2000-2001 Annual Report

A Message from WAHSA's President and Executive Director

As we look across the nation, we see about thirty-five sister state associations primarily serving not-for-profit long term care facilities and organizations. The roots of these associations have grown deep and their branches stretch across their respective states. These associations represent a wide range in size, scope and membership. WAHSA, with its forty-plus year history, has built a strong reputation within the long term care field for member services and advocacy, and continues to be acknowledged for its state and national leadership. With its active membership and dedicated staff, WAHSA is viewed as a leading long term care association. Some of the other associations marvel about how we can accomplish so much with so few resources; others raise an eyebrow and suggest that perhaps the time has come for WAHSA to expand its operations.

From our viewpoint, we are quite comfortable with our ability to operate as a “lean, mean working machine.” No matter what the issue, our plan is simple, yet effective – like Nike, we “Just Do It.” WAHSA, as an association, is fortunate to have an experienced staff and a dedicated membership that live in the belief that “If we can dream it, then we can achieve it.”

This “Do It” attitude, coupled with our mindset that “nothing is impossible,” has served us well throughout the years and most certainly within the last 12 months. In many instances, what might have seemed like impossible dreams last year at this time have become the highlights of our fiscal year. We raised the level of awareness among legislators and the public about the discrepancy between the state’s Medicaid reimbursement system and the need to provide payments that better reflect the demands of providing high quality care for the residents of Wisconsin’s skilled nursing facilities. We embarked upon an intense advocacy program to alert lawmakers and the public about the problems plaguing long term care. We developed, copyrighted and marketed a long-term-care-specific staff inservice game. We initiated a long range plan to enhance the image of long term care. We partnered with other associations across the country to make distance learning a reality for members. We fought to educate decision-makers on the value of preserving the property tax exemption for our housing facilities. These are just a few of the bonuses of the year to add in with all the traditional services such as ongoing representation and advocacy on your behalf, high-quality educational and networking offerings and informative mailings.

As the leaders of this association, we acknowledge that WAHSA, in many ways, is an exceptional organization. Yes, we do have a dedicated staff; but perhaps more importantly, we have a very active and engaged membership. We have members who willingly share their time, experience, talent and expertise to benefit other members and to help WAHSA serve you better. You make this association possible and you continually make us proud to serve as your leaders.

These are not easy times for long term care professionals. As we look across the landscape, there are rocky mountains, deep waters, jagged cliffs, and intimidating detours positioned between us and our ultimate goal. We are in this race for the long haul, however, so it’s time to put on the Nikes and “Just Do It!”

The good news is that our course is true – just follow the mission. Our passion is people. Our goal is quality. Our determination is real. Our legacy will be a vastly improved, people-centered long term care system. Keep the faith!

Respectfully submitted,

Kyran Clark, President

John Sauer, Executive Director

Creating Awareness

The last twelve months have been a whirlwind of exhausting and confusing rules, regulations, policies, proposals and interpretations. WAHSA took a strong position at every conceivable level on a diverse array of issues including wage pass-through, single task employees, and the Intergovernmental Transfer Program. At every turn, WAHSA was in the forefront advancing hypotheses, theories, facts and solutions that were in the best interests of not-for-profit long term care providers and the elderly/disabled individuals they serve. We can’t say every issue we took on went exactly as we had planned, especially when we were the people telling the media that long term care is in crisis. We can say, however, that this was the most successful year in WAHSA’s history when it comes to creating an unparalleled awareness across all lines about the challenges facing today’s long term care system.

We began the year forming a professional alliance with all the right people – long term care providers and their respective associations, state agencies, employee representatives, advocacy groups – designed with one common goal: A negotiated package deal to secure a wage pass-through for long term care providers, a deal that recognized the quality work care providers do in a difficult setting. The road that stretched before us was long, up-hill and strewn with obstacles and obstructions. Members of the alliance flooded the media and the community with rationalizations and justifications for this wage pass-through, and we succeeded – more or less. The Legislature did pass the wage pass-through; now we are working hard to cut through the red tape stuck to the process utilized to determine whose increased wages actually meet the complicated and conflicting requirements for the wage pass-through. What we can say is that, undeniably, legislators, reporters and the public came to a better appreciation for the people who care for the residents of long term care facilities.

As the wage pass-through saga continued to unravel through the course of the fiscal year, the federal Health Care Financing Administration (HCFA) gave the state of Wisconsin until the end of the year to develop a plan to bring Wisconsin’s single task employee program into compliance with federal law. Another day, another issue. WAHSA again went to bat fighting for a program that, although not a perfect solution, was at least a remedy for an injured system. The association conducted a survey of the membership showing that within the next two years about 88 percent of Wisconsin’s skilled nursing facilities would be employing single task employees to assist residents with feeding. It was a professional solution to the problems created by a dwindling workforce, but HCFA was not convinced. The battle has not yet been decided, but this we know: Today, governmental agencies, reporters, the public, advocacy groups and family members know the value of a caring, competent individual who spends time every day tending to the nutritional needs of a few residents who are too frail to feed themselves. Congressman Paul Ryan and Senator Herb Kohl have introduced federal legislation to enable Wisconsin’s single task program to continue. In addition, the public is slowly learning that we need to pursue creative possibilities to ensure we are able to continue providing quality care to the frail and the elderly. Quality long term care employees are a rare commodity that we need to treasure and reward. They are, indeed, worth their weight in gold; we just need to craft a system that enables us to pay them accordingly.

In September, WAHSA worked with other health care professionals on a joint press conference that pushed long term care into the limelight. The press conference focused on the financial state of nursing homes in Wisconsin and unveiled a study conducted by the national accounting firm of BDO Seidman, LLP. The study concluded that Wisconsin nursing homes on average are losing $10.90 per Medicaid patient day, or approximately $300,000 annually. The BDO analysis indicated that 271 of the 328 facilities in the database were not paid for their Medicaid costs and experienced total losses in excess of $125 million in 1999-2000. The study concluded Wisconsin’s 2000-01 Medicaid payment ceilings relative to costs are the lowest in the United States.

That study fostered intense efforts to address the inadequate Medicaid reimbursement system. After debates, discussions and press conferences that circled the state, WAHSA joined with other long term care professionals to negotiate another temporary fix to the system in the name of a “new and improved” Intergovernmental Transfer Program (IGT). Although the IGT apparently will be significantly curtailed, WAHSA is working tirelessly to ensure members receive higher reimbursement levels in the next biennium.

These issues, combined with others such as Family Care, medical review, background checks, bed banking, downsizing, physician certification/re-certification and surveys kept WAHSA and its members busy talking with legislators, reporters, public officials and concerned others. Some issues went very well, others remain to be seen, but all-in-all, WAHSA worked better than ever before to take our case to the public, to educate the stakeholders, and to demonstrate the adverse effects if somebody doesn’t do something to resolve the crisis in long term care.

Positioning for the Future of Senior Housing

Many times, when an entity plans and prepares for the future, what doesn’t happen can be even more important than what does happen. Senior housing is the up-and-coming growth child in long term care and everybody has interest in the potential opportunities that exist. As an association, we worked to protect the interests of our member senior housing providers by warding off efforts we believed to be detrimental to the future of senior housing.

The Benevolent Retirement Home for the Aged Task Force concluded its meetings in gridlock with two different final reports. Both, the report authored by WAHSA and other representatives embracing the not-for-profit perspective and “The Government 5 Report” have been forwarded to the Legislature for review and, most likely, will be addressed during the 2001 floor period.

In other housing-related activities: WAHSA provided feedback on proposed changes to HFS 83, the CBRF rule; opposed DHFS’s efforts to increase licensing fees for RCACs, CBRFs, adult day care and adult family homes; and opposed BQA’s initiative to give RCAC regulatory oversight duties to the BQA regional offices, urging the BQA to not blend the NF and RCAC regulatory philosophies. In addition, WAHSA successfully pushed DHFS and WHEDA to define “affordable assisted living” according to the cost of providing services rather than the resident’s available income.

WAHSA continues to watch the trends that affect the future of senior housing. We work to shape the rules, regulations and practices that enhance the ability of not-for-profit providers to offer a quality lifestyle at affordable prices. With renewed vigor in pro-active positioning, our goal is to help members interpret the trends so they can better meet the interests and needs of the elderly.

Milestones in Member Education

WAHSA’s 2000 Fall Conference welcomed back the past presidents of the Association who roasted and toasted the long term care profession in celebration of WAHSA’s 40th anniversary. The celebration reflected on the growth of not-for-profit long term care providers over the past 150 years and the development of your association over the last 40 years. Meanwhile, the educational offerings were a reflection of current concerns with topics ranging from the heart of caring to how to stay energized in a draining world, from OIG compliance to financing long term care, and from effective management to problem solving in long term care.

The 2001 Spring Conference offered a slate of sessions as a call to action for all those who are truly dedicated to the long term care profession. With the reasoning that “if we want a better long term care system, then we have to create it,” the conference spurred member ideas, networking, thoughts and action in areas such as quality long term care, funding, workforce, health and housing, image, legal matters and mission. This conference emphasized WAHSA’s continued focus on a course of action designed to repair long term care.

WAHSA offered numerous traditional seminars throughout the year to address member concerns and timely topics such as public policy, PPS, reimbursement, and care plans. Beyond tradition, however, WAHSA took a bold step to lead members into the age of technology in long term care. By partnering with other not-for-profit long term care associations throughout the nation, WAHSA helped develop The Learning Network (TLN) for Senior Services. Now available to WAHSA members and long term care providers across the country, this system of distance learning brings networking, CEU courses, staff training and professional mentoring directly to members and their staff on their home turf. WAHSA and the other TLN Partners continue to refine the learning opportunities available through TLN, and members soon will have even easier access to many more learning opportunities.

Dreaming and Achieving

The key to success in life and in living is finding and achieving balance. This is true not only for individuals, but also for associations. WAHSA is fortunate to have found and achieved a very harmonious balance in serving the needs of members. True, there are problems to address and there are efforts that do not always go as planned, but there also are successes, victories and celebrations.

This year WAHSA redesigned the Member Services and Community Relations Committee to serve as the “think tank” for WAHSA. The new purpose of this committee is to be the association’s feeder of new ideas, concepts and suggestions, to be the incubator of new programs that would be beneficial to the association’s membership. The committee had its first meeting under this new structure and identified many programs that the association will be considering as new member services.

In an association where individuals are connected by the common thread of dedication, nothing is as euphoric as a success story. WAHSA’s success story is Simple Savvy – a program that grew from a simple idea to improve the life skills of entry-level employees into a real multi-tiered program that is enhancing the skills of employees at every level throughout long term care. This year, WAHSA introduced, trademarked, copyrighted and marketed Simple Savvy – The Game. These 311 game cards are bringing a new dimension to staff inservice programs throughout Wisconsin and across the nation. Employees are laughing, interacting and having fun during the inservice sessions that have incorporated this one-of-a-kind long term care game. This game, which was just a thought at a task force meeting less than two years ago, has come to life through the dedicated efforts of a few individuals who believed in the power of their dreams. As WAHSA continues to market Simple Savvy, as more and more long term care organizations employ the power of these simple tools, another dream will come to life – the dream of improving the skills of a quality, caring long term care workforce.

Up to now, it seems the image of long term care has been a plague that we just haven’t been able to shake. Those in this profession point at the negative image and list it as at least a contributing factor to larger concerns ranging from inadequate reimbursement to over-regulation and from a dwindling pool of interested employees to an over-abundance of negative publicity. After several years of developing large-scale, image-enhancing productions, WAHSA, guided by another task force, downsized our focus to put together what we believe will be the most successful image-enhancing campaign in our history. This new campaign is designed and developed to utilize one of our strengths – the support and respect our members have within their local communities. This campaign is a continuous series of small steps that will be taken at the local levels with the idea that the positive notes then will grow up to higher levels. Guided by WAHSA’s efforts and utilizing tools provided by the association, WAHSA members will be working independently in their local communities yet simultaneously across the state to implement programs designed to draw more people into long term care professions, to enhance the morale of those who currently work in long term care, to acquaint the public with the valuable role long term care plays within the community, and to build stronger ties with other forces within the community. As we work, so will we grow into a leader throughout our respective communities, where we show our concern for our community, and our community reciprocates by giving us the support we need.

Year-End Wrap Up

Dreams becoming reality…That’s what it will take to shape long term care into the profession we know it can be. WAHSA, focused and driven by the collective interests of the membership, will continue to make strides in the critical areas of technology, education, awareness, workforce, regulations, funding, quality and image. Together, we will continue to dream and we will continue to achieve.

With another twelve months of successes behind us, we continue to look forward to the opportunities that lie ahead of us. With that knowledge, if you ever hear anybody comment that “Somebody should do something about long term care,” you can respond, “WAHSA is. How about you?”

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