The Lead March 15, 2021 - LeadingAge Illinois

Nursing and Rehabilitation:
CMS Encourages Nursing Homes to Report Vaccinations
IDPH Extends Rules on Discharges
IDFPR Extends Rules on Online CEs

Independent Affordable/Subsidized Housing:
LeadingAge Illinois and Nation Submit Comments on HUD NSPIRE Rule

Home Health and Hospice:
LeadingAge Home Health and Hospice Weekly Recap

Other:
Ombudsman Creates New Resident and Family Support Council
Apply to Serve on a LeadingAge Illinois Cabinet

From the Desk of Karen Messer, President & CEO:
On Friday, I joined other state LeadingAge affiliates to discuss with LeadingAge National the rolling out of a new a set of policy recommendations aimed at ensuring quality in nursing homes. This LeadingAge and AHCA proposal pulls together the first, immediate steps needed to address issues that LeadingAge has been talking about for years, including survey reform and staffing. Read more about the proposals now, and look at the virtual press event and press release. There will be more information to come and we will report updates and actions in The Lead.

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Top Stories:

CMS Infographic on Visitation
As you know CMS released their new guidance on visitation last week. We are told by the Illinois Department of Public Health (IDPH), they are working on their guidance. It likely will come to providers as a SIREN notice.

CMS also released this information graphic for families and friends of residents in nursing homes. It outlines in detail steps on how and when you may visit, safely, according to their guidance. We continue to contact IDPH on the progress of their guidance or any notifications from them to providers on visitation. One note IDPH made a clarification on this week in regards to screening forms, is that they are to be kept for 30 days, not three months as they verbally reported to us in our weekly meeting.

On another note, we have been informed by some Nursing Facilities Cabinet members that surveyors asking for CMS QSEP training completion dates.

Talking Points in Response to New York Times Story
The New York Times has run a story titled “Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public.” As a result, LeadingAge National has pulled together a few talking points, some links to 5 Star background, and the nursing home messaging for easy reference.

Talking Points on New York Times 5-Star Investigation:
There are no excuses for poor quality of care; bad performers must improve and there must be accountability for wrongdoing. Every nursing home must be striving for excellence every day.

There is no excuse for manipulating data, and it is a travesty if flawed or misleading data has led consumers to nursing homes that did not deliver on the promise of quality care.

As the need for a quality residential environment grows ever more critical, we must, as a country, renew our commitment to upholding the dignity and rights of older adults – particularly those who live in nursing homes. These individuals deserve nothing short of quality care and support that enables them to live lives of well-being and gives their families peace of mind that they are in good hands.

LeadingAge has long advocated for improvements to the 5-Star system on behalf of our mission-driven, nonprofit members. Consumers need to be able to rely on an easy way to understand nursing home quality and distinguish between high and low-performing nursing homes, and rely on a system that promotes transparency. But researchers have found that the survey and inspection system is flawed, and often arbitrary and ineffective.

The veracity of the system depends on truthful reporting by homes and inspectors. LeadingAge fervently endorses full transparency, which is crucial to establishing a trusting and productive relationship between nursing homes, care providers, residents and families.

Accessible, timely and credible information about quality and finances is a must — and it is critical to have objective measures that are meaningful to consumers and family members.

5-Star Overview:
2008: CMS implements the Five-Star Quality Rating System

What it does: assigns each nursing home an overall rating and three component ratings based on the extent to which the nursing home meets CMS’s quality standards and other measures. Goal is to provide consumers with an easy way to understand nursing home quality and to distinguish between high- and low- performing nursing homes

2016, November: GAO Report on 5-Star: Consumers Could Benefit from Improvements to the Nursing Home Compare Website and 5-Star Quality Rating System

History, per New York Times:
Seeds of 5-Star planted at Congressional hearings prompted in part by concerns that quality oat nursing homes was declining as large chains were acquired by private investment groups: “Washington Scrutinizes Nursing Homes,” Nov. 2007

Private equity buying into sector: “At many homes, more profit and less nursing,” Sept. 23, 2007 New York Times’ coverage of 5-Star

Aug. 24, 2014: “Medicare Star Ratings Allow Nursing Homes to Game the System,”

Mar. 13, 2021: “Maggots, Rap and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public,”

Nursing Home Reform and Accountability Messaging:
Nursing Homes Can and Should Be Bastions of Quality Health Care and Quality of Life:
Our goal is for every nursing home in the country to be a place where any of us would be comfortable living—or have a family member stay—if we needed the level of 24/7 care that they provide. Nursing homes should provide top-quality person-centered care, delivered by qualified staff, in a physical setting that reinforces the dignity and well-being of residents, so they can lead lives of purpose.

Nursing Homes Are an Important Part of Our Healthcare System:
We’ll always need residential care for people who cannot remain in their own home, for whatever reason. The U.S. nursing home system was set up during a time of shorter lifespans and faster health declines, but today, most of us will need some kind of paid caregiving over the course of our life. America’s population is rapidly aging and, more of us—especially once we’re over age 85—will live with frailty, dementia or other chronic conditions that require more care than our families can provide. The need for a quality residential environment is growing ever more critical.

Our Society has Long Undervalued Nursing Homes, and the Caregivers Who Work in Them:
For most Americans, attitudes about nursing homes are shaped by fear of getting older and societal ageism that devalues older lives. This negative bias toward aging, combined with outdated funding models and under-investment in the nursing home infrastructure, has led to systemic, chronic undervaluing of nursing homes workers. Those workers have been further marginalized because caregiving itself—which is provided primarily by women, especially women of color—is also often overlooked, taken for granted or dismissed as unskilled labor.

Frontline Workers Are the Heart of Nursing Homes, but Need More Support:
Direct care workers provide the majority of care in nursing homes. Caring for older adults in nursing homes requires not only a specialized understanding of their healthcare and functional needs, but also a dedication to their multidimensional quality-of-life needs. Aides and nursing assistants are professional caregivers who provide the intimate, hands-on care that is fundamental to long-stay nursing home care. Yet direct care workers—in nursing homes and other settings—remain so poorly compensated that 1 in 8 lived in poverty and more than half received public benefits in 2018.

Nursing Homes are Navigating an Unsustainable Public Funding Model:
Most nursing homes provide two types of care: long-term residential care, and short-stay services for rehabilitation or post-acute care. In the U.S., most revenue comes from three sources: 1) Medicare, 2) Medicaid, and 3) private pay. Medicaid is the joint federal and state government payor for over 80% of nursing home residents, but virtually no state pays nursing homes enough under Medicaid to cover actual costs. The cost of what it takes to provide quality care just doesn’t square with reimbursement rates. (Note that a very small fraction of nursing home care is paid for with private long-term care insurance.)

The COVID Crisis is Exacerbating Long-standing Problems—and Creating a Moment for Reform:
After a year struggling with COVID-19, extraordinary and continued pandemic-related expenses for critical supplies, coupled with census declines and reduced revenues, are pushing providers to the edge. As the pandemic exploded, staff stress, costs and shortages have multiplied. There has never been a better moment to build the nursing home system we need.

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Trio of Partners in Quality Virtual Visits Held Monday
We are two weeks away from the end of the first quarter of 2021 and we have had 25 Partners in Quality Virtual Visits with members and their legislators. Although we cannot personally be in communities to give legislators an opportunity to tour and talk with residents, the virtual briefings have allowed members the chance to focus specifically on challenges providers have faced over the last year and the need for support moving forward. On Monday, we had three separate virtual visits.

Rep. Amy Elik (R-111th District; Alton), Senator Neil Anderson (R-36th District; Moline), and Senator Laura Ellman (D-21st District; Naperville) were the three visits yesterday. Special thanks to the following members for telling their stories yesterday:

Greg Fonda, chief financial officer, Dial Senior Living
Becky Hinton, executive director, Overlook Village Retirement Community, Moline
Scott Hochstadt, administrator, Covenant Living at Windsor Park, Carol Stream
Anne Hoeksema, associate executive director, Covenant Living at Windsor Park, Carol Stream
John Klein, director of operations management, Life Care Services (LCS)
Anita Martinez, executive director, Asbury Village, Godfrey
Elizabeth McLaren, vice president of health services strategy, programming, and integration, Covenant Living Communities
Daniel Merriman, senior compliance and public policy analyst, Life Care Services (LCS)
Shelly Smith, executive director, Covenant Living at Windsor Park, Carol Stream

Rep. Elik is about three months into her first term in the Illinois House. She is a member of the Appropriations-Human Services, Committee. John Klein, director of operations management, and Daniel Merriman, senior compliance and public policy analyst at LCS, gave the representative the background on their organization, which has existed for 50 years. LCS cares for about 40,000 seniors and manages 10 communities in Illinois.

Anita Martinez, executive director, Asbury Village, Godfrey, gave the representative an overview of the community and educated her on how the organization dealt with the pandemic. They have 220 units with assisted living and independent living. They do not have Medicare of Medicaid. The community has been open 25 years. “It has been a journey and we have appreciated the opportunity to serve seniors of the Riverbend area.”

Anita said she has seen a lot of residents who moved out of state after retiring or moving away, come back home to live at Asbury. Anita talked about the financial challenges COVID has presented her organization and others like hers. The representative has visited and dined at the community previously, but not as a legislator. She was impressed with the longevity of staff and retention. “You are the gold standard,” said Rep. Elik. The representative is also co-sponsor of HB3498, which is a LeadingAge Illinois priority as a member of the Coalition to Protect Telehealth.

Becky Hinton, executive director at Overlook Village Retirement Community, a Dial Community in Moline informed Sen. Anderson of how your staff and residents handled the challenges of COVID-19. They have 125 residents in the independent living, assisted living, and memory care.

Greg Fonda, chief financial officer at Dial Senior Living, gave the senator a background on Dial’s communities. They were founded in 1999 and have 20 communities in seven states. They manage about 3,000 senior living units (Assisted Living, Independent Living, and Memory Care). Batavia is their most recent addition to their communities. We are so incredibly proud of our team and residents. The team kept other staff members and residents sage throughout this,” said Greg. Dial staff took the Dial Hero Pledge to keep other staff and residents safe throughout the pandemic.

Senator Anderson has participated in the Partners in Quality program since taking office. “From an outsider who goes to assisted livings all over outside of Moline, I can tell you that Overlook Village is very well run, the staff is responsive and responsible,” said Sen. Anderson. He appreciated the update heading into the in-person session this week. “As a legislator, these are the things I need to hear, especially as I head tonight to Springfield for session.”

Elizabeth McLaren, vice president of health services strategy, programming, and integration at Covenant Living Communities and her Covenant team updated Sen. Ellman on how COVID impacted their communities, highlighting Windsor Park in Carol Stream, which is in the Senator’s district.

Founded in 1866 in the Chicago area, Covenant is in nine states. The have 16 communities and two HCBS agencies. They serve 3,500 residents. In Illinois, they have four communities and one HCBS agency. Elizabeth walked through the challenges that were faced in 2020 and those still present today.

Shelly Smith, executive director at Covenant Living at Windsor Park, has been in the industry for over 30 years; the last two months at Windsor Park. She gave the Senator the background on the community. It is the 14th Covenant community that joined the organization in 1999. They are expanding their assisted living due to the need and have worked hard to fight COVID.

Elizabeth and Scott Hochstadt, administrator at Covenant Living at Windsor Park, discussed the toll the pandemic has taken on residents with the lack of being able to see loved ones. Anne Hoeksema, associate executive director at Windsor Park, discussed the community’s COVID unit and work to partner with a local hospital.

Sen. Ellman has previously visited the community, so has seen the quality care and services that were discussed on the zoom. Her district director also attended the meeting and they indicated they will follow up with the Illinois Department of Public Health (IDPH) on some of the issues presented, such as any Department guidance surrounding the new CMS Visitation Guidance.

It was another round of strong advocacy in front of legislators this week and we continue to schedule more visits with members and legislators. If you would like to schedule a virtual meeting with your legislators, contact Jason Speaks.

Urge Congress to Pass H.R. 1868 Before April 1
While encouraged by the recent downward trend of COVID-19 infections and deaths, along with significant progress in vaccinations, LeadingAge recognizes that the months ahead will continue to present obstacles and challenges for aging services providers and the older adults they serve. Congress must act now to prevent cuts to Medicare due to congressionally mandated cuts to programs. Help Congress move H.R. 1868 forward so the President can sign this important bill into law. Make your voice heard today by reaching out to your members of Congress.

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Act Now to Prevent Medicare Payment Cuts
Please take action to extend the Medicare sequester moratorium until December 2021 and prevent further Medicare cuts scheduled to begin next year. The House is expected to take action on this bill this week so let’s keep the pressure on! Contact Congress Now.

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LeadingAge Virtual Lobby Day Registration Is Now Live
Are your U.S. senators and representative aware of your organization’s critical work? Do they understand the challenges you face or policies that could improve care and services for older Americans? They should! That’s why we’re inviting you to join LeadingAge’s Congressional Lobby Day on April 21, 2021. It’s your chance to meet with your elected officials and advocate for issues that are important to aging services. Learn more and register today.

Assisted Living:

Member Spotlight: The Oaks Manor, operated by Oak Senior Care, LLC
In this week’s Member Spotlight, we shine a light on Marijo Eisbrenner, director and CEO of Oaks Manor, operated by Oak Senior Care, LLC.

How many years has the community existed?
Marijo: “The building was completed in 2008. This was the brain-storm of several Oakland business owners to build a long-term care facility that would serve the local community and keep their seniors at home. Although built to the standards of an assisted living facility, the founders never moved forward to obtain the licensing with IDPH as Assisted Living. For that reason, it was operated as 13 independent senior apartments. In August, 2019, Eric (her husband) and I purchased The Oaks Manor and immediately started jumping through the hoops with the State of Illinois. Our probationary license was granted in January 2020.”

What services are offered?
Marijo: “Our number one service at our small boutique community is to spoil our residents and their extended family members. We cater to their wants and desires from the food prepared to the way their rooms are cleaned. Like other assisted living communities, we offer three home-cooked meals daily; weekly housekeeping and personalized laundry service. Our suites have their own private geothermal heating system and central air conditioning. This allows our residents to set the temperature in their suites so it is comfortable for them, and it adds a measure of safety since air ducts are not shared between rooms. Our residents enjoy DirectTV, internet and the ability to visit with family via Zoom calls. We work directly with outside care providers such as occupational therapists, physical therapists, home health care providers and hospice. Activities include cards, Chinese checkers, bingo, crafts, piano music, exercise and educational learning on a wide variety of subjects. When permitted, local clergy lead Bible Study and provide Church Services weekly.”

What is unique about your community?
Marijo: “The Oaks Manor motto is ‘Residents do not live where we work, we work where they live’. Our community has beautiful furnishings to provide the feeling of home, not an institution. It also smells nice. We have lots of artwork on the walls including many canvas photographs of African wildlife taken by Eric and I while in Kenya in 2020. All our team members are CPR-certified and go through additional training to become Resident Aides. They are all cross-trained to help out wherever needed. We probably have the largest percentage (67%) of team members with a Food Manager’s License and the remainder with a food handler’s certification.

We have a very large backyard for the enjoyment of all where we grow tomatoes and peppers in the summer and lots and lots of flowers. Within a block we have the public library, the senior center, Oakland city park, post office, grocery store. Another unique feature of living in The Oaks Manor is the friendly and supportive people who live here. The art teacher from the elementary school loans artwork so it can be displayed on our hallway walls. The people of Oakland are, by far, the most friendly, loving and helpful people you will ever meet. They consistently send cards to our residents and bring by little gifts and treats. This has been essential toward keeping up the spirits of residents during this pandemic.”

What brought you to the industry and what do you enjoy most about it?
Marijo: “It is really all Eric’s fault! Eric worked at a long-term care facility as a young man and had a vision of owning his own one day. Eric is our CFO and has worked as a CPA and corporate fund-raising in a lot of different industries. He eventually focused in medical devices. I have a doctorate in Microbiology from Kansas State. I had worked the previous 15 years as a trainer and mentor in the realm of real estate investing. Putting all our experiences and training in a big cauldron and stirring it vigorously, out popped ‘The Oaks Manor’. We are both new to this industry, but we saw a financial opportunity and believe that the need for senior long-term care will explode in the next few years. We look at our involvement in this industry as our mission field.”

What are you most proud of at your community?
Marijo: “We are most proud of the relationships we have created with The Oaks Manor and the Oakland community. We are proud of the level of care we provide and how happy our residents and their family members are. One family member said, ‘The impact you have made on my mother has been incredible, she loves The Oaks Manor. We are so appreciative of what you do and if you need anything, we have your backs’.”

What vision for the future of your community do you have?
Marijo: “The vision I have for The Oaks Manor would be a waiting list for entry into our community. When that happens, we will consider building additional rooms on adjacent land’ possibly to provide care for Alzheimer’s. Eric and I both believe we are one of the best kept secrets in East Central Illinois and the need for long-term care is only going to increase in the coming years.”

Marijo closed with this comment on the experiences over the last year and path forward:
“The pandemic has brought this entire industry to its knees. A major setback full of unforeseen challenges, costly remedies, confusing government intervention leading to significant stress to our residents and their families. Many communities will cease to operate due to low census and increasing costs associated with Covid-19. We are optimistic that if you can survive the storm, you will emerge stronger on the other side of this better trained and better prepared. You will be in a poised to profit from the unstoppable Silver Tsunami. Be prepared to ride the wave.”

Nursing and Rehabilitation:

CMS Encourages Nursing Homes to Report Vaccinations
CMS notified nursing homes that they “strongly encourage” they report staff and resident vaccination rates through the CDC Vaccine Reporting Module in the National Healthcare Safety Network. The short email points out that the revised visitation guidance requires a 70% resident vaccination threshold for visits for unvaccinated residents in counties with greater than 10% positivity. Entering vaccine information into the module will “make it easy” to calculate the rate. The CMS email also mentions the LeadingAge-AHCA goal of 75% of all nursing home staff being vaccinated by June 30.

IDPH Extends Rules on Discharges
The Illinois Department of Public Health (IDPH) has adopted emergency rules for Skilled Nursing and Intermediate Care Facilities effective March 1, 2021 for a maximum of 150 days. These emergency rules continue the provisions of COVID-19 Executive Orders and previous emergency rules that expired February 28 prohibiting nursing homes from discharging residents for late payment or non-payment.

IDFPR Extends Rules on Online CEs
The Illinois Department of Financial and Professional Regulation (IDFPR) recently adopted rules regarding the Nursing Home Administrators Licensing and Disciplinary Act, effective March 1, 2021, concerning online continuing education (CE) requirements. The rules allow all CE requirements to be fulfilled online.

Independent Affordable/Subsidized Housing:

LeadingAge Illinois and Nation Submit Comments on HUD NSPIRE Rule
LeadingAge has submitted comments on HUD’s NSPIRE proposed rule to overhaul physical inspections of HUD-assisted properties. LeadingAge Illinois followed suit, submitting comments in support of National’s feedback. LeadingAge’s comments were generated from member input and highlighted the need for a robust yet feasible inspection protocol.

In particular, LeadingAge called for an enhanced risk-based inspection schedule and an NSPIRE implementation schedule adapted for COVID-19. LeadingAge also requested clarity from HUD on several proposed changes, including a proposed requirement to submit annual unit self-inspections to HUD; the comments also suggested several alternatives to streamline the inspection process while incentivizing good living conditions at HUD-assisted communities.

More information about the proposed rule and LeadingAge’s comments is available here. To join LeadingAge’s HUD Oversight Workgroup, which meets monthly to discuss HUD’s portfolio oversight mechanisms, email Juliana Bilowich at National.

Home Health and Hospice:

LeadingAge Home Health and Hospice Weekly Recap
LeadingAge National has put together a recap of issues and information for home health and hospice members. Click here to access the recap.

Other:

Ombudsman Creates New Resident and Family Support Council
The Illinois State Long Term Care Ombudsman has announced the creation of the statewide Resident and Family Support Council. The goal of this council is to educate and connect people on issues relating to residents in the long-term care system. The plan is to hold a virtual council meeting every other week.

The Ombudsman’s Office reports that the focus of the council is to:

Support residents and their families and friends,
Address concerns and complaints affecting residents of long-term care facilities,
Serve as a sounding board and advisory body on new ideas and improvements,
Advocate for positive change within the long-term care system,
Communicate with administrators and staff, and
Support activities that benefit all residents.

Apply to Serve on a LeadingAge Illinois Cabinet
The LeadingAge Illinois Cabinets set the association’s priorities for all of the settings we represent. If you’re a provider member interested in learning more about Cabinets, please review the below Cabinet Roles and Responsibilities Overview document. The second call for nominations deadline is March 19, 2021. Please take a look at the Cabinet materials and consider applying.

LeadingAge Illinois Cabinet Application (pdf)

LeadingAge Illinois Cabinet Roles and Responsibilities Overview