RIPPED FROM THE HEADLINES

Increasing Assisted Living Regulation is a Trend, NCAL Says

For the second year in a row, more than half of the states have changed their assisted living requirements, indicating a potential trend that the National Center for Assisted Living expects to continue, executives said Thursday in releasing the group’s annual “Assisted Living State Regulatory Review.”

Twenty-seven states updated their assisted living-related regulations, statutes and policies from June 2018 to June 2019, according to the latest report.

Since 2015, 84% of states have reported changes that affect assisted living, NCAL said, with 23 states making changes in 2015-2016, 17 doing so in 2016-2017 and 29 making changes in 2017-2018, according to previous “Assisted Living State Regulatory Review” reports.

“Changes each year can vary from big to small, but it is evident that state regulations are increasing in assisted living,” Lilly Hummel, NCAL’s senior policy director and the report’s author, said in a statement. “Each state is determining how to enhance assisted living for their specific resident population, and we anticipate this trend to continue.”

NCAL and other industry groups previously have expressed a desire that regulation of assisted living remain primarily at the state level. Read More...

Source: Lois Bowers / McKnight's Senior Living

Therapy’s PDPM Paradox: Clinicians Have More Control, But Smaller Rehab Staffs Needed for Now

The new Medicare payment model for nursing homes took effect this week with a bang, as therapists across the nation criticized a wave of staffing reductions in the immediate wake of the October 1 start date.

Several companies implemented workforce cuts as the federal government shifted to the Patient-Driven Payment Model (PDPM), which moves incentives away from the sheer volume of therapy and toward accurately capturing residents’ individual needs.

Publicly traded skilled nursing giant Genesis HealthCare (NYSE: GEN), for instance, cut about 5% of its overall rehabilitation staff, laying off 585 employees across its national footprint. Signature HealthCARE, meanwhile, negotiated a pay cut with its therapy staff in an attempt to save jobs and prevent changes to resident care, according to a spokesperson.

But those changes also belie another side of PDPM: Individual therapists and rehab teams have greater leeway to customize care for residents, without the pressure to meet certain minute-based thresholds.

“PDPM reinforces the importance of therapists using their clinical judgment when developing a patient-centered plan of care,” Guy Cowart, president of Consonus Healthcare’s rehab division, told SNN. “With therapists driving the appropriate amount of minutes for each patient, we look forward to gaining an even better understanding to the amount of treatment required to deliver exceptional outcomes.” Read More...

Source: Alex Spanko / Skilled Nursing News

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 REGULATORY

Avoiding the 6th Most Cited Deficiency - F689 Preventing Accidents

While this regulation is low on the number of facilities cited it is high on the scope and severity. Of the five deficiency statements selected this week for F689, four are cited at the scope and severity of an immediate jeopardy (IJ).

The primary way to avoid this tag is obvious - prevent an accident. To accomplish that goal, all staff in the facility must be “safety observers.” It means adopting a philosophy that safety is everyone’s concern. Staff should routinely be on the lookout for doors that are not secure, system failures, potential hazards, etc. For staff to know there is a system failure they need to know what systems are in place such as a system for entering/exiting the facility or a system to ensure residents on a secure unit do not leave the facility 

Avoiding this deficiency also means completing an assessment early in the admission process that quickly identifies a resident risks for falls, elopement, and more. Asking family members should be a routine part of a resident’s assessment.

When an adverse incident occurs it is still possible to avoid an immediate jeopardy tag. A thorough investigation answering five “whys” to determine how the adverse incident occurred, a remediation plan developed and implemented can help avoid being cited for F689.

I am available to review your investigation if you have an adverse incident.

Connie Cheren, RN, MSW, LeadingAge Florida's Clinical and Compliance Specialist, can be reached via email or phone at (678) 778-0561 to help answer questions before, during and after your surveys. As a value-added service provided by LeadingAge Florida, Connie can help nursing home and assisted living facility members improve regulatory compliance and clinical outcomes, in addition to offering suggestions about corrective plans of action to improve your surveys.

ADVOCACY

HB 1033 Rule Workshop Scheduled

On Monday, September 30, the Office of Insurance Regulation (OIR) filed its notice to develop the rules to implement HB 1033, the continuing care bill that was signed by Gov. DeSantis on June 27, 2019. A rule workshop has been scheduled for October 15 in Tallahassee, beginning at 9:30 a.m. at OIR, 116 Larson Building, 200 East Gaines Street, Tallahassee. To join by telephone, please call (850) 413-1558 and enter conference ID# 5490161.

There are several factors that will make for an interesting rulemaking proceeding. First, is the extensive number of changes to the statute. The bill amended 26 out of 47 sections in chapter 651, F.S., and created 6 new sections. Next, except for one rule, the Continuing Care Contract rule chapter, 69O-193, F.A.C., has not been amended since the rules were first adopted in 1993, more than 25 years ago. Last, over the past quarter century there has been a continuous narrowing of the authority given to state agencies to adopt rules. With all of these considerations, it is not surprising that the draft rule that OIR provided to LeadingAge Florida contains as many strike-throughs as it does new language. Further, many of the new sections of the draft rule reference new forms that have been developed to implement the new law so careful attention needs to be given to the forms provided with the draft proposed rules. The OIR’s draft of the proposed rule and form changes can be accessed here.

The LeadingAge Florida team will be participating in the rule workshop and will be working with you throughout the process.

For more information or any questions please contact Susan Langston, Vice President of Advocacy, at (850) 702-0318 or via email at slangston@leadingageflorida.org.

Assisted Living Modernization Bill Filed

This week saw the return of the assisted living “modernization” bill for the 2020 legislative session. Senator Gayle Harrell (R-Stuart) filed the bill, SB 402, on September 30, 2019. LeadingAge Florida provided assistance on language in the draft bill before it was finalized, and the final bill is very similar to the assisted living legislation supported by LeadingAge Florida last Session, with just a few changes. with just a few changes.

The bill proposes to update assisted living statutes to make the assisted living experience better for Florida’s seniors and to improve housing options for seniors who need to transition out of their own home, but are not frail enough to need the services of a nursing home. The bill makes it clear that assistive devices for ambulation and falls prevention may be used, and it allows for third party services to follow the senior from their private home to their assisted living home. For providers, the bill simplifies the medication examination admission form, adds needed clarity for various terms, and reduces burdensome reporting requirements that do not effect quality care.

For more information or any questions, please contact Susan Anderson, Director of Assisted Living Public Policy, at (850) 702-0306 or vial email at sanderson@leadingageflorida.org.

Governor’s Continuing Care Advisory Council Convenes for Annual Meeting

At this meeting, the Office of Insurance Regulation is required by law to present a summary and comparison of data on continuing care/life planned communities from information submitted by providers to OIR in the two most recent annual reports. Highlights from the presentation can be found here. Highlights include:

• 69 Certified providers in 2019, an additional 2 with a provisional certificate authority (PCOA)
• 1 CCRC in run-off, transitioning from CCRC contracts to rentals
• 3 acquisitions since 2017
• 4 COAs surrendered since 2017, three because of run-off completion and 1 due to minimal presales since the PCOA was issue
• 9 accredited CCRCs
• Greatest concentration of CCRCs are in Palm Beach County followed by Pinellas, Collier, Lee and Sarasota Counties
• Total number of residents increased slightly from 31,425 in 2017 to 31,549 in 2018
• Rental units decreased from 2,161 in 2017 to 1,834 in 2018
• Median occupancy for independent living decreased slightly from 90.1% in 2017 to 89.9% in 2018
• Median occupancy for assisted living increased from 76.6% in 2017 to 77.7% in 2018
• Median occupancy for skilled nursing increased from 83.4% in 2017 to 84% in 2018
• Facility median cash operating net income increased from $5,463,828 in 2017 to $6,328,378 in 2018 while facility median net income fell from ($4,795) to ($1,241,460) for the same years
• Entrance fees increased by an average of 3.78% from 2017 to 2018 while average monthly fees increased by an average of 2.69% and a 1.97% median increase from 2017 to 2018
• Six complaints were filed with the Division of Consumer Services, Department of Financial Services, over the past year. Three were refunds related; one related to a dispute over contract termination due to inappropriate resident behavior; and another related to the entrance fee amount which the residents alleged did not take into account their long-term care coverage

For those of you who are not familiar with the Advisory Council, it consist of 10 members: 3 residents, 3 providers, an individual with management experience, an attorney, an accountant, and a financial expert. When HB 1033 takes effect in January, the attorney slot will be replaced with a fourth resident.

Provider representatives on the Advisory Council include: Joel Anderson (CEO of Village on the Isle and LeadingAge Florida Chair), Troy Hart (President, SantaFe Senior living, Inc.), and Roger Stevens (CEO, Westminster Communities of Florida, Inc.)

SENIOR NEWS

Senior Living Town Hall in Boca Raton

Sinai Residences, in collaboration with LeadingAge Florida, Jewish Family Services, the Jewish Federation of South Palm Beach County and Life Care Services, hosted a Senior Living Town Hall with federal and state lawmakers to discuss important issues for older Floridians this week. Discussions were held on topics including affordable senior housing, nursing home Medicaid reimbursement, workforce crisis, and aging in place. Panelists included state and federal lawmakers including Congresswoman Lois Frankel, Congressman Ted Deutch, Sen. Lori Berman, Rep. Mike Caruso, Rep. Tina Polsky and legislative aides. Time was allotted for attendees to ask questions about the issues and spend time with their elected officials.

Florida Man Celebrates 93rd Birthday By Visiting Beach For The First Time

This was no average day at the beach. An Ellenton, Fla., man made a splash with his 93rd birthday request — to go to the beach for the first time.

Howard Fisher, who has lived in the Sunshine State for 20 years, had never managed to make it to the water.

“I guess he never went to the beach because he wasn’t motivated at the time!” Fisher’s daughter Sandra Fisher Van Nostrand told FOX 13. “By the time he decided to go, he is now 93 – and needed my help.”

On Sunday, Van Nostrand, who lives in Alabama, collected her dad and made a trip out to Anna Maria Island, where Fisher got a chance to enjoy the sun and surf — and enjoy he did.

“Look, I float just like a cork," he said, FOX13 reported. “Isn’t this great? Look at that sky and those clouds.”

In photos of the day Van Nostrand shared on her Facebook page, Fisher is seen smiling on the beach as he watches the water, and then when he finally goes out and takes a dip.

“My dad just celebrated his 93 birthday and this is what he said...Dad: ‘Sandra, isn't it ironic? I have lived here 20 years and never once went in the ocean....now I think I might like to but I can't’. Me: ‘Yes you can, dad. I will make sure of it.’ What an amazing day we had!... thank you AMI for the loaner beach wheelchair!” she wrote. Read More...

CMS

MDS 3.0 Technical Information

CMS announced the second revision to the initial release of the Patient-Driven Payment Model (PDPM) Grouper software. (The first revision was released within jRAVEN only.) Effective beginning October 1, 2019, the PDPM will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. This information should be shared with your EHR vendors. Please report any issues by contacting the PDPM Support team, using the following email address: PDPM@cms.hhs.gov.

A revision to the SNF - PDPM DLL Package (V1.0002 FINAL) is now posted and the previous version (V1.0000 FINAL) was removed. This version corrects a few bugs that were identified after the V1.0000 release and is available here.

Note that V1.0001 was only released within jRAVEN. jRAVEN will be updated shortly to contain V1.0002. The V.10002 package contains test files and documentation.

HOUSING

Virtual Policy Update

Tune in on Oct. 16 from 4-5 p.m. ET for our Virtual Policy Update featuring Tom Davis, Director, Office of Recapitalization at HUD, who will provide an overview of the new RAD for PRAC authority and what it means for the preservation of 202/PRAC communities.

This live presentation will be moderated by Linda Couch (LeadingAge) and is available to LeadingAge members only, will not be recorded and does not include CEs. To attend the Virtual Policy Update, click here.

Upcoming RAD for PRAC Training

In light of HUD releasing Revision 4 of the RAD notice, Recap Real Estate Advisors and The Gates Dunaway Group are hosting a RAD for PRAC Training in Atlanta Georgia on November 6 & 7th. The training will focus on the basics of RAD for PRAC and highlight key changes in HUD’s 4th Revision of the RAD Notice.

The Trainers for this Training are Gates Dunaway and Katie Buckner. Both of these ladies have a successful track record in the Public Housing Industry and have deep-dived into HUD’s 4th Revision of the RAD Notice.

Sign-up today to reserve your spot!

Early bird sign-ups are available now, through October 18! *Spots are limited per tier.

Prices are as follows:
Georgia PRAC Owner: $200 Per Person (Must own at least 1 GA PRAC Property to qualify for this Tier)
Non-Georgia PRAC Owner: $350 Per Person (Must own at least 1 PRAC Property to qualify for this Tier)
Non-PRAC Owners/Businesses: $450 per person

Sign-up with the links below! *You will be emailed an invoice once you sign-up.

Georgia PRAC Owner Sign-Up: https://forms.gle/ESbagGfY7jUH4f3j9

Non-Georgia PRAC Owner Sign-Up: https://forms.gle/BXGatUW8G4nt3wdG8

Non-PRAC Owners/Businesses: https://forms.gle/1U8dUgFBLMiS5Xdn6


Please feel free to reach out to radforprac@recapadvisors.com if you have any questions or concerns.

MEMBERSHIP DATA FORMS

Electronic Membership Data Forms are Due Today

Each year, LeadingAge Florida asks our member communities to provide updated annual revenue amounts from their organizations, and that data is used to calculate annual membership dues. Historically, the process has required our members to fill out pages of paper forms, often duplicating data that is already on file at LeadingAge Florida. Last year, LeadingAge Florida launched an online form you can use to report your annual revenue totals. The process should take only a few minutes to complete, and will:

• Simplify the process for you
• Eliminate needless duplication, and
• Eliminate the need to fill out paper forms

Our goal is to make the data collection and dues calculation process as easy as possible for our members.

Email messages with instructions on how to upload your information were distributed to each member community’s leader last week. Your updated information is due today. Beginning next week we will reach out to those communities who have not yet responded.

If you have questions or need assistance, please contact Dawn Jiménez at (850) 671-3700 or by email djimenez@LeadingAgeFlorida.org.

SENIOR DINING ASSOCIATION

SDA One-Day Experience

The Senior Dining Association (SDA) is hosting the SDA One Day experience on October 24, 2019, at the Edgewater at Boca Pointe in Boca Raton, an Acts Retirement Community. The One Day Experience offers a wide range of learning opportunities as well as a chance to network with committed professionals in your local area. The event provides an unmatched opportunity to pick up essential skills and remind yourself why you’re passionate about senior dining.

Leading experts in the senior dining space will be on hand to present recent trends and best practices, while SDA chats give you the opportunity to ask questions and share your experience. Registration is for senior living industry professionals only. All other operators are encouraged to attend.

Event Page: https://seniordining.org/sda-one-day
Registration Page: https://seniordining.wildapricot.org/event-3480901
Registration Code: LEADINGAGEFL2019

Please join us in welcoming our new business members and be sure to visit their website to learn more about the services they offer to senior living providers.

• Rapid Response Team - We are property restoration specialists who arrive in a hurry. 24/7 emergency service. Strategically-located for less than 1-hour response anywhere in Florida. Skilled craftsmen deployed with a hyper sense of urgency. We bring tools, materials, craftsmanship and empathy. And we bring it fast. Crisis mode is our normal mode. Disasters happen, we get there fast and make it right.
  
  
  
• Procyon Institutional Partners - We help Plan Sponsors effectively manage their retirement plans by embracing a best practices approach that focuses on fiduciary governance, prudent investment consulting, optimal plan design, regular fee evaluation and participant education/engagement.

The goal at LeadingAge Florida is to deliver the highest quality of service to our members. We strive to increase the value of, and return on, investment of your community's membership. As such, LeadingAge Florida works to connect our business members with your communities and facilities to help you secure the best possible services for your residents and benefits for your staffs.

If you have any questions or if you know of a business that we should contact, please let Business Development Manager Julie Copeland know by calling her at (850) 702-0317.

VALUE FIRST

Through our partnership with Vizient (formerly MedAssets), and an expanding portfolio of nearly 500 vendors, Value First helps you save money in all four purchasing categories – Medical, Food, Environmental/Janitorial/Sanitation, and Office Supplies and Capital Equipment.

Our program works in concert with your purchasing, finance and leadership teams to analyze current expenses and provide a price comparison on exactly how much you can save. Additionally, we can assist you with obtaining capital equipment quotes. You provide the project specifications, and we will work to get the best possible prices available. You receive ALL of this, at NO FEE TO YOU. Consider Value First to be an extension of your staff. Currently, there are approximately 500 communities enrolled in the Value First program in Region 8. We have had some successful cost studies recently in food and medical so please take advantage of this service.

I look forward to speaking with you and visiting your community. As a bonus to our members, please click on the “The BIG SAVINGS “graphic on the right, all employee’s full-time or part-time are eligible to accesses these employee savings by just registering their name. No fee, no commitment on the part of the community. All this for being a LeadingAge Florida Value First member.

This month, don't miss out on a group special from Direct Supply! Click here for more information. In addition to Direct Supply, Sherwin Williams Group will have a buy special for September and October. Click here for more information. 

For those attending LeadingAge National Annual Conference in San Diego, please stop by the Value First booth #2923 , hope to see you there.

Each LeadingLink newsletter has the latest Value First/Vizient-Provista Vendor Catalog. Check it out and get started with savings today. If you have any questions please email or give me a call.

See you on the road!

Robert "Bobby" Bernal, Value First Regional Southeast Manager

O: (850) 671-3700 | C: (850) 509-8112 | Email

COMING ATTRACTIONS

OCTOBER

LeadingAge Florida's State Night Reception on the USS Midway!

10/28/2019 | 6:30 - 8:00 PT
USS Midway Museum | San Diego, CA
In conjunction with LeadingAge's Annual Meeting
Click here for more information | Click here to register as a sponsor

NOVEMBER

Skilled Nursing Supportive Documentation for PDPM Webinar
11/6/2019 @ 2:00 PM EST
This webinar will focus on skilled nursing documentation requirements and best practices as it relates to the new Medicare payment model- PDPM. The webinar will include review of skilled level of care criteria with an emphasis on skilled nursing services and documentation to support the skilled stay.

DECEMBER

MDS Coding Precision & PDPM Audit Processes Webinar
12/4/2019 @ 2:00 PM EST
This webinar will focus on MDS coding accuracy and review processes to ensure appropriate reporting of information and supportive documentation under the new Medicare payment model- PDPM. The webinar will include review of steps for assessment and coding tips for certain MDS items with an emphasis on supporting coding decisions through documentation and auditing data prior to assessment submission.