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					Agency For Health Care Administration

Regulatory Update Training
September 2004 / January 2005

Presenters:
Polly Weaver, Chief of Field Operations Molly McKinstry, Chief of Long Term Care Services Susan Acker, Ph.D., Director of Nursing Services
Agency for Health Care Administration-Division of Health Quality Assurance

Agency for Health Care Administration

Hurricane Season 2004

Agency for Health Care Administration

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

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

Agency for Health Care Administration

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

Emergency Resources
• First Contact: Local Emergency Management
http://www.floridadisaster.org/County_EM/county_list.htm#

• Florida Emergency Information Line 800-342-3557 • Emergency Support Function – 8 850-410-1822 800-320-0519 (request ESF-8)

Agency for Health Care Administration

Regulatory Update
• Regulatory Changes • AHCA Information Regarding Trends • Regulatory Statistics

Agency for Health Care Administration

2004 Legislative Changes
• Inactive License for a Portion of Facility
– Rule Must First be Established – Allows a Contiguous Portion of Nursing Home Beds to Become Inactive for 12 Months, Renewable Annually – Retains Ability for Entire Facility to be Inactive for up to 18 Months – Established Requirements for Request and Approval

• Staffing
– CNA Increase to 2.9 Delayed from May 1, 2004 to July 1, 2005

• Certificate of Need
– Allows Development of New Nursing Home Beds in Limited Circumstances; An Exception to the CON Moratorium – Rural Counties in Limited Circumstances – Counties Without a Nursing Home Where a Nursing Home Closed Since July 2001

2004 Legislative Changes
Nursing Homes • CNA In-service Hours
– Requires In-Services Hours as a Condition of CNA Certification Rather Than Nursing Home Employment – Refers the In-Service Requirements of S. 464.203(7), F.S. – Remains 18 Hours Annually

• DON Signature on Care Plans
– Allows Another RN to Sign Resident Care Plans for DON – RN Must Have Institutional Responsibilities in Writing – RN Cannot be a Temporary Staff Person

• Gold Seal
– State and Federal Nursing Homes are Deemed Financially Stable and Not Required to Submit Financial Statements

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

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

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

Agency for Health Care Administration

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

Adverse Incidents Reported to AHCA
4000 3500 3000 2500 2000 1500 1000 500 0
May 15, 2001 to May 14, 2002 May 15, 2002 to May 14, 2003 May 15, 2003 to May 14, 2004 * As s is ted Living Facilities 1468 1302 1996
Agency for Health Care Administration

Nurs ing H om es 3145 3394 3175

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

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

Adverse Incident Outcomes
1800 1600 1400 1200 1000 800 600 400 200 0
Tra ns f e r M a y 1 5 , 2 0 0 1 to M a y 1 4 , 2 0 0 2 M a y 1 5 , 2 0 0 2 to M a y 1 4 , 2 0 0 3 M a y 1 5 , 2 0 0 3 to M a y 1 4 , 2 0 0 4 1 50 5 1 56 8 1 49 3 F r a c tu r e 1 0 30 948 837 A b u s e /N e g le c t 8 79 1 08 8 1 06 3 E lo p e m e n t 38 3 35 7 47 4 La w Enf orc e me nt 318 238 395

Agency for Health Care Administration

Nursing Home NOIs
Nursing Home Notices of Intent July 2002 - June 2004
110 100 90 80 70 60 50 40 30 20 10 0
Series1 7/02 56 8/02 74 9/02 46 10/02 11/02 12/02 60 82 80 1/03 106 2/03 96 3/03 83 4/03 74 5/03 103 6/03 72 7/03 75 8/03 56 9/03 75 10/03 11/03 12/03 71 49 57 1/04 56 2/04 64 3/04 50 4/04 54 5/04 50 6/04 33

*Based on NOI received by facility for month

**This data may change due to later reporting by facilities

Agency for Health Care Administration

Characteristics of Reported Litigation

For-Profit

Non-Profit

Total

Licensed Nursing Homes Lic NH Submitting NOI Total # of Lic NOI Submitted Total # of Lic Beds # Of NOI per 1000 Lic Beds Total # of Lic Complaints Complaints per 1000 Lic Beds

491 410 2,289 60,937 37.56 509 8.35

179 123 454 21,464 21.15 88 4.10

670 533 2,743 82,401 33.29 597 7.25

MultiFacility Owner 527 438 2,449 65,021 37.66 558 8.58

Agency for Health Care Administration

Notices of Intent Past 3-Years
548 Nursing Homes Reporting NOIs

May 2001 - May 2004

# Nursing Homes 100 224 149 75

# NOI Reported 1 2 to 4 5 to 9 10 or more

Agency for Health Care Administration

Notices of Intent Past Year
339 Nursing Homes Reporting NOIs

May 2003 - May 2004

# Nursing Homes 153 149 35 2

# NOI Reported 1 2 to 4 5 to 9 10 or more

Agency for Health Care Administration

Nursing Home Complaints Filed in Clerk of Court Complaint Service Dates June 2002 - April 2004

40 35 30 25 20 15 10 5 0
Jun02 Jul02 Aug02 Sep 02 Oct 02 No v02 Dec02 Jan03 F eb03 M ar03 Ap r03 M ay03 Jun03 Jul03 A ug 03 Sep03 Oct 03 No v03 Dec03 Jan04 F eb04 M ar04 A p r04

Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr02 02 02 02 02 02 02 03 03 03 03 03 03 03 03 03 03 03 03 04 04 04 04 Total 17 23 30 30 24 26 31 35 40 26 36 39 28 32 13 25 25 11 23 17 15 16 14

Agency for Health Care Administration

Nursing Home Complaints Filed in Clerk of Court By AHCA Receipt Date June 2002 - April 2004

90 80 70 60 50 40 30 20 10 0
Jun02 Jul02 Aug02 Sep 02 Oct 02 Nov02 Dec02 Jan03 Feb03 M ar03 A pr03 M ay03 Jun03 Jul03 Aug03 Sep 03 Oct 03 No v03 Dec03 Jan04 Feb04 M ar04 Ap r04

Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr02 02 02 02 02 02 02 03 03 03 03 03 03 03 03 03 03 03 03 04 04 04 04 Total 8 7 9 13 10 15 87 37 26 38 20 31 25 16 26 16 21 14 10 82 21 14 25

Agency for Health Care Administration

Number of Nursing Homes on The Watch List
Calendar Quarter April 1, 2001 – June 30, 2001 July 1, 2001 – September 30, 2001 October 1, 2001 – December 31, 2001 January 1, 2002 – March 31, 2002 April 1, 2002 – June 30, 2002 July 1, 2002 – September 30, 2002 October 1, 2002 – December 31, 2002 January 1, 2003 - March 31, 2003 April 1, 2003 - June 30, 2003 July 1, 2003 - September 30, 2003 October 1, 2003 - December 31, 2003 January 1, 2004 – March 31, 2004 Number of Facilities 79 90 89 82 87 71 50 52 51 46 44 39

Agency for Health Care Administration

Nursing Home Deficiencies
9000 8000 7000
Number of D eficiencies

Nursing Home Type of Deficiencies by Year

6000 5000 4000 3000 2000 1000 0 1999 2000 2001 Year 2002 2003 Jan-Jun 2004 Sc/Sv B through F Defs Sc/Sv G and higher Defs

Agency for Health Care Administration

Nursing Home Deficiencies for Failure to Have Sufficient Staff to Meet Resident Needs
Citations for F353 150 100 50 0 2000 2001 2002 2003 2004 thru June Citations for F353

Agency for Health Care Administration

All Nursing Home Staffing Deficiencies
2000 120 11 0 0 2001 2002 110 78 28 166 6 15 2 16 2003 64 83 7 4 2004 (June) 28 36 2 10

Citations for F353 N063 N063 & F353 N069

Agency for Health Care Administration

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

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

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

• Other Projects That Directly Benefits Facility Residents
Agency for Health Care Administration

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

Agency for Health Care Administration

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

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

Grant Process
• Initial Request for Interest and Proposals, Nursing Home Letter December 22, 2004 • Applications Will be Provided for Completion • Proposals Will be Reviewed Within Available Funding • Presentation May be Requested
Agency for Health Care Administration

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

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

Agency for Health Care Administration

Top 10 Nursing Home Deficiencies
Top Ten Nursing Home Cites Tag F371 F281 F241 F514 Description Food must be stored, prepared, and distributed under sanitary conditions Services provided by the facility must meet professional standards Facility must treat residents with dignity and respect Facility must maintain clinical records professionally and accurately Facility must provide adequate housekeeping and maintenance services Facility must develop comprehensive care plan for each resident Count Rank Rank Rank Rank 2004* 2004 2003 2002 2001 142 100 86 83 1 2 3 4 1 2 4 6 1 3 4 5 1 4 3 6

F253 F279

74 68

5 6

5 3

10 2

22 2

* January-June, 2004
Agency for Health Care Administration

Top 10 Nursing Home Deficiencies
Top Ten Nursing Home Cites Tag Description Comprehensive care plan must be timely, accurate and periodically reviewed Services must be delivered by qualified persons in accordance with care plan Drugs must be stored in locked compartments at proper temperature Facility must provide a safe, functional, sanitary, and comfortable environment Menus must meet nutritional needs of residents Count Rank Rank Rank Rank 2004* 2004 2003 2002 2001

F280 F282 F432 F465 F363

63 63 52 48 46

7 7 8 9 10

10 11 9 15 22

11 13 6 14 23

16 7 5 12 33

* January-June, 2004
Agency for Health Care Administration

Top 10 Nursing Home Complaint Allegations
Allegation Count 2004* Rank 2004 Rank 2003 Rank 2002 Rank 2001 Resident Care 380 1 1 1 1 Resident/Patient Abuse/Neglect 187 2 5 5 4 Resident Rights 179 3 2 3 3 Medicine Prob/Errors/Formulary 163 4 3 4 5 Staffing 155 5 4 2 2 Lack of Assessment 137 6 8 27 27 Administrative 120 7 14 14 13 Falls/Injury 102 8 6 6 8 Pressure Sores 99 9 9 10 7 Dietary 94 10 7 8 6 * January-June, 2004
Agency for Health Care Administration

AHCA Resources
Long Term Care Unit (850) 488-5861 Bureau of Long Term Care (850) 414-9707 Bureau of Field Operations (850) 414-9796 Health Standards and Quality Unit (850) 922-9138

AHCA Website: www.fdhc.state.fl.us

New Format
AHCA Facilities and Agencies Directory Website: www.floridahealthstat.com/qs/owa/facilitylocator.facllocator Federal Link to Survey Guidance: www.cms.hhs.gov/medicaid/survey-cert/siqhome.asp
Agency for Health Care Administration


				
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