News Throughout the Spectrum of Aging Services
Assisted Living Communities/Personal Care Homes
96 Ways to Measure Quality in Assisted Living
A new report from the Center for Excellence in Assisted Living (CEAL) recommends 96 tools that assisted living communities could use to measure and improve the quality of services they provide.
CEAL is a collaborative of 11 national organizations, including LeadingAge, which is dedicated to advancing excellence in assisted living.
Measures and Instruments for Quality Improvement in Assisted Living summarizes the results of an environmental scan of quality-measurement tools that was conducted for CEAL by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.
"This report lists many promising tools for measuring quality in assisted living," says Steve Maag, director of residential communities at LeadingAge and a CEAL board member. "We knew anecdotally that there are measures in different health care settings that could be adapted to assisted living. We just didn't have a very good handle on what those measures were."
Genesis of the Quality Improvement Project
CEAL decided to launch its quality-improvement project after hosting a 2-day invitational symposium exploring the "Future of Assisted Living." The October 2014 symposium gave a variety of assisted living stakeholder groups an opportunity to discuss how the assisted living sector could remain a viable service choice within a health care environment dominated by such health reform initiatives as managed care and accountable care organizations.
Symposium participants identified the need for assisted living communities to collect and share data across settings. That data would need to assess service quality and outcomes, they said. It would also have to reflect individual preferences, goals, and psychosocial needs, as well as medical and health care needs.
"We decided that moving forward on this priority meant developing some criteria for good practice in assisted living," says Maag. "But first we wanted to find out what kind of measurement tools were already being used in assisted living and other health care settings."
Now that those measurement tools have been identified, CEAL plans to create a toolkit to help organizations select and use specific measurement instruments that would work best in their organizations, he says.
What Researchers Found
Researchers initially identified 254 tools and instruments currently being used to measure various areas of quality in health care settings. After conducting a critical review of those tools, researchers selected 96 tools that they recommended for use in assisted living settings. The recommended tools fall into 5 categories:
- Person-centered care (6 tools)
- Medication management (10 tools)
- Care coordination/transitions (17 tools)
- Resident/patient outcomes (35 tools)
- Workforce (28 tools)
In addition, the report calls for the development of new tools that could be used to:
- Measure resident acuity to determine staffing sufficiency
- Provide an overall measurement of quality in assisted living
Why Measure Quality?
Measurement that provides benchmarks, determines quality of care, and guides quality improvement is just as important in assisted living as in other care settings, say the authors of the CEAL report. This measurement can:
- Help staff members better understand their services and the areas where improvement is indicated
- Allow assisted living communities using similar measures to compare themselves with other settings
- Give prospective residents and their families the benchmarking information they need to make informed decisions when selecting an assisted living provider
"Measuring quality is simply a way to determine whether you are providing the kind of care that you want to provide," says Maag. "It gives you a way to quantify what you are doing, rather than just hoping that you are doing a good job."
Federally Assisted Housing (HUD-Subsidized)
RAD for PRAC - Congress Must Open HUD Demo to Affordable Senior Housing
On Oct. 24, LeadingAge and 46 other organizations sent to Congressional appropriators a letter in support of eligibility for Section 202 senior affordable properties with Project Rental Assistance Contracts (PRACs) to participate in HUD's Rental Assistance Demonstration (RAD) program. "We were honored to by joined a variety of housing and senior organizations to support this essential affordable housing preservation effort,' said Linda Couch, director of housing policy and priorities. 'We hope Congress hears our request as it finalizes HUD funding for fiscal year 2017."
LeadingAge 2016 HUD Update
Last week, in Indianapolis, the national convention was held. The HUD update session was attended by over a hundred participants. The focus of the session was to talk about the Management Occupancy Reviews that are starting again and about some new laws that will be impacting our industry.
The MOR is a hot topic this year as Contract Administrators begin conducting them for the first time in years. Many of us in the industry have never gone through an MOR as our employee turnover is very high for these positions that are responsible for keeping our properties in compliance with HUD regulations. There are two main things that you should be concentrating on in preparation for the MOR.
1. Tenant Selection Plan – Contract Administrators are finding that many properties have not been updating their TSPs to stay in compliance. Specifically, there has been guidance from HUD on language about bullying, social security numbers, and limited English proficiency policies. Additionally, there is specific guidance on updating the criteria for applicants regarding criminal background screening. The MOR auditors are looking for these things to be updated and in compliance.
2. Enterprise Income Verification – the Auditors are also tasked with making sure that your policies and procedures regarding EIV are up to date and being followed. This includes running EIV for interim certifications in addition to the regular annual certification.
The session also provided information about HOTMA (Housing Opportunity Through Modernization Act) that was signed into law by President Obama. This act is geared to reduced spending in HUD programs and include some significant changes to subsidy qualifications.
- The elderly deduction will be increased from $400.00 to $525.00. This is a plus for our residents.
- The asset threshold level will be increases from $5000.00 to $50,000.00. This is another plus that should make calculating income form assets a bit easier.
- Medical expense disregard will in increase from 3% to 10%. This will have a significant negative impact on our population that is already struggling to pay for their medical expenses. This, in effect, will take away any medical deduction that a resident has for paying their Medicare premium. In essence, it will save us (the housing professionals) some time but will increase rents by around $30.00.
- The law is also adding a new criterion for qualification to receive subsidy. If an applicant or a resident has cash assets more than $100,000.00, they are no longer qualified for subsidy. This will affect all applicants and current residents as this is to be implemented at the annual recertification.
- Finally, any resident that owns a home that they could reasonably live in will be disqualified.
While the provisions of this law have not been implemented, these are the changes that are coming. HUD is still working through the "final guidance" and plans to enforce the new changes on the first of the year following the official rulings. These changes will likely become official late in 2017 with a January 1, 2018 implementation. There is no word on what impact this law have on Low Income Housing Tax Credit Properties. We expect to see guidance on this as time progresses.
Home and Community Based Services
How Home Health Can Ace the Updated ICD-10 Codes
Big changes are coming to ICD-10 this October, and home health providers need to be prepared. The extremely large code set was first implemented in the majority of states about a year ago, to the dismay of many home health providers across the country. Then, in June, the Centers for Medicare & Medicaid Services (CMS) added just under 2,000 new codes to ICD-10, as well as revised approximately 400 codes and deleted around 300 codes. This latest round of ICD-10 changes is scheduled to take effect when the FY2017 code set takes effect on October 1, 2016.
Home Health Provider Helps Slash Hospital Readmissions by 60%
A home health provider has helped a hospital reduce readmissions of highly at-risk patients by 60%, through a program that relies in large part on community health workers. Like other hospitals around the country, University of Maryland St. Joseph Medical Center (UMSJMC) has been looking for ways to cut its readmission rate, given that payments are being tied to this metric. As part of that effort, the 232-bed nonprofit hospital just north of Baltimore has been seeking out new partners to help coordinate care across the continuum.
Extraordinary' Nursing Shortage Forces CMS to Extend Staffing Exemption for Hospice
Hospice agencies hit by the ongoing nursing shortage can continue using contracted staff due to "extraordinary circumstances," the Centers for Medicare & Medicaid Services has announced. The Bureau of Labor Statistics forecast that the nursing shortage will persist through 2024, despite "faster than average" job growth rate in the industry, CMS said in a memo sent to state survey agency directors on October 21st.
Washington Post Implements Consumer Hospice Website
The Washington Post has gathered data largely from government sources on more than 3,000 hospices that participate in Medicare to develop a new Consumer Guide to Hospice that can be used by consumers to help them choose a hospice.
No single factor can predict the quality of a hospice's care, and these figures do not offer a complete picture of any single hospice. However, consumers can benefit from knowing how a hospice compares to others on these important measures.
The website allows consumers to find out more information on hospices in their states, specifically:
- Years in Business
- Crises Care
- Spending per day on patient care
The Washington Post this year has featured a number of articles on hospice.
In an October 26th, 2014, article, it was implied that consumers may not have a choice of which hospice that they use.
Life Plan Community (CCRC)
2016 Fitch CCRC Ratings Median Report
Below is a link to the 2016 Fitch CCRC Ratings Median Report, which was published recently and is full of insights and statistics on the 95 investment grade and 19 non-investment grade borrowers that Fitch follows.
Click HERE for report
Why CCRC Residents Are Taking Tech Support into Their Own Hands
Senior living providers know they should keep up with new technology trends, but it's tough to know what to invest in and how to get more residents engaged with tech. One continuing care retirement community (CCRC) in Atlanta has found an advantage in having tech super-users living among those who are just learning the ropes. The community's chief financial officer and one of its residents recently spoke with Senior Housing News about the CCRC's approach to tech investments, rolling out new offerings, and its Best Buy-inspired approach to tech support.
CARF Releases 2016 Edition of Financial Ratios and Trend Analysis of CARF-Accredited Life Plan Communities
This annual publication includes financial analysis of all CARF-accredited CCRCs/LPCs.
Nursing Home Final Rule: What You Need to Know
The Centers for Medicare and Medicaid Services (CMS) has issued the long-awaited Nursing Home Requirements of Participation Final Rule. The changes are significant and cover every aspect of service and care.
Although there is as yet no 'Guidance to Surveyor' language, which will help greatly in our understanding of details, we have provided 2 summaries for you.
- The first is a "short" 12-page tool that hits the topic areas and brief CMS language.
- The second is a much more lengthy resource that breaks out each section with key points, changes to the regulation, and what you need to do.
LeadngAge will also be sharing more resources in the coming months. For more information, please contact Evvie Munley at email@example.com.
Rehospitalization Measure a 'Strong Predictor' for Hospitals Seeking SNF Partnerships, Study Confirms
The rehospitalization rate measure recently added to Nursing Home Compare provides valid predictions of which skilled nursing facilities are likely to have residents readmitted to the hospital, according to a study published Friday.
The study, led by researcher Momotazur Rahman, Ph.D., of Brown University's Department of Health Services Policy and Practice, aimed to figure out if the rehospitalization rates posted on Nursing Home Compare "reflect true quality or are merely the result of favorable selection." Determining the ratings' true relevance is especially important for hospitals looking to succeed under the Centers for Medicare & Medicaid Services' Hospital Readmission Reduction Program.
5-Star Analysis Webinar and Handouts
Do you need help interpreting your 5-Star report? View the 5-Star Analysis Updated Webinar and handouts via LeadingAge NY.
CMS Final Rule to Reform the Requirements for Long-Term Care Facilities Powerpoint Presentation
Presented by Karen Tritz – Division of Nursing Homes Director Clinical Standards Group Long-Term Care Team Survey & Certification Group Division of Nursing Homes on October 27, 2016: Link: https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2016-10-27-LTC-Presentation.pdf
Are Uber and Lyft a Solution to Transportation Challenges for Older Adults? Transportation continues to be one of the largest gaps in services across the nation for older adults and people with disabilities. A new model in California involving ride-hailing companies like Uber and Lyft could potentially serve as a model to address this challenge. Uber and Lyft announced partnerships with service providers in California that will allow older customers to book rides through a phone operator. Among Americans 65 and older, 70 percent don't have access to smartphones and the 30 percent who do often don't use mobile apps like Uber and Lyft.
The partnership is mutually beneficial. Uber and Lyft can now target one of the fastest growing segments of our population, while older adults have an option to provide them with accessible transportation - furthering their ability to age independently and remain connected to their families and communities.
Inbox Zero: the Myth, the Legend Have an inbox full of delayed decisions? Do one of these four things to every email you have and you might be surprised how much more manageable your workload seems.
Summary of New CMS Survey and Certification Rule CMS has released the final rules revising the nursing home requirements of participation, which were published officially on Tuesday, October 4, 2016 and are available here.
The rule, which spans 185 pages in the Federal Register or 713 pages in a traditional word document, will be implemented in three phases, with the first November 28, 2016. The second phase is November 28, 2017, and the final phase is November 28, 2019.
This rule represents the most significant changes to the delivery of nursing home care since OBRA '87. LeadingAge (national) has produced a comprehensive summary of the final rule for members available here.
This is just the first of many more resources planned to support members on implementation of this massive rule. You will seem more resources and education available in the future, particularly after the new state operations manual and interpretive guidance for the final rules are released.
Hospital Readmission Rates Drop Significantly in 49 States Between 2010 and 2015 A recent CMS blog report on readmission rates showed a drop that resulted in 100,000 fewer hospital readmissions between 2010 and 2015. North Carolina saw a 6.5% decrease in readmissions. Maryland was the only state where readmissions did not drop.
Benefits of a Patient Centered Medical Home
The Hartford Foundation has just released an important report providing detail discussion of the benefits of a Patient Center Medical Home (PCMH) for your geriatrics practices. During the past week, I've had the opportunity to discuss its contents with one or more of you during the PCMH Congress in Chicago, the Georgia Association of Primary Health Care conference in Atlanta, or individual conversations. I've also promoted broader dissemination of this report through New American Media (P. Kleyman, editor Age Beat).
PCMH Promo Kit
PCMH Road Map
PCMH Paper Slide
Please feel free to share this information broadly within your organizations. I am also willing to discuss its details with interested parties.
The Patient Centered Medical Home Network of The John A. Hartford Foundation Change AGEnts Initiative has released an important new paper we think will interest you. "Patient-Centered Medical Homes and the Care of Older Adults: How comprehensive care coordination, community connections, and person-directed care can make a difference" provides a roadmap to guide primary care practices in how to enhance care to older, complex patients and their families.
This detailed and practical publication describes:
- Compelling stories of how PCMHs have transformed outcomes for older adults;
- How practices can improve outcomes by implementing evidence-based models of care;
- How community-based organizations can play an integral role in helping PCMHs maintain older adults' independence and quality of life;
- Recommendations for actions PCMHs can take to enhance primary care delivery;
- How advanced PCMHs can benefit under the Medicare Access and CHIP Reauthorization Act (MACRA) and employ Advanced Alternative Payment Models (APMs) without putting themselves at risk of financial loss.
- The challenges and opportunities PCMHs face in five areas: comprehensive care, whole-person care, patient empowerment and support, care coordination and communication, and ready access to care; and
- Links to resources to aid PCMHs in addressing workforce issues, partnering with community-based organizations, accessing clinical assessment tools, ensuring patient safety, and more.
PCMHs are uniquely positioned to provide outstanding care for older adults by embracing approaches to care that are whole person-oriented, coordinated, and comprehensive, with an emphasis on safety and quality of care. In focusing on their older patients, PCMHs can achieve their goals of great patient care to their most vulnerable populations AND succeed in the emerging value-based payment health care environment. We hope that you find this paper instrumental in guiding your work.
We also hope that you will pass it along to your network of others who are invested in improving health care for older adults. The Hartford Foundation Change AGEnts Initiative is administered by The Gerontological Society of America and is funded by The John A. Hartford Foundation.
Note: A limited number of hard copies of the paper are available. If you would like hard copies, please let us know how many you would like and how they will be used, and we'll be happy to send them. Email us at: firstname.lastname@example.org.
Summary of New CMS Survey and Certification Rule CMS has released the final rules revising the nursing home requirements of participation, which were published officially on Tuesday, October 4, 2016 and are available here. The rule, which spans 185 pages in the Federal Register or 713 pages in a traditional word document, will be implemented in three phases, with the first November 28, 2016. The second phase is November 28, 2017, and the final phase is November 28, 2019.
This rule represents the most significant changes to the delivery of nursing home care since OBRA '87. LeadingAge (national) has produced a comprehensive summary of the final rule for members available here. This is just the first of many more resources planned to support members on implementation of this massive rule. You will seem more resources and education available in the future, particularly after the new state operations manual and interpretive guidance for the final rules are released.
GAO: Lack of 'Meaningful' Quality Measures Hurting Providers A "misalignment" of healthcare quality measures may place a burden on providers and jeopardize the success of value-based payment methods, according to a new federal report. This misalignment — found in quality measures used in skilled nursing facilities, hospitals and physician offices — is primarily driven by variation in data collection and reporting systems, decision making gaps between public and private payers, and few meaningful measures, the Government Accountability Office said in an October 13th report.
Updated OSHA Guidelines Target Workplace Safety, Health The Occupational Safety and Health Administration has updated its Recommended Practices for Safety and Health Programs guidelines. The release is intended to help senior living operators and other employers establish a methodical approach to improving safety and health in the workplace. "We know that working together to implement these programs will help prevent injuries and illnesses, and also make businesses more sustainable," said Assistant Secretary of Labor for Occupational Safety and Health David Michaels, MPH, Ph.D.
Preventing Falls in Older Americans A recent study by the Centers for Disease Control reports that the leading cause of death for older Americans is falls.
Read this article to better understand the injuries that result from falls, root causes of falling, and how to reverse the trend.
Most Readmissions After 7 Days Due to Factors Beyond Hospitals' Control, Study Finds The majority of hospital readmissions that occur after a patient has been out of the hospital for a week or longer are likely due to factors beyond the hospital's control, according to new research. Investigators with the University of California-Davis found a "rapid decay" in the quality levels of hospital-linked quality in patients after they had been out of the hospital for seven days. That drop in quality — and increased risk of readmission — could be linked to community or household factors that the hospital can't control, researchers noted.
Arbitration Lawsuit Against Government to Proceed Without LeadingAge LeadingAge will not be joining the American Health Care Association's lawsuit challenging the government's ban on pre-dispute arbitration, the group said in a statement issued Tuesday. The American Health Care Association's lawsuit, announced last week during the group's annual convention, argues that the Centers for Medicare & Medicaid Services' arbitration ban goes beyond the agency's authority and "will needlessly deprive both SNFs/NFs and their residents of the benefits of arbitration." The suit asks that the U.S. District Court for the Northern District of Mississippi to block enforcement of the ban before it takes effect on November 28.
LeadingAge Statement on CMS Ban on Pre-dispute Arbitration Agreements LeadingAge has consistently supported arbitration agreements that are fair and balanced and are not made a requirement of admission to a nursing home.
We oppose the action taken by CMS in the recently released Requirements of Participation to ban all pre-dispute arbitration agreements between nursing homes and their residents, and we are assessing our options to ensure that we are making the most effective use of our resources. In the meantime, we urge LeadingAge members to continue to seek alternatives to litigation when responding to any dispute with a resident.
Litigation to prevent implementation and ultimately rescind the rule has been initiated. LeadingAge staff and our legal committee have reviewed this litigation and support the argument that CMS has exceeded its authority in promoting this regulation. We have concluded that it is not appropriate at this time and stage of the proceedings for LeadingAge to be involved in a legal challenge to the rule.
Nevertheless, we will continue to actively monitor the circumstances and will take whatever actions we believe are in the best interests of our members as well as the residents and seniors they serve moving forward.
2016 Technology and Aging Summit
We encourage you to join us for the 2016 Technology and Aging Summit in collaboration with Georgia Tech Faculty, Students, Consumers, Aging Services Professionals, and Innovation Experts to use a design model to create technology solutions to meet identified needs of older Georgians.
This year, the Technology & Aging Summit (November 10th) will feature a keynote from Dr. Majd Alwan – Executive Director of the Center for Aging Services Technologies (CAST) as well as attendee participation in a design solution model with GA Tech staff and students, to address challenges elders are currently facing.
Click HERE for registration.
Hasbro Introduces Golden Pup Hasbro introduced the Golden Pup, the second product in its Joy For All brand, on Monday. The release follows the launching of the brand with three companion cats last November. The companion cats marked the toy company's first foray into products designed specifically for older adults. The brand was inspired by consumer feedback highlighting the appeal of certain toys and games for seniors, and the cats were developed with extensive consumer research with older adults and their caregivers, according to the company.