(Annual Conference Registration)  (Conference Program)  (Speakers)  (Conference Notes)  (Pictures)

Program Topics
Nashville, Tennessee
September 19-22, 2010
 
SUNDAY SESSION 9-19-2010
Bonnie Kantor, Pioneer Network

During my time with the group I will provide updates on:  1.The CMS Dining Symposium and the follow-up Stakeholder Workshop that took place in May. In addition to an update I will discuss the  planned next steps and their potential  implications; 2. The findings of the “case for adoption”  that focus on the survey process and outcome;  3. The roll-out of the on-line artifacts of culture change tool (which is a CMS  instrument) and the initial findings;  4. The  Promising Practices web program that will be launched later this summer which operationalizes the new Interpretive Guidelines (the ones issued April 10, 2009); and, of course; 5. The current work of the National Life Safety Code Task Force (of which AHFSA is a member.)
MONDAY MORNING KEYNOTE 9-20-2010
Steven Levenson, M.D.

 There are many calls to "reform" health care. The claim is that health care too often is costly, inefficient, unsafe, unavailable, and ineffective, and that it often does not provide good value. Countless efforts and money have been spent to devise and implement strategies to try to improve and reform health care. To date, no tactic or approach has succeeded consistently in facilitating good performance or correcting poor performance.
This session will consider and discuss things that we do not hear often, but that are critical for meaningful health care reform. It will consider key components of a comprehensive, biologically sound reform strategy, including the elements of desirable care and how it can be more consistent; how we can and must promote competent clinical problem solving and decision making across all settings; and the meaning of evidence-based care and its correct application. The session will consider how reimbursement must support–and not inhibit–the consistent, correct implementation of the care delivery process. Throughout, this session will emphasize how state regulatory agencies (including state survey agencies) can help to transform health care positively by aligning their policies and practices with these key biological principles and related care processes.
CMS Presentation (Tuesday)
 Cindy Graunke, CMS

This session will outline the provisions of the Affordable Care Act passed by Congress in March 2010; describe what initiatives have begun and are planned; and provide an opportunity to ask questions related to the Nursing Home Transparency & Improvement provisions of the larger Affordable Care Act.  Topics include Background Checks, Nursing Home Compare, collection of staffing information based on payroll, changes in the nursing home participation requirements (such as quality assurance and performance improvement and dementia and abuse prevention training); changes in the CMP regulations and more.

BREAKOUT SESSIONS A

A1 Co habilitation of a group living space by individuals made vulnerable by medical frailty, cognitive illness, or emotional vulnerability can create a high risk setting for interpersonal conflict.  Factors of physical space, diagnostic mix of residents, and staff training and programming all can impact on the risk of abusive relationships occurring.  This workshop will examine best practice models in residential care, with special focus on dementia environments.  The special role of leadership with staff training and the development of the philosophy of caring will be examined.  The translation to specific programming to maximize quality of life, value of the person, and feelings of personal empowerment will be examined, as well as, their impact on abuse prevention.  Case vignettes will illustrate these principles.  Attendees are encouraged to share experiences and dilemmas.

A2 I will be discussing the infection control requirements and the audit tool being used in ASCs.  I will be describing some of the findings from these inspections and how these findings and the work being done by surveyors is driving prevention efforts at CDC.

A3 Outline: 1. Alabama's definition of an unlicensed assisted living facility  
                2. Recent legislative action addressing unlicensed ALF
                3. Discovery and reporting of unlicensed facilities
                4. Organization of the survey process
                5. Cooperation with other State Agencies
                6. Legal action and results
                7. Stake-holder response
                8. Complicating factors and issues

This purpose of this talk is to provide an overview of the process used by the Alabama agency to take action against unlicensed assisted living facilities. I plan to review the scope of the problem and recent legislative action assisting the department in enforcement. I plan to outline our forms and procedures used in the investigation and reporting of unlicensed facilities. I will discuss some of the problems and complicating factors that we have discovered in our investigations. I will outline the level of cooperation with sister agencies we have been able to develop. Finally I will discuss the results of legal action so far and the effects of this initiative on the Bureau and our relationship with industry groups.

A4 Discuss who the OIG is- their authority, how are they different from CMS, their role in enforcing the False Claims Act.

-Discuss collaboration with State Agencies when entities are being investigated.

-OIG Exclusion List and Corporate Integrity Agreements

-State reporting requirements to the OIG when entity or individuals have had a license revoked

-Examples from the past year of cases the OIG has investigated for failure to provide quality care

A5 CMS will present on the following issues related to Immediate Jeopardy:

p  Discuss current IJ citation trends among regions and nationally

p  Identify the key components of what constitutes IJ.

p  Discuss how to manage the IJ process and what constitutes removing the IJ

BREAKOUT SESSIONS B

B1 Presentation will be on: Illinois Department of Public Health regulations for identified offenders in Long Term Care facilities.  This will include the history leading to the need for regulations, the struggles Illinois has encountered enforcing the regulations.
B2  The session will provide an overview of the modifications that the Joint Commission has made to the standards and survey process to meet CMS deeming requirements, as well as a review of new initiatives in the Accreditation process. These initiatives include the Joint Commission’s Center for Transforming Healthcare, the Leading Practices Database, and E-dition Compliance Monitor. The presentation will also address Joint Commission-State Licensing Agency agreements and changes to the National Practitioner Data Bank reporting requirements that impact both accrediting bodies and state licensing authorities.
B3  Does the term, "Aging in Place," represent enlightened policy or slick marketing geared at legislators and regulators?  Is there a middle ground between unbridled resident/family choice of where to live and inviolable categories of care created by rigid state bureaucrats who never color outside the lines?  This presentation will attempt to describe the dilemma facing state assisted living regulators who must negotiate the conflicting demands created by consumers, providers, and their own experiences of what can happen in facilities that are ill-prepared to care for the residents they have admitted.  The discussion will then propose a framework for evaluating the settings where residents may be safely admitted, and for determining when residents must be discharged even against their own choices.   
B4 Fire Ant Cases: Win Some, Lose Some, But What Are The Lessons To Be Learned?"
This session will examine the lessons learned from the fire ant cases, including surveyor investigation, theories of deficiencies and what happens when you start immediate jeopardy too late.  It will also focus on the 11th Circuit decision rejecting CMS's case in Emerald Shores v. HHS, available at https://www.lexisone.com/lx1/caselaw/freecaselaw?action=OCLGetCaseDetail&format=FULL&sourceID=gdjf&searchTerm=eUSU.KWba.UYeO.HbLU&searchFlag=y&l1loc=FCLOW
and the Court's decision to award Emerald Shores $104,801.32 in attorneys' fees.
 B5 Transition from MDS 2.0 to MDS 3.0:

•       History of MDS

•       Why the Change to MDS 3.0?

•       MDS 3.0 Timeline

•       MDS 3.0 Training – Now and Beyond

•      Quality Measures and Public Reporting
BREAKOUT SESSIONS C

C1 Numerous efforts have been made over several decades to improve and reform nursing home care. There is an enormous amount of advice being offered to nursing homes about what "best practices," that is, what they should do differently and how they should provide the care. The pertinence and appropriateness of these strategies and recommendations vary considerably.  Following up on the discussions in the general session, this session will focus on applying these concepts to long-term care. It will consider the pros and cons of the "conventional wisdom" about what is good and bad about nursing home care and how to improve and reform it. It will consider the evidence about whether current common practices for conditions such as pressure ulcers, weight loss, and behavioral symptoms are truly based on relevant evidence and whether they are really helping or hindering reform. Throughout, it will consider many things that state regulatory and survey agencies could do to promote true reform and avoid being unduly influenced by the "conventional wisdom." Along these lines, it will consider what could be done to apply firm and consistent expectations across the care continuum, so that others can learn from what nursing homes do well and nursing homes can better identify and use evidence in providing their care.

C2 

C3 This session will outline the provisions of the Affordable Care Act passed by Congress in March 2010; describe what initiatives have begun and are planned; and provide an opportunity to ask questions related to the Nursing Home Transparency & Improvement provisions of the larger Affordable Care Act.  Topics include Background Checks, Nursing Home Compare, collection of staffing information based on payroll, changes in the nursing home participation requirements (such as quality assurance and performance improvement and dementia and abuse prevention training); changes in the CMP regulations and more.

C4 This session will review cases that involve survey practices.  The focus of the program will be a discourse on cases that will help state lawyers guide their client units in regard to survey recommendations.  This discussion will include a review of pertinent Departmental Appeals Board decisions, state cases and administrative law judge decisions.  The session will conclude with an interactive discussion of the decision-making process that state survey agencies employ in making recommendations to CMS.
C5  ASPEN System Changes: Planning and Responsibilities

1)     Security and Privacy Information (PI):  What you need to know

a.      Understanding the CMS Acceptable Risk Safeguards

                                                    i.     Password management

                                                   ii.     Encryption – protecting PI on the computer

2)     ASPEN 10.0

a.      Early software release and deployment schedule

                                                    i.     IT deployment planning

                                                   ii.     ASE account setup

b.      Functional and new technology overview

c.      QIS integration    i.     Training update for current QIS states

                                                   ii.     MDS views: 2.0 and 3.0

                                                  iii.     Follow-up release for MDS 3.0 quality indicators

 3)     Coming Releases: Schedule and Functionality

a.      ASPEN 10.1.1: General Enhancements Across ASPEN

                                                    i.     Key functional changes

b.      ASPEN 10.1.2: CLIA Phase 4

                                                    i.     Functional overview

 4)     Other Need to Know…

a.      IT Planning:

                                                    i.     Windows upgrades and testing

                                                   ii.     Change from 32- to 64-processors\

                                                  iii.     ePOC
BREAKOUT SESSIONS D
 

D1 In 2008, the Pioneer Network symposium on culture change addressed myriad subjects including the role of codes in promoting (or hindering) culture change in the long term care environment.   Since 1970, compliance with the NFPA Life Safety Code® has been a condition of participation for the CMS regulated programs.  Non-compliance with NFPA codes can result in K-Tag violations and in the extreme, loss of reimbursement funding for the facility. 

Cooking spaces in community kitchens, gathering areas in corridors, fireplaces in resident areas and certain decorative materials on the wall can all be viewed as ‘violations’ of NFPA 101 in its current form.  Yet, these four subjects are among the foundations of the culture change movement.  Clearly, a need to bridge the goals of culture change and the regulatory systems that govern the built environment is in order. 

A series of actions and activities to make NFPA 101 congruent with the goals of culture change has been underway since 2009.  A series of proposal have been considered and at this moment, are being further evaluated by NFPA Technical Committees.  The second round of deliberations on this subject will take place in October of 2010.  This session will discuss the proposed changes, their status and the next steps as NFPA moves to consider how our codes can accommodate this new model.

 

D2 Topics covered will include the role of ESRD Networks, an update of ESRD prevalence, an overview of organizational trends, the impact of MIPPA, an update on clinical measures, and a discussion of issues related to patient issues, including complaints and involuntary discharge.
D3  “The Person Beyond the Pathology, The Doctor Beyond the Degree”
    Pete Feigal uses his 30 year experience with the mental health system to explore the relationship between consumers, family members and mental health professionals. He discusses the best ways to utilize crucial time, maintaining healthy boundaries, working as a team with other health professionals and personal members of the consumer's "team." He will talk about issues of trust, communication, kindness, and ways to break down the rift of mistrust that has sometimes existed between patients and doctors with this most complex and misunderstood disease. Suitable for consumers, family members and mental health professionals.

D4 This is a PowerPoint presentation covering the legal framework which protects our most vulnerable citizens from abuse in the long term care setting, and the implications of this regulatory scheme for the following stakeholders:

 

·         Residents themselves;

·         Nurses and other health care practitioners;

·         Facility administrators; and

·         Health care companies.

 

Using Tennessee law as a representational template for how such matters are resolved in various jurisdictions across the country, the presentation will provide conference attendees a foundational understanding of the federal regulation that forms the basis of all long-term care abuse cases: 42 CFR 488.301.   

I will address the legal definitions of “abuse”, how abuse complaints arise, and the process – in Tennessee – for resolving abuse complaints against individual practitioners, and the potential regulatory and civil liability implications which abuse cases have for facilities and companies that employ and hence oversee those practitioners. 

I plan to also discuss regulatory alternatives to placing a nurse or other practitioner on the abuse registry, and ways in which a prosecuting agency can go about selecting the most appropriate forum for prosecuting abuse cases.   

D5 The presenters will discuss the sequence of events as they unfurled in NYS in April 2009.  The first outbreak in a children's school -recognition of a new strain of influenza -public reaction to the illness and school closures -hospital and clinics getting surged- ways that they managed- -State Department of Health activity in addressing the surge and the media frenzy -Long Term care issues -infection control issues -CMS waiver protocols once presidential emergency declaration was made -impact on healthcare- what lessons did we learn?  Positve practices -proposed study with AHRQ on alternate care/screening practices -next steps.

 
KEY: 1 - Long Term Care Topics
           2 - Non Long Term Care Topics
           3 - Assisted Living Facilities Topics
           4 - Legal Topics
           5 - Management Topics

(Top)