Fire Sprinklers Once Again Prove Effective

Stan Szpytek

I would like to yield my blog space to my good friend and colleague, Tom Lia, executive director of the Northern Illinois Fire Sprinkler Advisory Board (NIFSAB). His team produced an excellent press release on fire sprinkler effectiveness  during a recent fire in a skilled nursing facility:

 ORLAND PARK, Ill., Feb. 19, 2015 This morning, a single fire sprinkler controlled a mattress fire at Ballard Rehabilitation, a skilled nursing facility (SNF) at 9300 Ballard Road in Des Plaines, Ill., until North Maine Fire Protection District crews provided final extinguishment. The fire sprinkler system contained the fire to a single room on the second floor and prevented major damage and possible deaths, thereby validating a Centers for Medicare & Medicaid Services (CMS) decision to require fire sprinklers in all new and existing long term care facilities nationwide.

The CMS federal rule requiring fire sprinklers in long term care facilities became effective on Aug. 13, 2013, following a five-year phase-in time frame after publication in 2008. The rule, which applies to SNFs that are regulated by CMS for Medicare and Medicaid licensure, is a direct result of two deadly nursing home fires in 2003—one in Hartford, Conn., and the other in Nashville, Tenn.

“The success of the fire sprinkler controlling the fire should be a reminder to the state of Illinois to follow up on any remaining skilled nursing facilities that have deficiencies,” says Tom Lia, executive director of the nonprofit Northern Illinois Fire Sprinkler Advisory Board.

If cited for deficiencies, SNFs must submit a plan of correction and achieve fire sprinkler installation within three months. After the three-month period, the Social Security Act requires that any facility that is not in substantial compliance will be subject to a denial of payment of new admissions and termination from Medicare participation at the end of six months.

“Fortunately, the Ballard Rehabilitation facility was compliant with the federal rule and protected by a fire sprinkler system,” says Lia. “This successful fire sprinkler activation proves the value of the federal rule and the ability of quick-response fire sprinklers to save lives and property.”

Unfortunately, the effectiveness of fire sprinklers is not fully appreciated until ignition occurs. I would like to thank Tom Lia and other fire and life safety professionals around the country who continue to “beat the drum” every day promoting the importance of installed fire suppression systems in buildings of every type of occupancy classification. While it is purely speculation, the fire that Tom wrote about could easily have been a catastrophic event. Now, it will likely be written up as a health care success story in a future edition of the National Fire Protection Association (NFPA) Journal.

 About NIFSAB

NIFSAB, http://www.firesprinklerassoc.org, is a nonprofit organization dedicated to promoting progressive legislation, raising public awareness, and educating code officials and governmental policy makers by demonstrating the proven performance of fire sprinklers in saving both lives and property.

 Stan Szpytek is the president of Fire and Life Safety (FLS), and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. FLS, www.EMAllianceusa.com, provides life safety and disaster planning consultative services to health care and senior living providers around the nation. He can be reached at Firemarshal10@aol.com.

 

 

Making A Difference

Ken Lund, president and CEO, Nosilla Relyt

Good afternoon, ProviderNation.

During the past four years, Ken Lund headed up a team that survived a 75 percent reduction in daily Medicare reimbursement and transformed Shea Family, an 80-year-old, regional skilled nursing operator, into a full-continuum, post-acute care powerhouse in demand by local accountable care organizations (ACOs) and managed care organizations (MCOs). This article is the first in a series that will chronicle the experience.

I have a signed and dated poster from the grand opening of the Kennedy Presidential Library in 1979 that reads: “One person can make a difference, and everyone should try.” I look at it, read it, and reflect on its deeper meaning daily.

Politics aside, it seems to me we should all aspire to accomplish simple daily tasks and minor miracles that lead to a quantum shift for the betterment of our society. We can no longer trust in or believe in conventional mechanisms, as they are broken and incapable of rational and logical change or repair.

Believing In A Vision

I have an enormous amount of hope and faith in the spirit that resonates in each of us to do well. We are born with it. Most of us in the long term and post-acute care business start our actions with the intent to “do no harm” and with our personal/individual commitment to do right for our residents, in simple ways, every single day. It doesn’t take government intervention; it takes a commitment to an idea or vision.

The road to health care reform has been fraught with plenty of failures—and plenty of us will continue to crash and burn—but it is in failure that we find learning and strength. If reform were easy, we would have made better decisions about Medicare decades ago, when it was first rolled out … around 1966, during the Johnson administration.

The Choice

For Shea Family, the moment of epiphany came four years ago. Market forces were lining up, and the tipping point had been reached—indicating it was time to take the plunge. The team had a choice to make: Either change fast or watch revenue evaporate.

Few can imagine a 50 to 70 percent cut in skilled rates, but that’s exactly what unfolded in southern California. Today, providers are contractually obliged to demonstrate measurable outcomes in exchange for volume from MCOs and ACO partners.

As a team, we tinkered, experimented, and restructured several times before getting the model right (and to some degree not only are we still at it, we will always be at it). The model we have today has been in operation for the past two years. In future blogs, I will unpack the five innovations that make it work, one by one.

The Results

Today Shea Family is demonstrating performance that is two times more effective and efficient than the norm at a county, state, and national level, as follows:

• 75 percent of patients in Shea Family skilled rehab go home in less than two weeks, compared with 35 percent across California.
• More than 50 percent lower readmission rates compared with peers.
• 75 percent of Shea Family Care Centers are Four- to Five-Star rated, as calculated by the Centers for Medicare & Medicaid Services. This compares with just over 33 percent nationwide.

What Went Into The Model

The new model for care requires a coordinated network with aligned values and a breadth of service lines across the full continuum. We borrowed ideas from other industries as we innovated. Referrals from partners flow in because Shea Family was able to eliminate layers of management overhead that the ACO/MCO would have had to absorb. The model also aligns with acute hospitals and managed care payers.

Changing the way business is done resulted in enhanced outcomes, higher satisfaction from participants, and dramatically reduced expenses to payers. Change is always tough, but for this provider, in this very competitive region, survival depended on it.

So when I look up at JFK’s boat on the water I’d like to think he understood how to read the wind, the water, and adapt strategy accordingly. He’s looking not at the sail, but through the sail—an important lesson about balancing short-term needs with moving an organization forward toward a broader horizon. Success for him required anticipating course corrections and staying in front of changes to come.

I would like to think then, just like today in our changing environment, he knew that failure to anticipate and adapt would likely leave him in very rough waters without the right people, a plan, and the resources to get through it.

Our patients, families, employees, partners, our kids, and our country are counting on each of us to do our part. We must not only read the wind and the water but also look deeply into ourselves … to chart a new course.

Ken Lund is among the nation’s leading experts in reform for post-acute care, having implemented a successful model in San Diego County that quickly captured majority share from the three health systems dominating the region: Kaiser Permanente, Sharp Healthcare (a Pioneer ACO), and Scripps. In addition to his current role at Shea Family, Lund heads Nosilla Relyt, a consulting practice, where he has helped fellow chief executives design, execute, and run a variety of programs, including strategic planning processes, vendor/contractor agreements, purchasing programs, key executive recruiting, benefit plan design, operational start-ups, and management training programs.

 

 

Aloha, National Nursing Home Week

Joe DeMattos

As AHCA/NCAL’s National Nursing Home Week draws to a close, Hawaii-native Joe DeMattos brings us all a little closer to Hawaii with some insights about the word “aloha” and its true meaning.

Good Morning, ProviderNation.

Aloha is among the best-known words in the world. Most people know it as the traditional way to say “hello” and “good-bye” in Hawai’i.

But aloha means so much more. When you say “aloha” to someone, you are saying that love flows between you.

“Aloha au iā ‘oe” means “I love you” in ‘Olelo Hawai’i, the language of Hawai’i.

This year, the theme of National Nursing Home Week is “Living the Spirit of Aloha.” When one lives with the aloha spirit, one lives with, and is, an agent of it. In this sense, aloha is a noun, and it is a powerful verb of action.

To hold the idea, the noun of aloha and all that it means in the thousands of years of proto-Polynesian and Hawai’i history is to believe and value right thought, right action, respect for others, forgiveness, kindness, compassion, empathy, and love. Aloha is the description of the ultimate world-view of abundance.

Putting aloha into action as a verb means acting on its values in how you treat yourself and in how you view and treat others.

“Living the Spirit of Aloha” in health care assumes the best of yourself and of those with whom you interact—family, patients, residents, colleagues, and even opponents.

Interestingly, the “hand shake” of Hawai’i is to look into the eyes of the person you are greeting, to embrace, touch foreheads and noses, and to exchange the breath of life, the spirit of aloha.

Here in Maryland, 233 skilled nursing and rehab centers provide over 9 million days of care each year to Marylanders in need.

Many in care are “kupuna,” our treasured elders; some, increasingly more, are younger.

As we celebrate and create new living examples of the meaning of aloha, we have an opportunity to double our efforts to “Live the Spirit of Aloha” with all in care, young and elder.

Here are seven simple steps to “Live the Spirit of Aloha” every day:

• Love yourself in a positive way.
• See the best in yourself and others.
• Self-right any of your wrongs.
• Seek and offer forgiveness openly and often.
• View and act as your best possible self and view others the same.
• Work as a team—the flowing love always implies relationship—with others and your highest self.
• Make it your mission to help all with whom you interact to be their best self.

Aloha au iā ‘oe.

Born and raised in Hawaii, Joe DeMattos is chief executive officer of the Health Facilities Association of Maryland, which represents most of the state’s 233 skilled nursing and rehabilitation centers. He can be reached at: jdemattos@hfam.org.

Minimum Wage Increase: It Makes Sense, And It’s Also The Right Thing To Do

Joe DeMattos

Good morning, ProviderNation.

In recent years, the inadequacy of the $7.25 federal minimum wage has been a painful reality at the kitchen table of too many families across our nation. Today, millions of people of all ages in communities across the country work full-time at minimum wage jobs, often at more than one job.

The Health Facilities Association of Maryland (HFAM) represents Maryland’s largest and oldest provider community of skilled nursing and rehabilitation centers, which employ 24,000 people and care for 19,000 people daily.

On average, HFAM member skilled nursing and rehabilitation centers pay starting hourly wages of $9.27 for housekeeping workers, $9.11 for dietary workers, and $10.53 for certified nurse assistants. These key members of the care team ensure that our state’s most vulnerable population of older adults, rehab patients of all ages, and people with disabilities are provided with efficient and high-quality care on a daily basis.

The starting HFAM member wage, excluding higher wage earners in administration, is $9.64 per hour, and the average HFAM member wage with the same exclusion is $12.56 per hour. If HFAM were a state, measured by either starting or average wage, it would pay the highest minimum wage in the country.

Even today, about 70 cents on every dollar paid for care in our centers is used to pay wages.

That is why the board and leaders of HFAM voted to support a reasonable and sustainable increase in the minimum wage here in Maryland. It is simply the right thing to do. Recently, President Obama announced an Executive Order requiring federal contractors to pay at least a minimum wage of $10.10 per hour starting in 2015, and funding those contracts to support such a wage. Just as living wages are supported in the funding of federal contracts, so, too, must state and federal reimbursement rates be incrementally increased to support phased-in increases of Maryland’s minimum wage.

Like many states across the country, here in Maryland skilled nursing and rehabilitation centers are a powerful economic engine, with over $5 billion of annual economic impact, producing more than $100 million a year in various taxes. A phased-in, reasonable, and sustainable increase in the minimum wage in Maryland, supported by appropriately funded federal and state rates for care, will ensure access to quality care, set the stage for better care integration between hospitals and skilled nursing centers supported by appropriate staffing, and, most importantly, will create new jobs that are attractive to top talent.

The danger of an abrupt minimum wage increase without the support of adequate funding can have a detrimental effect on employers like HFAM members who already pay wages much higher than the minimum wage. Higher wages without sufficient support in the rate put quality care and job growth at risk.

There are some who eye an increase in the minimum wage with a view of scarcity: There is not enough to go around. And there are some who view it from abundance: Investing in people now will lift all boats. How much of an increase? When? We leave that to the smarter folks. We simply choose abundance: The time is now for a reasonable and sustainable increase in the minimum wage here in Maryland coupled with an investment in quality care.

Joe DeMattos is president of the Health Facilities Association of Maryland, which represents most of the state’s 233 skilled nursing and rehabilitation centers. He can be reached at: jdemattos@hfam.org.

 

Life Safety Compliance: As Easy As Closing A Door

As life safety consultant conducting mock life safety surveys at provider facilities around the nation, a common deficiency that I frequently see cited is K-18 as it pertains to doors to residents’ rooms. Quite simply, tags are being issued when the door to a resident’s room does not positively latch or some type of obstruction (typically a bed) is so positioned that it restricts the door from closing during the survey.From a training and cost perspective, this is one of the easiest tags to avoid. The recommendation for preventing this citation is to have the center’s maintenance team develop and implement a well-documented, preventative maintenance program to ensure that all doors within the facility properly close and latch as required.

This concept should not be limited to doors to residents’ rooms, but every door that is equipped with a latch within the facility. A door in a health care center is a barrier that will help limit the passage of smoke during a fire emergency. In most cases, a simple adjustment to the door or latching mechanism will ensure that the door operates in accordance with design criteria and regulations.

In older buildings, it is not uncommon to find the bed in a resident’s room that is closest to the hallway door positioned away from the back wall and directly within the swing path of the door, subsequently preventing complete closure.

Additionally, beds are sometimes moved around in accordance with a resident’s specific request to position the bed directly adjacent to the hallway wall. When this occurs, the foot of the bed is often positioned within the swing path of the door. More commonly, beds are moved around during the housekeeping process and not placed back in their original position, which is typically free and clear of the door.

Staff must be trained to make sure that beds or other items are never positioned within the swing-path of a door so they can close and latch without impediment. The corridor wall and door to every room are part of the passive fire and life safety features built into every health care facility and must be maintained in a condition that provides residents and staff with appropriate compartmentalization within the building.

In addition to survey considerations, every staff member needs to understand that a properly functioning and compliant door during a fire inside of a health care facility is an essential component of the environment of care that will help limit the spread of smoke and fire during a real-world emergency.

Stan Szpytek is the president of Fire and Life Safety (FLS) and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and California Association of Health Facilities (CAHF). Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. FLS provides life safety and disaster planning consultative services to healthcare and senior living providers around the nation. For more information, visit www.EMAllianceusa.com or email Szpytek at Firemarshal10@aol.com.

A Father’s Legacy

Good afternoon, ProviderNation.

Our newest guest blogger, Jay Sackman, is a long term care expert and consultant with 42 years of experience working with nursing home operators, labor organizations, and elder advocates. We think Jay’s unique perspective on employee engagement and satisfaction, management and staff relations, and performance improvement will make for some compelling and interesting blog posts.

Today, Jay introduces someone who inspired his career path and his desire to help people—his father.

Professionally and personally, I owe so much of my passion for aging services and staff welfare to my father, Michael Sackman, who passed away in 1999. Mickey—as he was known to his friends and family—was born nearly 100 years ago to immigrant parents on the Lower East Side of Manhattan. He was the youngest of six children, and when his father died he took over as the main financial support of the family at the age of 12.

In 1934, he was making 25 cents an hour as a soda fountain worker on Delancey Street, working 12-hour days, with one day off every two weeks.

One day, he became fed up with the situation and decided to start a labor union to represent culinary workers. He then founded the Regional Clerks International Association 1115. His vision was that the union would be the vehicle for lifting people out of poverty so that they would have a chance to go to school and improve their financial status.

He retired 60 years later.

Dad was either loved and admired or respected and feared. You could not be ambivalent about him. This was the life I was born into.

Jay and his father, Michael “Mickey” Sackman, in 1994.

The Local 1115 began organizing nursing home staff in the early 1960s. I started working in the office at the age of six and went to work with him frequently over the years. I learned how to shake someone’s hand, look them in the eye when speaking with them, as well as the importance of being on time, keeping my word, and keeping my commitments.

I worked at the union offices as an organizer, started a legal service plan for union members and their families, and represented them for 13 years. I served as president of a local and executive vice president of the Service Employees International Union (SEIU) 1199 United Healthcare Workers East until 2006.

My father and I believed in representing the interests of union members and that strategic and legal partnerships with providers were essential to accomplishing the union’s purpose.

I have learned that the vast majority of people who go to work in the field of long term services and supports have something personal at stake. Their motivation starts with a special relationship with a grandparent, parent, or other elder who played a special role in their lives. They want to know the people they are taking care of, and they want to fulfill their personal needs. They want to hear their stories and learn from them.

And what they expect of their supervisor is engagement, empowerment, and that their own observations will be taken into consideration in the care plan.

In future entries on this page, I will share my experiences and recommendations for engaging and retaining staff. I will try to keep the entries practical and focused on current organizational issues arising in long term and post-acute care settings.

Jay Sackman, JD, is principal of Jay M. Sackman Consulting Services. For two decades, Jay served as an elected leader of labor organizations, including a stint as a member of the International Executive Board of the Service Employees International Union (SEIU) and as the executive vice president and Nursing Home Division director of SEIU 1199 United Healthcare Workers East. He is now treasurer of the Board of the Advancing Excellence in Long Term Care Collaborative and has served on the Steering Committee of Advancing Excellence in America’s Nursing Home Campaign for six years. Jay works with organizations that are committed to creating real homes for elders in nursing homes and with executive leadership and other formal and informal leaders to facilitate “ground-up” sustainable change.

Savoring The Gold

Trudy Erickson

Good afternoon, ProviderNation. Today’s post is from Trudy Erickson, administrator for 2012 Gold Award recipient Golden LivingCenter, Continental Manor, in Abbotsford, Wis.

When we received the call last August that our skilled nursing facility, Golden LivingCenter, Continental Manor, had been recognized as a 2012 recipient of the Gold – Excellence in Quality award, presented by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), the team was ecstatic, jumping up and down and on top of the world!

For anyone who is not acquainted with this award, I will give you some background: Since its inception in 1996, AHCA/NCAL’s National Quality Award program has recognized skilled nursing facilities and assisted living communities nationally for providing excellence.Facilities must achieve an award at each level, Bronze first, and then Silver in order to progress to Gold Award status.

If you think your facility has what it takes to become an award recipient, check out this video for an overview of the program here. And if you’re really serious about quality, consider attending the AHCA/NCAL Quality Symposium next month in San Antonio. The deadline for registration is Friday.

I am humbly proud to share that Continental Manor is one of only two skilled nursing facilities nationally to earn this distinguished award in 2012, and one of only 13 long term care providers to have ever received the award at this level. As I have been at Continental Manor for 20 years, I am thrilled that the team has achieved this recognition.

When asked what sets us apart from the others, the aspects that immediately come to my mind are our quality care, our dedicated staff, and our strong community presence. Our philosophy here is simple: The day is not over until things get done. Most workers can pack up and leave at the end of the day, but our team’s job is done for the day when our patients and residents are satisfied and cared for.

When you walk through our doors, you can feel the love in the facility. Continental Manor is my home away from home, truly. My daughter works here as a certified nurse aide, while my mother works in the activities department.

All the other team members are just as much a part of my family, too. Every team member puts their heart into providing quality care, and it took each individual on the team to collaboratively win the Gold.

To us, here at Continental Manor, this honor means the world.

A Gift Not Under The Tree

Good morning, ProviderNation.

Hope your Festivus was the best ever.

Just in case you didn’t get everything on your list, the Congressional Black Caucus has a late gift for you: The group is taking up the cause against provider tax cuts.

In an open letter to President Obama, the group says its members “are troubled by how the proposed reductions likely would not only sustain, but exacerbate many of the long-standing racial and ethnic health disparities that have a devastating impact on the health and wellness of African-Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders.”

The letter, dated Thursday, is signed by Caucus Chair and U.S. Rep. Emanuel Cleaver, II, (D-Mo.), as well as the Virgin Island’s delegate, Donna Christensen.

“We are also deeply concerned that the proposed reductions would hit the nearly nine million individuals who receive both Medicare and Medicaid benefits—known as dual-eligibles—the hardest,” the letter says.

You’ll recall that House Republicans briefly flirted with the idea of cutting provider taxes last week, but thought the better of things after a frank exchange of views with long term care advocates.

Everyone we’re talking to says that we’re going over the fiscal cliff no matter what happens, but advocates have been working hard to remind Washington types that provider assessments are, um, not to be touched.

So sometimes even symbolism is fun.

I Got Your Merry Christmas Right Here, Pal

Bill Myers, senior editor

Good morning, ProviderNation.

Not that you didn’t have enough to worry about already, but the House is going to vote on a “fiscal cliff” package that would slash provider assessments, from 6 percent to 5.5 percent.

This has not been well received by long term care advocates.

The bill’s chances of becoming law are remote, but sometimes symbolism counts extra.

“This is a key vote,” AHCA lobbyist Jeff Myers says. “I’m taking attendance on this.”

Speaking of Congress—and Myers and his team could probably use a hug (at least) after this lame-duck session—the Senate Judiciary Committee has scrapped plans to mark up Sen. Herb Kohl’s bill on painkillers in nursing homes.

You’ll recall that the bill was supposed to come up in committee today, but after AHCA President & CEO Gov. Mark Parkinson sent a whiff of grapeshot, Kohl is, as they say, rethinking his options.

Let’s Keep Talking

Greg Crist

Today’s guest blog is from Greg Crist, vice president of public affairs at the American Health Care Association.

“Let’s keep talking,” you hear people in Washington say.

It’s one of those awful expressions that creeps into conversations, the go-to cliché of wannabes, kind of like, “Let’s do lunch,” or “paradigm.” Even worse, it’s one of those expressions that, by some weird Orwellian process, you can accidentally blurt it out yourself.

But watching the political races this year, I’m giving another thought to the idea of keeping on talking. Because it might be working.

Two (more-or-less) random examples:

Earlier this year, CMS decided to end the practice of freezing payments while facilities are being audited under ZPIC. That came after pressure from House Republicans who were worried about quality of care for our patients.

And then, I’m sure you saw the shout-out our industry got from former President Bill Clinton at the Democratic Convention this summer.

I’d love to tell you that each of these moments were because we’ve got Washington power-brokers on speed dial and they quake at the very idea of crossing us.

Still, these efforts by our nation’s leaders aren’t coming out of nowhere, either. Clearly they must have heard the talk. And it must have come from more than just us here in Washington.

I was on the road a lot this summer, talking with members about what’s going on. And I’m both proud and pleasantly surprised when the things I heard “out there” get to the ears of Washington leaders.

We’ve got a new poll out that shows voters don’t want any more cuts to nursing homes. Those are powerful voices. We’re going to need to hear even more of them as we veer closer to the fiscal cliff.

So, yeah, providers: Let’s keep talking.

Greg Crist
Vice President, Public Affairs
American Health Care Association