Agency For Health Care Administration Regulatory Update Training September 2004 / January 2005

1. Agency For Health Care AdministrationRegulatory Update TrainingSeptember 2004 / January 2005 Presenters: Polly Weaver, Chief of Field Operations Molly McKinstry, Chief of Long Term Care Services Susan Acker, Ph.D., Director of Nursing Services Agency for Health Care Administration-Division of Health Quality Assurance

2. Hurricane Season 2004

3. Emergency Plans • Check Current Plans to Ensure They Are Up-to-date • Consider Lessons Learned From Recent Experience • Check Vendors to Ensure They Will Honor Agreements – Supplies, Transportation, Receiving Facilities • Consider Secondary Evacuation Plan/location If Initial Is Affected • Ensure Appropriate Receiving Facility • Prior to Evacuation, Reach Agreement on Supplies and Resources and Who Will Provide

4. Emergency Preparedness • Test Emergency Generators • Check Supply of Drinking Water; If Contractor Is Used Ensure Service Provider Is Able to Meet Needs • Check Non-perishable Food Supplies; Assure Regulatory Minimums Are Met • Review Loss of Power Plans

5. Evacuation • Notify AHCA Of Evacuation • Staffing and Other Basic Requirements to Meet Resident Needs Are Not Waived • Ensure Resident Information Follows the Resident • When Returning Residents to a Facility After Damage, Obtain AHCA Approval First

6. Emergency Resources • First Contact: Local Emergency Management http://www.floridadisaster.org/County_EM/county_list.htm# • Florida Emergency Information Line 800-342-3557 • Emergency Support Function – 8 850-410-1822 800-320-0519 (request ESF-8)

7. Regulatory Changes AHCA Information Regarding Trends Regulatory Statistics Regulatory Update

8. 2004 Legislative Changes • Inactive License for a Portion of Facility • Rule Must First be Established • Allows a Contiguous Portion of Nursing Home Beds to Become Inactive for 12 Months, Renewable Annually • Retains Ability for Entire Facility to be Inactive for up to 18 Months • Established Requirements for Request and Approval • Staffing • CNA Increase to 2.9 Delayed from May 1, 2004 to July 1, 2005 • Certificate of Need • Allows Development of New Nursing Home Beds in Limited Circumstances; An Exception to the CON Moratorium • Rural Counties in Limited Circumstances • Counties Without a Nursing Home Where a Nursing Home Closed Since July 2001

9. 2004 Legislative Changes Nursing Homes • CNA In-service Hours • Requires In-Services Hours as a Condition of CNA Certification Rather Than Nursing Home Employment • Refers the In-Service Requirements of S. 464.203(7), F.S. • Remains 18 Hours Annually • DON Signature on Care Plans • Allows Another RN to Sign Resident Care Plans for DON • RN Must Have Institutional Responsibilities in Writing • RN Cannot be a Temporary Staff Person • Gold Seal • State and Federal Nursing Homes are Deemed Financially Stable and Not Required to Submit Financial Statements

10. Nursing Home Gold Seal • Thirteen Homes Received the Award in November, 2004 • Performance Criteria Include: • Financial Soundness and Stability • High Quality of Care Ranking Among Other Nursing Homes in Their Region • Excellent Record With the State Long-term Care Ombudsman Program • No “Conditional” Licenses nor Nursing Home Watch List Appearances in the Past 30 Months • Evidence of Community Involvement • Stable Workforce

11. Gold Seal Awards New Gold Seal Recipients: • Baldomero Lopez Memorial Veterans’ Nursing Home, Land O Lakes • Bay Village of Sarasota, Sarasota • Life Care Center of Hilliard, Hilliard • Mayflower Healthcare Center, Winter Park • Miami Jewish Home & Hospital for the Aged, Miami • Ponce Plaza Nursing and Rehabilitation, Miami • Sunnyside Nursing Home, Sarasota • Water’s Edge Extended Care, Palm City

12. Nursing Home Gold Seal Renewing Gold Seal Recipients: • Harbour’s Edge, Delray Beach • John Knox Village Medical Center, Tampa • The Pavilion for Health Care, Penney Farms • River Garden Hebrew Home for the Aged, Jacksonville • Village on the Green, Longwood

13. Report to the LegislatureMay 2004 – Status Report Nursing Home and Assisted Living Facility: Adverse Incidents & Notices of Intent Filed http://www.fdhc.state.fl.us/Publications/index.shtml Also see Semi-Annual Report on Nursing Homes Report to the Legislature December 30, 2004

14. Adverse Incidents Reported to AHCA

15. For The One Year Period May 15, 2003 Through May 14, 2004, The Agency Received: 3,175 Nursing Home Adverse Incidents 1,996 Assisted Living Facility Adverse Incidents 19,378 Total Reports Submitted - 5,171 Were Determined To Be Adverse Incidents After Final Facility Staff Review Adverse Incident Analysis

16. AHCA On Site Visits In Response To Adverse Incidents: 84 On-Site Visits To Nursing Homes 48 On-Site Visits To Assisted Living Facilities Of These Surveys 3 Nursing Homes And 5 Assisted Living Facilities Were Cited For Class I and/or Class II Deficiencies  Adverse Incident Analysis

17. Adverse Incident Outcomes

18. Nursing Home NOIs

19. Characteristics of Reported Litigation

20. Notices of Intent Past 3-Years 548 Nursing Homes Reporting NOIsMay 2001 - May 2004

21. Notices of Intent Past Year339 Nursing Homes Reporting NOIsMay 2003 - May 2004

22. Nursing Home Complaints Filed in Clerk of CourtComplaint Service Dates June 2002 - April 2004

23. Nursing Home Complaints Filed in Clerk of CourtBy AHCA Receipt Date June 2002 - April 2004

24. Number of Nursing Homes on The Watch List

25. Nursing Home Deficiencies

26. Nursing Home Deficiencies for Failure to Have Sufficient Staff to Meet Resident Needs

27. All Nursing Home Staffing Deficiencies

28. CMPs Returned to Florida Based Upon Medicaid Participation of Sanctioned Nursing Homes Deposited in State Quality of Long Term Care Improvement Trust Fund Authorization to Spend $500,000 Annually Expenditures Must be Consistent with State and Federal Requirements Grant Proposal RequestsUse of Civil Money Penalty (CMP) Funds

29. Federal Regulations 42 CFR 488.442(g) and Section 7534B of the State Operations Manual Direct Use of CMPs for Protection of Health or Property of Residents of Facilities That the State or the Centers for Medicare and Medicaid Services (CMS) Finds Deficient Federal Guidance

30. Prevention of Deficient Practice Through Educational Means by Development of Videos, Pamphlets, or Other Publications Providing Best Practices Development of Public Service Announcements on Issues Directly Related to Identified Deficient Areas Employment of Consultants to Provide Expert Training to Deficient Facilities Issuing Grants to Facilities for Projects Such As the Eden Alternative Other Projects That Directly Benefits Facility Residents Federal Guidelines

31. A Loan to a Facility Having Financial Difficulty Meeting Payroll or Paying Vendors is an Inappropriate Use of the Funds Funds Cannot Be Used to Bring a Facility Into Current Regulatory Compliance Projects Should Be Limited to Funding on Hand and Should Be Relatively Short-term Projects Federal Limitations

32. All Florida Nursing Homes May Apply Proposals Must be Innovative and: Provide Well Conceived Vision/Plan with Detailed Explanation and Steps to Achieve Improvement Propose Achievable Goals Provide Education Plan for Residents/Staff Provide Detailed Implementation Plan Provide Budget of Expenditures Grant Proposals

33. All Florida Nursing Homes May Apply Proposals Must be Innovative and: Provide Well Conceived Vision/Plan with Detailed Explanation and Steps to Achieve Improvement Propose Achievable Goals Provide Education Plan for Residents/Staff Provide Budget of Expenditures Grant Proposals

34. Initial Request for Interest and Proposals, Nursing Home Letter December 22, 2004 Applications Will be Provided for Completion Proposals Will be Reviewed Within Available Funding Presentation May be Requested Grant Process

35. Recipients of Grants Will Enter Into a Contract With the Agency Contracts Will Generally Be One Year; No More Than Two Years Monitoring Will Be Developed Based Upon the Project Quarterly Reports Onsite Reviews Grant Participation

36. Bureau of Long Term Care Services Barbara Dombrowski Phone: (850) 922-0048 E-mail: dombrowb@fdhc.state.fl.us Grant Information & Proposal Submission

37. Top 10 Nursing Home Deficiencies

38. Top 10 Nursing Home Deficiencies

39. Top 10 Nursing Home Complaint Allegations

40. AHCA Resources • Long Term Care Unit (850) 488-5861 • Bureau of Long Term Care (850) 414-9707 • Bureau of Field Operations (850) 414-9796 • Health Standards and Quality Unit (850) 922-9138 • AHCA Website: www.fdhc.state.fl.us • New Format • AHCA Facilities and Agencies Directory Website: • www.floridahealthstat.com/qs/owa/facilitylocator.facllocator • Federal Link to Survey Guidance: • www.cms.hhs.gov/medicaid/survey-cert/siqhome.asp