2013 Member Directory Enclosed

Summer 2013

A publication for Wisconsins Long-Term Care Profession by

CHAASEing Perfection
How the Center for Health Administration and Aging Services Excellence (CHAASE) Helped UW-Eau Claire become the Nations Top Program for Long-Term Care

Including: Employee Immunization Programs Key to Quality Advancement Legislative Advocacy Begins with You DHS Secretary to Tackle Key Policy Challenges

Wisconsin Health Care Association

Real Care. In Real Time.

Welcome
Moving Forward!
With the Summer 2013 Issue of Continuum, we are pleased to include a copy of our 2013 WHCA/ WiCAL Membership Directory. WHCA/WiCAL offers this Directory to membership, other long-term care providers, policymakers and the public as a useful resource and roadmap for locating quality long-term care facilities in Wisconsin. The first half of 2013 has been an important period in the field of long-term care in the State of Wisconsin. For skilled nursing providers, welcomed news came earlier this summer with the signing of the 2013-15 Biennial State Budget into law. As a result of thoughtful Wisconsin State Government leadership, as well as WHCA/WiCAL membership advocacy, $38.6 million in Nursing Home Bed Tax revenue that was skimmed in previous budgets for purposes other than providing quality long-term care was returned to fund its intended purpose. While the amount returned through the budget is only half of what was skimmed from the provider community during previous legislative sessions, it represents an important step in the right direction. On the assisted living front, many critical challenges remain including: redefining the functional screen, reforming the lack of transparency in the rate-setting process and continued concern over the financial stability of some Family Care MCOs in the state. These policy questions along with several others are addressed in this issues Stakeholder Spotlight, which features a Continuum interview with Secretary of the Wisconsin Department of Health Services, Kitty Rhoades. Other feature articles include: a column on the success Clement Manor Health Center has realized in implementing an employee influenza immunization program, a legal column on CPR policies, a column on the branding challenges facing long-term care and what to do about them, an article on the grassroots advocacy efforts by the WHCA/WiCAL membership, and this issues cover story on the national reputation of UWEau Claires Health Care Administration program and the Center for Health and Advancing Aging Services Excellence (CHAASE). Thank you for taking the time to read Continuum! As always, if you have any questions about its content or suggestions for future issues, please contact the Managing Editor of Continuum, John Vander Meer. Sincerely,

Wisconsin Center for Assisted Living

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Contents
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Continuum is published for the Wisconsin Health Care Association and the Wisconsin Center for Assisted Living 131 W. Wilson Street, Suite #1001 Madison, WI 53703 Phone: 608.257.0125 Fax: 608.257.0025 www.whcawical.org

Summer 2013

Clinical Corner LTC Employee Influenza Immunization Critical to Quality Advancement

Experience of Clement Manor Offers Insight into Program Implementation
WHCA/WiCAL member, Clement Manor Health Center made the decision several years ago to have all employees and volunteers of the organization receive the flu vaccination. Now, with Wisconsins health care provider associations unanimously adopting the goal of implementing mandatory policies, that achieve a rate of greater than 95 percent, Clement Manors experience may offer insights to other providers.

Media Matters Public Education and Communication Campaign Provides Insight into LTC Branding Challenges
Campaign Highlights Need to Recast the Critical Services that Providers Offer
Nearly 70 percent of Baby Boomers will require long-term care, and the LTC provider community needs to be ready. The American Health Care Association realized that the public held a negative perception of the profession. And in a search to find the answer, AHCA established the Public Education and Communications Campaign (PECC). How is the PECC going about changing these perceptions and what can providers do to help?

Managing Editor John J. Vander Meer Publisher Dean Gille Editor Melissa Keller Account Manager Kris Holden Creative Director Sara Rice Layout & Design David Cox Published by

10

Capitol Connection Legislative Advocacy on both State and Federal Levels Begins with You
Providers are the Most Effective Messengers in Voicing Concerns to Legislators
The WHCA/WiCAL Board of Directors unanimously adopted a 2013 Legislative Agenda for the 2013-14 session of the Wisconsin Legislature in December. The agenda is used as a directive to staff to focus on priority issues, but also is a guideline for all members to use in meetings with their local legislators who tour facilities, attend district meetings, and present to legislators in their Madison offices as part of our Legislative Day program.

14

Cover Story CHAASEing Perfection

How the Center for Health Administration and Aging Services Excellence (CHAASE) Helped UW-Eau Claire become the Nations Top Program for Long-Term Care
In the last two decades, the University of Wisconsin Eau Claire Health Care Administration (HCAD) program has evolved into what experts consider to be one of if not the preeminent collegiate long-term care administration program in the country. A key component of this success, these experts say, has resulted from the participation of the long-term care providers through UW-ECs Center for Health Administration and Aging Services Excellence (CHAASE).

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For more information in advertising in Continuum call 608.257.0125 or go to www.whcawical.org/continuum. If you are planning on moving and would wish to continue receiving Continuum, call 608.257.0125 and inform WHCA/WiCAL of your new address. 2013 Badger Graphic Systems. All rights reserved. The contents of this publication may not be reproduced by any means, in whole or in part, without prior written consent of the publisher. PUBLISHED AUGUST 2013

18

Stakeholder Spotlight DHS Secretary Ready to Tackle Key Challenges Kitty Rhoades Familiar with the Issues Facing Long-Term Care
Secretary Rhoades hopes to make strides in the development of a regulatory structure for facilities that specialize in the treatment of mental and behavioral health issues for the elderly. Continuum recently asked Secretary Rhoades to discuss the ways in which she wants DHS to approach the creation of these kinds of facilities.

22

LTC LEGAL LETTER Despite Misplaced Media Hype, California CPR Story Offers Providers Opportunity for Evaluation
Facilities Should Review Systems to Assure Compliance, Honor Expressed Wishes
A dramatic 911-call beckons skilled nursing and assisted living providers to review and evaluate their current policies, procedures and staff training.

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SUMMER 2013 | CONTINUUM 5

Clinical Corner

LTC Employee Influenza Immunization Critical to Quality Advancement

By Dennis Ferger and Linda Struhar

Experience of Clement Manor Offers Insight into Program Implementation

more information or clarify any misconceptions. If the employee still refused we had them view the Center for Disease Control video titled Health Care Worker Influenza Vaccination. At this point, if the employee refused they were required to sign a declination form stating so. A decision was made in late-2011 that the flu vaccination would be required as a condition of employment for the 2012 flu season. This was also expanded to include volunteers in the facility. Immediate notification was communicated to our employees during the 2011 flu vaccination program, and at the same time all new hires were informed of this requirement. Again, education became the catalyst for moving this goal forward.

The flu shot was given free of charge to all staff and volunteers, which was seen as a nice benefit. Reminders were sent to staff periodically throughout the year regarding this requirement. On September 1, 2012, a strong notice was sent to staff to ensure they understood the consequences of their decision. Vaccine administration times were made available on all 3 shifts and if necessary, additional appointments were scheduled. Our results were amazing! Out of 323 employees, only onestaff member did not take the vaccination due to medical reasons. No one was terminated, however, two volunteers refused the vaccination and therefore their association with our facility ended. We still had a flu outbreak but the symptoms were milder, there were fewer staff call ins and employees returned to work sooner. At Clement

Manor, we feel that transparency is always important with our staff so when information came out that the 2012 flu vaccination was not as effective this year, this was shared with our staff. There were no comments by staff to discontinue the requirement but rather staff was supportive of continuing it. As always, our goal of providing a safe environment will not stop with this past years success. We will continue to provide education to our residents, families, staff and volunteers on this very important issue. During the process of implementing a mandatory flu immunization policy at your facility there are resources available for you that were not available to us when implementing our policy that we would encourage you to use. WHCA/WiCAL members are encouraged to go to www.whcawical.org/flu for a policy

implementation toolkit, a link to the video our employees watched, and a link to a recording of a webinar that many of our member facilities participated in.

everal years ago, Clement Manor Health Center made the decision to have all employees and volunteers receive the flu vaccination. While our facility always had a high participation level of staff receiving the flu shot, we felt we could improve in this area. Therefore, leadership at our organization decided that a 100 percent immunization rate would be our goal.

as a vital step in providing safety to our residents. This education began many months before the actual flu shot was to be administered in 2011. The importance of the mandatory flu vaccination was a key subject of department meetings, memorandums, resident and family councils and was discussed during the hiring process. During our discussions with our employees, one topic kept resurfacing. Employees were confusing the respiratory flu with the gastrointestinal flu. Many employees stated that the flu shot did not prevent them from getting the flu. When we delved further into this we realized that some of our employees thought the flu shot would also prevent the gastrointestinal flu. In further education sessions this was very important to highlight. In 2011 we did not mandate the flu shot, however, there was a strong effort to have 100 percent of our employees vaccinated. If an employee refused the vaccination we required them to discuss this further with their manager and/ or Infection Control Preventionistto provide

Dennis Ferger, NHA, is the Administrator and Linda Struhar, MS, RN, is the Director of Nursing for Clement Manor Health Center in Greenfield, WI, a 166-bed skilled nursing facility that is a WHCA/ WiCAL member facility. Dennis Ferger can be reached at dferger@clementmanor.com and Linda Struhar can be reached at lstruhar@clementmanor.com.

Now, with the Wisconsin Health Care Influenza Prevention Coalition, of which WHCA/WiCAL is a member, having adopted the goal of achieving a greater than 95 percent immunization rate among staff, we wanted to offer members of Wisconsins long-term care provider community a sense of our experience in the hopes that our story may provide some perspective for other facilities in implementing their own employee immunization programs. Education has always been paramount to any initiative Clement Manor proceeds with, and this includes the topic of infection control issues starting with the flu vaccination. We developed mandatory education sessions for staff to attend in which we had our infection control preventionist and representatives from outside the organization speak to the importance of the flu vaccination

Heath Care Professional Influenza Vaccination Implementation ToolkiT: www.whcawical.org/flu

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Media Matters

Public Education and Communication Campaign Provides Insight into LTC Branding Challenges
By Greg Crist
ork-centric. Independent. Driven. Competitive. When you read of these traits, who do you picture first? Is it you? A friend? Your boss? If any of these individuals is part of the Baby Boomer generation, then youd be right on track. Over the next decade, America will see millions of these characteristically self-sufficient Boomers enter into retirement age. Nearly 70 percent of these individuals will require long-term care at some point in their lives, and the profession needs to be ready. We need not only to be prepared with high quality care, but we also need to be ready for the unique (sometimes demanding!) personalities. Boomers, while incredibly resourceful and resilient as a whole, are a challenge when it comes to health care. This generation grew up in the era of the original

to educate the public about the services provided in skilled nursing facilities and establish the profession as part of the total health care continuum. As most research goes, the first and most fundamental part is defining the parameters of the current situation. Where are we, how did we get here, and where do we hope to go? By collecting the opinions of Baby Boomers, current consumers of longterm care services, family caregivers, and opinion elites, AHCA was able to identify several key opportunities for change: A majority (60 percent) of survey participants said they had never had a long-term care conversation; 94 percent of individuals had never gone online for information about longterm care; and 85 percent had never visited a facility to learn more about options within the six months prior to taking the survey. Most striking for the long-term care profession, however, was the repeated findings that the term nursing home was perceived as inherently negative in comparison to the term skilled nursing and rehab centers. The PECC research also provided valuable insight to the next wave of consumers: Baby Boomers. Research confirmed that Boomers have high expectations of themselves and those who care for them. Boomers want freedom and flexibility, and they prefer small communities, life-enriching activities, and access to technology.
Photo: John Vander Meer

Campaign Highlights Need to Recast the Critical Services that Providers Offer

term care, either as a patient, family member, or professional caregiver. In order to judge the effectiveness of the commercials, three key indicators were identified-change in the publics favorability rating of the profession, advertisement recall, and visits to a designated website: CareConversations.org.

Superman: a heroic persona who can do everything, be everywhere, and needs no help. But, whether Boomers want our help or not, they will need it. And long-term care will be there. Several years ago, the American Health Care Association realized that regardless of the innovative and effective health care solutions providers were offering, the public held a negative perception of the profession. The Association committed resources to get to the bottom of the issue: Why did Americans view the profession negatively? And in a search to find the answer, AHCA established the Public Education and Communications Campaign (PECC), a large-scale movement to change the publics neutral-to-negative perception of the long-term and post-acute care sector. Born in early 2011, the PECC aimed

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The ads were tested in three media markets: Richmond, VA; Omaha, NE; and Lexington, KY; and compared against three similar control markets: Greensboro, NC; Wichita, KS; and Mobile, AL. Audiences in both What does this mean for the individual facility? Learn to help yourself. Use the term skilled nursing facility and move nursing home to the back shelf. Create a website for your facility
Greg Crist is Senior Vice President of Public Affairs for the American Health Care Association. He can be reached at gcrist@ahca.org.

This website was created particularly for the campaign, and features valuable resources about having difficult conversations regarding aging, health care needs, and finding appropriate facilities.

markets were tested prior to the start of the media campaign, in the middle of the five-month effort, and immediately after the completion of the testing period. The results were impressive, and each of the key measures experienced significant gains: 55 percent of the public in the test markets recalled seeing the advertisements; use of the Internet to search for long-term care tripled, and visits to local facilities increased by 30 percent. And, most importantly, there was a strong upswing of four percent an impressive number when experts predicted just a 0.9% shiftin the publics perception of skilled nursing facilities. These outcomes were promising, and similar campaigns in different markets have since produced similar results.

and get it out there in the public. Be not only present, but active in social media. Tout your new technologies and make the lifestyle offered at your facility appealing to an independent Boomer. And get families into your facility to experience it firsthand to understand that nursing homes are not what they used to be in the 1940s and 1950s. This is a new era of health care, and a new era of senior living. For more information on the Public Education and Communications Campaign, please visit www. CareConversations.org or contact the American Health Care Association.

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Armed with a foundation of research and a clear image of how the PECC might change public opinion, AHCA staff and a team of advertising professionals developed a sophisticated approach to delivering key messages regarding the services and priorities of the profession to the public. Significant investments were made to create commercials that featured the true stories of people whose lives were impacted by long-

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SUMMER 2013 | CONTINUUM 9

Capitol Connection

Legislative Advocacy on Both State and Federal Levels Begins with You
Providers are the Most Effective Messengers in Voicing Concerns to Legislators
By Jim McGinn

January shortly after inauguration. Every administrator and staff member were asked to write, email and call our state officials with a simple and very direct message, please return the bed tax skim. Following those efforts, WHCA/ WiCAL requested all members to attend our Legislative Day program on Tuesday, March 26, 2013, at the Inn on the Park in Madison. The morning program included presentations by key state officials on skilled nursing and assisted living facility initiatives in the proposed state budget bill and other legislative proposals impacting long-term care. During the program, Secretary Kitty Rhoades, of the Wisconsin Department of Health Services, addressed members for almost an hour, highlighting Gov. Walkers proposed recommendations contained in his 2013-15 biennial budget. Secretary Rhoades noted that Gov. Walker stated that his budget would reduce prior administration revenue transfers by increasing funding to nursing facilities by 2 percent in each year of the biennium. The Secretary noted that $38.6 million (all funds) is appropriated in the budget for the increase, and while the budget did not include all of the $45 million being skimmed, the Governor is committed to restoring all nursing home bed tax revenues as they were intended.
Photos: John Vander Meer

Secretary Rhoades discussed her agencies $7.7 billion Medicaid program, as well as a wide range of services to clients in the community, at state institutions, and long-term care support and care programs, including Badger Care, Senior Care, and Family Care. Following Secretary Rhoades comments, the new Chair of the Assembly Aging and Long-Term Care Committee, Representative Mike Endsley (R-Sheboygan), addressed the membership. Rep. Endsley shared with the members that he was elected to the Assembly in 2010, re-elected in 2012, and while focused on jobs, the economy and taxes, he has been touring and visiting long-term care facilities in his district and looking forward to working with all long-term care providers this session. The last individual to address the members was Representative Robin Vos (R-Burlington). Rep. Vos is the Speaker of the Assembly, and previously served as the Assembly Co-Chair of the Joint Finance Committee. Speaker Vos is the presiding officer of the Assembly and leads the 60-member majority in the 101st Wisconsin State Assembly. Speaker Vos provided an overview of the Assemblys reactions to the Governors budget bill, commenting on the significant amount of state (GPR) dollars included in the budget for the Department of Health Services, his efforts to reduce taxes, stimulate economic growth, and assist businesses by reducing surcharges on payroll taxes to pay back funds borrowed from the federal government to pay unemployment compensation. At the conclusion of Speaker Voss comments, an overview of Medicaid funding for skilled nursing facilities, skilled nursing facility formularies, transfer of licensed nursing facility beds, and the contributions that skilled

nursing facilities make to Wisconsins economy and employment was presented by WHCA Executive Director Tom Moore. Brian Purtell, Executive Director of WiCAL reviewed assisted living issues for the members to discuss with their legislators as well. With issue papers in hand, members walked across the street to the Capitol to discuss with their legislators the important issues confronting longterm care providers in Wisconsin. Several members also extended invitations to their legislators to tour facilities back in their districts, meet with staff, and spend time personally observing the delivery of care and services to Wisconsins frail elderly and disabled. While the members focused on state issues, AHCA/NCAL also requested Wisconsin members to attend the national associations Congressional Briefing on June 3-4, in Washington D.C. AHCA/NCAL solicited our help on federal long-term care issues, noting that members of Congress listen to their constituents, and the most effective way to communicate with Congress is to personally meet with them or their staff. That is precisely why AHCA/NCAL invited members to attend the conference, because legislative issues are the most powerful when the message comes straight from home. Accordingly, the WHCA/WiCAL office contacted our federal officials and meetings were scheduled with our Congressional delegation. The Congressional Conference included a briefing on federal long-term care issues and featured speakers Congressman Kevin McCarthy, Majority Whip (R-CA), Congresswoman Nancy Pelosi,

Democratic Leader (D-CA), and Pulitzer Prize-winning writer and investigative reporter Bob Woodward of the Washington Post. Similar to our Legislative Day, members traveled to congressional offices and requested our elected officials to: Ensure observation stays in hospitals count toward the required three-day hospital stay for Medicare coverage; Support an extension or permanent fix to the Medicare physician fee schedule (Doc Fix); Request our delegation write to CMS asking the agency to keep assisted living as a Medicaid home and community-based services option. While members attended both events this year, the issues confronting long-term care continue. With summer recess scheduled for both the Wisconsin Legislature and U.S. Congress, now is a great time to invite your elected officials to tour and experience real life examples of the issues you shared in Madison and Washington D.C. with your residents, families, and staff. Recognition of our issues occurs because members have advocated for change, if no effort is made, change will not happen. This fall, as the Legislature and Congress reconvene and consider long-term care issues, legislators will have a much better understanding of the issues having been briefed by their local constituents.
James McGinn is WHCA/ WiCALs Director of Government Relations. He can be reached at jim@whca.com.

he over-used and often-used phrase all politics is local appears in every interest group/ trade associations efforts to enlist the support of its respective membership to attend a Legislative Day at the State Capitol or Congressional Conference in Washington D.C. While over-used, the phrase has an important element of truth. At the beginning of the 2013-14 biennial session of the Wisconsin Legislature and the convening of the 113th U.S. Congress, WHCA/ WiCAL, as well as our national affiliates, the American Health Care Association and the National Center for Assisted Living (AHCA/ NCAL) were planning programs for members to attend in the spring as the Wisconsin State Legislature and U.S. Congress began debate on their respective budget bills for the upcoming fiscal year(s). In anticipation of the current legislative session, at the December 4, 2012 WHCA/WiCAL Board of Directors meeting, the Board unanimously adopted a 2013 Legislative Agenda for the 2013-14 session of the Wisconsin Legislature. The agenda is used as a directive to staff to focus on priority issues, but is also a guideline for all members to use in meetings with their local legislators who tour facilities or attend district meetings.

Once again, the top priority for WHCA/WiCAL in 2013 is the return and rededication of the nursing home bed tax skim. The nursing home bed tax is a mechanism used by many states to generate federal funds to support and improve skilled nursing facility home resident care. Unfortunately, the state skims $45 million of federal funds generated by the nursing home bed tax for other Medicaid purposes each year. WHCA/WiCAL requested Gov. Scott Walker and Legislature to return the $45 million skim to support improvement in skilled nursing facility resident care. To accomplish our number one agenda item, all members need to play an active, effective and aggressive role in our lobbying efforts. WHCA/WiCAL prepared background information for members to write to Gov. Walker and legislators in early

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SUMMER 2013 | CONTINUUM 11

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Cover Story

CHAASEing Perfection
By John J. Vander Meer

How the Center for Health Administration and Aging Services Excellence (CHAASE) Helped UW-Eau Claire become the Nations Top Program for Long-Term Care

today, even though the program is one of 11 NAB accredited long-term care administration programs in the country, the UW-EC HCAD graduates account for over half of the senior care administrator program students from these programs in the country. UW-EC HCAD graduates are working in key leadership capacities in skilled nursing/therapy centers and assisted living facilities, not only throughout Wisconsin and the Midwest, but in important roles in long-term care across the country. From its inception until a couple of years ago, Ive watched the evolution of the program to become the premiere long-term care administration baccalaureate program in the country, said Richard Rau, CEO of Clement Manor Health Center, a 166-bed skilled nursing facility in Greenfield, WI. The commitment of UW-EC to the program itself has been a key component of the programs success.

he acronym might be CHAASE, but the Center for Health Administration and Aging Service Excellence program at University of Wisconsin Eau Claire is in fact chasing after no one. Over the past two decades, experts say, the UW Eau Claire Health Care Administration (HCAD) program has emerged as one of if not the preeminent collegiate longterm care administration program in the country. During that time, CHAASE, with its longstanding LTC community partnerships, has helped the HCAD program develop a rigorous in-field work requirement before graduation and a cutting-edge curriculum that is leading the way. The University of Wisconsin at Eau Claires Health Care Administration program and its unique collaboration with CHAASE provides a valuable setting for developing longterm care talent and leadership, said Gov. Mark Parkinson, President and CEO of the American Health Care Association and the National Center for Assisted Living in Washington, D. C.

We essentially have the Harvard of long-term care administration right here in Wisconsin, said Mike Schanke, a WHCA/WiCAL Board of Directors and CHAASE Board Member, as well as a 1985 graduate of the program. The leadership and passion that (professors) Doug Olson and Jennifer Johs-Artisensi have for our profession and our training; the people who make up the CHAASE Board; and the commitment of UWEau Claire; put that together and what you get is the best program in the country period. Best in the Nation The program, which is accredited by the National Association of Long-Term Care Administrator Boards (NAB),is widely regarded for itscurriculum, which integrates health care with business content, as well as classroom instruction

with field experience. As a result of this reputation, UW-Eau Claire HCADstudents are in demand, with nearly 100 percent of the programs graduates routinely reporting they are employed or continuing their education. First of all, position the UW-Eau Claire up there with the best in the nation, and then even set it apart, said Randy Lindner, President of the National Association of Long-Term Care Administrator Boards. Its a very, very fine program. Its strength really lies on its partnership with CHAASE and the community thats what really makes it stand apart from other programs. During his tenure with the program, UW-EC HCAD Professor and CHAASE Director Douglas Olson said the program has quadrupled its enrollment, and

Practicum Requirement Students take coursework in biology, chemistry, business, economics, social sciences, and health care administration. But unique to HCAD is a paid, 12-month practicum that requires all students to work in a health care facility before graduating. Unlike many professional degrees, the UW-EC HCAD program provides students with a significant amount of field experience in a longterm care facility. We set ourselves apart because of that 50-week practicum, said Schanke, who has hired two UW-EC HCAD graduates at his facility, Oakridge Gardens Nursing Center, a 111-bed skilled nursing facility, located in Menasha, WI. (The practicum) is a tremendous commitment for the facility. But providers get great students to work with, and students really do put the final edge on their abilities. Students working to complete their practicum requirement receive provider-sponsored stipend assistance, offsetting costs and allowing them to focus on the program experience. The practicum frequently offers participants some of their most important lessons as they prepare for a career in long-term care and students

appreciate the experience, too, as it allows them to immerse themselves in their chosen field even before graduating. In order for our students to do their jobs well it is important that they understand how to interact with residents, their family members and the (provider) community, Diane Hoadley, Dean of the UWEC College of Business, where the HCAD program is situated. When the program was first conceived by Gene Decker, he was smart enough to think about it in terms of teaching/learning, scholarship, research and service, Hoadley added. Gene had a great vision and he worked at that program for many years and to a certain extent he was ahead of his time. We have been really fortunate to have Doug Olson and Jennifer Johs-Artisensi because they know how to do all of those things very well. LTC Partnerships Graduates of the program are eligible to take the Wisconsin and Minnesota licensure examinations for Nursing Home Administrators (NHA). Many other states accept graduates from this program for licensure on an individual basis. (CHAASE) gives us lots of access to members of the LTC provider community for students to do their practicums with, and in return, weve been able to provide the industry with graduates who are prepared to do great work.
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Hosting a practicum student is just one of many ways in which provider partners have embraced the program. Providers frequently also appear as lecturers in class, participate in panel discussions, open their facilities for student tours, and more. Many help to fund scholarships and various student organizations. These and other aspects of the LTC community partnerships are a cornerstone of program success, leaders say. CHAASE gives us a clear opening to several aspects of the industry, which wouldnt be there but for the great relationships that it has with the industry, Hoadley said. One thing that is very unique about this program is the symbiotic relationship that exists between the CHAASE Board and the school. You usually dont see that kind of relationship between the providers and the educators. Rich, ongoing partnerships also help keep the curriculum relevant in a rapidly changing field, said JohsArtisensi, Director of the UW-EC HCAD program

We know that this is a dynamic field, and some of the things that are taught right now may not be taught in 10 or 15 years, Johs-Artisensi said. One of the advantages of the program to the curriculum is that (providers) have been involved for decades. This unique cooperation offers critical benefits to LTC consumers in Wisconsin. We do have empirical evidence that there is a direct correlation between academic and field experience with quality care, Lindner said. UW-EC has incorporated one of the highest standards for the practicum of any program in the country. They are the only program in the country that has developed that partnership. Students Who Choose LTC Head for business, hearts for caring, hands for working with people. This phrase is used to describe the type of students who enroll in the UW-EC HCAD program. To see evidence of these character traits, one need look no further than the 2013 WHCA/WiCAL UWEC HCAD Scholarship Award winners, Jaimee Moran and Crystal Frazer.

Im most excited about establishing relationships with my residents and their families, said Moran, a junior from Platteville, WI. I think the elderly have so much wisdom to share and certainly an interesting perspective on life, and Im really looking forward to spending my days surrounded by people that I adore. Schanke said that a key component of the admissions process for prospective students is the fact that each student is personally interviewed, and their capabilities shine through when you talk to them. I am most excited about the challenges, making sure the residents are cared for using their specific care plans, and using knowledge gained from the Health Care Administration Program to create growth in a facility, said Frazer, a junior from Eagleton, WI. This program would not be known nationally for the students and leadership programs that come out of UWEC if not for the assets and possibilities given to us as students by organizations like WHCA/WiCAL.

Last spring, I had the pleasure of speaking to students, alumni and partners of this program. I am impressed with the caliber of the students and the associated community. Effective instruction on long term care administration and the quality management process is a critical component of providing resident-centered care and quality long term care services, Parkinson said. I commend our state affiliate WHCA/WiCAL for their partnership, which has existed since the programs founding, with CHAASE. What Does this Mean for Providers? Increasing demand for long-term care professionals resulting from the aging Baby Boomer generation, and staffing shortages as a result of the aging LTC workforce are two key challenges for providers in coming years. However, these factors present some strategic advantages to Wisconsins provider community for having a program of the caliber of the UW-EC HCAD program right here in the Badger State. The demand for the ever-evolving health and aging services administrative field is growing, and right now the supply is not meeting the demand, Olson said. For the first time in recorded history the demand for people who can work with the elderly is constantly growing, Hoadley added. Professor Johs-Artisensi said that UW-EC HCAD graduates have a strong understanding of whats expected of them as a result of their coursework and their practicum

experience, which translates into a greater ability for graduates to give back to an organization. Future of the Program Program leaders are turning their focus increasingly to research and policy impact, part of a $2.5 million Call to Lead campaign recently launched under the guidance of the CHAASE Board of Advisors. Were at a good place right now in our program and with the Center, said Olson, who is looking to emphasize a greater level of political engagement as well as the publishing and promotion of applied academic research now and in coming years. Political engagement is no longer optional. We aim to ensure that our graduates are skilled in getting their messages across to legislators. Olson said the long-term care administrative provider profession is in a fragile state, and research can play an important role in advocacy for the profession. (CHAASE and the UW-EC HCAD Program) have a standing in longterm care that provides a voice to credibly quantify the field from a research perspective, added Schanke, who indicated that the same perspective isnt always extended to providers in the legislative process. Theres an assumption that if you live in Eau Claire you cant be influential this is just not the case, said Hoadley, pointing to the national boards, committees and speaking opportunities UW-EC HCAD personnel are responsible for serving

on and attending. Last summer Doug Olson testified before the Senate Aging Subcommittee as part of the National Emerging Leadership Summit and is on numerous national boards, and Jennifer is the Chair of the NAB Education Committee. The UWEC (health care administration program) is exemplary, said Marianna Kern Grachek, President & CEO of the American College Health Care Administrators. (Professors Olson and Johs-Artisensi) are out there and they are visible at the national level, which connects them to professionals across the country. Emphasizing political engagement and research, leaders say, will help keep the CHAASE, HCAD and Wisconsin in the forefront of LTC for years to come. An aging Baby Boomer population means increased demand for long-term care professionals. At the same time, many facilities face staffing shortages as LTC workers themselves grow older. But many view these challenges facing the industry nationally as strategic advantages for Wisconsins provider community thanks to the UW-EC HCAD program. The reason for supporting the program from an employers perspective should be pretty obvious, Schanke said. CHAASE is the reward it is not a means to do anything youre helping to provide for individual students and the future of the profession.
John J. Vander Meer is WHCA/ WiCALs Director of Communications. He can be reached at john@whca.com.

For more information: CHAASE: www.uwec.edu/COB/chaase

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Photos Courtesy: UW-Eau Claire

SUMMER 2013 | CONTINUUM 17

Stakeholder Spotlight

DHS Secretary Ready to Tackle Key Challenges

Q&A
itty Rhoades is no stranger to the world of long-term care policy. As a former State Assembly Representative from the Hudson area, she served as Chairwoman of the Assembly Aging and Long-Term Care Committee, and Co-Chair of the Legislatures powerful budget-writing body, the Joint Finance Committee. In 2011, Gov. Scott Walker nominated Rhoades to the position of Deputy Secretary of the Wisconsin Department of Health Services, and earlier this year, she moved up to the top job when she was unanimously confirmed by the Wisconsin State Senate as Secretary of the Department. One of the areas of long-term care that Secretary Rhoades has indicated she hopes to make strides in during her tenure is the development of a regulatory structure for facilities that specialize in the treatment of mental and behavioral health issues for the elderly. Continuum recently asked Secretary Rhoades to discuss the ways in which she wants DHS to approach the treatment of mental health in longterm care and other key issues facing the LTC community

Kitty Rhoades Familiar with the Issues Facing Long-Term Care

What differences in policy direction and management style do you envision under your leadership at the helm of the Department of Health Services? We are all in this together. I will continue to focus on improving communication within the Department and with external stakeholders. We are facing some of the biggest changes in health care that we have ever seen. From the implementation of the Affordable Care Act, to changes in how longterm care will be delivered, these are changes in which all of us have to come together to make it work. As I have said for decades, if we need to implement a change and I do it to you, it will usually be wrong. But, if we do it together, we will get it right. Is DHS still on track to realize the cost savings it projected from the Medicaid Reform package it advanced to bring stability and sustainability to its Medical Assistance Program? Among the reforms the Department has implemented thus far, which has had the greatest effect on program sustainability?

Over the 2011-13 Biennium, the Department was required to develop a reform package to address the immediate projected budget deficit while also implementing reforms that would put the program on a path towards sustainability. The Department implemented a wide range of initiatives in the areas of payment reform, service delivery reform, benefit reform, and eligibility reform. Over the biennium the Department generated $127.8 million in GPR savings to meet the goal of balancing the 11-13 biennial budget. This is the first time since 2007 where the Medicaid program did not require a budget repair bill to finish the biennium. An improvement that generated savings while also making the program more sustainable was the implementation of enhanced third-party liability. Medicaid as a program is

required to be the payer of last resort. This means that Medicaid should only pay claims after other insurance is exhausted. By enhancing our identification of Medicaid members with other insurance, Medicaid was able to offset costs and ensure that the program continues to be the payer of last resort. This proposal generated an estimated $10.6 million in GPR savings over the biennium. In addition, the insurance segments identified and the process developed will continue to offset Medicaid costs in the future. The Department also pursued initiatives that may not have generated large savings in the biennium but will have long lasting and significant impacts on delivering better care at a lower cost. Through the development of the medication therapy management program and the AIDS/HIV Health Home Medicaid

enrollees will receive more coordinated care that will lead to better health outcomes and lower cost. In addition, to the additional care members receive from these initiatives, implementing these efficiencies allowed the Medicaid program to develop the necessary policies and system infrastructure to in the future enhance medication therapy management and apply health homes to other high cost high need populations. Finally, another health care efficiency that will have a significant impact in the future is the implementation of a new reimbursement system for outpatient hospital services. Under the project to implement Enhanced Ambulatory Patient Groups (EAPGs), Medicaid moved from reimbursing a flat per diem rate for hospital services to a reimbursement that is specifically for the services being provided. This will allow for more significant payment reform in the future to ensure that Medicaid payments correctly align incentives to ensure that care is being provided in the most appropriate setting. What is the status of DHS proposed Virtual PACE demonstration program, which is designed to integrate care provided to dual eligibles residing in Wisconsin skilled nursing facilities. Do you have any prediction on when CMS may approve the proposal and, assuming that occurs, when the program will be up and running? The DHS-proposed demonstration program to integrate

care for dually eligible nursing home residents continues to make strong progress in its planning stage. Key upcoming milestones include the negotiation of a Memorandum of Understanding (MOU) directly with the federal Centers for Medicare & Medicaid Services (CMS); the development of the three-way contract; and a CMS decision regarding the Departments request for implementation funding. The MOU will serve as the program design framework for the initiative. Department staff have drafted a proposed MOU which was vetted by our key stakeholders, and it has been submitted to CMS. CMS has indicated that MOU negotiations typically require three months of ongoing work, and the two agencies are in the first month of that negotiation process. Successful negotiation of the MOU will be followed by the creation of a three-way contract, to be signed by the federal and state governments, as well as each of the managed care entities that will offer the program. That binding agreement will set forth the specific terms and conditions of the demonstration. Among other things, the contract will include the specific quality measures the plans will need to meet and will include the specific financing provisions that will support the plans. It will do so in a way that streamlines the administrative overhead these two large health care programs have created on their own. A grant proposal has been submitted to CMS which would, if funded, provide substantial federal support for critical infrastructure and implementation activities. Progress on each of these three key priority areas will put us in a very strong position to implement the
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permanent disabilities, such as Alzheimers Disease, are not to be committed under Chapter 51, but if necessary because of behavioral issues requiring a specialized setting, be placed under the Chapter 55 protective placement statute. This means that we need appropriate, specialized settings that are capable of safely caring for elders (and others) with permanent dementias or other permanent disabling conditions, who also have challenging behaviors. Would it be a fair statement to assert that your recent appointment of former Brown County Human Services Director, Brian Shoup to head the DHS - Division of LongTerm Care is aligned with the Departments intensified focus on addressing mental and behavioral health issues? Brian brings skills to the Department that will be essential as we move our long-term care programs down a more sustainable path and his experience will be extremely valuable to our work in creating integrated care health homes. What action has DHS taken to monitor the financial condition and stability of the current Family Care Managed Care Organizations, to avoid a reoccurrence of what occurred with Community Health Partnership? The Department takes a very proactive role in the financial oversight of the Managed Care Organizations (MCOs) who we contract with to provide Family Care services. Companies are required to maintain cash balances sufficient to respond to routine fluctuations in revenues and expenditures. More substantial restricted reserves are required in order to provide stability in the face of extraordinary, unexpected

financial circumstances. MCOs that fail to meet reserve requirements are placed under corrective action, and they are required to meet enhanced reporting standards, as well as satisfy performance expectations specified by the Department. This oversight structure is implemented in conjunction with financial experts within the Office of the Commissioner of Insurance. In cases where an MCO continually resists efforts to evolve their business practices to be in accordance with contract requirements and Family Care program expectations, the Department reserves the right to seek other providers more willing and able to provide the high-quality, cost effective long-term care services that DHS expects for all of the programs members. This is a key strategy in achieving the Departments broader interest in collaborating with highly competitive and well-administered MCOs. Family Care providers continue to be frustrated with the lack of transparency in the MCO ratesetting process. WHCA/WiCAL appreciates the contract changes you directed last year that defines the circumstances under which MCOs can change provider rates. Would DHS entertain an additional contract change that would permit providers to review MCO rate-setting calculations, including access to the functional screen that was utilized in setting a resident specific rate. The relationship of the MCO and their providers is delineated in the contract between those two entities. DHS is not a party to those contracts. It is certainly reasonable that providers want to know and understand MCO rate-setting processes, and DHS encourages

MCOs to be open and transparent in their rate-setting practices. Information from residential providers should be considered when a functional screen is being updated, since the provider interacts with members on a daily basis and is in a position to know much about the individuals functioning. That said, functional screens contain Personal Health Information and cannot be freely shared but are subject to the HIPAA rules. WHCA/WiCAL and other longterm care stakeholders have always asserted the Functional Screen was never designed or intended to serve as a means to assess Family Care enrollee acuity and or as a rate-setting tool. Can you advise what DHS efforts are underway to review the appropriateness and effectiveness of the use of Functional Screen for those purposes? The Department is engaged in a process to determine if there are additional data elements that can be gathered either as part of the screen or an auxiliary tool that would capture factors that can influence service costs. DHS is meeting with stakeholders to explore additional information that can be collected regarding behaviors, mental illness and dementia that could be added to the screen. The Department will pilot the new questions and do additional analysis to determine changes to the on-line screen. Per the Departments document Testing the Reliability and Validity of the Wisconsin LTC Functional Screen. The objectives for administering (and gathering data on) the LTCFS include: Determining functional eligibility for Family Care Evaluating potential clients functional status

DHS Secretary Kitty Rhoades has been a frequent speaker at WHCA/WiCAL events throughout her career as a public official. program in January, 2014. It is the Departments expectation that CMS can meet the target dates associated with these critical milestones, as our team has set forth to do. At WHCA/WiCALs Legislative Day Event in March, you indicated that long-term care should prepare for an influx of new DHS initiatives and expectations relating to mental and behavioral health. Can you provide further background on the new or expanded role you anticipate skilled nursing and assisted living facilities may be called upon to assume in care and treatment of individuals with behavioral challenges? Family Care, IRIS and the legacy waivers, are not intended to or authorized to serve individuals for the sole purpose of treating a mental illness. That said, there are many individuals who are frail elders, or have developmental or physical disabilities, who also have mental health needs; some of these individuals have very significant mental health and behavioral challenges. The entire long-term care system is focusing on achieving long-term, stable community living situations for these individuals; many of these settings must be designed around and for the individual who will live there, because their support needs are specialized and unique to the individual. We will need providers who are willing to step up and work with us, including MCOs, IRIS and counties, to serve those individuals, many of whom have dual DD/MH issues and diagnoses. That is one real way current providers will be called upon to participate in development of care options for people with behavioral challenges. Another challenge that we need providers to help us respond to stems from the Helen E.F. decision, in which the Wisconsin Supreme Court ruled that individuals with

Determining potential clients living arrangement preferences Assigning clients to the appropriate Nursing Home level of care Upon the completion of planned research, assigning clients to appropriate cost bands to allow for accurate and adequate capitated payments to the responsible agency and its providers Collecting baseline and on-going data for the evaluation of client outcomes and assessment of the programs cost effectiveness. Monitoring and enhancing of program quality. Detection and early referral of special and urgent needs like adult protective services. Establishing a critical consultation gate keeping point for clients and family members that are contemplating transitions, especially to institutional settings Collecting data on clients financial resources, to assist in LTC choice counseling preadmission and other benefit consultations. Kitty Rhoades at a Glance Appointed DHS Secretary, February 2013 Appointed Deputy DHS Secretary, January 2011 Served Wisconsin State Assembly, 1999-2010 Co-chair of the Joint Legislative Committee on Finance Chair, Aging and LongTerm Care Committee Served on the Health Committee

Photo: John Vander Meer

We will need providers who are willing to step up and work with us
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LTC Legal Letter

Despite Misplaced Media Hype, California CPR Story Offers Providers Opportunity for Evaluation
By Brian Purtell
dramatic 911-call recording of a dispatcher pleading with a California assisted living facility staff member to perform CPR on an 87-yearold woman experiencing apparent cardiac arrest dominated the attention of the national news media this spring. The fact that the woman was a tenant of the independent living section of a care community who was aware of the facility policy of not providing CPR, and had previously expressed a desire not to be resuscitated, was treated as an afterthought to the audio recording of the 911 call. With the dust having settled on this sensationalistic incident, but with the issue lingering in the minds of the public and regulators, it is a good time for skilled nursing and assisted living providers to review and evaluate their current policies, procedures and staff training. Perhaps most importantly, this provides a critical opportunity to communicate with residents and families regarding honoring individuals advance care planning wishes and what the facility will and will not provide in the event of a residents cardiac or pulmonary arrest. Policy regarding provision of CPR: Any long-term care facilitys review should begin its current policy

flexibility in assisted living settings, the policy decision about whether and when to provide CPR by staff will vary greatly by setting and provider. However, such important decisions should be made upon careful review of the resident population served, staff training and capacity. Policy development should be based upon applicable regulatory requirements, as well as current and authoritative standards, such as those available through the American Heart Association, American Medical Directors Association, etc. Local emergency response personnel should also be consulted in the development stage, given their role and potential involvement. Establish clear and unambiguous policy and procedures: Upon development of the facility policy, the establishment of clear and unambiguous procedures and internal communications systems is imperative. Ensure that the how and where of an individuals expressed wishes and physicians orders are documented with clarity. If the individual is no longer capable of making health care decisions, procedures should address assuring the identification of the proper decision-maker, as well as establishing their authority to consent to end-of-life decisions.

Facilities Should Review Systems to Assure Compliance, Honor Expressed Wishes

regarding the provision of CPR in the event of a resident arrest. Most skilled nursing facilities policies include the provision of CPR by staff;1 however, review of these policies should carefully examine clarity of expectations, including how it addresses witnessed versus unwitnessed events. While there are ample studies calling into question the efficacy of the provision of CPR for an unwitnessed arrest in the skilled nursing facility setting, there is a practical challenge to establishing a policy that guards against second guessing when the passage of time may be unclear. Deferring to the professional judgment of personnel involved adds little clarity to a policy. Assisted living providers in particular should carefully review their current policies and communications to assure internal and external clarity. While there is far greater regulatory

Assure that the expressed wishes are immediately available and unambiguous for staff to follow. Establish and provide clear instructions of how staff members are expected to respond in the event of a residents arrest. Avoid cumbersome or time-consuming restrictions that may inhibit staff from summoning assistance in the absence of nursing personnel on site at time. Organize scheduled and asneeded reviews of resident decisions to assure that the documented wishes are consistent with their current desires and condition. Significant changes of condition should trigger a review of a residents CPR and/or hospitalization wishes, as previously expressed decisions may not be reflective of their desires following a decline or improvement.

Clearly communicate and engage residents AND decision makers regarding their wishes and your ability or inability to abide by these: The expectations and understandings of members of the public may vary more significantly than the realities that LTC providers face, and it is therefore imperative that providers clearly communicate to residents and families the facilitys policies. Given the significant misunderstandings of the likelihood of successful resuscitation, particularly in elders, and the general public has assumptions about the medical capabilities of LTC providers, frank discussions and documentation of understandings is critical. Engagement of the residents attending physician is essential in the communication and decisionmaking process.

Lack of clear policies, procedures and communications can create significant liabilities for providers. Regular review and focusing on assuring resident wishes are followed are essential steps that should be taken by all providers.
There are conflicting interpretations regarding whether a federally certified skilled nursing facility must provide CPR as a routine service in the facility. A facility decision to be DNR only should be made with consultation of counsel and with an eye toward possible definitive clarification from CMS or other authorities.
1

Brian Purtell, partner at DeWitt Ross & Stevens, is W H C A / W i C A Ls Legal Counsel, and Executive Director of the Wisconsin Center for Assisted Living. He can be reached at brian@whca.com or brp@dewittross.com.

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