein, or that abnormal or unusual
circumstances may not warrant or require further or additional
procedures, resources or advice.
-
Monday January 12, 2015
In many cases, employers are experienced with the walk around
and employee interview aspect of an OSHA Inspection, but are unsure
of what documents the compliance officer is entitled to inspect and
to request copies. The article in the link below is intended to
give guidance in this area.
Click here for article - Responding to An OSHA Inspection IV.
Disclaimer: I would like to emphasize that the discussions,
examples and templates set forth above are from an insurance/risk
management perspective and is NOT legal advice. We do not
provide legal advice as we are not qualified to do so. I
highly recommend that you seek the advice of legal counsel in order
to become fully apprised of the legal implications related to these
issues. The information contained herein was obtained from sources
which to the best of the writer's knowledge are authentic and
reliable. Arthur J. Gallagher makes no guarantee of results,
and assumes no liability in connection with either the information
herein contained, or the safety suggestions herein made.
Moreover, it cannot be assumed that every acceptable safety
procedure is contained herein, or that abnormal or unusual
circumstances may not warrant or require further or additional
procedures, resources or advice.
-
Monday January 12, 2015
During an OSHA inspection, the Compliance Officer will request
employee interviews in order to gather facts as to whether there
may have been violations of the Agency's regulations. Many
employers fail to advise their employees of their rights during
such interviews and these rights are never exercised. The links
below provide you with the general rights of employees during
employee interviews.
Click here for article - RMSI - Responding to
An OSHA Inspection II - Employee Interviews
Click here for article - RMSI - Responding
to An OSHA Inspection III - Employee Interview Rights
Disclaimer: I would like to emphasize that the discussions,
examples and templates set forth above are from an insurance/risk
management perspective and is NOT legal advice. We do not
provide legal advice as we are not qualified to do so. I
highly recommend that you seek the advice of legal counsel in order
to become fully apprised of the legal implications related to these
issues. The information contained herein was obtained from sources
which to the best of the writer's knowledge are authentic and
reliable. Arthur J. Gallagher makes no guarantee of results,
and assumes no liability in connection with either the information
herein contained, or the safety suggestions herein made.
Moreover, it cannot be assumed that every acceptable safety
procedure is contained herein, or that abnormal or unusual
circumstances may not warrant or require further or additional
procedures, resources or advice.
-
Wednesday March 4, 2015
A close call or an accident without injury is easy to shrug off
and forget. But there is a danger in brushing off accidents that
don't hurt, harm or cause damage. This article provides you with
information on what you should consider doing when an accident or
close call occurs.
Read the article.
-
Thursday March 5, 2015
This article provides information about the rise in OSHA related
whistleblower claims and Affordable Care Act whistleblower
protected activities.
Read the article.
-
Friday March 6, 2015
Legionella 101
Legionellae are rod-shaped, gram negative bacteria. Over 40
species of Legionella have been identified; L. pneumophila appears
to be the most virulent and is associated with approximately 90% of
cases of Legionellosis. The risk of acquiring Legionnaires' disease
is greater for older persons and for those who smoke tobacco or
have chronic lung disease. Persons whose immune system is
suppressed by certain drugs or by underlying medical conditions
appear to be at particularly high risk.
Legionellae bacteria are commonly present in natural and
man-made aquatic environments. The organism is occasionally found
in other sources, such as mud from streams and potting soils. In
natural water sources and municipal water systems, Legionellae are
generally present in very low or undetectable concentrations.
However, under certain circumstances within manmade water systems,
the concentration of organisms may increase, a process termed
"amplification." Conditions that are favorable for the
amplification of legionellae growth include water temperatures of
25-42 degrees Celsius (ยฐC) (77-108 degrees Fahrenheit), stagnation,
scale and sediment, biofilms, and the presence of amoebae.
Legionellae infect and multiply within several species of
free-living amoebae, as well as ciliated protozoa. The initial site
of infection in humans with Legionnaires' disease is the pulmonary
macrophage. These cells engulf Legionellae, provide an
intracellular environment that is remarkably similar to that within
host protozoa, and allow for multiplication of the bacterium.
Growth in nature in the absence of protozoa and/or in the absence
of complex microbial biofilms has not been demonstrated.
There is an indication that growth of Legionella is influenced
by certain materials. Natural rubbers, wood, and some plastics have
been shown to support the amplification of Legionella, while other
materials such as copper inhibit their growth. Generally,
Legionella thrive in diverse, complex microbial communities because
they require nutrients and protection from the environment.
Controlling the populations of protozoa, and other microorganisms
may be the best means of minimizing Legionella.
Transmission of Legionnaires' Disease
Most data on the transmission of Legionnaires' disease are
derived from investigations of disease outbreaks. These data
suggest that, in most instances, transmission to humans occurs when
water containing the organism is aerosolized in respirable droplets
(1-5 micrometers in diameter) and inhaled by a susceptible host. A
variety of aerosol-producing devices have been associated with
outbreaks of Legionnaires' disease, including cooling towers,
evaporative condensers, showers, whirlpool spas, humidifiers,
decorative fountains, and a grocery store produce mister.
Aspiration of colonized drinking water into the lungs has been
suggested as the mode of transmission in some cases of
hospital-acquired Legionnaires' disease. Numerous investigations
have demonstrated that cooling towers and evaporative condensers
have served as the sources of Legionella-contaminated aerosols
causing outbreaks of community- and hospital- acquired infection. A
number of outbreaks of Legionellosis associated with cooling towers
and evaporative condensers have occurred after these devices have
been restarted following a period of inactivity. Shower heads and
tap faucets can also produce aerosols containing legionellae in
droplets of respirable size.
Common amplifiers (growth factors) associated with building
water systems, including the treatment recommended to minimize the
risk of Legionellosis, are discussed below.
Potable Water Systems
Factors associated with the plumbing system that may influence
the growth of legionellae are as follows:
- Chlorine concentration;
- Temperature; and
- Plumbing system design and materials
Municipal potable water supplies are generally chlorinated to
control the presence of microorganisms associated with sewage.
Legionellae are more tolerant of chlorine than many other bacteria,
and may be present in small numbers in municipal water supplies.
Potable water can also support legionellae growth if the water
temperature is in the range of 77-108ยฐF. Plumbing design and
materials also influence the growth of legionellae.
Growth of legionellae may occur in portions of the system with
infrequent use, in stagnant water, and in portions of the system
with tepid temperatures. Growth may also occur in dead-end lines,
attached hoses, shower nozzles, tap faucets, hot water tanks, and
reservoirs. Rubber washers and fittings, including water hammer
arrestors and rubber hoses with spray attachments, have been shown
to provide sites for growth of legionellae. Organic compounds
leached from plumbing materials may contribute to growth of
heterotrophic bacteria, including legionellae.
Contaminated potable water sources present the greatest risk
when dispersed into the air in a very small droplet size (less than
5 micrometers) that can be inhaled deeply into the lungs. Actions
that may generate small droplets are those that break up the water
stream, i.e., shower nozzles, aerators, spray nozzles, water
impacting on hard surfaces, and bubbles breaking up. Both dead and
living microorganisms, biofilms, and debris may provide nutrient
sources for legionellae growth. When legionellae are found in
plumbing systems, it is common to detect the microbes in the
sediment in hot water tanks, and in peripheral plumbing fixtures
that accumulate sediment.
Where practical in high-risk situations, cold water should be
stored and distributed at temperatures below 20ยฐC (68ยฐF), while hot
water should be stored above 60ยฐC (140ยฐF) and circulated with a
minimum return temperature of 124ยฐF. However, great care should be
taken to avoid scalding problems. One method is to install preset
thermostatic mixing valves. Where buildings cannot be retrofitted,
periodically increasing the temperature to at least 66ยฐC (150ยฐF) or
chlorination followed by flushing should be considered. Systems
should be inspected annually to ensure that thermostats are
functioning properly. Where practical in other situations, hot
water should be stored at temperatures of 120ยฐF or above. Those hot
or cold water systems that incorporate an elevated holding tank
should be inspected and cleaned annually. Lids should fit closely
to exclude foreign materials.
Where decontamination of hot water systems is necessary
(typically due to implication of an outbreak of Legionellosis) the
hot water temperature should be raised to 160~170ยฐF and maintained
at that level while progressively flushing each outlet around the
system. A minimum flush time of five minutes has been recommended
by the Center for Disease Control. However, the optimal flush time
is not known and longer flush times may be necessary.
Emergency Water Systems-safety Showers, Eye Wash Stations, And
Fire Sprinkler Systems
These systems are generally plumbed to the potable water system,
have little or no flow with resulting stagnant conditions, and may
reach temperatures warmer than ambient. The presence of
legionellae, heterotrophic bacteria, and amoebae in these systems
has been documented. When the devices are used, aerosolization is
expected.
Safety shower and eye wash stations should be flushed at least
monthly. In the case of fire sprinkler systems, it is recommended
that fire-fighting personnel wear protective respiratory gear and
that non- firefighting personnel exit the burning area. Appropriate
precautions should be taken when checking the operation of fire
sprinkler systems.
Architectural Fountains And Waterfall Systems
In these systems, water is either sprayed in the air or cascades
over a steep media such as rocks, and then it returns to a man-made
pool. These systems are sometimes operated intermittently with
on-time often scheduled only during certain time periods. Systems
that are operated intermittently may encourage greater
biocontamination.
Because of the high temperature ranges needed for proliferation
of legionellae bacteria, outdoor fountains and pools in hotter
climates, and indoor fountains and pools subject to sources of heat
may be susceptible to legionellae growth. Temperature increases may
be facilitated by heat from pump/filter systems themselves.
Intermittent operation may also create situations where temperature
increases occur in isolated areas of the system. Fountains are
subject to contamination from a wide variety of potential nutrient
sources, including materials scrubbed from the air and returned to
the pool with the falling water droplets as well as organic and
inorganic materials dropped, thrown, or blown into the pool. โ
The recommended treatment for fountains includes:
- Regular cleaning is recommended; and
- Use of filters should be considered; however, systems with a
small water volume may be drained, and refilled with fresh water
every few weeks in lieu of filtering.
Microbial fouling control is important, especially where the
conditions are such that there are significant periods of time when
the temperature of the fountain water is in the range that is
favorable for the amplification of legionellae growth. When
biocidal treatment is employed for microbial fouling control, the
biocide must be registered with the United States Environmental
Protection Agency (USEPA) for use in decorative fountains.
Cooling Towers Including Fluid Coolers (closed-circuit Cooling
Towers) And Evaporative Condensers
Evaporative heat rejection equipment such as cooling towers and
evaporative condensers have been implicated in numerous outbreaks
of Legionnaires' disease, and studies have shown that detectable
levels of legionellae are present in many of these devices.
A cooling tower is an evaporative heat transfer device in which
atmospheric air cools warm water, with direct contact between the
water and the air, by evaporating part of the water. Air movement
through such a tower is typically achieved by fans, although some
large cooling towers rely on natural draft circulation of air.
Cooling towers typically use some media, referred to as "fill," to
achieve improved contact between the water and the cooling air. The
typical temperature of the water in cooling towers ranges from 85ยฐF
to 95 ยฐF although temperatures can be above 120 ยฐF and below 70ยฐF
depending on system heat load, ambient temperature, and system
operating strategy.
Closed-circuit cooling towers and evaporative condensers are
also evaporative heat transfer devices. Both are similar to
conventional cooling towers, but there is one very significant
difference. The process fluid (either a liquid such as water, an
ethylene glycol/water mixture, oil, etc., or a condensing
refrigerant) does not directly contact the cooling air. Rather, the
process fluid is contained inside a coil assembly. Water is drawn
from the basin and pumped to a spray distribution system over the
coil assembly while the cooling air is blown or drawn over the coil
by fans. Removal of heat is achieved by evaporating part of the
water. Water temperature in closed-circuit cooling towers and
evaporative condensers is similar to that in cooling towers.
Cooling towers and evaporative condensers incorporate inertial
stripping devices called drift eliminators to remove water droplets
generated within the unit. While the effectiveness of these
eliminators can vary significantly with the design (new
state-of-the-art eliminators are significantly more efficient than
older designs) and the condition of the eliminators, it should be
assumed that some water droplets in the size range of less than 5
micrometers leave the unit. In addition, some larger droplets
leaving the unit may be reduced to 5 micrometers or less by
evaporation.
Because cooling towers and evaporative condensers are highly
effective air scrubbers and because they move large volumes of air,
organic material and other debris can be accumulated. This material
may serve as a nutrient source for legionellae growth. Diverse
biofilms, which can support the growth of legionellae, may be
present on heat exchanger surfaces, structural surfaces, sump
surfaces, and other miscellaneous surfaces.
The key recommendations are that the system be maintained clean
and that a biocidal treatment program be developed and implemented.
It is also recommended that the services of a qualified water
treatment specialist be used to define and oversee the treatment.
Keeping the system clean reduces the nutrients available for
Legionella growth. Regular visual inspections should be made for
general cleanliness. The cold water basin of the unit should be
cleaned when any buildup of dirt, organic matter, or other debris
is visible or found through sampling. Mechanical filtration may be
used to help reduce these solids. Strainers, cartridge filters,
sand filters, centrifugal-gravity-type separators, and bag-type
filters can be used to assist in removal of debris. The drift
eliminators should also be inspected regularly and cleaned if
required or replaced if deteriorated or damaged.
An effective water treatment program allows more efficient
operation due to lower fouling, a longer system life due to
decreased corrosion, and safer operation of the system due to
reduced chances of microbial exposure to the public.
Control of scaling and corrosion is necessary in many water
treatment programs. Scale such as calcium carbonate and/or other
minerals containing silica, magnesium, and phosphate may
precipitate onto heat exchanger and piping surfaces. Scaling can be
minimized by use of inhibitors containing phosphonates, phosphates,
and polymers to keep calcium and carbonate and other minerals in
solution. Corrosion can be minimized by the use of inhibitors such
as phosphate, azoles, molybdenum, and zinc. Scale and corrosion
inhibitors are effective if microbial fouling and biofilm
development are properly controlled. Microbial fouling can
influence scaling and corrosion processes and can affect the
performance of inhibitors. Microbial biofilms on surfaces can
consume certain inhibitors (such as phosphates, phosphonates, and
azoles), prevent access of inhibitors to surfaces, create localized
oxygen-depleted zones, change the pH near surfaces, and accumulate
or trap deposits onto surfaces.
Microbial fouling is controlled by the use of biocides, which
are compounds selected for their ability to kill microbes while
having relatively low toxicity for plants and animals. In the USA,
the Environmental Protection Agency has regulatory authority for
biocides and requires registration of all biocides. In addition,
registration is required in each state where the biocide will be
distributed. Non-oxidizing biocides include many organic compounds
registered with the USEPA for cooling water applications. These
biocides function in a number of ways, including reacting with
intracellular enzymes, solubilizing cell membranes, and
precipitating essential proteins in microbial cell walls. Properly
used, non-oxidizing biocides are effective for control of the
microbial fouling process in cooling water systems. It is generally
good practice to regularly alternate the biocides used for a
cooling water system to avoid the selection and growth of resistant
strains of microbes. The alternating biocide approach has been
emphasized with the rationale that the population that survives the
biocide treatment one week is susceptible to the alternate biocide
a week or two later. Alternating the dose and frequency of the same
biocide is also used to achieve this goal.
Equally important to controlling scale and corrosion is keeping
the system clean and free of sediment. Common sources of sediment
include materials scrubbed from the air (dirt, leaves, paper,
kitchen or other organic exhaust), precipitated solids (calcium,
magnesium, carbonate silica), and corrosion products (rust).
Microbes including bacteria, protozoa, algae, and (infrequently)
fungi can grow in cooling systems and use the above materials as
nutrients. Consequently, it is desirable to either prevent the
entry of the material into the system or to remove it from the
system. โ
When the system is to be shut down for a period of more than
three days, it is recommended that the entire system (cooling
tower, system piping, heat exchangers, etc.) be drained to waste.
When draining the system is not practical during shutdowns of short
duration, the stagnant cooling water must be pretreated with an
appropriate biocide regimen before tower start-up.
-
Wednesday April 15, 2015
This article provides guidance from OSHA for protecting
healthcare and social service workers from workplace violence.
Click here to view the article
-
Wednesday April 15, 2015
CMS has developed a system for facilities to submit staffing and
census information - Payroll Based Journal (PBJ). This system will
allow staffing and system information to be collected on a regular
and more frequent basis than currently collected. It will also be
auditable to ensure accuracy. All long term care facilities will
have access to this system at no cost to facilities. The following
links contain technical information related to the PBJ and are
available below.
Click here for pdf.
Click here for link.
-
Wednesday July 1, 2015
If you are a Chubb Policyholder then you have access to valuable
loss prevention information. Chubb designs comprehensive risk
management services to accurately fit a client's risk needs. Many
of these value added services are available to Chubb clients at no
additional fee. The attachment to this News Article includes a list
of the risk management services that are available to Chubb
clients.
Download the attachment
-
Tuesday July 7, 2015
This guide outlines 5 steps health care professionals should
take to prepare for ICD-10 by the October 1, 2015, compliance date.
You can complete parts of different steps at the same time if that
works best for your practice.
Download the attachment
-
Wednesday July 8, 2015
In response to requests from the provider community, CMS is
releasing additional guidance that will allow for flexibility in
the claims auditing and quality reporting process as the medical
community gains experience using the new ICD-10 code set. For more
details, please see the joint announcement on the CMS ICD-10
website. The website link is included in the attachment to this
News Article.
Download the attachment
-
Friday August 14, 2015
The article below is from a recent edition of McKnight's and
addresses the importance of Statistical Analysis in defending fraud
and abuse allegations in long term care facilities. To learn more
about Arthur J Gallagher's Billing Errors & Omissions Liability
Insurance Program please open the attachment below. Please contact
Gerry Gilbert in our office to discuss this Liability Insurance
Program and its availability. He can be reached at 205-414-6184 or
by email at gerry_gilbert@ajg.com.
In this month's McKnight's article, the author reviews the
increasing importance of statistical analysis in defending against
fraud and abuse allegations.
False Claims Act enforcement, and the attendant risk of
financial liability, is on the rise. The United States Department
of Justice has obtained almost $44 billion in FCA settlements and
judgments since 1986, and almost $6 billion in 2014 alone.
Significantly, roughly $2.5 billion of the funds recovered in 2014
came from the health care industry, marking the fifth straight year
of fraud recoveries in excess of $2 billion. If FBI estimates that
3% to 10% of all federal healthcare billings are lost to fraud,
then it would appear that these eye-popping numbers still have room
to grow.
FCA enforcement in the long term care industry has been no
exception. The industry has been squarely in the sights of
government enforcement attorneys following a 2012 report from the
Office of Inspector General that found roughly 20% of all Medicare
Part A SNF claims were upcoded to a higher RUG group in 2009,
resulting in $1.2 billion in improper payments. Recent FCA
complaints have relied on a number of arguments to substantiate the
submission of false claims for Medicare reimbursement: systematic
upcoding to higher RUG levels due to corporate pressure on front
line care providers; targeting therapy at or around RUG thresholds;
increasing therapy during look back periods; and providing skilled
therapy that was not required for improvement in functioning.
Although long-term care providers and other FCA defendants have
raised a wide range of reasonable explanations for the billing
patterns identified in recent complaints, the DOJ and private
whistleblowers have been emboldened by a series of significant
settlements. Enforcement attorneys have also been given a new, and
potentially game-changing, tool thanks to a series of recent court
opinions involving the use of statistical sampling and
extrapolation to demonstrate FCA liability.
Wait, don't they need to identify an actual claim?
While courts have long recognized statistical sampling as a
valid method of proof, its use in FCA cases has been, until
recently, fairly limited. The reasons for this limitation are
somewhat intuitive, as sampling has typically been used to prove
the amount of damages resulting from a fraudulent billing scheme
(i.e., the amount the government was overbilled). This status quo,
however, was disrupted in late 2014 when the Eastern District of
Tennessee gave its blessing for prosecutors in U.S. ex rel. Martin
v. Life Care Centers of America to use statistical sampling and
extrapolation to prove not only damages, but actual liability under
the FCA.
Life Care operates over 200 skilled nursing facilities
nationwide that received $4.2 billion in Medicare reimbursement
between 2006 and 2011. In Martin, the company is alleged to have
engaged in a systematic practice of upcoding and providing
medically unnecessary services that resulted in the submission of
150,000 false claims involving over 54,000 patients. In the typical
FCA case, the government would have needed to demonstrate which of
those 150,000 claims were false (i.e., submitted for medically
unnecessary services) and whether the defendant knew those claims
were false at the time they were submitted to a federal health care
program. In Martin, however, the government analyzed just 400
representative sample cases and then sought to extrapolate the
percentage of claims identified as false to the larger universe of
150,000 unidentified claims. Not surprisingly, Life Care sought
summary judgment (i.e., that there is no factual dispute and the
law requires a judgment in its favor) as to the unidentified
claims, arguing that the falsity of an individual claim cannot be
determined through statistical means.
Contrary to established expectations, the court denied Life
Care's motion and allowed the case to go to trial. While granting
that using extrapolation to establish damages when liability has
been proven is different than using extrapolation to establish
liability and finding no definitive precedent for doing so, the
court still found that the government could use the evidence to
prove its case due to the general acceptability of statistical
analysis. Life Care, meanwhile, would be free to argue that the
jury should not credit the government's analysis because it is
wrong or flawed.
As a practical matter, the use of statistical analysis to prove
liability instead of damages would do two things. First, it would
dramatically reduce the time and scrutiny of individual claims that
is usually necessary to prosecute a credible FCA case. Second, and
relatedly, it would allow the government and/or private
whistleblowers to expand vastly the universe of allegedly false
claims and set the stage for an environment where, once a handful
of allegedly false claims is identified, every claim a defendant
made within a specific time period could be fair game. And in this
sort of environment, long-term care providers could see their FCA
exposure driven less by pesky details like fact and medical
necessity, and more by their ability to hire a better mathematics
expert than their whistleblower.
This is not good news for providers, especially in light of the
other recent changes to the FCA statute that have made it easier
for whistleblowers to extract significant settlements.
A slippery slope ahead
Already, Life Care is beginning to bear fruit for whistleblowers
and their attorneys. In U.S. ex rel. Ruckh v. CMC II LLC, for
example, a federal judge in the Middle District of Florida cited
Life Care in an order allowing the relator to use statistical
evidence to prove liability in an FCA case involving roughly
identical allegations of upcoding and medically unnecessary
procedures. If Life Care continues to gain traction in cases such
as Ruckh, it will create a dangerous precedent for long term care
providers.
Download the
attachment
-
Sunday October 4, 2015
The link below contains a website developed by the Office of
Justice Programs designed to help victims of mass violence and
terrorism. This website's toolkit provides tools and resources for
developing a comprehensive victim assistance plan that can be
incorporated into your facility's existing emergency response plan.
Victim assistance plans support and enhance your response and
recovery efforts. The toolkit's Partnership and Planning Section
reviews how to create and maintain partnerships, addresses resource
gaps, and develop victim protocols, and its Response and Recovery
Section covers how to use the protocols after an incident of mass
violence or terrorism. The Tools Section includes checklists,
samples, a glossary, and a collection of victim assistance
resources.
http://www.ovc.gov/pubs/mvt-toolkit/
-
Thursday October 8, 2015
The link below contains a good article from McKnight's on new
proposed rules from CMS that will establish specific requirements
when a long term care facility uses bed rails on a resident's
bed.
http://www.mcknights.com/guest-columns/examining-bed-rail-use-in-long-term-care/article/443728/?DCMP=EMC-MCK_Daily&spMailingID=12611976&spUserID=NDM1NzE4MTg1NTMS1&spJobID=640492421&spReportId=NjQwNDkyNDIxS0
-
Thursday October 8, 2015
The link below contains a good article from McKnight's on
different ways to provide good customer service at your long term
care facility.
http://www.mcknights.com/guest-columns/delivering-good-customer-service-in-long-term-care/article/442886/?DCMP=EMC-MCK_Daily&spMailingID=12589489&spUserID=NDM1NzE4MTg1NTMS1&spJobID=640364571&spReportId=NjQwMzY0NTcxS0
-
Thursday October 8, 2015
The link below contains a good article from McKnight's on
resident's chronic pain in long term care facilities and the use of
opioids as part of the pain management treatment.
http://www.mcknights.com/guest-columns/america-should-talk-about-chronic-pain/article/442864/
-
Friday October 9, 2015
The attachment below contains an Investigative and Reporting
Visitor Injuries Checklist that can be used as a resource to help
develop or revise your facility's Visitor Injury Guidelines. These
guidelines should not be interpreted as facility policy and should
only be used as a resource.
Download
the attachment
-
Thursday November 12, 2015
Healthcare is one of the most regulated industries in the U.S. and healthcare providers are extremely vulnerable to allegations of improper billing by both governmental payers and private commercial payers. The Gallagher Billing E&O Program provides important protection to healthcare providers against such allegations .This exclusive program provides the following key benefits:
ยท Indemnity and Defense Protection from regulatory fines & penalties associated with billing errors
ยท Protection includes both governmental payers and private payers
ยท Qui Tam Plaintiffs
ยท Coverage for EMTALA, Stark, or HIPAA Proceedings
ยท Expert panel defense counsel
ยท Prior acts coverage available
ยท Expeditious Quotation and Underwriting process
Please contact Gerry Gilbert for questions and to secure a quote for this coverage. Gerry can be reached by telephone at 205-414-6184 or by email at gerry_gilbert@ajg.com.
-
Wednesday November 18, 2015
The link below contains information from the CDC that you should
know about the 2015-2016 influenza season.
http://www.cdc.gov/flu/about/season/flu-season-2015-2016.htm
-
Friday August 12, 2016
With the recent shooting tragedies in healthcare facilities,
businesses, schools, etc., it is apparent that no facility/business
is immune to these acts of violence. These tragedies should
be an alert for all businesses to evaluate current policies,
practices and drills in order to prepare staff on how to respond in
these potential situations that place residents and staff at risk.
Attached please find sample resources relating to Active
Shooter policies, Workplace Violence policies, and a resource
published by FEMA, HHS, US Department of Homeland Security, and the
Assistant Secretary for Preparedness and Response. Please
feel free to utilize these tools as you evaluate your current
procedures.
Active
Shooter Policy-AJG 2015
Active-shooter-planning-eop2014
Workplace
Violence Policy-AJG 2014
-
Friday December 4, 2015
With the winter weather season upon us it's time to review your
winter weather preparedness procedures to make sure your facility
is ready for winter weather. The attachment below contains a Winter
Weather Preparedness presentation that was developed by Arthur J
Gallagher and Agility Recovery. This information may be helpful to
you when you are making sure your facility is ready for winter
weather.
Agility Winter Weather Preparedness Webcast Handouts 2015
-
Friday December 11, 2015
Probably, as a result of the Supreme Court's recent decision in
Young v. UPS.
Many employers have had a long-standing policy or practice of
providing temporary light duty only to employees who are returning
to work from an on-the-job injury. "Light duty" is typically a job
or project that is specially created to help an injured worker that
would otherwise not exist. Limiting these special assignments to
workers who get hurt at work makes sense. Employers feel an
obligation to their employees that get hurt at work, and employers
have a financial interest in these employees coming back to work as
soon as possible. Also, most employers have limited light duty
opportunities and, therefore, want to preserve them for employees
who are recovering from work-related accidents. Someone with a
condition unrelated to the job, such as injuries from a car
accident or pregnancy, does not get light duty under the typical
policy. If the employee with a non-occupational injury cannot do
the essential functions of the job, even with accommodation, he
must go on leave of absence.
That is what happened to the pregnant UPS driver in Young v. UPS.
Her doctor put her on a lifting restriction that prevented her from
lifting some UPS packages. Although it would have allowed someone
injured at work with the same lifting restriction to perform light
duty, Young had to go on unpaid leave and could not afford to keep
her health insurance.
Ultimately, the United States Supreme Court rejected both parties'
positions and created a new standard for judging the legality of
such policies. If a company's policy "significantly burdens"
pregnant workers (as most light duty policies do), the company must
advance "sufficiently strong" reasons to justify the burden. Cost
and inconvenience are not sufficient, the Court said. The Supreme
Court sent the case back to the lower court for further litigation
under this new standard. Given what the Court has required that it
prove, however, UPS is not likely to be able to successfully defend
its policy.
Policies like UPS's, which are common, will now be very difficult,
if not impossible, to defend. Even if such a policy can be
successfully defended, an employer will spend a lot of money doing
it. In our opinion, an employer would have to have substantial
operational reasons, apart from cost and inconvenience, to limit
light duty opportunities to only those who have been hurt at work
and to the exclusion of pregnant workers. All employers should
review their policies and consult with counsel about the ability to
defend them after this important change in the law.
Click on the link to read the Young v. UPS U.S. Supreme Court
decision.
http://www.supremecourt.gov/opinions/14pdf/12-1226_k5fl.pdf
-
Monday December 14, 2015
CMS has allowed nursing homes to voluntarily submit staffing and
census data through the PBJ system since October 1, 2015. As
of July 1, 2016, collecting this staffing and census data will be
mandatory for all nursing homes. Section 6106 of the
Affordable Care Act (ACA) requires facilities to electronically
submit direct care staffing information (including agency and
contract staff) based on payroll and other auditable data.
The data, when combined with census information , can be used
to not only report on the level of staff in each nursing home, but
also to report on employee turnover and tenure, which can impact
the quality of care delivered. (Resource: www.CMS.gov )
For registration
and training, please refer to the attached PDF.
-
Friday January 8, 2016
In accordance with Section 6106 of the Affordable Care Act
facilities are required to electronically submit staffing
information to drive accountability effective July 1, 2016.
Providers will be required to submit their staffing and census
data quarterly. They will have 45 days after the last day in each
fiscal quarter to submit - making the due date for the first PBJ
submission November 14, 2016
Get Ready With These Five Steps:
1. Identify & Classify All Direct Staff - all direct
care staff (including agency and contract staff), does not include
individuals whose primary duty is maintaining the physical
environment (example housekeeping).
CMS defines direct care staff as those individuals who, through
interpersonal contact with residents or resident care management,
provide care and services to allow residents to attain or maintain
the highest practicable physical, mental, and psychosocial
well-being.
ยท Create a Unique Employee ID - for each direct care employee;
should not contain any personally identifiable information, such as
a Social Security Number (SSN).
ยท Hire Date - the first date of a staff member's employment and
is paid for services rendered, either through direct employment or
under contract. Note: Contract Employees -first date worked at the
facility and billed for.
ยท Termination Date - the last date of a staff member's
employment and is paid for services rendered either through direct
employment or under contract. Note: Contract Staff - the last date
the facility communicates that the contract employee will no longer
be providing services (either voluntary or involuntary).
ยท Pay Type Code - categorizes the staff member as a direct
employee of the facility (exempt or non-exempt), or hired under
contract and paid by the facility. Note: non-exempt - entitled to
overtime pay, exempt - not entitled to overtime pay, contract -
individuals under contract and individuals who provide services
through organizations that are under contract.
2. Assign CMS Job Codes - identifying and assigning a CMS
job code to an employee for each and every shift to ensure a
payroll-based reporting submission is accurate and complies with
CMS requirements. CMS has defined 37 job Codes to be used when
reporting direct care hours worked. Facilities should report the
hours worked based on an employee/s primary function for that
shift.
There must be a job code attached for every hour submitted through
the PBJ system. Job responsibilities can change multiple times
throughout the day and CMS recognizes that most roles have a
variety of non-primary duties that are provided throughout the
day.
Assign each position and shift a job code, this job code should be
used and paired with the direct care staff including agency and
contract staff, which works those shifts.
See Attached CMS PBJ Version 1.0 Policy Manual Table 1: Labor and
Job Codes and Descriptions.
3. What Should Be Counted, What Should Not Be Counted? - It
is important for facilities to know what should and should not be
reported in the PBJ when compiling a complete an accurate file for
submission. CMS has provided situations where direct care hours
worked should not be reported:
ยท Hours paid for any type of leave or non-work related absence
from the facility.
ยท Any unpaid overtime (a salaried employee works 10 hours but is
only paid for 8 hours).
ยท Hours for services performed that are billed to FFS Medicare or
other payer.
ยท Hours providing services to residents in non-certified
beds.
One of the biggest challenges for submission of the PBJ will be to
gather and aggregate staffing data from disparate sources. Direct
care hours are usually tracked through time and attendance systems.
The following situations could possibly be overlooked but should be
reported:
ยท Contract and Agency work.
ยท Corporate staff at a facility performing task/duties that fit
into a CMS job category (e.g. Regional Director fills in for the
Administrator that's out on vacation or leave).
ยท Salaried staff that do not clock in or clock out.
4. Create a Checks and Balances System - CMS provided
examples of the difficulty facilities may experience in their
ability to appropriately track and allocate exact hours.
ยท For Medical Directors, it might be difficult to allocate the
exact hours spent performing medical director duties as opposed to
primary care duties.
ยท For Consultants, it might be difficult to identify the exact
hours a specialist contractor (e.g. non-agency nursing staff) is
on-site.
(Note: It is important for facilities to define their expectations
within their service provider contract.)
(CMS has stated that the hours reported should be based on
payments made for services and be verified through payroll,
invoices and/or tied back to contract).
5. Start Now and Be Ready - Your success will be determined
based on staffing with the PBJ staffing measurements by
implementing a proactive process to identify and adjust staffing
levels. Staffing is a challenging process with constant shift
updates including call-offs, time-off requests, employee no-shows,
and fluctuations in census, activity, acuity and workload.
Set up a process that allows staffing information to be easily
accessed, create dashboards that identifies staffing requirements
based on census, against budgeted hours. If gaps are identified
adjustments should be made.
CMS has identified staffing as a key component in delivering
quality care and positive resident outcomes. They use staffing
information in the Nursing Home Five Star Quality Rating System to
help consumers understand the level and differences of staffing in
nursing homes. CMS requires facilities to submit CMS Form 671 and
CMS Form at the time of survey to calculate the Staffing Domain of
the Five Star Rating System.
Hopefully utilizing these 5 steps will help your facility achieve
the staffing and management goals that will enable you to correctly
document and report direct care hours worked.
Payroll
Based Journal
-
Wednesday January 20, 2016
Just a quick heads-up from the team at eHDS. See below for a
notice received from CMS. Please plan accordingly!
Please be aware that CMS has planned an off-schedule extended
maintenance period for all of the national QIES systems, which
include the MDS 3.0 Submission and CASPER systems, for Wednesday,
March 16, 2016 beginning at 8:00 PM ET and continuing through
Monday, March 21, 2016 at 11:59 PM ET.
This makes for a 5+ day window where all of the national QIES
systems will be offline and providers will be unable to transmit
any MDS assessments or obtain reports. This also applies to vendors
who submit assessments on the providers' behalf. CMS has started to
post notices to the related application and support websites that
encourage vendors and providers to take this downtime into account
and plan their business around it.
This information is also noted on your Care Watch home page. We
recommend making sure your team is well informed and is planning
for this scheduled downtime.
For access to the original CMS notice, please click
here.
eHealth Data
Solutions
-
Tuesday February 9, 2016
The link below contains information from the Centers for Disease
Control (CDC) about the Zika Virus including areas with Zika,
Prevention, and Symptoms, Diagnosis and Treatment.
http://www.cdc.gov/zika
-
Tuesday March 1, 2016
MDS 3.0 Focused Pilot Surveys were conducted in June and July of
2014 in 5 states, and in 2015 the MDS Focus Surveys were conducted
in all states. The Surveys consist of a review of MDS 3.0
assessments, medical records, interviews with staff and residents,
and resident observations. This enables Surveyors to review
the nursing home resident assessment processes in-depth, more so
than during an annual survey. The MDS Focus Survey, the Focused
Survey Facility Worksheet, the Electronic Staffing Data Submission
Payroll Based Journal, and the Preparation for MDS Focus Survey are
included in the attachments below.
Click here to download "MDS Focus Survey Entrance Conference Worksheet"
Click here to download "MDS Focus Survey Facility Worksheet"
Click here to download "MDS FOCUS SURVEY 5-27-2015"
Click here to download "PBJ-Policy-Manual-Draft"
Click here to download "Preparation for MDS Focus Survey Checklist"
-
Wednesday June 15, 2016
In an effort to review and examine compliance with the Health
Insurance Portability and Accountability Act of 1996 and its
implementing regulations ("HIPAA"), the Department of Health and
Human Services Office for Civil Rights ("OCR") is conducting Phase
2 HIPAA audits for both covered entities and business associates.
OCR is conducting the audits to assess new risks, identify
effective privacy and security measures, and develop targeted
guidance on specific areas of concern.
The first step in the audit phase is a pre-audit screening email
sent to potential auditees. We have seen several of these delivered
recently. A sample of the pre-audit screening email can be found
here. The email contains a questionnaire addressing size, entity
type, services, contact information, and other background
information. The online questionnaire must be completed and
returned to OCR within 30 days. Based on the responses received and
the information gathered, OCR will create a smaller, representative
sample audit pool. Thus, not all entities that receive the initial
pre-audit screening email will be audited. However, failure to
respond to the questionnaire will not remove an entity from the
audit selection pool. OCR will use publicly available information
about an entity if it receives no response within the 30-day
timeframe.
Every covered entity and business associate is eligible to
receive the pre-audit screening email and to be entered into the
audit selection pool. However, at this point, we believe the
screening e-mail is being sent to entities who have filed a breach
notification report with OCR. Based on the responses to the
pre-audit questionnaire contained in the screening e-mail, OCR will
choose a representative sample of auditees. Entities will be
notified if selected.
Phase 2 audits will target areas of frequent non-compliance with
HIPAA, such as risk management, privacy practices, individual
access to protected health information ("PHI"), breach
notifications, and electronic security. Most audits will not
involve site visits, though some may. Once an entity is selected
for the audit process, it has only 10 days to respond to OCR's
audit request, submit all requested documentation through OCR's
online portal, and provide a listing of its business associates.
While OCR has not stated the exact information that will be
requested, we suspect the information requests will include, among
other things, HIPAA policies, procedures, and plans, listing of
systems that house electronic PHI, risk assessment(s), breach
notification documents, Notice of Privacy Practices and other HIPAA
forms, and a business associate listing.
Depending on an entity's size, the 10-day window may leave
little time to compile and provide the requested information. Thus,
while receiving the pre-audit screening e-mail does not guarantee
that an entity will be audited, it is recommended that receiving
entities take proactive steps to prepare in the event they are
ultimately audited. Recommended steps include the following:
ยท Assemble a
HIPAA response team and hold an initial meeting so that everyone
may be prepared in the event of an audit. Potential team members
may include your privacy officer, security officer, compliance
officer, IT department supervisor, and administrator.
ยท Locate all
HIPAA-related materials so that they can be gathered quickly in the
event of an audit.
ยท Review HIPAA
policies and procedures to make sure they are up to date, operating
effectively, and do not contain any gaps.
ยท Review HIPAA
forms to make sure they are up to date and are being properly
used.
ยท Compile a
listing of business associates, which, for larger entities, could
take a significant amount of time. There are several pieces of
information OCR has indicated it will request with respect to
business associates. A template form for gathering this information
is available here. While use of the template is not required, it
does ensure inclusion of all the business associate information OCR
is seeking.
ยท In relation,
confirm that a business associate agreement is in place for each
instance where one is required. We have seen some recent
enforcement actions whereby covered entities have been fined for
not having a business associate agreement in place when one was
required.
ยท Compile and
review the latest risk assessment(s) to make sure they are still
valid and cover all the systems that house, transmit, and store
electronic PHI. (We have seen recent enforcement actions whereby
covered entities have been fined for not having a risk assessment
or a series of risk assessments that cover all relevant
systems.)
ยท Compile an
inventory of systems and system assets that house, transmit, and
store electronic PHI.
OCR has indicated that the Phase 2 audits are not designed to
determine an entity's compliance with HIPAA. Nonetheless, OCR has
retained the right to initiate a compliance review based on
information received during an audit. Thus, we believe it is
worthwhile to take the steps mentioned above in order to help
reduce the risk of a compliance investigation.
For more information on the Phase 2 HIPAA audits, please contact
any of the Burr & Forman attorneys listed below.
Howard Bogard
Partner ~ AL
(205) 458-5416
hbogard@burr.com
Richard Brockman
Counsel ~ AL
(205) 458-5175
rbrockman@burr.com
Kelli Fleming
Partner ~ AL
(205) 458-5429
kfleming@burr.com
Jim Hoover
Partner ~ AL
(205) 458-5111
jhoover@burr.com
Chet Hosch
Partner ~ GA
(404) 685-4279
chosch@burr.com
Matt Kroplin
Partner ~ TN
(615) 724-3248
mkroplin@burr.com
Jack Mooresmith
Counsel ~ AL
(334) 387-2072
jmooresmith@burr.com
Angie Smith
Partner ~ AL
(205) 458-5209
asmith@burr.com
Jerry Taylor
Partner ~ TN
(615) 724-3247
jtaylor@burr.com
Chris Thompson
Associate ~ AL
(205) 458-5325
cthompson@burr.com
Rob Williams
Partner ~ FL
(813) 367-5712
rwilliams@burr.com
Tom Wood
Partner ~ AL
(251) 345-8203
twood@burr.com
No representation is made that the quality of services to be
performed is greater than the quality of legal services performed
by other lawyers. ADVERTISEMENT
๏ปฟ
-
Friday June 17, 2016
The article below from Starnes Davis Florie LLP addresses the
new overtime regulations for Long Term Care Organizations that will
go into effect on December 1, 2016.
Click here to download "New Overtime Regulations"
-
Tuesday October 18, 2016
Introduction: Workplace Violence is the second leading
cause of work-site deaths in the United States according to the
Bureau of Labor Statistics, and is one of the most frightening
exposures companies face. Such an incident can devastate a company,
destroying its bottom line and even threatening it survival.
Workplace Violence Expense Insurance will help you prepare for an
unthinkable event like this if it should happen at your facility.
Here are some of the reasons why your facility should consider
buying workplace violence expense insurance:
ยท The expenses
incurred in the aftermath of a workplace violence incident are
often staggering and unforeseen
ยท Unexpected
expenses can stem from crisis management, independent security,
employee counseling, public relations, medical care for employees,
salaries for victim employees and for replacement employees and
loss of business income
ยท Long term care
facilities are at an increased risk of workplace violence because
they deal with members of the public and operate late at night
The attachment below contains Chubb Insurance Company's
Forefront Portfolio Risk Analyzer which may help you uncover some
of the biggest potential threats to your facility's bottom line.
Gerry Gilbert in our office can assist you in identifying possible
financial exposures your facility might have. Gerry can be reached
at 205-414-6184 or by email at gerry_gilbert@ajg.com
.
Click here to download "Workplace Violence Risk
Analyzer"
-
Tuesday November 29, 2016
The article below focuses on CMS's national goal to reduce the
use of antipsychotic medication use in long term care nursing homes
by 30% by the end of 2016.With the improvement of dementia care in
nursing facilities, there have been significant reductions in the
prevalence use of antipsychotics for long term care residents. This
article will provide you with the requirements that facilities must
follow to make sure residents don't have unnecessary declines in
the development of their Dementia.
Click here to download Dementia
article.
-
Wednesday January 4, 2017
"Infection
Prevention"
An
Infection Prevention and Control Program (IPCP) is currently
required by Federal Regulations, that state all facilities must
establish a program that investigates, controls, and prevents
infections in the facility. The program, at a
minimum, would adopt procedures to follow with individual residents
such as residents exhibiting specific symptoms, or are diagnosed
with certain types of infections. The facility would also
be responsible for maintaining a record of any infectious incident
and what corrective measures were implemented to manage the
infection. The facility is also charged with the task of
determining ways to prevent the possible spread of infections to
other individuals within facility.
The Federal
Register/Vol. 81, No. 192/Tuesday, October 4, 2016/Rules and
Regulations indicate that CMS put the foundation in place for the
Infection Prevention rule changes. These changes will be
implemented in "Phases", Phase 1: timeframe is effective
date of the final rule November
28, 2016, Phase 2: 1 year following the effective date of the final
rule (November 2017), and Phase 3: 3 years following the effective
date of the final rule (November 2019).
Phase
1:
Each
facility must establish and maintain an infection prevention and
control program designed to provide:
-
a safe, sanitary, and comfortable environment and,
-
to help prevent the development and transmission of communicable
diseases and infections.
A system of
surveillance should be developed by each facility to identify
possible communicable diseases or infections before they can spread
to other persons in the facility. The plan for surveillance
may be a stand-alone policy or it may be included in the facility's
infection prevention and control program. The facility should: a)
identify what data should be collected; b)when the data should be
collected; c)how the data should be collected; d)how the data will
be analyzed; and e)how the results of the analyzed data will be
documented and implemented. This
is not an all-inclusive list and should be viewed as an example
only.
Phase
2:
Assessments
for Infection Control and Antibiotic Stewardship are two of the
items that will be required in this phase. Assessments for
Infection Control is an assessment tool
developed by the facility to evaluate the potential risk for
acquiring and transmitting infections, identifying opportunities
for improvement, identify threats to residents health and identify
gaps in facility practices. The assessment should be
completed by a multidisciplinary team and is one of the key
building blocks of the Infection Prevention and Control
Plan. The assessment is used to
establish goals and objectives, identify focus areas for
surveillance, prioritize infections and control activities and/or
initiatives. The Antibiotic Stewardship
Program includes protocols for
antibiotic use and a system to monitor antibiotic use. These policies and
practices are in place to protect residents and improve clinical
care as it relates to the use of antibiotics in nursing
homes.
Phase
3:
Infection
Control and Prevention Offices (ICPO) is defined as one or more
individuals who are responsible for the facility's Infection
Prevention and Control Program. Facilities should be
designating the ICPO in Phase 3. This individual(s) must:
Have primary professional training in nursing, medical technology,
microbiology, epidemiology, or other related field; be qualified by
education, training, experience or certification; work at least
part-time at the facility; have completed specialized training in
infection prevention and control; and participate in the quality
assessment and performance improvement committee. The individual designated
as the Infection Preventionist must be a member of the facility's
Quality Assessment and Performance Improvement committee with the
responsibility to report to the committee on the Infection
Prevention and Control Plan on a regular basis.
For more
comprehensive information on Infection Control and the Final Rule
including the Phases and Timelines for Implementation, you should
contact the Alabama Nursing Home Association for
Seminars/Trainings/Workshops or review the list of
references/resources provided below.
References:
Federal
Register/Vol. 81, No. 192/Tuesday, October 4, 2016/Rules and
Regulations
Alabama
Nursing Home Association Weekly Round Up
CDC
Long Term Care Antibiotic Stewardship
Arthur
J Gallagher & Co/12-2016
๏ปฟ
-
Wednesday January 4, 2017
AJG Educational Services will be hosting Alzheimer's Disease and
Dementia Training Seminars in four Alabama cities in 2017. These
seminars are required for those pursing CDP Certification and who
qualify through the National Council of Certified Dementia
Practitioners.
To see if you qualify please visit the NCCDP website at
www.nccdp.com. All participants must attend the entire seminar to
receive a certificate of completion and all participants will be
provided an application to apply for CDP (Certified Dementia
Practitioners) through the National Council of Certified Dementia
Practitioners.
Seminars will be held in Birmingham, Montgomery, Mobile, and
Huntsville later in the year.
Alzheimer's Disease & Dementia Care
Seminar
July 13 & 14,
2017
Mobile, AL
Alzheimer's Disease & Dementia Care
Seminar
October 19 & 20, 2017
Huntsville, AL
๏ปฟ
-
Monday May 15, 2017
The attachment below contains a flyer from Arthur J Gallagher
that will provide you with information about potential cyber risks
as well as the percentage of customers lost by companies due to
cyber-attacks, and the cyber security vulnerability by industry
including the healthcare industry. Please contact either Gerry
Gilbert or Billy Dodson on how you can protect your business from
cyber risks. Gerry and Billy can be reached at:
Gerry Gilbert
-
phone : 205-414-6184
email : gerry_gilbert@ajg.com
Billy Dodson
-
phone 205-414-2653
email billy_dodson@ajg.com
Click
here to Download the attachment
-
Monday May 22, 2017
The healthcare sector saw 310 cyber related incidents in 2016
with 16,100,000 individuals affected by those data breaches. As you
know healthcare records have valuable personal information that can
be used by cyber criminals in a variety of malicious ways. With
access to healthcare information and other personal data, attackers
can access healthcare services on behalf of the individual, file
fraudulent claims, or use the victim's identity to commit other
crimes. The flyer below contains five steps that will help you
mitigate your risk of a cyber incident occurring at your facility.
Please contact Martha Acker, Gerry Gilbert, or Billy Dodson if you
would to learn more about how you can protect your facility from a
cyber incident. Martha, Gerry and Billy can be reached at
Martha Acker
-
phone : 205-414-2640
email : martha_acker@ajg.com
Gerry Gilbert
-
phone : 205-414-6184
email gerry_gilbert@ajg
Billy Dodson
-
phone : 205-414-2653
email billy_dodson@ajg.com
Click
here to Download the attachment
-
Thursday June 1, 2017
October 10-13, 2017
Location:
AJG Education
Center
2200 Woodcrest
Place
Birmingham. AL
35209
October 10- 13, 2017
8:00 am-5:00 pm
Registration7:45 am - 8:00 am
Space is limited- 40
Registration
fee:
-
NON-CCC AL Nursing Home Insurance Program Members
Only:$750(required at the time of registration)
-
For additional Information, please
contact:
-
Nancy
Lee,
Registration Coordinator
205-414-6169
nancy_lee@ajg.com
The ALTCQIreservestherighttocancelthis training on thebasisof low registration.If thist
raining is cancelled,all those registered will be notified and registration fees will be refunded.
To
cancel your registration you must email
no
later than September 29, 2017
to:
NancyLee, Registration
Coordinator
nancy_lee@ajg.com
You
will be refundedyourregistrationfee minus$100.00administrationfee.
-
Norefundswillbegiven after September
29,2017.
-
Substitutes are welcomed.
-
ALL NO SHOWSforfeit registration fees
This comprehensive course is designed
to arm you with a practical knowledge of Risk Management strategies
in the Senior Living Industry.
-
Friday June 2, 2017
This comprehensive program will train each student to identify,
assess, and prioritize risks in a coordinated effort within the
Senior Living environment. The e-brochure below contains more
information about these training sessions and an application that
will allow you to enroll your staff in this course. Training
sessions will be held at the AJG Training Center in Birmingham, AL
on October 10-13, 2017.
Click here to download the attachement
-
Sunday June 11, 2017
AJG Educational Services will be hosting Alzheimer's Disease and
Dementia Training Seminars in Atlanta Georgia in 2017. These
seminars are required for those pursuing CDP Certification and who
qualify through the National Council of Certified Dementia
Practitioners.
To see if you qualify please visit the NCCDP website at
www.nccdp.com. All participants must attend the entire seminar to
receive a certificate of completion and all participants will be
provided an application to apply for CDP (Certified Dementia
Practitioners) through the National Council of Certified Dementia
Practitioners. The attachments contain additional information about
these seminars and how to sign up for them.
Seminars will be held in Atlanta Georgia on:
Alzheimer's Disease & Dementia Care
Seminar
August
15, 2017
Atlanta Georgia
Click here to download the attachement
Alzheimer's Disease & Dementia Care
Seminar
August
17, 2017
Atlanta Georgia
Click here to download the attachement
-
Tuesday June 27, 2017
Nursing home surveys are conducted in accordance with survey
protocols and Federal requirements to determine whether a citation
of non-compliance is appropriate. Consolidated Medicare and
Medicaid requirements for participation (requirements) for Long
Term Care (LTC) facilities (42 CFR part 483, subpart B) were first
published in the Federal Register on February 2, 1989 (54 FR 5316).
The requirements for participation were recently revised to reflect
the substantial advances that have been made over the past several
years in the theory and practice of service delivery and safety.
The revisions were published in a final rule that became effective
on November 28, 2016.
The survey protocols and interpretive guidelines serve to
clarify and/or explain the intent of the regulations. All surveyors
are required to use them in assessing compliance with Federal
requirements. Deficiencies are based on violations of the
regulations, which are to be based on observations of the nursing
home's performance or practices.
The attachment below contains the PowerPoint from CMS relating
to the new survey process effective November 28, 2017.
Click here to download the attachment
-
Tuesday June 27, 2017
One of the worst forms of workplace violence is an active
shooter situation. Policy may respond promptly to your 911 call
but, in the interim, lives are at risk. The article below will
provide you with things that you and your staff can do to protect
these lives.
Click here to
download the attachment
-
Thursday June 29, 2017
The attached article will provide you with information on OSHA's
proposal to delay the reporting compliance deadline, until December
1, 2017, for certain employers to electronically file injury and
illness data.
OSHA Delays Electronic Filing Date for Injury and
Illness Records Until December 1, 2017
-
Monday September 11, 2017
Relias Learning offers you and your staff over 500 interactive,
online continuing education courses to meet the educational and
licensure requirements of their profession. At Relias
Learning their one-of-a-kind management system allows you and your
staff to search courses by F-Tags to quickly and effectively
resolve deficiencies. Attached is a
tool to help you navigate through the Relias Learning center to
identify a variety of modules related to Long Term Care regulatory
topics. New F-Tag modules will be forthcoming to meet the
Phase 2 CMS regulations. If you need additional information,
please contact Dena Humphreville, Tier II Client Success Manager at
Relias Learning, 919-655-7832 or email
dhumphreville@reliaslearning.com.
-
Friday October 27, 2017
Staffing has become one of the biggest challenges encountered in
the senior housing industry. Proper staffing is not only integral
to the day-to-day mission and operations of providing quality care
to residents, but also crucial to meeting the ever-increasing
staffing-targeted regulations.
Click
here to download the attachment
-
Monday December 4, 2017
On November 24, 2017, the Survey and Certification Group
(S&C) at CMS issued two memos that further delay enforcement of
provisions of the new requirements but falls short of a complete
delay. These memos indicate that CMS is delaying some enforcement
provisions of the Phase 2 requirements, but CMS will proceed with
implementing the new survey process beginning on November 28.
Click
here to download the attachment
-
Monday August 20, 2018
The Food and Drug Administration (FDA) is strengthening the
current warnings in the prescribing information that
fluoroquinolone antibiotics may cause significant decreases in
blood sugar and certain mental health side effects. The low blood
sugar levels can result in serious problems, including coma,
particularly in older people and patients with diabetes who are
taking medicines to reduce blood sugar. We are making these changes
because our recent review found reports of life-threatening low
blood sugar side effects and reports of additional mental health
side effects.
Please click on the link bellow to review more on this
topic:
https://www.fda.gov/Drugs/DrugSafety/ucm611032.htm
-
Wednesday August 1, 2018
Center for Clinical Standards
and Quality/Quality, Safety and Oversight Group
Ref:
QSO
-17-30- Hospitals/CAHs/NHs
DATE: June 02, 2017
REVISED 07.06.2018
TO:
State Survey Agency Directors
FROM:
Director
Quality, Safety and Oversight Group (
formerly Survey & Certification Group
)
SUBJECT:
Requirement to Reduce
Legionella
Risk in Healthcare Facility Water Systems to Prevent Cases and
Outbreaks of Legionnaires' Disease (LD)
***Revised to Clarify Expectations for Providers, Accrediting
Organizations, and Surveyors***
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO17-30-HospitalCAH-NH-REVISED-.pdf
-
Wednesday February 14, 2018
Facility Requirements to Prevent Legionella Infections:
Facilities must develop and adhere to policies and procedures that
inhibit microbial growth in building water systems that reduce the
risk of growth and spread of legionella and other opportunistic
pathogens in water.
Facility Requirements to Prevent Legionella
Infections Document
-
Wednesday March 21, 2018
Assisted Living, Specialty Care Assisted Living, Memory Care
Facility, Resident Care Homes - whatever title they go by, each
state has its own set of rules and regulations for these care
facilities. The criteria for admission and retention for any of
these centers will vary depending on the state in which you
live.
Inappropriate Residents in ALF and SCALF
Whitepaper
-
Wednesday March 21, 2018
It seems that long-term care providers are struggling to stay
the course in developing thorough, comprehensive, "Person-Centered
Care" plans. Amid all the numerous regulatory changes, nursing and
rehabilitation facilities are attempting to find a balance between
shifting the care model while also maintaining regulatory
compliance.
Person Centered Care Plans
-
Monday May 6, 2019
The Alabama Long Term Care (LTC) Preparedness Toolkit was
developed to assist with emergency preparedness planning for this
specialized health care population. LTC facilities, as they are
referred to in the toolkit, include nursing homes, skilled nursing
facilities, and assisted living facilities. This toolkit was
originally created by the Minnesota Dept. of Health, Care Providers
of Minnesota, Aging Services of Minnesota, and regional
representation from the Health Care Preparedness Program who
developed this tool to assist LTC facilities in emergency
preparedness. The toolkit was revised with permission by members of
the Alabama Nursing Home Association to assist Alabama facilities
in preparing for disasters.
ANHA LTC
Preparedness Toolkit
-
Wednesday June 5, 2019
The common law and regulatory climates of North American health
systems have been shaped by an Anglo-Saxon heritage regarding the
role of the corporation. This view of the corporation has, in turn,
shaped the role and responsibilities of corporate bards as they
perform certain key fiduciary duties wisely. At the 2018 Cayman
Captive Forum, our session on governance trends and best practices
for risk management sought to position the role of boards to not so
much be experts in risk management, but to be enablers of a
superior risk management culture that supports talented executives
and risk management professionals to master and continuously
enhance the use of modern Enterprise Risk management principles,
policies and practices.
This paper has been modified from discussions at the recent
Cayman Captive Forum organized by the Insurance Managers
Association of Cayman (MAC). Requests at the Forum for materials
that might help stimulate health systems boards to enhance the
effectiveness of their enterprise risk management encouraged the
authors to assemble and share this collection of ideas and insights
about governing modern risk management strategies and
structures.
2019 Health System Boards and Cultures that
Support Effective Enterprise Risk Management White paper
-
Wednesday June 5, 2019
Some of you may have heard about Candida auris in recent media
stories based on a recent New York Times article. C. auris is an
emerging yeast that can be misidentified as other organisms, is
multidrug-resistant, and can spread in health care settings. It is
important to know how to identify, treat, and control the spread of
this organism.
Guidance on Emerging Infection Candida
Auris
-
Tuesday July 23, 2019
Active Shooter situations are often over within 10 to 15
minutes, before law enforcement arrives on the scene, individuals
must be prepared both mentally and physically to deal with an
active shooter.
Below is a link to the U.S. Department of Homeland Security
"Active Shooter How to Respond" guide.
https://www.dhs.gov/sites/default/files/publications/active-shooter-how-to-respond-508.pdf
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Monday March 9, 2020
A new respiratory disease - coronavirus disease 2019 (COVID-19)
- is spreading globally and there have been instances of COVID-19
community spread in the United States. The general strategies CDC
recommends to prevent the spread of COVID-19 in LTCF are the same
strategies these facilities use every day to detect and prevent the
spread of other respiratory viruses like influenza.
Strategies to Prevent the Spread of
COVID-19
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Monday March 9, 2020
Coronavirus disease 2019 (COVID-19), caused by the COVID-19
virus, was first detected in Wuhan, China, in December 2019. On 30
January 2020, the WHO Director-General declared that the current
outbreak constituted a public health emergency of international
concern.
This document summarizes WHO's recommendations for the rational
use of personal protective equipment (PPE) in healthcare and
community settings.
Rational use of personal protective equipment for
coronavirus disease 2019 (COVID-19)
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Wednesday February 5, 2020
The Centers for Disease Control and Prevention (CDC) is closely
monitoring an outbreak of respiratory illness caused by a novel
(new) coronavirus first identified in Wuhan, Hubei Province, China.
Chinese authorities identified the new coronavirus, which has
resulted in thousands of confirmed cases in China, including cases
outside Wuhan City. Additional cases have been identified in a
growing number of other international locations, including the
United States.
About 2019 Novel Coronavirus
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Wednesday May 20, 2020
Document, document, document - a phrase that is familiar in the
senior living industry and many other healthcare arenas. During the
COVID-19 pandemic, documentation is critical in order to provide a
historical timeline of the facility's response to the COVID-19
pandemic.
Many facilities may be at risk for lawsuits and CMS Infection
Control Focused Surveys in the future, and the documentation
process for providing a historical timeline of each facility's
individual response is key.
COVID-19 Documentation whitepaper 5-14-20
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Tuesday June 9, 2020
As news headlines about the coronavirus (COVID-19) disease
continue to increase, so has concern over its potential to affect
employee welfare, disrupt global supply chains and slow business
operations. Gallagher's experts are here to support you in the
development and implementation of risk management policies and
procedures during a pandemic.
Responding to the
Coronavirus (COVID-19)
-
Tuesday June 9, 2020
It seems that long-term care providers are struggling to stay
the course in developing thorough, comprehensive, "person-Centered
Care" plans. Amid all the numerous regulatory changes, nursing and
rehabilitation facilities are attempting to find a balance between
shifting the care model while also maintaining regulatory
compliance.
Person Centered
Care Plans
-
Thursday June 11, 2020
Assisted Living, Specialty Care Assisted Living, Memory Care
Facility, Resident Care Homes - whatever title they go by, each
state has its own set of rules and regulations for these care
facilities. The criteria for admission and retention for any of
these centers will vary depending on the state in which you live.
The State of Alabama is no exception; it has its own set of rules
and regulations; especially when it comes to admission and
retention of a resident into one of its Assisted Living Facilities
(ALF) and Specialty Care Assisted Livings (SCALF).
Inappropriate Residents in ALF and SCALF
Whitepaper
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Thursday June 11, 2020
Will I be able to cover this shift next week? Is the weekend
coverage in place? These are questions every person working in the
Senior Living industry has asked. Staffing has become one of the
biggest challenges encountered in the senior housing industry.
Proper staffing is not only integral to the day-to-day mission and
operations of providing quality care to residents, but also crucial
to meeting the ever-increasing staffing-targeted regulations.
Senior Living Staff Whitepaper
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Wednesday December 16, 2020
"Global pandemic," "COVID-19" and "mask" are all familiar terms
that have become a part of our daily (and sometimes hourly)
conversations with friends, family and colleagues. And,
unfortunately, as COVID-19 cases increase and new restrictions are
implemented in some areas, your staff may be feeling fear, stress,
panic and anxiety. Developing a strategy to adequately address
these feelings in the healthcare space can be daunting. Long-term
care (LTC) nurses are managing the emotional wellbeing of residents
along with their own personal troubles each day. Similarly, members
of nursing facility staffs are under immense pressure, not to
mention handling situations their profession has never experienced
before.
Dealing with Stress in Senior Living