1 continued on page 7 MAR 8 2011 LEADER LTC Assessing Staff Satisfaction Betty Frandsen, RN, NHA, MHA, C-NE Caregivers have difficult jobs, and learning what they think and need, and seeking their input into improvement efforts in the nursing home are important components of assuring that quality care is given to residents. For this reason the Advancing Excellence in America’s Nursing Homes Campaign has selected Assessing Staff Satisfaction with the Work Environment to Inform Quality Improvement Activities as Goal 8 in their program designed to promote quality of life for residents and quality of work life for employees. continued on page 6 Aging seems to be the only available way to live a long life. —DANIEL FRANCOIS ESPRIT AUBER WWW. AANAC .ORG Section M—Staging Ulcers “Present/Not Present on Admission” Carol Maher, RN-BC, RAC- CT Staging pressure ulcers for MDS coding should begin as soon as the resident enters the facility. The MDS asks whether pressure ulcers coded on each MDS were “present on admission.” In order to code this, each admitting nurse must be able to identify and accurately stage pressure ulcers during the admission process. Staging ulcers should not be left to the expertise of wound/treatment nurses. Ulcers can deteriorate and look very different between admission and the day the treatment nurse is available to examine the resident. When staging an ulcer, the nurse must consider both the ulcer’s appearance at the time of examination and its historical stage. A Stage 3 ulcer may improve to have the appearance of a Stage 2, but the ulcer continues to be coded Stage 3 until it heals. Coding “present on admission” can be complicated. An ulcer identified on a newly admitted resident is coded “present on admission” on the Admission assessment. If that ulcer does not deteriorate (change to a worse stage) it will continue to be coded “present on admission” on each MDS until it heals. However, if that resident is admitted to the hospital before the ulcer heals and returns to the facility with the ulcer at the same stage as coded on the Discharge assessment, that ulcer is now coded “NOT present on admission.” CMS counts each resident’s ulcers behind the scenes. If that ulcer were coded “present on admission” it would appear that the resident had developed a second ulcer. However, if the resident’s ulcer deteriorated while in the hospital, upon readmission the pressure ulcer at the new, worsened stage is coded “present on admission.” Staging ulcers should not be left to the expertise of wound/treatment nurses.
Caregivers have difficult jobs and learning what they think and need and seeking their input into improvement efforts in the nursing home are important components of assuring that quality care is given to residents For this reason the Advancing Excellence in Americarsquos Nursing Homes Campaign has selected Assessing Staff Satisfaction with the Work Environment to Inform Quality Improvement Activities as Goal 8 in their program designed to promote quality of life for residents and quality of work life for employees
continued on page 6
Aging seems to be the only available way to live a long life
mdash D a n i e L F r a n C o i s e s p r i T a u b e r
w w w a a n a C o R g
Section MmdashStaging Ulcers ldquoPresentNot Present on AdmissionrdquoCarol Maher rn-bc rac-ct
Staging pressure ulcers for MDS coding should begin as soon as the resident enters the facility The MDS asks whether pressure ulcers coded on each MDS were ldquopresent on admissionrdquo In order to code this each admitting nurse must be able to identify and accurately stage pressure ulcers during the admission process Staging ulcers should not be left to the expertise of woundtreatment nurses Ulcers can deteriorate and look very different between admission and the day the treatment nurse is available to examine the resident When staging an ulcer the nurse must consider both the ulcerrsquos appearance at the time of examination and its historical stage A Stage 3 ulcer may improve to have the appearance of a Stage 2 but the ulcer continues to be coded Stage 3 until it heals
Coding ldquopresent on admissionrdquo can be complicated An ulcer identified on a newly admitted resident is coded ldquopresent on admissionrdquo on the Admission assessment If that ulcer does not deteriorate (change to a worse stage) it will continue to be coded ldquopresent on admissionrdquo on each MDS until it heals However if that resident is admitted to the hospital before the ulcer heals and returns to the facility with the ulcer at the same stage as coded on the Discharge assessment that ulcer is now coded ldquoNOT present on admissionrdquo CMS counts each residentrsquos ulcers behind the scenes If that ulcer were coded
ldquopresent on admissionrdquo it would appear that the resident had developed a second ulcer However if the residentrsquos ulcer deteriorated while in the hospital upon readmission the pressure ulcer at the new worsened stage is coded ldquopresent on admissionrdquo
Staging ulcers should not be left to the expertise of woundtreatment nurses
A ANAC LTC LE ADER 3 8 20112
Dear AANAC Members
On behalf of the Board of Directors I want to thank everyone who participated in our nominating
process Our nominees represent the best and brightest in terms of knowledge skills and commitment
to the issues that affect long-term care Because the candidates were so well qualified selecting
among them was a daunting task The Nominating Committee reviewed every one who was
nominated to identify those with the knowledge experience and skills to fill a Board position After
this initial screen candidates were interviewed and evaluated according to the criteria set by the
Board to strengthen the Board of Directors As a result of these deliberations the top nominees were
recommended by the Nominating Committee to the Board of Directors for approval The Board of
Directors is pleased to announce the following slate of candidates for your consideration
Following your review of the slate if no alternative candidates are put forth through a petition process
these candidates will be approved and seated on July 1 2011 If you wish to nominate an alternate
candidate by petition the process is as follows you may nominate a candidate by petition of 25 of the
membership (312 members) Should you wish to engage in this process the petition must be submitted
by May 3 2011 If you have questions do not hesitate to contact me at csiemaanacorg
Part Three in a Three-Part SeriesInterview With a Purveyor
Several physicians associated with hospices referred me to Alex Madans as a responsible supplier of medical marijuana (MMJ) He began offering MMJ in 1993 when it became legal in California where he then lived He personally has used MMJ for chronic back pain for decades and often smokes with his clients as he introduces them to it which he comments lessens their anxiety
Most of his clients have chronic pain of various etiologies for example neuropathic pain from diabetes For clients with cancer he suggests regular small preventive doses that inhibit the onset of pain ldquoinstead of waiting for bad pain or nauseardquo Doctors use FDA-approved pain medication similarly He
also has found it enhances appetite in HIV and cancer patients His clients have been referred by both friends and professionals such as hospice and palliative care doctors
When clients begin there are many choices Some cannabis varieties appear to be suited to particular problems Each variety also has its own odor which is
similar in both the unburned state and as smoke This means that clients can choose prior to smoking whichever strain smells appealing as a ldquostarterrdquo He advocates smoking rather than vapor or oral intake because he feels itrsquos more controlled (Note that tinctures and vaporizers avoid the ldquono smokingrdquo rules of institutions but do not solve the problem of federal prohibition) ldquoYou stop when yoursquove had enoughrdquo he said contrary to oral intake which may turn out to be excessive once swallowed He starts with the smallest ldquodoserdquo and works up For ingestion material must be bonded to fat (he uses butter) or alcohol to become usable
The smoking apparatus has its own mystique which I suspect may enhance the experience I saw several types of water pipes (bongs) of beautifully blown glass some with sinuous decorative overlays and long-stemmed narrow-bowled pipes reminiscent of colonial
America I also saw a vaporizer and various metal tools one used to shake the resin free from the plant and one with cutters that shred the leaves and buds to usable size
When Alex visits a client he likes to consult with the entire family so they understand the procedure It also
encourages sociability and enhances mood However there are limits He related an experience with a hospice patient where outdoor smoking was permitted When her entire family joined her and passed around the
ldquojointrdquo the facility had to call a rapid halt to that practice
He had a poor result with a client who insisted upon a specific regimen for smoking as if it were a tablet prescribed by a doctor specifying so many puffs at so many hourly intervals ldquoIt really
MEDicAL MARijuAnA in Long-TERM cARE
Dr Fredrick R Abrams md
Some cannabis varieties appear to be suited to particular problems Each variety also has its own odor which is similar in both the unburned state and as smoke
continued on page 4
4 A ANAC LTC LE ADER 3 8 2011
doesnrsquot work that wayrdquo he said Rather he likens it to appraising a flower shop potpourri How does the unburned smell make you feel ldquoCannabis has a lsquobouquetrsquo and different folks like different scentsrdquo he noted ldquobecause some people like roses and some like liliesrdquo
Finally he pointed out that doctors may not prescribe MMJmdashonly recommend itmdashbut he keeps careful records of the recommendations as a de facto prescription
Interview With an Academic Physician
Mark SWallace MD Board certified in anesthesiology and pain medicine is the chair of the Division of Pain Medicine Department of Anesthesiology at the University of CaliforniamdashSan Diego He is involved in clinical care teaching and research including ongoing clinical trials for pain managementmdashacute chronic and cancer related He pointed out that there are over 400 compounds in cannabis so research has a long way to go but he feels it has great potential noting especially that its toxicity level is minimal compared with all the approved pain relievers on the market One significant difference between MMJ and opioids is that withdrawal of the
latter at higher doses needs a significant detoxification process MMJ cessation results in less of a withdrawal syndrome Also noteworthy is the presence of cannabinoid receptors naturally present throughout the body
(I found an FDA compilation on the site wwwProConorg that noted drug reports by doctors from 1997 to 2005 comparing adverse events from 17 FDA-approved drugs with those from cannabis The
total deaths reported from FDA-approved drugs was 10008 from cannabis zero)
Regarding the synthetic cannabinoid oral THC (Marinol Dronabinol) Dr Wallace noted that absorption is quite variable between patients Blood-level tests have shown that between 1 and 25 is absorbed In patients with pain secondary to spinal column degeneration effective doses varied from 5 to 60 mg daily for relief of pain and better sleep was characteristic at either dose
Research continues on neuropathic pain (diabetics HIV) and routes vary from
vaporizers transdermal sublingual spray and oral for the elements that have been isolated
In general he feels that as research continues and elements are defined there is great potential for the cannabinoids in pain management with fewer side effects than many drugs currently available Overdose is a hazard with the latter and appears to be unheard of with cannabis
Risks for Long-Term Care Facilities
The threshold question is ultimately one of risk acceptanceaversion Almost all long-term care facilities are funded in large part by Medicare or Medicaid programs They are federally contracted programs Medicaid is state and federal Openly permitting the use of marijuana even when approved under state law is hazardous I have found no long-term care facilities where it is permitted
Policies and ProceduresFacility administrators who wish to take the risk (as well as those who donrsquot if MMJ someday becomes legal by federal ruling) need policies and procedures in place Attorney Fred Miles using Colorado as an example suggests that at minimum these include the following (These may vary among states Under Colorado law a cannabis purveyor is a ldquocaregiverrdquo)
bull There should be residentrsquos ldquoproofrdquo of registration (confidential registry waiver may be required)
bull Until there is further clarification by federal agencies storage should be avoided The facility may not dispense the drug
bull There should be proof of identity of and relationship with primary caregiver
Almost all long-term care facilities are funded in large part by Medicare or Medicaid programshellip Openly permitting the use of marijuana even when approved under state law is hazardous
Medical Marijuana continued from page 3
continued on page 5
5 A ANAC LTC LE ADER 3 8 2011
There should be a right to approve caregiver access to facility
bull Users must abide by facility rules on MMJ use
bull There should be check-in procedures when primary caregiver brings resident MMJ
bull Under state laws only the patient or the caregiver may possess and only the patient may use MMJ
bull No employee may act as a primary caregiver to residents of the facility No employee may deliver the MMJ to the resident (state laws prevent possession by anyone other than caregiver or patient)
bull If an employee acts as caregiver legally heshe may be considered an agent of the facility (and in most states would be acting illegally)
Patientbull must apply for and be approved for
inclusion on confidential registry
bull must have registration ID on hisher person and
bull may only have one primary caregiver at a time
Primary Caregiverbull must be registered
bull may only manage a restricted number of patients (eg one in Arkansas Rhode Island Washington five in Colorado Maine Minnesota some states do not specify)
bull if in California may be the owneroperator of health care facility who may also designate three employees as caregivers and
bull if in Maine may be a hospice or nursing facility
General Issues to Considerbull Should MMJ only be used in an
edible form
bull Smoking may be a problem even if it occurs outdoors (many states restrict where MMJ may be consumed)
bull Use may be limited to residentrsquos room what about roommatersquos rights
bull Storage issues locked container limited to legally allowed quantity
access to storage by facility administration Again storage on premises is certainly ill-advised Currently state law provides little guidance
Conclusions
After spending weeks reading numerous articles (technical and otherwise) and speaking to patients physicians nurses counselors and lawyers I am reminded of the blind men and the elephant
It was six men of Hindustan to learning much inclined
Who went to see the elephant (though all of them were blind)
That each by observation might satisfy his mindhellip
And so these men of Hindustan disputed loud and long
Each in his own opinion exceeding stiff and strong
Though each was partly in the right and all were in the wrong
We need more extensive research to take the blinders off the elephant examiners to isolate the multiple components of cannabis and to understand their synergies At this time in the unfolding history of cannabis we are left primarily
with the subjective observations of individual long-term care patients who try it under medical supervision Smoking as a mode of dosing may become unnecessary with vaporizers and sublingual transdermal and oral ingestion of new isolates
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful Due to their advanced years andor pathologies the shorter time exposure of long-term care patients to deleterious elements may diminish bad effectsmdasheffects that are primarily attributed to decades of use in much younger persons
The evolution of cannabis may come to be comparable historically (not pharmacologically) to that of cocaine Initially those who abused it ruined their health However research gave us the
-caines (benzo- xylo- nova- and many others) that made tooth extraction and surgery pain free Similarly current needs call for continued properly controlled research and evaluation for cannabis just like any other experimental drug to distinguish adverse from potentially valuable characteristics
Medical Marijuana continued from page 4
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful
6 A ANAC LTC LE ADER 3 8 2011
is compendium of articles describes optimum techniques for nurses to encourage culture change including
GET EXPERT GUIDANCE
Visit aanacorgstore to order your copy today
How do you code ldquopresent or not present on admissionrdquo for a pressure ulcer unstageable on admission after it becomes stageable (declares itself) For example a pressure ulcer unstageable
due to slough or eschar upon admission is coded unstageable due to slough or eschar and ldquopresent on admissionrdquo After a few weeks the ulcer has been debrided and can be staged as Stage 3 On the next MDS it will be coded as one Stage 3 pressure ulcer that was ldquopresent on admissionrdquo The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo If a Stage 3 or 4 ulcer that was ldquopresent on admissionrdquo becomes unstageable during the residentrsquos stay it continues to be coded ldquopresent on admissionrdquo until
its stage can once again be seen If the ulcer is at the same stage as it was before becoming unstageable continue to code the ulcer as present on admission However if a Stage 2 ulcer becomes
covered with slough or eschar it is coded ldquoNOT present on admissionrdquo because Stage 2 ulcers do not contain slough or eschar Remember when a pressure ulcer deteriorates to a worse stage after admissionreadmission to the skilled nursing facility it is considered ldquoNOT present on admissionrdquo even though present upon admission at a lesser stage
Section MmdashStaging Ulcers continued from page 1
The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 3 8 20112
Dear AANAC Members
On behalf of the Board of Directors I want to thank everyone who participated in our nominating
process Our nominees represent the best and brightest in terms of knowledge skills and commitment
to the issues that affect long-term care Because the candidates were so well qualified selecting
among them was a daunting task The Nominating Committee reviewed every one who was
nominated to identify those with the knowledge experience and skills to fill a Board position After
this initial screen candidates were interviewed and evaluated according to the criteria set by the
Board to strengthen the Board of Directors As a result of these deliberations the top nominees were
recommended by the Nominating Committee to the Board of Directors for approval The Board of
Directors is pleased to announce the following slate of candidates for your consideration
Following your review of the slate if no alternative candidates are put forth through a petition process
these candidates will be approved and seated on July 1 2011 If you wish to nominate an alternate
candidate by petition the process is as follows you may nominate a candidate by petition of 25 of the
membership (312 members) Should you wish to engage in this process the petition must be submitted
by May 3 2011 If you have questions do not hesitate to contact me at csiemaanacorg
Part Three in a Three-Part SeriesInterview With a Purveyor
Several physicians associated with hospices referred me to Alex Madans as a responsible supplier of medical marijuana (MMJ) He began offering MMJ in 1993 when it became legal in California where he then lived He personally has used MMJ for chronic back pain for decades and often smokes with his clients as he introduces them to it which he comments lessens their anxiety
Most of his clients have chronic pain of various etiologies for example neuropathic pain from diabetes For clients with cancer he suggests regular small preventive doses that inhibit the onset of pain ldquoinstead of waiting for bad pain or nauseardquo Doctors use FDA-approved pain medication similarly He
also has found it enhances appetite in HIV and cancer patients His clients have been referred by both friends and professionals such as hospice and palliative care doctors
When clients begin there are many choices Some cannabis varieties appear to be suited to particular problems Each variety also has its own odor which is
similar in both the unburned state and as smoke This means that clients can choose prior to smoking whichever strain smells appealing as a ldquostarterrdquo He advocates smoking rather than vapor or oral intake because he feels itrsquos more controlled (Note that tinctures and vaporizers avoid the ldquono smokingrdquo rules of institutions but do not solve the problem of federal prohibition) ldquoYou stop when yoursquove had enoughrdquo he said contrary to oral intake which may turn out to be excessive once swallowed He starts with the smallest ldquodoserdquo and works up For ingestion material must be bonded to fat (he uses butter) or alcohol to become usable
The smoking apparatus has its own mystique which I suspect may enhance the experience I saw several types of water pipes (bongs) of beautifully blown glass some with sinuous decorative overlays and long-stemmed narrow-bowled pipes reminiscent of colonial
America I also saw a vaporizer and various metal tools one used to shake the resin free from the plant and one with cutters that shred the leaves and buds to usable size
When Alex visits a client he likes to consult with the entire family so they understand the procedure It also
encourages sociability and enhances mood However there are limits He related an experience with a hospice patient where outdoor smoking was permitted When her entire family joined her and passed around the
ldquojointrdquo the facility had to call a rapid halt to that practice
He had a poor result with a client who insisted upon a specific regimen for smoking as if it were a tablet prescribed by a doctor specifying so many puffs at so many hourly intervals ldquoIt really
MEDicAL MARijuAnA in Long-TERM cARE
Dr Fredrick R Abrams md
Some cannabis varieties appear to be suited to particular problems Each variety also has its own odor which is similar in both the unburned state and as smoke
continued on page 4
4 A ANAC LTC LE ADER 3 8 2011
doesnrsquot work that wayrdquo he said Rather he likens it to appraising a flower shop potpourri How does the unburned smell make you feel ldquoCannabis has a lsquobouquetrsquo and different folks like different scentsrdquo he noted ldquobecause some people like roses and some like liliesrdquo
Finally he pointed out that doctors may not prescribe MMJmdashonly recommend itmdashbut he keeps careful records of the recommendations as a de facto prescription
Interview With an Academic Physician
Mark SWallace MD Board certified in anesthesiology and pain medicine is the chair of the Division of Pain Medicine Department of Anesthesiology at the University of CaliforniamdashSan Diego He is involved in clinical care teaching and research including ongoing clinical trials for pain managementmdashacute chronic and cancer related He pointed out that there are over 400 compounds in cannabis so research has a long way to go but he feels it has great potential noting especially that its toxicity level is minimal compared with all the approved pain relievers on the market One significant difference between MMJ and opioids is that withdrawal of the
latter at higher doses needs a significant detoxification process MMJ cessation results in less of a withdrawal syndrome Also noteworthy is the presence of cannabinoid receptors naturally present throughout the body
(I found an FDA compilation on the site wwwProConorg that noted drug reports by doctors from 1997 to 2005 comparing adverse events from 17 FDA-approved drugs with those from cannabis The
total deaths reported from FDA-approved drugs was 10008 from cannabis zero)
Regarding the synthetic cannabinoid oral THC (Marinol Dronabinol) Dr Wallace noted that absorption is quite variable between patients Blood-level tests have shown that between 1 and 25 is absorbed In patients with pain secondary to spinal column degeneration effective doses varied from 5 to 60 mg daily for relief of pain and better sleep was characteristic at either dose
Research continues on neuropathic pain (diabetics HIV) and routes vary from
vaporizers transdermal sublingual spray and oral for the elements that have been isolated
In general he feels that as research continues and elements are defined there is great potential for the cannabinoids in pain management with fewer side effects than many drugs currently available Overdose is a hazard with the latter and appears to be unheard of with cannabis
Risks for Long-Term Care Facilities
The threshold question is ultimately one of risk acceptanceaversion Almost all long-term care facilities are funded in large part by Medicare or Medicaid programs They are federally contracted programs Medicaid is state and federal Openly permitting the use of marijuana even when approved under state law is hazardous I have found no long-term care facilities where it is permitted
Policies and ProceduresFacility administrators who wish to take the risk (as well as those who donrsquot if MMJ someday becomes legal by federal ruling) need policies and procedures in place Attorney Fred Miles using Colorado as an example suggests that at minimum these include the following (These may vary among states Under Colorado law a cannabis purveyor is a ldquocaregiverrdquo)
bull There should be residentrsquos ldquoproofrdquo of registration (confidential registry waiver may be required)
bull Until there is further clarification by federal agencies storage should be avoided The facility may not dispense the drug
bull There should be proof of identity of and relationship with primary caregiver
Almost all long-term care facilities are funded in large part by Medicare or Medicaid programshellip Openly permitting the use of marijuana even when approved under state law is hazardous
Medical Marijuana continued from page 3
continued on page 5
5 A ANAC LTC LE ADER 3 8 2011
There should be a right to approve caregiver access to facility
bull Users must abide by facility rules on MMJ use
bull There should be check-in procedures when primary caregiver brings resident MMJ
bull Under state laws only the patient or the caregiver may possess and only the patient may use MMJ
bull No employee may act as a primary caregiver to residents of the facility No employee may deliver the MMJ to the resident (state laws prevent possession by anyone other than caregiver or patient)
bull If an employee acts as caregiver legally heshe may be considered an agent of the facility (and in most states would be acting illegally)
Patientbull must apply for and be approved for
inclusion on confidential registry
bull must have registration ID on hisher person and
bull may only have one primary caregiver at a time
Primary Caregiverbull must be registered
bull may only manage a restricted number of patients (eg one in Arkansas Rhode Island Washington five in Colorado Maine Minnesota some states do not specify)
bull if in California may be the owneroperator of health care facility who may also designate three employees as caregivers and
bull if in Maine may be a hospice or nursing facility
General Issues to Considerbull Should MMJ only be used in an
edible form
bull Smoking may be a problem even if it occurs outdoors (many states restrict where MMJ may be consumed)
bull Use may be limited to residentrsquos room what about roommatersquos rights
bull Storage issues locked container limited to legally allowed quantity
access to storage by facility administration Again storage on premises is certainly ill-advised Currently state law provides little guidance
Conclusions
After spending weeks reading numerous articles (technical and otherwise) and speaking to patients physicians nurses counselors and lawyers I am reminded of the blind men and the elephant
It was six men of Hindustan to learning much inclined
Who went to see the elephant (though all of them were blind)
That each by observation might satisfy his mindhellip
And so these men of Hindustan disputed loud and long
Each in his own opinion exceeding stiff and strong
Though each was partly in the right and all were in the wrong
We need more extensive research to take the blinders off the elephant examiners to isolate the multiple components of cannabis and to understand their synergies At this time in the unfolding history of cannabis we are left primarily
with the subjective observations of individual long-term care patients who try it under medical supervision Smoking as a mode of dosing may become unnecessary with vaporizers and sublingual transdermal and oral ingestion of new isolates
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful Due to their advanced years andor pathologies the shorter time exposure of long-term care patients to deleterious elements may diminish bad effectsmdasheffects that are primarily attributed to decades of use in much younger persons
The evolution of cannabis may come to be comparable historically (not pharmacologically) to that of cocaine Initially those who abused it ruined their health However research gave us the
-caines (benzo- xylo- nova- and many others) that made tooth extraction and surgery pain free Similarly current needs call for continued properly controlled research and evaluation for cannabis just like any other experimental drug to distinguish adverse from potentially valuable characteristics
Medical Marijuana continued from page 4
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful
6 A ANAC LTC LE ADER 3 8 2011
is compendium of articles describes optimum techniques for nurses to encourage culture change including
GET EXPERT GUIDANCE
Visit aanacorgstore to order your copy today
How do you code ldquopresent or not present on admissionrdquo for a pressure ulcer unstageable on admission after it becomes stageable (declares itself) For example a pressure ulcer unstageable
due to slough or eschar upon admission is coded unstageable due to slough or eschar and ldquopresent on admissionrdquo After a few weeks the ulcer has been debrided and can be staged as Stage 3 On the next MDS it will be coded as one Stage 3 pressure ulcer that was ldquopresent on admissionrdquo The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo If a Stage 3 or 4 ulcer that was ldquopresent on admissionrdquo becomes unstageable during the residentrsquos stay it continues to be coded ldquopresent on admissionrdquo until
its stage can once again be seen If the ulcer is at the same stage as it was before becoming unstageable continue to code the ulcer as present on admission However if a Stage 2 ulcer becomes
covered with slough or eschar it is coded ldquoNOT present on admissionrdquo because Stage 2 ulcers do not contain slough or eschar Remember when a pressure ulcer deteriorates to a worse stage after admissionreadmission to the skilled nursing facility it is considered ldquoNOT present on admissionrdquo even though present upon admission at a lesser stage
Section MmdashStaging Ulcers continued from page 1
The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
3 A ANAC LTC LE ADER 3 8 2011
Part Three in a Three-Part SeriesInterview With a Purveyor
Several physicians associated with hospices referred me to Alex Madans as a responsible supplier of medical marijuana (MMJ) He began offering MMJ in 1993 when it became legal in California where he then lived He personally has used MMJ for chronic back pain for decades and often smokes with his clients as he introduces them to it which he comments lessens their anxiety
Most of his clients have chronic pain of various etiologies for example neuropathic pain from diabetes For clients with cancer he suggests regular small preventive doses that inhibit the onset of pain ldquoinstead of waiting for bad pain or nauseardquo Doctors use FDA-approved pain medication similarly He
also has found it enhances appetite in HIV and cancer patients His clients have been referred by both friends and professionals such as hospice and palliative care doctors
When clients begin there are many choices Some cannabis varieties appear to be suited to particular problems Each variety also has its own odor which is
similar in both the unburned state and as smoke This means that clients can choose prior to smoking whichever strain smells appealing as a ldquostarterrdquo He advocates smoking rather than vapor or oral intake because he feels itrsquos more controlled (Note that tinctures and vaporizers avoid the ldquono smokingrdquo rules of institutions but do not solve the problem of federal prohibition) ldquoYou stop when yoursquove had enoughrdquo he said contrary to oral intake which may turn out to be excessive once swallowed He starts with the smallest ldquodoserdquo and works up For ingestion material must be bonded to fat (he uses butter) or alcohol to become usable
The smoking apparatus has its own mystique which I suspect may enhance the experience I saw several types of water pipes (bongs) of beautifully blown glass some with sinuous decorative overlays and long-stemmed narrow-bowled pipes reminiscent of colonial
America I also saw a vaporizer and various metal tools one used to shake the resin free from the plant and one with cutters that shred the leaves and buds to usable size
When Alex visits a client he likes to consult with the entire family so they understand the procedure It also
encourages sociability and enhances mood However there are limits He related an experience with a hospice patient where outdoor smoking was permitted When her entire family joined her and passed around the
ldquojointrdquo the facility had to call a rapid halt to that practice
He had a poor result with a client who insisted upon a specific regimen for smoking as if it were a tablet prescribed by a doctor specifying so many puffs at so many hourly intervals ldquoIt really
MEDicAL MARijuAnA in Long-TERM cARE
Dr Fredrick R Abrams md
Some cannabis varieties appear to be suited to particular problems Each variety also has its own odor which is similar in both the unburned state and as smoke
continued on page 4
4 A ANAC LTC LE ADER 3 8 2011
doesnrsquot work that wayrdquo he said Rather he likens it to appraising a flower shop potpourri How does the unburned smell make you feel ldquoCannabis has a lsquobouquetrsquo and different folks like different scentsrdquo he noted ldquobecause some people like roses and some like liliesrdquo
Finally he pointed out that doctors may not prescribe MMJmdashonly recommend itmdashbut he keeps careful records of the recommendations as a de facto prescription
Interview With an Academic Physician
Mark SWallace MD Board certified in anesthesiology and pain medicine is the chair of the Division of Pain Medicine Department of Anesthesiology at the University of CaliforniamdashSan Diego He is involved in clinical care teaching and research including ongoing clinical trials for pain managementmdashacute chronic and cancer related He pointed out that there are over 400 compounds in cannabis so research has a long way to go but he feels it has great potential noting especially that its toxicity level is minimal compared with all the approved pain relievers on the market One significant difference between MMJ and opioids is that withdrawal of the
latter at higher doses needs a significant detoxification process MMJ cessation results in less of a withdrawal syndrome Also noteworthy is the presence of cannabinoid receptors naturally present throughout the body
(I found an FDA compilation on the site wwwProConorg that noted drug reports by doctors from 1997 to 2005 comparing adverse events from 17 FDA-approved drugs with those from cannabis The
total deaths reported from FDA-approved drugs was 10008 from cannabis zero)
Regarding the synthetic cannabinoid oral THC (Marinol Dronabinol) Dr Wallace noted that absorption is quite variable between patients Blood-level tests have shown that between 1 and 25 is absorbed In patients with pain secondary to spinal column degeneration effective doses varied from 5 to 60 mg daily for relief of pain and better sleep was characteristic at either dose
Research continues on neuropathic pain (diabetics HIV) and routes vary from
vaporizers transdermal sublingual spray and oral for the elements that have been isolated
In general he feels that as research continues and elements are defined there is great potential for the cannabinoids in pain management with fewer side effects than many drugs currently available Overdose is a hazard with the latter and appears to be unheard of with cannabis
Risks for Long-Term Care Facilities
The threshold question is ultimately one of risk acceptanceaversion Almost all long-term care facilities are funded in large part by Medicare or Medicaid programs They are federally contracted programs Medicaid is state and federal Openly permitting the use of marijuana even when approved under state law is hazardous I have found no long-term care facilities where it is permitted
Policies and ProceduresFacility administrators who wish to take the risk (as well as those who donrsquot if MMJ someday becomes legal by federal ruling) need policies and procedures in place Attorney Fred Miles using Colorado as an example suggests that at minimum these include the following (These may vary among states Under Colorado law a cannabis purveyor is a ldquocaregiverrdquo)
bull There should be residentrsquos ldquoproofrdquo of registration (confidential registry waiver may be required)
bull Until there is further clarification by federal agencies storage should be avoided The facility may not dispense the drug
bull There should be proof of identity of and relationship with primary caregiver
Almost all long-term care facilities are funded in large part by Medicare or Medicaid programshellip Openly permitting the use of marijuana even when approved under state law is hazardous
Medical Marijuana continued from page 3
continued on page 5
5 A ANAC LTC LE ADER 3 8 2011
There should be a right to approve caregiver access to facility
bull Users must abide by facility rules on MMJ use
bull There should be check-in procedures when primary caregiver brings resident MMJ
bull Under state laws only the patient or the caregiver may possess and only the patient may use MMJ
bull No employee may act as a primary caregiver to residents of the facility No employee may deliver the MMJ to the resident (state laws prevent possession by anyone other than caregiver or patient)
bull If an employee acts as caregiver legally heshe may be considered an agent of the facility (and in most states would be acting illegally)
Patientbull must apply for and be approved for
inclusion on confidential registry
bull must have registration ID on hisher person and
bull may only have one primary caregiver at a time
Primary Caregiverbull must be registered
bull may only manage a restricted number of patients (eg one in Arkansas Rhode Island Washington five in Colorado Maine Minnesota some states do not specify)
bull if in California may be the owneroperator of health care facility who may also designate three employees as caregivers and
bull if in Maine may be a hospice or nursing facility
General Issues to Considerbull Should MMJ only be used in an
edible form
bull Smoking may be a problem even if it occurs outdoors (many states restrict where MMJ may be consumed)
bull Use may be limited to residentrsquos room what about roommatersquos rights
bull Storage issues locked container limited to legally allowed quantity
access to storage by facility administration Again storage on premises is certainly ill-advised Currently state law provides little guidance
Conclusions
After spending weeks reading numerous articles (technical and otherwise) and speaking to patients physicians nurses counselors and lawyers I am reminded of the blind men and the elephant
It was six men of Hindustan to learning much inclined
Who went to see the elephant (though all of them were blind)
That each by observation might satisfy his mindhellip
And so these men of Hindustan disputed loud and long
Each in his own opinion exceeding stiff and strong
Though each was partly in the right and all were in the wrong
We need more extensive research to take the blinders off the elephant examiners to isolate the multiple components of cannabis and to understand their synergies At this time in the unfolding history of cannabis we are left primarily
with the subjective observations of individual long-term care patients who try it under medical supervision Smoking as a mode of dosing may become unnecessary with vaporizers and sublingual transdermal and oral ingestion of new isolates
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful Due to their advanced years andor pathologies the shorter time exposure of long-term care patients to deleterious elements may diminish bad effectsmdasheffects that are primarily attributed to decades of use in much younger persons
The evolution of cannabis may come to be comparable historically (not pharmacologically) to that of cocaine Initially those who abused it ruined their health However research gave us the
-caines (benzo- xylo- nova- and many others) that made tooth extraction and surgery pain free Similarly current needs call for continued properly controlled research and evaluation for cannabis just like any other experimental drug to distinguish adverse from potentially valuable characteristics
Medical Marijuana continued from page 4
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful
6 A ANAC LTC LE ADER 3 8 2011
is compendium of articles describes optimum techniques for nurses to encourage culture change including
GET EXPERT GUIDANCE
Visit aanacorgstore to order your copy today
How do you code ldquopresent or not present on admissionrdquo for a pressure ulcer unstageable on admission after it becomes stageable (declares itself) For example a pressure ulcer unstageable
due to slough or eschar upon admission is coded unstageable due to slough or eschar and ldquopresent on admissionrdquo After a few weeks the ulcer has been debrided and can be staged as Stage 3 On the next MDS it will be coded as one Stage 3 pressure ulcer that was ldquopresent on admissionrdquo The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo If a Stage 3 or 4 ulcer that was ldquopresent on admissionrdquo becomes unstageable during the residentrsquos stay it continues to be coded ldquopresent on admissionrdquo until
its stage can once again be seen If the ulcer is at the same stage as it was before becoming unstageable continue to code the ulcer as present on admission However if a Stage 2 ulcer becomes
covered with slough or eschar it is coded ldquoNOT present on admissionrdquo because Stage 2 ulcers do not contain slough or eschar Remember when a pressure ulcer deteriorates to a worse stage after admissionreadmission to the skilled nursing facility it is considered ldquoNOT present on admissionrdquo even though present upon admission at a lesser stage
Section MmdashStaging Ulcers continued from page 1
The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
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ecumen
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pinon management
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preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
4 A ANAC LTC LE ADER 3 8 2011
doesnrsquot work that wayrdquo he said Rather he likens it to appraising a flower shop potpourri How does the unburned smell make you feel ldquoCannabis has a lsquobouquetrsquo and different folks like different scentsrdquo he noted ldquobecause some people like roses and some like liliesrdquo
Finally he pointed out that doctors may not prescribe MMJmdashonly recommend itmdashbut he keeps careful records of the recommendations as a de facto prescription
Interview With an Academic Physician
Mark SWallace MD Board certified in anesthesiology and pain medicine is the chair of the Division of Pain Medicine Department of Anesthesiology at the University of CaliforniamdashSan Diego He is involved in clinical care teaching and research including ongoing clinical trials for pain managementmdashacute chronic and cancer related He pointed out that there are over 400 compounds in cannabis so research has a long way to go but he feels it has great potential noting especially that its toxicity level is minimal compared with all the approved pain relievers on the market One significant difference between MMJ and opioids is that withdrawal of the
latter at higher doses needs a significant detoxification process MMJ cessation results in less of a withdrawal syndrome Also noteworthy is the presence of cannabinoid receptors naturally present throughout the body
(I found an FDA compilation on the site wwwProConorg that noted drug reports by doctors from 1997 to 2005 comparing adverse events from 17 FDA-approved drugs with those from cannabis The
total deaths reported from FDA-approved drugs was 10008 from cannabis zero)
Regarding the synthetic cannabinoid oral THC (Marinol Dronabinol) Dr Wallace noted that absorption is quite variable between patients Blood-level tests have shown that between 1 and 25 is absorbed In patients with pain secondary to spinal column degeneration effective doses varied from 5 to 60 mg daily for relief of pain and better sleep was characteristic at either dose
Research continues on neuropathic pain (diabetics HIV) and routes vary from
vaporizers transdermal sublingual spray and oral for the elements that have been isolated
In general he feels that as research continues and elements are defined there is great potential for the cannabinoids in pain management with fewer side effects than many drugs currently available Overdose is a hazard with the latter and appears to be unheard of with cannabis
Risks for Long-Term Care Facilities
The threshold question is ultimately one of risk acceptanceaversion Almost all long-term care facilities are funded in large part by Medicare or Medicaid programs They are federally contracted programs Medicaid is state and federal Openly permitting the use of marijuana even when approved under state law is hazardous I have found no long-term care facilities where it is permitted
Policies and ProceduresFacility administrators who wish to take the risk (as well as those who donrsquot if MMJ someday becomes legal by federal ruling) need policies and procedures in place Attorney Fred Miles using Colorado as an example suggests that at minimum these include the following (These may vary among states Under Colorado law a cannabis purveyor is a ldquocaregiverrdquo)
bull There should be residentrsquos ldquoproofrdquo of registration (confidential registry waiver may be required)
bull Until there is further clarification by federal agencies storage should be avoided The facility may not dispense the drug
bull There should be proof of identity of and relationship with primary caregiver
Almost all long-term care facilities are funded in large part by Medicare or Medicaid programshellip Openly permitting the use of marijuana even when approved under state law is hazardous
Medical Marijuana continued from page 3
continued on page 5
5 A ANAC LTC LE ADER 3 8 2011
There should be a right to approve caregiver access to facility
bull Users must abide by facility rules on MMJ use
bull There should be check-in procedures when primary caregiver brings resident MMJ
bull Under state laws only the patient or the caregiver may possess and only the patient may use MMJ
bull No employee may act as a primary caregiver to residents of the facility No employee may deliver the MMJ to the resident (state laws prevent possession by anyone other than caregiver or patient)
bull If an employee acts as caregiver legally heshe may be considered an agent of the facility (and in most states would be acting illegally)
Patientbull must apply for and be approved for
inclusion on confidential registry
bull must have registration ID on hisher person and
bull may only have one primary caregiver at a time
Primary Caregiverbull must be registered
bull may only manage a restricted number of patients (eg one in Arkansas Rhode Island Washington five in Colorado Maine Minnesota some states do not specify)
bull if in California may be the owneroperator of health care facility who may also designate three employees as caregivers and
bull if in Maine may be a hospice or nursing facility
General Issues to Considerbull Should MMJ only be used in an
edible form
bull Smoking may be a problem even if it occurs outdoors (many states restrict where MMJ may be consumed)
bull Use may be limited to residentrsquos room what about roommatersquos rights
bull Storage issues locked container limited to legally allowed quantity
access to storage by facility administration Again storage on premises is certainly ill-advised Currently state law provides little guidance
Conclusions
After spending weeks reading numerous articles (technical and otherwise) and speaking to patients physicians nurses counselors and lawyers I am reminded of the blind men and the elephant
It was six men of Hindustan to learning much inclined
Who went to see the elephant (though all of them were blind)
That each by observation might satisfy his mindhellip
And so these men of Hindustan disputed loud and long
Each in his own opinion exceeding stiff and strong
Though each was partly in the right and all were in the wrong
We need more extensive research to take the blinders off the elephant examiners to isolate the multiple components of cannabis and to understand their synergies At this time in the unfolding history of cannabis we are left primarily
with the subjective observations of individual long-term care patients who try it under medical supervision Smoking as a mode of dosing may become unnecessary with vaporizers and sublingual transdermal and oral ingestion of new isolates
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful Due to their advanced years andor pathologies the shorter time exposure of long-term care patients to deleterious elements may diminish bad effectsmdasheffects that are primarily attributed to decades of use in much younger persons
The evolution of cannabis may come to be comparable historically (not pharmacologically) to that of cocaine Initially those who abused it ruined their health However research gave us the
-caines (benzo- xylo- nova- and many others) that made tooth extraction and surgery pain free Similarly current needs call for continued properly controlled research and evaluation for cannabis just like any other experimental drug to distinguish adverse from potentially valuable characteristics
Medical Marijuana continued from page 4
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful
6 A ANAC LTC LE ADER 3 8 2011
is compendium of articles describes optimum techniques for nurses to encourage culture change including
GET EXPERT GUIDANCE
Visit aanacorgstore to order your copy today
How do you code ldquopresent or not present on admissionrdquo for a pressure ulcer unstageable on admission after it becomes stageable (declares itself) For example a pressure ulcer unstageable
due to slough or eschar upon admission is coded unstageable due to slough or eschar and ldquopresent on admissionrdquo After a few weeks the ulcer has been debrided and can be staged as Stage 3 On the next MDS it will be coded as one Stage 3 pressure ulcer that was ldquopresent on admissionrdquo The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo If a Stage 3 or 4 ulcer that was ldquopresent on admissionrdquo becomes unstageable during the residentrsquos stay it continues to be coded ldquopresent on admissionrdquo until
its stage can once again be seen If the ulcer is at the same stage as it was before becoming unstageable continue to code the ulcer as present on admission However if a Stage 2 ulcer becomes
covered with slough or eschar it is coded ldquoNOT present on admissionrdquo because Stage 2 ulcers do not contain slough or eschar Remember when a pressure ulcer deteriorates to a worse stage after admissionreadmission to the skilled nursing facility it is considered ldquoNOT present on admissionrdquo even though present upon admission at a lesser stage
Section MmdashStaging Ulcers continued from page 1
The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
5 A ANAC LTC LE ADER 3 8 2011
There should be a right to approve caregiver access to facility
bull Users must abide by facility rules on MMJ use
bull There should be check-in procedures when primary caregiver brings resident MMJ
bull Under state laws only the patient or the caregiver may possess and only the patient may use MMJ
bull No employee may act as a primary caregiver to residents of the facility No employee may deliver the MMJ to the resident (state laws prevent possession by anyone other than caregiver or patient)
bull If an employee acts as caregiver legally heshe may be considered an agent of the facility (and in most states would be acting illegally)
Patientbull must apply for and be approved for
inclusion on confidential registry
bull must have registration ID on hisher person and
bull may only have one primary caregiver at a time
Primary Caregiverbull must be registered
bull may only manage a restricted number of patients (eg one in Arkansas Rhode Island Washington five in Colorado Maine Minnesota some states do not specify)
bull if in California may be the owneroperator of health care facility who may also designate three employees as caregivers and
bull if in Maine may be a hospice or nursing facility
General Issues to Considerbull Should MMJ only be used in an
edible form
bull Smoking may be a problem even if it occurs outdoors (many states restrict where MMJ may be consumed)
bull Use may be limited to residentrsquos room what about roommatersquos rights
bull Storage issues locked container limited to legally allowed quantity
access to storage by facility administration Again storage on premises is certainly ill-advised Currently state law provides little guidance
Conclusions
After spending weeks reading numerous articles (technical and otherwise) and speaking to patients physicians nurses counselors and lawyers I am reminded of the blind men and the elephant
It was six men of Hindustan to learning much inclined
Who went to see the elephant (though all of them were blind)
That each by observation might satisfy his mindhellip
And so these men of Hindustan disputed loud and long
Each in his own opinion exceeding stiff and strong
Though each was partly in the right and all were in the wrong
We need more extensive research to take the blinders off the elephant examiners to isolate the multiple components of cannabis and to understand their synergies At this time in the unfolding history of cannabis we are left primarily
with the subjective observations of individual long-term care patients who try it under medical supervision Smoking as a mode of dosing may become unnecessary with vaporizers and sublingual transdermal and oral ingestion of new isolates
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful Due to their advanced years andor pathologies the shorter time exposure of long-term care patients to deleterious elements may diminish bad effectsmdasheffects that are primarily attributed to decades of use in much younger persons
The evolution of cannabis may come to be comparable historically (not pharmacologically) to that of cocaine Initially those who abused it ruined their health However research gave us the
-caines (benzo- xylo- nova- and many others) that made tooth extraction and surgery pain free Similarly current needs call for continued properly controlled research and evaluation for cannabis just like any other experimental drug to distinguish adverse from potentially valuable characteristics
Medical Marijuana continued from page 4
The effects of cannabis appear to be helpful for many not helpful for some and for others under special circumstances significantly harmful
6 A ANAC LTC LE ADER 3 8 2011
is compendium of articles describes optimum techniques for nurses to encourage culture change including
GET EXPERT GUIDANCE
Visit aanacorgstore to order your copy today
How do you code ldquopresent or not present on admissionrdquo for a pressure ulcer unstageable on admission after it becomes stageable (declares itself) For example a pressure ulcer unstageable
due to slough or eschar upon admission is coded unstageable due to slough or eschar and ldquopresent on admissionrdquo After a few weeks the ulcer has been debrided and can be staged as Stage 3 On the next MDS it will be coded as one Stage 3 pressure ulcer that was ldquopresent on admissionrdquo The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo If a Stage 3 or 4 ulcer that was ldquopresent on admissionrdquo becomes unstageable during the residentrsquos stay it continues to be coded ldquopresent on admissionrdquo until
its stage can once again be seen If the ulcer is at the same stage as it was before becoming unstageable continue to code the ulcer as present on admission However if a Stage 2 ulcer becomes
covered with slough or eschar it is coded ldquoNOT present on admissionrdquo because Stage 2 ulcers do not contain slough or eschar Remember when a pressure ulcer deteriorates to a worse stage after admissionreadmission to the skilled nursing facility it is considered ldquoNOT present on admissionrdquo even though present upon admission at a lesser stage
Section MmdashStaging Ulcers continued from page 1
The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
6 A ANAC LTC LE ADER 3 8 2011
is compendium of articles describes optimum techniques for nurses to encourage culture change including
GET EXPERT GUIDANCE
Visit aanacorgstore to order your copy today
How do you code ldquopresent or not present on admissionrdquo for a pressure ulcer unstageable on admission after it becomes stageable (declares itself) For example a pressure ulcer unstageable
due to slough or eschar upon admission is coded unstageable due to slough or eschar and ldquopresent on admissionrdquo After a few weeks the ulcer has been debrided and can be staged as Stage 3 On the next MDS it will be coded as one Stage 3 pressure ulcer that was ldquopresent on admissionrdquo The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo If a Stage 3 or 4 ulcer that was ldquopresent on admissionrdquo becomes unstageable during the residentrsquos stay it continues to be coded ldquopresent on admissionrdquo until
its stage can once again be seen If the ulcer is at the same stage as it was before becoming unstageable continue to code the ulcer as present on admission However if a Stage 2 ulcer becomes
covered with slough or eschar it is coded ldquoNOT present on admissionrdquo because Stage 2 ulcers do not contain slough or eschar Remember when a pressure ulcer deteriorates to a worse stage after admissionreadmission to the skilled nursing facility it is considered ldquoNOT present on admissionrdquo even though present upon admission at a lesser stage
Section MmdashStaging Ulcers continued from page 1
The first time an ulcer can be accurately staged this stage is considered the stage that was ldquopresent on admissionrdquo
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
7 A ANAC LTC LE ADER 3 8 2011
Goal 8 seeks to assure that almost all nursing homes will assess staff satisfaction at least annually and when a staff member leaves employment Objectives targeted for achievement by December 2011 include
bull The national average of nursing homes that regularly assess staff satisfaction and incorporate the results into their quality improvement activities will exceed 85
bull Each state will attain an average facility level improvement of one decile
bull Each nursing home will set a target to improve staff satisfaction by one decile rank over the 24 month period
Steps to follow to incorporate survey satisfaction information into quality improvement activities are included in a 37 page Implementation Guide for Goal 8 They are
bull Identify improved staff satisfaction as an area for potential improvement Use information from staff surveys focus groups learning circles interviews with current and departing staff quality improvement data review of actual situations involving staff etc
bull Identify authoritative information about improving staff satisfaction Separate valid ideas from assumptions myths and misconceptions Seek reliable and evidence- based information
bull Identify current approaches to improving staff satisfaction Determine which activities are in use to improve staff satisfaction and how issues are being addressed
bull Identify areas for improvement in processes and practices related to improving staff satisfaction Determine if policies and procedures are consistent with desirable approaches and if those approaches are followed consistently
bull Identify the causes of issues related to improving staff satisfaction including root causes of undesirable variations in performance and practice Determine if issues or practices inhibit improved staff satisfaction and conduct a root cause analysis of factors related to an inability to improve staff satisfaction
bull Reinforce optimal practice and performance Promote an atmosphere of ldquodoing the right thing the right wayrdquo
bull Implement pertinent interventions Address underlying causes of challenges and obstacles to achieving staff satisfaction
Assessing Staff Satisfaction continued from page 1
continued on page 8
By learning what our employees think and feel about their work we take an important step toward improving quality for everyone
Do you find yourself mired in the confusing complex and ever-changing regulations and requirements of Medicare If so this three-day intensive seminar is for you From admissions to audits expert Judy Wilhide Brandt will guide you through the dorsquos and donrsquots to ensure your facility is being reimbursed accurately and your residents are receiving the care they need
Topics to be covered include
MEDICARE UNIVERSITY
MU
Medicare University
Example scenarios flowcharts checklists and other tools will help you apply the knowledge you
a must-attend event for clinicians and anyone involved in the billing process
Upcoming Medicare University Workshops taught by Judy Wilhide Brandt RN BA RAC-MT C-NE
March 22 ndash 24 2011 Kansas Health Care AssociationmdashTopeka KS
April 11 ndash 13 2011AANAC Spring ConferencemdashAtlanta
Go to aanacorgworkshops to register
The three-day Medicare University provides 75 CEs each day for a total of 225 CEs for nurses
Register today aanacorgworkshops
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
8 A ANAC LTC LE ADER 3 8 2011
Assessing Staff Satisfaction continued from page 7
bull Reevaluate performance practices and results Monitor progress and adjust approaches as necessary
Other tools available from the Campaign to help nursing homes improve staff satisfaction include
bull Considerations in Survey Selection and Implementation and Special Issues for Nursing Home Surveys a nine page guide with tips for satisfaction survey design development and testing
bull Fact Sheet for Consumers
bull Fact Sheet for nursing home staff members
bull Staff Satisfaction Survey Tools an 18 page document listing tools for measuring staff satisfaction that addresses the domains of Training Supervision Management Work EnvironmentCulture Self-Empowerment and Wages and Benefits
It has often been said that as we treat our staff so will they treat our residents Staff satisfaction is closely linked to resident satisfaction By learning what our employees think and feel about
their work we take an important step toward improving quality for everyone Campaign resources are designed to help with survey development and administration and with implementation of actions that address findings from the survey The end result is greater satisfaction for both staff and residents Visit the Campaign website httpwwwnhqualitycampaignorg today to access tools that will make a difference for your nursing home Your residents and staff are counting on you to lead this effort
Need information that you can trust Quickly Look no further than these newly updated AANAC manuals
Each manual gives you and your staff accurate guidance and reference information at your fingertips for more effective healthcare planning
MDS 30 Coding for OBRA and PPS (AANAC Best Seller)
Administrative Oversight
Pressure Ulcer Prevention and Management
Accurately Assessing for Physical Restraints and the MDS 30
Visit aanacorgstore to order today
Build Your LTC Reference Library
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
9 A ANAC LTC LE ADER 3 8 2011
Coalition of Geriatric Nursing Organizations (CGNO)mdashWorking for Long-Term Care NursesThe Coalition of Geriatric Nursing Organizations (CGNO) is a group of eight geriatric nursing advocacy organizations funded largely with the support of the Hartford Institute for Geriatric Nursing (HIGN) at the College of Nursing New York University AANAC is a member of the group The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members The organizations have collaboratively spoken with one voice since 2001 in the policy arena of health care as the Coalition of Geriatric Nursing Organizations (CGNO)
CGNO includes nursing education in its focus and is working toward improving
the level of geriatric nursing education available to nursing students as well as nurses already practicing Most recently the group collaborated with the American Association of Colleges of Nursing to develop six web-based modules designed to attract new nurse graduates to geriatric nursing at both the undergraduate and graduate levels
The group has been assessing the IOM reports which focus on nursing workforce issues Both the 2008 Retooling for an Aging America and the 2010 The Future of Nursing reports show that the aging demographic as well as the aging nursing workforce could have a huge impact on the ability of the healthcare system to provide needed care to the geriatric community in the future CGNO is active in helping to
highlight this oncoming problem for our policy makers in Washington
The culture change movement is also a priority for the group as well as supporting the Advancing Excellence in Americarsquos Nursing Homes campaign CGNO has worked with the HIGN to develop and distribute a bill of rights
for hospitalized older adults The ldquonext stepsrdquo section at the conclusion of this report provides a more in-depth analysis and plan for supporting geriatric nurses Please go to httpwwwaanacorg pagesdoc_libdetailaspxid=3057 and read about the exciting activities that AANAC as part of the CGNO is involved in as an advocate for long-term care nurses and residents
The eight organizations represent more than 28000 nurses more than 12000 of which are AANAC members
Making Nursing Homes Better Places to Live Work and Visit
Find Out What 6500 LTC Leaders Staffand Consumers Already Know
Nursing homes that participate in the Campaign improve faster than those that donrsquot
Advancing Excellence has quality improvement tools that help nursing homes self-monitor performance
Coalitions at the state level foster successful partnerships that help nursing homes make change
The Advancing Excellence website has what you need for your QI Program
Join Today wwwnhqualitycampaignorg
Please submit all photographs digitally to tlonnaanacorg by March 31st Include your mailing address and receive a free AANAC tote bag for participating
Receive a free AANAC tote bag
Call for PhotographyWersquore working on a little project to be unveiled at the aanaC 2011 spring Conference and we need your help Wersquore looking for pictures of you or your staff interacting with residents working together as peers and the creative ways that yoursquove implemented practices that exemplify person-centered care and compassion in your facility You donrsquot need to be a professional photographermdashthis is your chance to share your story and highlight the people that tell it
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201110
A resident has a PICC line All we are doing with it is changing dressing routinely He is going to the hospital for daily IV antibiotics and they are flushing the PICC line there Do I check IV medications under O0100H2
Yes you would code these as ldquowhile a residentrdquo in O0100H2 since he is not being discharged just getting the IV medications as an outpatient
Ronald A Orth RN NHA CPC RAC-MT raorthclinicalreimbursementcom
While out to lunch with her daughter a resident experienced chest pain and her daughter took her to the emergency room The resident was hospitalized had a 3-day stay and is returning to our facility today Do I need to do a Reentry record If so then do I also need to do a Discharge assessment Or should I just start the PPS schedule without doing a Discharge or Entry
Since the resident was admitted to the hospital you must do a Discharge assessment On readmission you must do an Entry tracking record coded as Readmission and start your PPS schedule Code it a 5-day assessment (A0310B=1) if she wasnrsquot on Part A when she left your facility code it a Medicare ReadmissionReturn assessment (A0310B=6) if she was on Part A when she left If she was on Part A prior to the discharge new therapy initial evaluations will be needed and the physician certification process must be restarted
Carol Maher RN-BC RAC-CT cmaher0121earthlinknet
I have heard that we are not to transmit to CMS PPS-type assessments that we do for Medicare Advantage (MA) plans Is this correct Also what if itrsquos another type HMO other than an MA planmdashdo we submit those
The only assessments that are transmitted are
bull The OBRA assessments (the assessments in A0310Amdashthey are required for all residents in Medicare andor Medicaid certified beds)
bull Assessments completed for Medicare Part A reimbursement (assessments that will be used to bill the fiscal intermediary [FI] or Medicare Administrative Contractor [MAC] that pays or denies claims on behalf of Medicare)
bull MDS assessments used for Medicaid reimbursement in some statesmdashthose assessments are transmitted per state requirements
Assessments completed for reimbursement under any other plan including Medicare Advantage plans (which are billed to the HMO and not to the FI or MAC) and other insurance programs are not to be transmitted
Rena R Shephard MHA RN RAC-MT C-NE RRS2000aolcom
Q + ADemonstrate Your Solution at the LT-PAC Interoperability ShowcaseThe 2011 Long-Term and Post-Acute Care Health Information Technology (LTPAC-HIT) summit will take place June 13ndash14 2011 at the Hyatt Regency Baltimore on the Inner Harbor Hotel in Baltimore MD This yearrsquos summit will feature an LTPAC Interoperability Showcase demonstrating HIT interoperability for shared care transfer of care personal health and e-prescribing The Showcase will take place Mon June 13 from noon to 7 pm with dedicated demonstration time from 3 ndash 5 pm Apply by April 4 2011 to showcase your interoperable HIT system Several Showcase participants will be invited to participate in a Summit panel on interoperability
Get an application and additional information
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201111
Cue up ThE coDEsAANAC Board of DirectorsCarol siem msn rn bc gnp Chair
ruth minnema rn ma c-ne rac-ct Vice Chair
elaine Townsley msn mba dha Secretary
Josephine Cronin rn mba rac-ct Treasurer
peter arbuthnot aa ba rac-ct
beth irtz rn bsn nha
Carol maher rn-bc rac-ct
sue mitchell bs rhia
Christine mueller phd rn bc nea-c faan
Joanne powell nha rhia
Diana sturdevant ms gcns-bc
Editorial Advisory BoardAll articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our all volunteer reviewers who represent the best and the brightest in our field
becky Labarge rn rac-mt Vice President Clinical Reimbursement The Tutera Group
robin L Hillier cpa stna lnha rac-mt President RLH Consulting
Deb myhre rn c-ne rac-mt Nurse Consultant Continuum Health Care Services
ron orth rn nha rac-mt President Clinical Reimbursement Solutions LLC Milwaukee WI
Jennifer pettis rn c-ne rac-mt InstructorRegional Consultant Harmony Healthcare International Topsfield MA
rena r shephard mha rn rac-mt c-ne AANAC Clinical Editor President RRS Healthcare Consulting Services San Diego CA
Find the hidden question by using the letters directly below each of the blank squares Each letter is used only once A black square indicates the end of a word
The answer is ldquoYes code 1mdashsupervisionrdquo
what is the Question
(Hint ADL Coding question)
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201112
AAnAc 2011 woRkshop schEDuLE
TRAINING PARTNER MASTER TEACHER DATES CITYSTATE
RAC-CT CERTIFICATION WORkSHOPS
judy wilhide MDs consulting judy wilhide Brandt Mar 8 ndash 10 philadelphia pA
pathway health services inc Amy Franklin Mar 15 ndash 17 oklahoma city ok
harmony healthcare international jennifer pettis Mar 15 ndash 17 Branford cT
pathway health services inc judi kulus Mar 22 ndash 24 white Bear Lake Mn
TAhsA Ronald orth Mar 22 ndash 24 Austin TX
harmony healthcare international jennifer pettis Mar 22 ndash 24 Milwaukee wi
nYAhsA sandy Biggi Mar 29 ndash 31 new hyde park nY
AophA jane Belt Apr 5 ndash 7 columbus oh
harmony healthcare international jennifer pettis Apr 5 ndash 7 portland oR
hFAM Amy Franklin April 6 ndash 8 columbia MD
Life services network Ronald orth April 6 ndash 8 springfield iL
AAnAc spring conference (3 day) Andrea otis-higgins Apr 11 ndash 13 Atlanta gA
AAnAc spring conference (2 day Recert) Becky LaBarge Apr 12 ndash 13 Atlanta gA
Aging services of Michigan Amy Franklin Apr 12 ndash 14 grand Rapids Mi
pathway health services inc cynthia perrault Apr 19 ndash 21 westmont iL
khcAmdashkansas health care Association Becky LaBarge Apr 20 ndash 22 olathe ks
harmony healthcare international jennifer pettis Apr 27 ndash 29 jacksonville FL
MEDICARE UNIVERSITY WORkSHOPS
khcAmdashkansas health care Association judy wilhide Brandt Mar 22 ndash 24 Topeka ks
AAnAc spring conference judy wilhide Brandt Apr 11 ndash 13 Atlanta gA
CONQUERING CHAOS
AAnAc spring conference (1 day) sandy Biggi Apr 13 Atlanta gA
The workshop schedule is subject to change and is updated regularly To see a full AAnAc Training partner workshop schedule visit aanacorgworkshops
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
13
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
A ANAC LTC LE ADER 2 22 201114
Dear Betty
Our nursing home was recently purchased by a larger company Previously we had a very active Culture Change program which the new management is not interested in continuing We are upset for our residents and donrsquot want to revert to an institutional model of care How can we be home-like if we canrsquot even talk about Culture Change
Signed Concerned About Culture Change
Dear Concerned
Good for you that you want to help your residents feel at home in your setting Misunderstandings about the meaning of Culture Change exist and perhaps that is why your new managers seem disinterested in your program or they may have initiatives they prefer to implement that have been successful in their other settings The most important thing to remember is that true Culture Change is not just about environmental changes and defined programs but is actually a philosophy that guides care and interaction with residents families and co-workers
The MDS 30 supports the intent of the Culture Change movement through the use of interview tools designed to focus attention on each resident as an
individual Information learned is used to create meaningful individualized care plans that the care team follows If your state is using the Quality Indicator Survey (QIS) you understand that its focus on resident preferences leads to individualized care as well Information gathered by the MDS and QIS is foundational in giving residents voice and choice so you have a natural introduction of person-centered care If you are unfamiliar with the QIS interviews you can obtain them for your home by visiting httpswwwqtsocomqisformshtml
The outcome of data collected via the MDS and QIS interviews should be to individualize delivery of care activity programming meal times and seating food preferences preferred rising and bed times and a myriad of other areas that create a sense of home by continuing each personrsquos former habits As your team collectively works to address the information learned through conversation with residents you will instill the philosophy of Culture Change in your work practices without following a defined program Encourage your staff to always think of the resident first not merely the task they must perform and both residents and staff alike will experience a greater sense of satisfaction with daily life in your nursing home And so will you
Betty
Treatment of Members PolicyAANAC has posted the Treatment of Members Policy on the website If you need to access it please click here
Request for FeedbackAANAC is collecting comments on the CMS New QIO Notification Requirements for Medicare Residents Please submit your comments to infoaanacorg by March 30 2011
FAQ referralDo you have a question you need answered NOW Members of AANAC can go directly to the experts Go to the FAQ section of the website The answer may be right in front of you aanacorgpagesfaq_30faq_browseasp
What You Need to knowCheck out these latest updates from the ldquoNeed to Knowrdquo section of the AANAC homepage and find the information you need to get the job done right
March 17 Next SNFLTC Open Door Forum (211) Providers UPDATED (211)
CASPER Reporting Users Guide for MDS Providers UPDATED (211)
CMS Proposes New Rule Targeting Medicaid Payments for Healthcare Acquired Conditions (211)
Ask BETTY
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
E u R E E E
15
Platinum Business Partners
aHCa
CareTracker by resource systems
Compudata
eli
Forest
Long-Term Living For The Continuing Care professional
mcKnightrsquos Long-Term Care news amp assisted Living
meD-pass inc
nYaHsa
provider magazine
Gold Business Partners
american HealthTech
Keane Care inc
Leaderstat
pointright
Valley Forge press Therapy Times
Silver Business Partners
accu-med services inc
ais systems
answers on Demand
Frampr Healthcare Consulting inc
Golden Living Centers
HCr manorCare
mDi achieve
pointClickCare
simpleLTC inc
sunDance rehabilitation
Corporate Sponsors
benedictine Health systems
brookdale senior Living
Care initiatives
Catholic Health services
Centura Health at Home
Christian Homes inc
Colavria Hospitality
ConvaCare management inc
Cornerstone Health services Group
DarT Chart systems LLC
ecumen
elim Care inc
ensign Facility services inc
evangelical Lutheran Good samaritan society
evergreen Healthcare
extendicare Health services inc
Five star Quality Care inc
Friendship Health and rehab Center
Goshen Care Center
HmG services LLC
Hattiesburg medical park Corporation
Health Dimensions Group
Horizon West HealthCare inc
Kissito Healthcare
Lexington Healthcare
Lutheran senior services
magnum Health Care management
new Courtland elder services
nHs management LLC
paramount Health Care Company
pinon management
plantation management Company
preferred Care partners management Group
prestige Healthcare
regent Care Center
riverside Health Care
savaseniorCare
senior Care Centers
skilled Health Care
st Francis Health services
Ten broeck Commons
Trinity senior Living Communities
Trisun Healthcare
BusinEss pARTnERs amp coRpoRATE sponsoRs
AANAC | 400 S Colorado Blvd Suite 600 | Denver Colorado 80246 | Phone 8007681880 | Fax 3037583588
copy 2011 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
CUE UP ThE coDEs Answer key
D i D R E s i D E n TR E Q u i R E o V E R s i g h TE n c o u R A g E M E n T o R
c u i n g T h R E E o RM o R E T i M E s
M n Q o i R A T D V E n T o o R TD i c i R E s M h s R s i R hE o R u n g E g o M n E gR c D E u T i i E R E T
