Leadership Report: Have Pride

It's interesting how modest we have become both as a group of individual long term care organizations and as an association. For example, reflecting back over the past twelve months, at first blush it seemed there wasn't any singularly grandiose achievement to focus on as the core topic of this annual report -- nothing grandiose despite our successes with Medicare and Medicaid funding initiatives, Simple Savvy , The Learning Network, employee recruitment and retention initiatives, and efforts dedicated to a multitude of rules and regulations. We have become so accustomed to successes and accomplishments that we sometimes fail to recognize our achievements. Yet, if we do not recognize and give credit to our great strides, how can we expect others to commend us on our efforts? Thinking about this, it became  evident that despite the hectic speed of life, all things do not change as quickly as we might think. That in itself became our focus.

Wherever two or more are gathered in the name of long term care, the mood almost instantaneously turns to panic, or frustration, or depression, or concern. Everybody is talking about the lack of funding for long term care, about the negative image of long term care, about the lack of quality employees who are interested in working in long term care, about the burgeoning pile of rules and regulations we contend with each and every day. And everyone is beginning to feel overwhelmed.

Remember the "good ole days"? The days when we had money pouring into our facilities? The days when everybody thought nursing homes were the only place to live, work, and play? The days when consumer advocates were fighting to get an elderly individual the next available room on our waiting list? The days when legislators and administrative agencies refused to impose another regulation on long term care? The days when we had to chase interested employees out the door because we already were swamped with over-qualified employees? The days when reporters were waiting at our offices in the morning to cover the daily bingo party? Remember those days?

Of course you don't, because those days never existed. The point is, the problems we face today are not new problems. They are the same problems we have faced for years. Yes, the problems have perhaps become more acute, more pressing. And yes, we have fewer people in our facilities to help us overcome these problems. But, nevertheless, they are the same problems.

Since they are the same problems, what are the new solutions?

First, we must all calm down, take a deep breath and relax. Let's remember that it is not only permissible but necessary to enjoy what we are doing. Have some fun. Allow your employees and residents to have fun. Let smiles and laughter become contagious throughout your facility. If you don't think there is anything to smile about, then take a break, take a walk, or go talk with a resident. Make it a point to find something to smile about. As the managers and supervisors of your organization, your number one priority should be ensuring your residents and your employees enjoy your facilities. Go share some smiles!

Second, we must wholeheartedly dedicate ourselves to new ideas and innovative strategies. If you are tired of the same old problems then make it your mission to find the new solutions. Nurture a spirit of adventure throughout your facility and celebrate every success you and your employees achieve. Be proud of your achievements, your successes and your celebrations -- proud enough to share them with everyone in your community. It is paramount that we begin telling our stories. WAHSA's developing programs on staffing and image enhancement will depend heavily on the local support you are building right there in your community.

Third, we must remember our mission. Just as our problems are not new, neither is our mission. As WAHSA's newly formed Task Force on Image Enhancement recently stated, "Our public relations efforts should focus on our ministry. We are committed to quality. We face funding and staffing shortages, but we are dedicated to creative efforts that ensure our challenges do not impact our hallmark of quality. We believe in innovation. We believe in peer assistance to help facilities clean up their bad acts. We want to comply with the rules and regulations." That pretty much says it all. No matter what obstacles stand before us, we are dedicated to quality. If we always choose the option that leads us to higher quality, how can we go wrong?

Finally, we must get back to "no-nonsense" long term care. Let's face it. We have not chosen this profession because of any scheme to "get rich quick." We are not here because of an unquenchable thirst for power. And this is not our idea of an easy, "cushy" job.

We have chosen this profession simply because we are a group of caring professionals who truly do want to make a difference in the lives of people. It seems rather sad that there are individuals out there who question our motives, but there are.

If we have any words of advice or comfort to share with you as we close our 1999-2000 fiscal year, it is this: Be true to yourself and be true to your calling. Let's all get back to the basics of caring for people. That's what "no-nonsense" long term care is all about -- caring for people. Someday, somehow, somewhere, maybe somebody will begin to understand what we are all about. Even if they don't, we will always have what we started with -- a mission to care. That in and of itself is a reason for each and every one of us to stand proud. Our rewards are deeply rooted and cherished in the lives of those for whom we care.


Respectfully submitted,

Kyran Clark, President

John Sauer, Executive Director


Have Faith

Your association has never stood stronger than it does today. This strength is due to the dedicated membership and the support you so willingly offer to the association and to your peers. Take comfort from the strength of your association -- the strength we nurture from your support today means we will be even better equipped to represent your interests and to address your issues tomorrow. WAHSA's strength is well documented in the accomplishments during the past twelve months in the areas of administration and management.

• The WAHSA Reserve Policy has been changed to establish a floor of at least 35% of annual operating expenses. This policy reflects the strength of WAHSA's investment performance. Long term reserves are held in a diversified portfolio that has produced substantial growth in investment earnings and income, in turn reducing WAHSA's reliance on dues.
  
  
• All WAHSA computers and files survived Y2K related issues. Computers have been upgraded to enable staff to utilize DVD, CD writing/copying and expanded desktop publishing software. Support staff have attended classes on Access database construction and management.
  
  
• To reflect the changing membership, WAHSA's Nominating Committee guidelines were amended to consider total beds and units when determining appropriate regional representation. Also, to assure an active and representative Board of Directors, the WAHSA bylaws were modified to extend voting rights to all AAHSA delegates serving on the WAHSA Board.
  
  
• 110 facilities participated in the MRA salary survey.

Your association's reputation as a recognized leader in long term care continues to grow across the state and throughout the nation. Members and staff alike have earned the respect we deserve from elected officials and administrative representatives. We have become known as a credible resource in the long term care profession. Take confidence in knowing our reputation serves us well as we continue representing your interests. This is readily evident in the achievements throughout the past year in the public policy arena.

• WAHSA continues to devote substantial time and resources to issues relating to Family Care, the Department of Health and Family Services' (DHFS) proposal to redesign the state's long-term care delivery system. The association, working with the Long Term Care Provider Coalition, successfully convinced the Legislature to require Family Care to be pilot tested before any effort is made to pursue statewide implementation. The Legislature agreed to require a full evaluation and this evaluation will be done by an independent, third party--not DHFS. WAHSA authored the primary comments from the Provider Coalition on DHFS' proposed Family Care emergency rule. WAHSA created a Family Care Task Force comprised of members from the Family Care pilot counties. This task force already has proven helpful in identifying issues related to a reduction in the comprehensive capitation rate for new enrollees, adverse selection/creaming of clients directed to enroll in the program, and the ability of small rural counties to operate as a CMO.
  
  
• WAHSA and members serving on the State Benevolent Retirement Home for the Aged Task Force have been vocal advocates for not-for-profit health and housing facilities.
  
  
• Major efforts were devoted to securing relief from Medicare reductions imposed under the federal 1997 Balanced Budget Act.
  
  
• Following  months of intensive member and staff efforts, in October 1999, the Governor signed into law the CNA wage pass-through proposal advocated by the provider and labor coalition.
  
  
• When the 1999-2001 State budget was finally passed and signed into law, it contained Medicaid nursing home rate increases twice the level recommended by the Governor. As DHFS worked to implement the 1999-00 reimbursement formula, several battles were fought and won. WAHSA successfully urged DHFS to use a more realistic inflation projection to update cost reports, leaving additional dollars to fund actual rate increases.  Staff provided detailed consulting to help members better understand the 1999-00 bed banking provisions and applicable cost report periods. After major analysis and discussion at the Committee and Board level, a compromise was reached regarding the DHFS labor region changes (based on Medicare figures).
  
  
• WAHSA authored an issue paper on the need to structurally address the Medicaid funding system. The paper serves as the basis for the association's advocacy efforts intended to force policy-makers to confront payment, labor region, case-mix, acuity and staffing issues that must be addressed under Medicaid reimbursement.
  
  
• WAHSA approached DHFS officials, advocates, academicians and elected representatives and asked for their support to pilot a new survey system. Surprisingly, there is widespread agreement that Wisconsin should develop an alternative to the federal survey process. During the 2000 Public Policy Seminar, DHFS Secretary Joe Leean announced BQA will pilot a system in which BQA staff will offer off-cycle consultation services and attempt to provide facilities with feedback (including praising facilities that are providing exemplary care). This pilot is scheduled to begin in July 2000.
  
  
• WAHSA has a solid partnership with AAHSA. David Keller represents WAHSA on AAHSA's Board of Directors. WAHSA's Mary Ann Kehoe presented before the US Senate Aging Committee. Members and staff serve on the AAHSA "Rump Group", a subcommittee considering ways to change the long term care survey process to one that measures outcomes and promotes quality. Mary Lou Stuenzi and David Keller serve on AAHSA's Budget Committee and Business Development Committee respectively. WAHSA's Member Services Director was again appointed to AAHSA's National Public Relations Task Force and our Finance Director continues to serve with distinction on the AAHSA Medicare Payment Workgroup.
  
  
• Some WAHSA members had payments related to physician certifications and recertifications denied by  the Medicare fiscal intermediary. WAHSA aggressively represented these members by briefing the entire Wisconsin congressional delegation on the hardship these denials created for long term care facilities. Staff met with the HCFA Region V Medicare contract official and provided a factual summary of how the fiscal intermediary denied claims and failed to provided timely information on the requirements for claim submittals. As a result, the fiscal intermediary rescinded its prohibition on the  physician's use of a rubber stamp and now acknowledges that signatures may be timely even if they are not obtained on the day of admission. Finally, several members have successfully appealed claim denials.
  
  
• WAHSA successfully asked DHFS to stop a scheduled release of a new provider memo on PASARR (second edition) and related guidance that would have prohibited facilities from admitting certain residents with significant behavioral symptoms.
  
  
• WAHSA successfully urged DHFS to rescind a proposed increase in the mandated CBRF minimum staffing ratio required under HFS 83.
  
  
• WAHSA is completing a survey on members' utilization of pool staff and continues to study ways to limit the use of pool staffing in facilities.
  
  
• Significant and positive changes to the State's Criminal Background Check law were passed and signed into law by the Governor. These changes better empower organizations, versus the State, to determine which prospective employees are suitable for long term care employment.
  
  
• WAHSA's Legal Counsel issued a member alert regarding discounts for ambulance services paid for under the Medicare program. Several members reported having to renegotiate their provider contracts to avoid any possible Medicare anti-kickback concerns.
  
  
• Staff and members participated in a televised health/LTC forum in La Crosse sponsored by The La Crosse Tribune and Channel 8 to discuss Medicare/Medicaid funding and coverage issues.
  
  
• Staff and members testified before Legislative and Gubernatorial committees on Y2K preparedness. Policy-makers agreed that legislation imposing additional drug inventory requirements on long term care facilities was unnecessary and that facilities were well prepared for Y2K.
  
  
• WAHSA assisted WHEDA and DHFS in coordinating a bus tour to visit three long term care campuses (two WAHSA members) with the goal being to develop a better understanding of the issues confronting long term care providers. The tour provided members an opportunity to visit with staff from BQA, Medicaid, Supportive Living and the Secretary's office.
  
  
• WAHSA continues to provide staff support for the Statewide ICFs-MR Committee. WAHSA ensured that ICFs-MR could receive the full benefit of the Medicaid CNA wage pass-through (some residential living staff may not be certified CNAs).
  
  
• WAHSA voiced its strong opposition to the HCFA abuse prevention poster and successfully offered a motion before the State Task Force on the Year of the Long Term Care Worker expressing the Task Force's opposition to this poster. WAHSA shared with HCFA posters developed by members that more humanely and compassionately express our intolerance for improper care.
  
  
• WAHSA's Medicaid database of over 155 homes provides excellent data on the impact wages, hours and benefits have on staff turnover. The database shows that only 9% of WAHSA's nursing facilities are fully reimbursed for Medicaid costs.
  
  
• WAHSA worked with WHEDA and DHFS to produce a survey of RCACs designed to gather information on the state of assisted living.
  
  
• WAHSA continues to support and partner with SAGE to promote improved and innovative physical environments for older persons. The SAGE conference was held in Madison on March 9, 2000.
  
  
• WAHSA received clarification from BQA that the new federal survey guidelines in fact do not prohibit facility staff from passing meds during mealtime if this is not done solely for staff convenience.
  
  
• WAHSA aggressively responded to a "report" by a political advocacy group claiming that political contributions by nursing home officials have forced Medicaid's "institutional bias" and stopped the State from implementing Family Care. WAHSA's response to this allegation was printed in its entirety in the Wisconsin State Journal.
  
  
• WAHSA staff presented as a guest lecturer during a UW Graduate School of Nursing class and discussed several LTC public policy issues, including mandated staffing ratios and payment systems.   Students were encouraged to pursue a LTC career.
  
  
• WAHSA is working with the Department of Workforce Development to develop strategies to direct more workers to a long term care career.
  
  
• Members pushed BQA to prepare for the possibility of multiple facility closures. Ironically, BQA's response to these discussions likely helped the state address the subsequent delicensure and decertification of a Bayside nursing home.
  
  
• WAHSA staff and members successfully offered award allocation options before the State Nursing Home Appeals Board. These options helped target additional dollars to homes with high direct care and overall losses due to high Medicaid census.
  
  
• WAHSA's HFS 132 Task Force met three times to develop comments on the DHFS' proposed nursing home rule changes. The Task Force recommended and the WAHSA Board concurred that the HFS 132 rule should include only those provisions necessary to implement the state statutory requirements. Regulatory areas that already are addressed under the federal OBRA nursing home reform regulations should not be restated or otherwise modified under the State code.
  
  
• WAHSA has joined the Bureau of Quality Assurance in opposing HCFA's concerns about facilities' use of single task employees. Over 110 members responded to WAHSA's survey indicating that over 525 residents per day receive assistance with feeding from single task employees. Staff followed up with a supporting letter to BQA and presented an issue paper on this subject to our congressional delegation.
  
  
• WAHSA authored several issue papers to supplement the AAHSA papers presented to the congressional delegation during the March 14-15, 2000 Capitol Hill visits. Papers addressed: Medicare payments and consolidated billing, user fees, piloting a new survey process, single task employees, and Medicare payment denials.
  
  

Long term care is an honorable profession. It's about mission; it's about doing good for the sake of doing good. When a strong, credible entity dedicates its efforts toward creating a better future for a mission-focused profession, you know that entity will achieve outstanding results. WAHSA continuously strives to develop new services, new programs and new products that will enhance the future of long term care. Consider the past year's worth of highlights from the area of member services.

• WAHSA developed the complete Simple Savvy program (video, poster, booklet and wallet card) and marketed it to WAHSA members, sister associations and LTC facilities across the nation. Nine sister state associations have agreed to market the program which will offset the cost of producing the Simple Savvy game. Staff acquired the appropriate trademarks and copyrights to protect WAHSA's investment in Simple Savvy. The Simple Savvy game should be available to members within six months.
  
  
• WAHSA joined TLN Partners as a founding member and helped develop The Learning Network for Senior Services as a source of distance learning, designed to best serve WAHSA members. Staff worked to keep the cost of this program affordable and insisted that the number of in-service training programs increase each year.
  
  
• As a follow-up to our highly successful publication, Enhancing Employment in Long Term Care (second edition), WAHSA published Models for Practice During the First 90 Days of Employment. These documents have been used across the country by long term care associations and providers to improve recruitment and retention strategies. The documents are posted on the WAHSA web page.
  
  
• WAHSA published Best Practices in Senior Housing as an informative document designed to spark new ideas for senior housing professionals.
  
  
• WAHSA worked with the UW Center for Health Systems Research and Analysis (CHSRA) to enhance the MDS Quality Indicator Project, including the publication of additional care guidelines. Further, CHSRA agreed to lower the participation price from an initial fee of over $1,000 to $750. Homes in their third year with the program received a rebate lowering their fee to only $510.
  
  
• The WAHSA web page has become a major communication vehicle for the membership. The home page has been updated and expanded to include the association's issue papers, publications on staffing recruitment and retention, housing and service options, and links to state and federal elected officials. Nearly 100% of the web page management is done in-house. Web page sponsorships generate $2,375 in annual revenues. There are over 8,000 hits per month to WAHSA's web page, with some months surpassing 11,000. The web page now includes a search engine specific to the WAHSA site. Also, 13 members have their web sites hosted through WAHSA.
  
  
• Staff and members serve on the BOALTC Year of the LTC Worker Task Force. The Task Force planned the April 3-4, 2000 Summit on the LTC Staffing Crisis and continues to pursue creative ways to address the LTC worker shortage.
  
  
• WAHSA distributed More Memorable Moments to Wisconsin state and federal elected officials, television stations, daily newspapers, and DHFS regulators.
  
  
• WAHSA researched and published the list of Reasons to Celebrate in Long Term Care, a comprehensive calendar of occasions/events to celebrate. Many facilities use this publication to help plan activities and to build staff morale. Reasons to Celebrate has become one of WAHSA's most frequently requested publications, both by the members and WAHSA's sister associations.
  
  
• WAHSA continues its mission of providing the best possible educational opportunities at the lowest feasible cost. Several networking meetings featured free presentations (e.g., care planning, pain management) and the Legislative seminar included free presentations on the LTC survey process/facility appeal rights and on the OSHA bloodborne pathogens rules. WAHSA's programs are consistently offered at a price significantly lower than other LTC associations.
  
  
• WAHSA's educational programs were highly successful in 1999-00. The educational offerings included:
  
  
  • Understanding the QIs and Changes to the Federal Long Term Care Survey Process
    
  • The Fiscal Intermediary Share System Refresher Training Course
    
  • Reaching for Out-of-This World Care - 1999 Fall Conference
    
  • Medicaid and Medicare Financial Strategies Seminar
    
  • Momentum for the New Millennium - Public Policy Seminar 2000
    
  • Intense 2000 - Spring Conference
    
  • June 2000 Seminar on Care Planning 2000
    
    
• A WAHSA Image Enhancement Task Force has been established. The initial meeting produced a number of possible strategies focusing on helping the individual member improve its public image within the community.
  
  
• WAHSA provided PPS training materials for hospitals and physicians and posted this information on the association's web page.
  
  
• A pain management pathway tool is being pilot tested within WAHSA member facilities. A review group intends on fine-tuning this tool after which it will be distributed to all WAHSA nursing facilities.
  
  
• WAHSA sponsored a special meeting for WAHSA members to discuss innovative strategies in staff recruitment. The meeting discussed efforts to recruit persons residing on Indian reservations and from foreign countries. Staff facilitated efforts to review the cost and performance of companies specializing in obtaining RNs from the Philippines. Background checks were conducted and price comparisons were completed. WAHSA also authored an issue paper urging the Congress to remove immigration restrictions which impede the ability of long term care providers to attract foreign workers to the United States.
  
  
• WAHSA assisted the following members in strategic planning sessions: The Lutheran Home, Milwaukee Catholic Home, Evergreen Retirement Community, Edgewater Haven, Bethany Riverside, Cedar Crest, and The Congregational Home.
  
  
• WAHSA assisted the Center for Future Aging Services in applying for a grant from the Commonwealth Fund to study nursing home quality improvement systems and the Wellspring program. A $380,000 grant has been awarded.
  
  
• The WAHSA Award Committee has developed a new award category to recognize members' successful marketing programs.
  
  

Wisconsin Association of Homes and Services for the Aging
204 South Hamilton Street
Madison, WI 53703
Telephone: (608)255-7060 FAX:(608)255-7064