OHCA District II & Miami Valley Long Term Care Association

1. OHCA District II &Miami Valley Long Term Care Association January 2018 Kenn Daily, LNHA kenn@qissurvey.com

2. District Update • CEUs for today’s program is 2 hours • Certificate of attendance @ table

3. OHCA Fall Conference • Next week is OHCA Winter Conference January 30 - 31, 2018- Hyatt Regency Columbus • LTC Update - Bob Applebaum • Ohio Department of Medicaid Update - Barbara Sears • Medicare Eligibility Trends • Survey Update, Carol Rolf, ODH • Census Management, Linda Saunders • Emergency Preparedness, Legionella and LSC, Kenn Daily, Rick Hoover, Dusty Ellinger • Immediate Jeopardy, Shane Craycraft

5. Social Media • MVLTCA has launched a LinkedIn group site • Start a conversation • Post a job

6. MVLTCA & OHCA District II Golf Outing Annual Golf Outing August 23th at Pipestone Golf Club

7. Golf Sponsors 2017 Platinum • Pinnacle Pointe Nursing and Rehabilitation Gold • Haven Behavioral Hospital of Dayton • M&S Management and Network Services, LLC • Life Line Pharmacy Silver • Remedi Senior Care • Mobilex

8. 2017 Hole Sponsors and Supporters • Brown & Bills Architects • CareSource • Collett Propane • Concept Rehab, Inc. • Cypress Pointe • Elder Care Systems Group • Encore Rehabilitation Services • Friends Care Community • Genesis Troy • Grace Brethren Village • Heartand Hospice • InRange Systems • Kettering Home Care • The Laurels of West Carrollton • Legacy Village • Marietta Law • Otterbein Small Houses • Wade Management Group • Widows Home • Ziehler Lawn & Tree Care

9. CMS EMERGENCY RULE CMS Actions • On September 2016 CMS released FINAL disaster rule, Emergency Preparedness Standards for Medicare and Medicaid Participating Providers and Suppliers • Providers have one-year to comply and the requirements will be enforced effective beginning November 15, 2017

10. CMS Emergency Preparedness Regulation

11. Legionella • CMS in June published S&C 17-30-Hospitals/CAHs/NHs REVISED 06.09.2017 • Facility Requirements to Prevent Legionella Infections: Facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of legionella and other opportunistic pathogens in water. • Facility must have a comprehensive policy • Facility must complete a facility risk assessment

12. ODH Legionella F880 • Surveyors should be looking for: • Facility policy and procedures and water management program • The facility risk assessment • Evidence that the policy is being followed(facility on-going measures being followed) • Testing protocols • Staff awareness and steps to be taken should Legionella be identified.

13. Governor Override • The override of Item #27 • SNF payment cap. Governor Kasich did not veto the statutory cap on • The now-restored provisions state that ODM must share data on total SNF spending (fee-for-service and managed care) with the SNF associations on a monthly basis. • After six months, ODM is to work with the associations to project spending for the fiscal year and to compare it to the cap. If spending projects to be higher than the cap, a corresponding percentage rate reduction will be imposed on all SNFs, with thirty days’ notice.

14. Quality Indicators Change from five to seven by splitting the pressure ulcers and antipsychotics measures into long-stay and short-stay measures. • Pressure Sores (long term) • Pressure Sores (short-term) • Antipsychotic (long term) • Antipsychotics (short term) • Unplanned Weight Loss (replaces potentially preventable hospital admission measure ) • Staff Retention • Preferences for Everyday Living Inventory (PELI) • Hospice patients are excluded from the antipsychotics measures.. • The 40th percentile will be used uniformly for the pressure ulcers, antipsychotics, weight loss, and staff retention measures.

15. Ohio Top 10 Deficiencies FFY2107

16. Ohio Survey Reviewed • Enforcement Actions transferred from State to Feds • 436 Facilities • PER DAY Fines $1,260,702 • Average 41 days and $52,529 • PER INTANCE Fines • 44 Facilities • $210,188 (Average $4777) • JEOPARDIES • 30 Annual Surveys • 44 Complaint Survey • HARM CITES • 63 Annual Surveys • 107 Complaint Surveys

17. Ohio NH Licensure • Ohio Nursing Home licensure completed its “Five Year Rule Review” with all licensure changes effected January 1, 2018 • Through this process, many issues impacting providers are addressed and regulations dealing with day-to-day operations, quality, workforce and environment are modified, deleted or added.

18. 3701-17-01 - Definitions • Toilet rooms - No more than two residents may share a toilet room. • Changed definition of “Complex therapeutic diet” and “Special diet”; added definition of “Therapeutic Diet” • “Complex therapeutic diet” has the same meaning as “therapeutic diet” • “Special diet” means a therapeutic diet limited to: • Nutrient adjusted diets, including high protein, no added salt, and no concentrated sweets; • Volume adjusted diets, including small, medium, and large portions; • The use of finger foods or bite-sized pieces for a resident's physical needs; or • Mechanically altered food.

19. 3701-17-01 Definitions • "Therapeutic diet" means a diet ordered by a health care practitioner: (1) As part of the treatment for a disease or clinical condition; (2) To modify, eliminate, decrease, or increase certain substances in the diet; or (3) To provide mechanically altered food when indicated. • "Mechanically altered food" means that the texture of food is altered by chopping, grinding, mashing, or pureeing so that it can be successfully chewed and safely swallowed.

20. 3701-17-05 Prohibitions • Transient guest • No operator, administrator, employee, or other person shall: • Exceed the nursing home's authorized maximum licensed capacity. • Allow transient guests to remain in a licensed part of a home for more than thirty-six hours in any seventy-two hour period. Accommodations for transient guests may be provided in an area or areas outside the licensed part of a home. • For purposes of this rule, "transient guest" means an individual, whether related to a resident or not, who stays in a home. "Transient guest" does not include an individual who stays in a home for a period of time not exceeding fourteen days and is: (1) Admitted to the home for short term respite care; (2) Staying with a resident upon admission to the home; or (3) Staying with a resident receiving end-of-life care

21. 3701-17-06 QAPI • Responsibility of operator and nursing home administrator; quality assurance and performance improvement • Completely rewritten, previous rule rescinded • Adds QAPI language into previous QA rule • Each nursing home shall establish and maintain an ongoing quality assurance and performance improvement (QAPI) program to address all systems of care and management practices, including clinical care, quality of life, and resident choice. As part of the QAPI program, each home shall, at minimum: • Establish a quality assurance committee that shall meet on an ongoing basis, but at least quarterly to systematically:

22. 3701-17-06 QAPI (a) Monitor and evaluate the quality of care and quality of life provided in the home; (b) Track, investigate, and monitor incidents, accidents, and events that have occurred in the home; (c) Track and monitor the effectiveness of the infection control program; (d) Identify problems and trends; and (e) Develop and implement appropriate action plans to correct identified problems; and (2) Participate in at least one quality improvement project every two years from those approved by the department of aging through the nursing home quality initiative established under section 173.60 of the Revised Code.

23. 3701-17-07 Personnel Qualifications and health of personnel • A food service manager designated pursuant to paragraph (K) of rule 3701-17-18 of the Administrative Code who has supervisory and management responsibility and the authority to direct and control food preparation and service shall obtain the level two certification in food protection according to rule 3701-21-25 of the Administrative Code. • Specifies courses to be completed • New staff member orientation requirement now requires “person-centered care”.

24. 3701-17-07 Personnel No nursing home shall employ a person who applies for a position that involves the provision of direct care to an older adult, if the person: (1) Has been convicted of or pleaded guilty to an offense listed in division (C)(1) of section 3721.121 of the Revised Code, unless the individual is hired under the personal character standards set forth in rule 3701-13-06 of the Administrative Code; or (2) Fails to complete the form(s) or provide fingerprint impressions as required by division (B)(3) of section 3721.121 of the Revised Code.; (3) Is the subject of a finding of abuse or neglect of a resident or misappropriation of the property of a resident on the nurse aide registry, established pursuant to section 3721.32 of the Revised Code;

25. 3701-17-07 Personnel (4) Is the subject of a finding of abuse or neglect of a resident or misappropriation of the property of a resident on the nurse aide registry established by another state where the home believes or has reason to believe the person resides or resided; or (5) Has had a disciplinary action taken against a professional license by a state licensure body as a result of a finding of abuse, neglect, mistreatment of residents or misappropriation of resident property. • Required training and competency evaluation for nurse aides working in long-term care facilities • New staff member orientation requirement now requires “person-centered care” as well as all previously required areas. • Performances shall include the principles of person-centered care.

26. 3701-17-07 .1 Personnel • When a nursing home or part thereof is considered to "hold itself out as providing specialty care" when it advertises the home provides specialty care, represents to the department or the public that it provides specialty care, or admits ten or more individuals with common specialized care needs such as dementia care, behavioral care, mental health care, or hospice care. • Shall ensure each nurse aide who provides specialty care receives sufficient additional hours of training each year to ensure competency and to meet the individual needs of the residents.

27. 3701-17-08 Personnel Personnel requirements • Removed maintain sufficient additional staff, and replaced it with, “conduct an assessment of the residents admitted to the facility, based on the residents' plans of care, to determine the staffing level needed”

28. 3701-17-09 Activities; social services; chaplain services; visiting hours; telephone service; pets; mail • Removes requirement for full time or full time equivalent Activities' Director • All nursing homes shall provide a comprehensive activity program designed to meet the physical, mental, emotional, psycho-social well-being and personal interests of each resident. • Activities shall be provided based on the needs and preferences of each resident as identified on their comprehensive assessment and care plan required by rules 3701-17-10 and 3701-17-14 of the Administrative Code, respectively, and needs and preferences identified during resident's time in the home. • Activities shall be implemented and adjusted based on resident input and residents' changes in abilities, physical and mental status. • Activities shall be scheduled for day time, week end, evening, and include the community to the extent possible.

29. 3701-17-09 Activities; social services; chaplain services; visiting hours; telephone service; pets; mail • Changed social services requirements to include: • Meet the medically-related social service needs of each resident; • Meet the physical, mental, and psycho-social well-being of each resident; and • Assist each resident in attaining or maintaining the highest practicable level of functioning.

30. 3701-17-09 Activities; social services; chaplain services; visiting hours; telephone service; pets; mail Visitor rule used to only reference resident's immediate family, guardian, physician, friends, sponsors, or spiritual advisor, now anyone of their choice. Residents may receive visitors of their choice at any time. The nursing home may establish reasonable policies to ensure that visits will not unduly disturb other residents or interfere with the operation of the home and shall provide or arrange for private space for visitation. Residents may keep pets if allowed by facility policy. • Added: For resident pets, if the resident is transferred, discharged or otherwise unable to care for the pet, responsibilities for care of the pet until a family member or sponsor can retrieve the pet; • Removed - All nursing homes shall provide, facilitate or arrange for services to meet the spiritual preferences of their residents.

31. 3701-17-10 Assessment and Care Planning • Added language “including allergies and intolerances” to the required admission assessment. • The comprehensive assessment shall include the following: • Added new language into: • Nutritional and dietary requirements, food preferences, and need for any adaptive equipment, and needs for assistance and supervision of meals • History of weight changes • Need for eyeglasses or other visual aids • Dental function; including the need for dentures or partial dentures; • Hearing function, including the need for hearing aids or other hearing devices

32. 3701-17-14 Plan of Care/ Discharge • Added that the plan shall be resident-focused and goal driven • Added: The home shall offer opportunities for the resident, the resident’s sponsor, and those of the resident's choice to participate in the care planning process and will provide necessary information, support, and options for engaging in the process to ensure that the resident/sponsor directs the process to the maximum extent possible and is enabled to make informed choices and decisions.

33. 3701-17-14 Plan of Care/ Discharge • Transfer and discharge plan • Replaced family members with those persons of the resident's choice • Added that the plan: indicates where the individual plans to reside, and any arrangements that have been made for the resident's follow up care and any post-discharge medical and non- medical services • Added: Upon a resident's transfer, discharge, or death, the nursing home shall make an accounting of all that resident's monies held by the facility. The nursing home shall convey any remaining funds immediately to the resident or within thirty days to the resident's estate unless otherwise directed by law

34. 3701-17-18 Dietary • Added language: Meals daily to all residents at regular hours “comparable to normal mealtimes in the community” • Added language: The meals shall be “varied and meet the nutritional needs of the residents and be capable of providing” the dietary referenced intake of the "Food and Nutrition Board" of the "National Academy of Science.“ • Removed: For scheduled meal services, there shall be at least a four-hour interval of time between the mid-point of the breakfast and the mid-point of the noon meal and between the mid-point of the noon and mid-point of the evening meal. • Added language: allow for resident choice, and accommodate religious, ethnic, cultural and personal preferences. • Reduced the requirement to keep the meal records on file in the nursing home to at least three months after being served and made available to the director upon request, down from one year.

35. 3701-17-18 Dietary • Removed complex therapeutic and replaced with all diets • For each resident receiving a therapeutic diet, on an on-going basis: (a) Determine that the diet ordered is appropriate according to the resident's individual nutritional care plan; (b) Monitor the resident's nutritional intake and acceptance of the diet; (c) Evaluate the home's compliance in the provision of the diet; and (d) Adjust nutritional care plans and diets as needed.

36. 3701-17-25 Disaster/ Fire/ CO • Each nursing home shall install and maintain carbon monoxide alarms or carbon monoxide detectors in accordance with manufacturer's directions. Carbon monoxide alarms shall be installed in the following locations: (1) On the ceiling of each room containing a permanently installed fuel-burning appliance; and (2) Centrally located on every habitable level and in every heating/ventilation/air conditioning zone of the building. • Nursing homes licensed as such prior to the effective date of this rule have twelve months to come into compliance with paragraph (G) of this rule.

37. 3701-17-25 Disaster/ Fire/ CO (1) "Carbon monoxide alarm" means a single- or multiple-station alarm tested to underwriters laboratory standard 2034, that is intended for the purpose of detecting carbon monoxide gas and alerting occupants by a distinct audible signal comprising an assembly that incorporates a sensor, control components, and an alarm notification appliance in a single unit operated from a power source either located in the unit or obtained at the point of installation; (2) "Carbon monoxide detector" means a device tested to underwriters laboratory standard 2075 that is intended to be connected to a carbon monoxide detection system for the purpose of detecting carbon monoxide gas and alerting occupants by a distinct and audible signal; and (3) "Carbon monoxide detection system means" a system of devices that consists of a control panel and circuits arranged to monitor and annunciate the status of carbon monoxide detectors and to initiate the appropriate response to those signal.