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 The Alverno and Klein Center set the Iowa standard for Quality First
Congratulations to the Alverno Health Care Facility in Clinton and the Great River Medical Center – Klein Center in Burlington, for being recognized as the first two IHCA Quality First 5-Star Award recipients in Iowa. Their accomplishment was announced at an awards ceremony at the IHCA state convention of long term care providers on September 28, 2005 in Des Moines.
 The award signifies the facility’s commitment to a continuous quality improvement process. “IHCA’s Quality First 5-Star Award is the highest recognition of quality within Iowa’s long term care profession,” said Steve Ackerson, IHCA Executive Director. “This achievement by the Alverno and Klein Center demonstrates that their mission of exceptional care for the elderly is embraced and relentlessly pursued.”
Quality First is a nationwide initiative to develop and measure quality care in long term care facilities and programs. The initiative calls for facilities to adopt a people-centered approach to daily routines and activities, putting people first whether it is facility residents, families, staff, volunteers, vendors, the general public, or the greater community. Iowa Health Care Association member long term care facilities that achieve the set Quality First criteria receive the IHCA Quality First 5-Star Award.
As recipients of the Quality First 5-Star Award, both have met the criteria, demonstrating their commitment to achieving excellence in the quality of care and services and quality of life for their residents. “In today’s environment, the long term care profession is being asked to lead the way in defining new standards of quality and in holding ourselves accountable to higher, public standards of quality,” said Baddeloo. As a Quality First 5-Star facility, these IHCA members have proven their readiness and commitment to show the public—by demonstrated quality results—that the needs of their residents and families are important, above all else, Baddeloo added.
All IHCA and ICAL members who have taken the Quality First pledge are eligible to earn the 5-Star Award. To learn more about Quality First and the 5-Star Award criteria go to www.iowahealthcare.org, Members Only, Quality First, or contact Cindy Baddeloo at cbaddeloo@iowahealthcare.org.
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Congratulations to the 2005 Excellence in LTC award recipients
The IHCA•ICAL Excellence in Long Term Care Awards presents a special opportunity for our members to recognize outstanding individuals at their facilities. Just being nominated speaks volumes about an employee’s contributions and commitment to their long term care facility and the respect they’ve earned from administration, coworkers and residents.
This year, a total of 28 nominations were received in 11 categories. But, unfortunately, not everyone worthy of a nomination can take home the award. The 2005 IHCA•ICAL Excellence in Long Term Care Award winners were recognized at the IHCA•ICAL annual convention on September 28.
Administrator of the Year - Pat Zaugg, West Bend Care Center and Rolfe Care Center
Assisted Living Director of the Year - Judith Roddy, Park Place Estates, LeMars
Director of Nursing of the Year - Julie Fedders, Good Samaritan Village of LeMars
Nurse - Norma Jaeger, Chautauqua Guest Home #3, Charles City
Nurse Assistant - Virginia Shively, Keystone Nursing Care Center
Universal Caregiver - Shelley Schuver, Landsmeer Ridge Retirement Community, Orange City
Social Services - Bonnie Ward, Garden View Care Center, Shenandoah
Dietary Services - Michelle Arnold, Great River Medical Center - Klein Center, Burlington
Environmental Service - Jim Phillips, The Alverno Health Care Facility, Clinton
Activity Services - Linda Stein, Red Oak Good Samaritan Center
Administrative Services - Sandra Splinter, Heritage Manor, Dubuque
Front: Sandra Splinter, Linda Stein, Virginia Shively, Norma Jaeger, Judith Roddy.
Back: Michelle Arnold, Bonnie Ward, Julie Fedders, Jim Phillips, Pat Zaugg.
Not pictured: Shelley Schuver
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IHCA member completes AHCA leadership development program
IHCA First Vice President, Doug Johnson, has successfully completed the “Future Leaders of Long Term Care in America,” a new training and professional development program operated by the American Health Care Association (AHCA) and National Center For Assisted Living (NCAL). The program's goal is to identify and develop new leaders in the long term care community and AHCA/NCAL. Twenty AHCA/NCAL members from across the country participated in the program.
The year-long training curriculum covers the latest theories in quality management, customer satisfaction and leadership. Having completed the future leaders program, Johnson is positioned to accept a vital role in advancing IHCA's mission of providing the highest quality, resident-centered care to America’s frail, elderly, and disabled.
Johnson is the Director of Operations of Hawkeye Care Centers, Inc., which owns and operates seven facilities in Iowa.
The Future Leaders program is part of the Quality First initiative, a covenant for healthy, affordable and ethical long term care. Quality First promotes uniform, publicly articulated and measurable performance goals with the overarching purpose to achieve excellence in the quality of care and publicly report results to strengthen the confidence of the public.
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Attend an IHCA ICAL Legislative Forum near you!
Our members are the most important element at the IHCA•ICAL Fall Legislative Forums. Your attendance at Forums sends strong message to your legislators about the impact their decisions have on the people who live in your care and your ability to provide the highest in quality care.
 At the forums long term care takes the spotlight and we discuss with Iowa legislators what we need them to know about long term care in our state. They want to hear from people working directly in the long term care profession: administrators, nurses, CNAs, RAC members and family members. They want to know what obstacles you and your residents face daily and find ways they can help ease these concerns through decisions they make in funding and regulations. Our profession’s concerns mean much more to them when they can put a face with the concern.
That’s why your attendance and participation at the IHCA Legislative Forums is so important. When legislators hear from YOU, they learn that the concerns our lobbyist Susan Cameron discusses with them are, indeed, the concerns shared by their constituents (you, your employees, residents and families).
Who should attend? All administrators and DONs should attend and bring with them other employees, RAC committee members, board members, family members and anyone else who can share their experience and concerns with legislators.
Not sure what to say? The IHCA staff will do a presentation that outlines our concerns to the legislators in attendance. You can touch on any topics that are of a particular concern to you. To help, we've compiled a list of talking points for you to consider. They are available at http://www.iowahealthcare.org/userdocs/2005_Forum_Talking_Points.pdf.
The forums begin October 31 and run through December 5. For a complete schedule, go to www.iowahealthcare.org, Calendar. No registration is necessary to attend. If you have questions, please call Cindy Haverkamp, IHCA Deputy Director at 800-422-3106.
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IME letter clarifies ambulance services and supplies
The Department of Human Services, in Informational Letter No. 474, approves ambulance services and supplies that are reasonable and medically necessary, subject to exclusions and limitations set forth in the provider manual and Iowa Administrative Code (rules). Medical Services reviews ambulance claims as needed to establish medical necessity.
The Iowa Medicaid Enterprise has implemented a provision to approve ambulance services effective July 1, 2005 based on clinical conditions and their associated ICD-9-CM codes. Some of the conditions include but not limited to:
- Diabetic coma
- Hypoglycemic coma
- Respiratory arrest
- Drowning
- Coma
- Hypothermia
These conditions are consistent with Medicare guidelines and are in addition to those outlined in the Provider Manual, Chapter E-3, Coverage and Limitations. As always documentation must support the codes billed. Claims submitted using appropriate codes will not necessarily need supporting documentation to accompany the claim. However, all claims are subject to post-pay review and any unsubstantiated claim payments will be recovered.
For any claim where the emergent nature of the transport cannot be demonstrated by diagnosis code, to expedite the payment of your claim, the ambulance run report and Emergency Department record should be submitted as supporting documentation.
If you would like assistance with the development of electronic billing, please contact Provider Services at the Iowa Medicaid Enterprise. For questions regarding this release, please contact Provider Services at 800-338-7909 or locally at 515-725-1004.
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DEA's Train the Trainer: Mandatory Reporters of Dependent Adult Abuse
The Department of Elder Affairs will hold Train the Trainer Certification sessions at several sites across the state in November. The session certifies trainers who use the Iowa Department of Elder Affairs Trainer’s Guide for Mandatory Reporters of Dependent Adult Abuse, Approval #19. This certification is valid for three years.
The brochure with cost, dates, times, locations can be found at www.iowahealthcare.org, Members Only, What's New. Registrations must be received 7 days prior to the training date. Any session that does not have at least 15 people registered, will be cancelled. Trainer Certification is not mandatory, however it is anticipated such administrative rules will be in place by Spring, 2006. The next opportunity to participate in a Train the Trainer Certification will be Spring/Summer 2006.
A Train the Trainer Certification workshop will also be held in Des Moines in conjunction with the Elder Rights Conference, November 7 & 8. To view the registration brochure, please visit www.state.ia.us\elderaffairs.
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CMS’ Final Nutrition/Hydration Rule upheld in court
In September the U.S. District Court for the Western District of Washington, Seattle, Washington, upheld the use of trained feeding and hydration assistants in nursing homes. The decision represents both a victory for an improved quality of life for nursing home residents, as well as for the long term care profession's ability to sustain care quality improvements in the nation's long term care facilities.
The key issue in this case is whether or not CMS’ final nutrition/hydration rule violates the Nursing Home Reform Act (OBRA’87) and the Administrative Procedure Act (APA), and subsequently, whether or not CMS’ final nutrition/hydration rule should be revoked. In July 2004, the complaining parties, a group of nursing home residents and their advocates, filed this class action lawsuit alleging that CMS’ final nutrition/hydration rule, which allows nursing homes to employ semi-skilled workers meeting state and federal requirements to feed and hydrate residents without complicated eating problems, is not only a violation of federal laws, but reduces the quality of care in nursing facilities and places residents at risk to injury and harm. AHCA anticipates that the plaintiffs will appeal this matter to the U.S. Court of Appeals for the 9th Circuit.
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CMS emphasizes nurse aide registry requirement
The Centers for Medicare and Medicaid Services (CMS) issued a program directive letter dated September 22, 2005 to all State Survey Agency Directors emphasizing the regulatory requirements for checking the nurse aide registry.
The directive, S&C-05-46, states "Nursing homes have the responsibility to employ qualified nurse aides who are properly trained, appropriately tested and have no adverse findings against them of abuse, neglect or misappropriation of property. The purpose of this memorandum is to remind nursing homes of the responsibilities related to screening potential hires, including the responsibility to check the nurse aide registry."
Nursing homes are required to check the nurse aide registry. Current Federal regulations prohibit nursing homes from employing individuals who have been found guilty of abusing, neglecting or mistreating residents by a court of law or have had a finding entered into the State nurse aide registry concerning resident abuse, neglect or misappropriation of property. In addition, nursing homes must check the nurse aide registries of other States that the potential employer believes might contain information about an individual. The regulations require that before allowing an individual to serve as a nurse aide, a facility must seek information from every State registry, established under sections 1819(e)(2)(A) or 1919(e)(2)(A) of the Social Security Act, the facility believes will include information on the individual.
This memorandum asks all State Survey Agencies (SAs) to remind all Medicare and Medicaid participating nursing homes in the State of the Federal requirements related to screening potential employees and checking with all appropriate nurse aide registries.
The directive also contains a reminder to nursing homes that Federal regulations allow individuals enrolled in an approved nurse aide training and competency evaluation program to work up to four months, performing only those skills for which their trainer has determined proficiency, before successfully passing their nurse aide competency evaluation examination and being included on the nurse aide registry.
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NCAL offers guide for Medicare Part D in AL/RCF settings
NCAL has compiled an overview of the new Medicare Part D Prescription Drug coverage as it applies to assisted living and residential care facility members. To access the guide, go to http://www.ahca.org/members/assisted/partd050928.htm.
As you know, the federal government has begun a massive effort to educate Medicare beneficiaries about the complex new Medicare drug benefit, which takes effect Jan. 1, 2006. Also known as Medicare Part D, the drug benefit will help many residents of assisted living/residential care (AL/RC) facilities and transform the way medications are delivered in these facilities. Although the initial enrollment period does not begin until Nov. 15, residents should begin preparing themselves now to make a series of decisions about whether the Medicare drug benefit is right for them, which drug plan to choose, and when to sign up.
We encourage you to review the information in NCAL guide, Medicare's New Drug Benefit: Key Dates for Assisted Living/Residential Care Residents and assist your tenants with the process of choosing the right drug plan for their needs.
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HHS releases report on AL/RCF policy
The U.S. Department of Health and Human Services released, “State Residential Care and Assisted Living Policy: 2004,” describing and analyzing state policies concerning assisted living/residential care. The report summarizes state regulations and Medicaid policies affecting assisted living and residential care. Copies are available online at http://aspe.hhs.gov/daltcp/reports/04alcom.htm.
In 2004, states reported a total of 36,451 state-licensed residential care facilities with a total of 937,601 units/beds, according to the researchers. From a national perspective, the number of facilities and units grew more slowly between 2002 and 2004 than in the previous four years.
 Twenty-eight states revised their regulations in 2003 and 2004. Regulatory changes included: staffing requirements, direct care and administrative training requirements, criminal background checks, admission and retention criteria, disclosure rules, and resident agreements. Twenty-nine states and the District of Columbia had some regulations concerning assisted living philosophical concepts--such as those promoting residents’ privacy, autonomy, and decision making--in their residential care or Medicaid standards.
The number of Medicaid recipients living in residential care settings continued to rise, growing from 102,000 in 2002 to 121,000 in 2004 (and spread across 41 states). The report provides a great deal of information about the complexities and challenges of providing Medicaid coverage in residential care/assisted living settings.
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NCAL announces election results
On October 3, the NCAL State Leaders and Board of Directors unanimously elected the organization’s national officers. The new officers are:
Chair: Van Moore, Westcare Management, Salem, Ore.
Vice Chair: Marj Shell, Fall Creek Retirement Village, Pendleton, Ind.
Secretary: Howie Groff, Tealwood Care Centers, Bloomington, Minn.
Treasurer: Nicolette Merino, Chelsea Senior Living, Summit, NJ.
Immediate Past Chair: Bob Van Dyk of Van Dyk Health Care, Ridgewood, N.J., will replace Jan Thayer as immediate past chair.
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Help for Hurricane Katrina victims
People with Mental Retardation and Developmental Disabilities (MR/DD) are especially vulnerable during a natural disaster. According to The Arc, Louisiana has no central registry of people with mental retardation or developmental disabilities served by MR/DD intermediate care facilities (ICFs), group homes and assisted living apartments. Many of these homes were totally destroyed in the storm and residents are scattered across the country.
Additional information specific to the MR/DD community include:
- Before the hurricane, the State of Louisiana was advising that people with special needs evacuate to the Super Dome.
- Many group homes had emergency plans in place, although there is no information on whether these were followed.
- The fate of people with only informal supports (e.g. living with family, assisted by neighbors, etc.) may never be known, especially as these informal support givers have been scattered across the country.
- Regarding specific state ICFs/MRDD: Metropolitan Developmental Center was evacuated and residents went to Hammond Developmental Center. The Metropolitan Center was not damaged, but it is currently being occupied by the National Guard. Pinecrest Developmental Center was not affected.
- The New Orleans, Shreveport, Baton Rouge, and Lake Charles Independent Living Centers are assisting evacuees. The Independent Living Center in Biloxi, Mississippi was completely destroyed.
The Arc requests that those who can provide assistance post an announcement on its “Katrina Special Needs Assistance Page” which case managers and state officials are monitoring and responding to as needed. To post a listing go to http://www.thearclink.org/, click on "Katrina Special Needs Relief," click on "Katrina Special Needs Assistance Page" at the bottom of the screen, and click on “Post A Listing.” Registration is required to post an ad but it is free of charge. The listings on the Assistance page are for every Katrina survivor with special needs, regardless of where they are presently located. Resources may also be posted at https://www | | |
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Links
Our hats are off to Creston Nursing and Rehabilitation Center in Creston which will be recognized at the AHCA/NCAL National Convention as a Step I Quality Award recipient. By completing the Step I criteria, Creston Nursing and Rehabilitation Center has demonstrated a strong commitment to a systematic process for continuous quality improvement. 
Congressmen Henry Waxman (D-CA) and Sherrod Brown (D-OH) of the House Energy and Commerce Committee to look into asset transfers by individuals for purposes of gaining Medicaid eligibility. Because the GAO only looked at cash transfers - not transfers of property or other assets - they did not find significant evidence to support the claim that individuals transfer assets to become eligible for Medicaid long term care. 
On September 16, 2005, CMS announced that the monthly Medicare Part B premium will increase from $78.20 to $88.50 in 2006, a 13 percent increase, according to CMS. The Part B deductible will increase from $110 to $124. The Part A deductible will increase from $912 to $952. The premium increases are in line with what CMS actuaries have been predicting since earlier this year. The CMS announcement, a CMS Fact Sheet, and a CMS analysis of the 2006 Part B Premium rate are available at: 
The Iowa Foundation for Medical Care hosts a bi-monthly conference call for nursing home medical directors. The next call is scheduled for Tuesday, November 1, 5:00-6:00 p.m. The topic will be Home Health Care in Iowa, with discussion leader Ben Collins, D.O.