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Agency for Health Care Administration
Agency For Health Care Administration
Regulatory Update TrainingSeptember 2004 / January 2005
Presenters:Polly Weaver, Chief of Field Operations Molly McKinstry, Chief of Long Term Care ServicesSusan Acker, Ph.D., Director of Nursing ServicesAgency 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 Line800-342-3557
• Emergency Support Function – 8850-410-1822800-320-0519 (request ESF-8)
Agency for Health Care Administration
Regulatory Update
• Regulatory Changes• AHCA Information Regarding Trends• Regulatory Statistics
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 ChangesNursing 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
Agency for Health Care Administration
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 AwardsNew 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 LegislatureMay 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
Agency for Health Care Administration
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
0200400600800
10001200140016001800
May 15, 2001 to May 14, 2002 1505 1030 879 383 318
May 15, 2002 to May 14, 2003 1568 948 1088 357 238
May 15, 2003 to May 14, 2004 1493 837 1063 474 395
Transfer Fracture A buse/Neglect Elopement Law Enf orcement
Agency for Health Care Administration
Nursing Home NOIsNursing Home Notices of Intent July 2002 - June 2004
0
10
20
30
40
50
60
70
80
90
100
110
*Based on NOI received by facility for month **This data may change due to later reporting by facilitiesSeries1 56 74 46 60 82 80 106 96 83 74 103 72 75 56 75 71 49 57 56 64 50 54 50 33
7/02 8/02 9/02 10/02 11/02 12/02 1/03 2/03 3/03 4/03 5/03 6/03 7/03 8/03 9/03 10/03 11/03 12/03 1/04 2/04 3/04 4/04 5/04 6/04
Agency for Health Care Administration
Characteristics of Reported Litigation
For-Profit
Non-Profit
Total
Multi-
Facility Owner
Licensed Nursing Homes 491 179 670 527 Lic NH Submitting NOI 410 123 533 438
Total # of Lic NOI Submitted 2,289 454 2,743 2,449 Total # of Lic Beds 60,937 21,464 82,401 65,021
# Of NOI per 1000 Lic Beds 37.56 21.15 33.29 37.66 Total # of Lic Complaints 509 88 597 558
Complaints per 1000 Lic Beds 8.35 4.10 7.25 8.58
Agency for Health Care Administration
Notices of Intent Past 3-Years 548 Nursing Homes Reporting NOIs
May 2001 - May 2004
# Nursing Homes
# NOI Reported
100 1 224 2 to 4 149 5 to 9 75 10 or more
Agency for Health Care Administration
Notices of Intent Past Year339 Nursing Homes Reporting NOIs
May 2003 - May 2004
# Nursing Homes
# NOI Reported
153 1 149 2 to 4 35 5 to 9 2 10 or more
Agency for Health Care Administration
Nursing Home Complaints Filed in Clerk of CourtComplaint Service Dates June 2002 - April 2004
0
5
10
15
20
25
30
35
40
Jun-02
Jul-0 2
Aug-02
Sep -02
Oct -0 2
No v-02
Dec-0 2
Jan-03
Feb-03
M ar-03
Ap r-03
M ay-03
Jun-03
Jul-0 3
A ug -03
Sep-03
Oct -03
No v-03
Dec-03
Jan-04
Feb-0 4
M ar-04
A p r-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
Jun-02
Jul-02
Aug-02
Sep-02
Oct-02
Nov-02
Dec-02
Jan-03
Feb-03
Mar-03
Apr-03
May-03
Jun-03
Jul-03
Aug-03
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
Mar-04
Apr-04
Agency for Health Care Administration
Nursing Home Complaints Filed in Clerk of Court
By AHCA Receipt Date June 2002 - April 2004
010
20
3040
50
6070
80
90
Jun-02
Jul-02
Aug-02
Sep-02
Oct-02
Nov-02
Dec-02
Jan-03
Feb-03
Mar-03
Apr-03
M ay-03
Jun-03
Jul-03
Aug-03
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
M ar-04
Apr-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
Jun-02
Jul-02
Aug-02
Sep-02
Oct-02
Nov-02
Dec-02
Jan-03
Feb-03
Mar-03
Apr-03
May-03
Jun-03
Jul-03
Aug-03
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
Mar-04
Apr-04
Agency for Health Care Administration
Number of Nursing Homes on The Watch List
Calendar Quarter Number of Facilities April 1, 2001 – June 30, 2001 79 July 1, 2001 – September 30, 2001 90 October 1, 2001 – December 31, 2001 89 January 1, 2002 – March 31, 2002 82 April 1, 2002 – June 30, 2002 87 July 1, 2002 – September 30, 2002 71 October 1, 2002 – December 31, 2002 50 January 1, 2003 - March 31, 2003 52 April 1, 2003 - June 30, 2003 51 July 1, 2003 - September 30, 2003 46 October 1, 2003 - December 31, 2003 44 January 1, 2004 – March 31, 2004 39
Agency for Health Care Administration
Nursing Home DeficienciesNursing Home
Type of Deficiencies by Year
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
1999 2000 2001 2002 2003 Jan-Jun 2004
Year
Num
ber o
f Def
icie
ncie
s
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
050
100150
2000 2001 2002 2003 2004thruJune
Citations forF353
Agency for Health Care Administration
All Nursing Home Staffing Deficiencies
2000 2001 2002 20032004
(June)Citations for F353 120 110 78 64 28N063 11 28 166 83 36N063 & F353 0 6 15 7 2N069 0 2 16 4 10
Agency for Health Care Administration
Grant Proposal RequestsUse 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 ServicesBarbara Dombrowski
Phone: (850) 922-0048E-mail: [email protected]
Agency for Health Care Administration
Top 10 Nursing Home DeficienciesTop Ten Nursing Home Cites
Tag DescriptionCount 2004*
Rank 2004
Rank 2003
Rank 2002
Rank 2001
F371Food must be stored, prepared, and distributed under sanitary conditions 142 1 1 1 1
F281Services provided by the facility must meet professional standards 100 2 2 3 4
F241Facility must treat residents with dignity and respect 86 3 4 4 3
F514Facility must maintain clinical records professionally and accurately 83 4 6 5 6
F253Facility must provide adequate housekeeping and maintenance services 74 5 5 10 22
F279Facility must develop comprehensive care plan for each resident 68 6 3 2 2
* January-June, 2004
Agency for Health Care Administration
Top 10 Nursing Home DeficienciesTop Ten Nursing Home Cites
Tag DescriptionCount 2004*
Rank 2004
Rank 2003
Rank 2002
Rank 2001
F280
Comprehensive care plan must be timely, accurate and periodically reviewed 63 7 10 11 16
F282Services must be delivered by qualified persons in accordance with care plan 63 7 11 13 7
F432Drugs must be stored in locked compartments at proper temperature 52 8 9 6 5
F465Facility must provide a safe, functional, sanitary, and comfortable environment 48 9 15 14 12
F363Menus must meet nutritional needs of residents 46 10 22 23 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 2001Resident Care 380 1 1 1 1Resident/Patient Abuse/Neglect 187 2 5 5 4Resident Rights 179 3 2 3 3Medicine Prob/Errors/Formulary 163 4 3 4 5Staffing 155 5 4 2 2Lack of Assessment 137 6 8 27 27Administrative 120 7 14 14 13Falls/Injury 102 8 6 6 8Pressure Sores 99 9 9 10 7Dietary 94 10 7 8 6
* January-June, 2004
Agency for Health Care Administration
AHCA Resources
Long Term Care Unit (850) 488-5861Bureau of Long Term Care (850) 414-9707Bureau of Field Operations (850) 414-9796
Health Standards and Quality Unit (850) 922-9138
AHCA Website: www.fdhc.state.fl.usNew 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