April 20, 2022
Featured News
ICYMI: Biden Administration Announces Sweeping EO to Support Care Workers
On April 20, 2023 by LeadingAge
The Biden Administration outlined several new plans ostensibly targeted at supporting care workers and family caregivers. Continuing a framework set out early in the Biden campaign, the strategy targets caregivers and workers in childcare, aging services, and services for people with disabilities.
The fact sheet supporting the executive order outlines ambitious goals at a very high level. As the details emerge, providers will be able to gain a practical understanding of how these sweeping actions will impact care. While many of the plans announced in the document have been announced before, a number of the elements appear to be new.
Much of the executive order focuses on making childcare more accessible and affordable for families, including military families; improving access to home-based care for veterans; and boosting job quality for early educators.
On the positive side, we are pleased that:
- The Administration continues to say it is focusing on aging services and specifically on paid and unpaid caregivers. Aging services providers are facing a staffing crisis of historic proportions.
- The White House has heard our message that an “all of government” approach is needed.
- The President continues to talk about his proposed $150 billion expansion of Medicaid home and community-based services.
- The President is directing the US Department of Health and Human Services (HHS) to focus on dementia.
There are a few concepts related to, or potentially related to, long-term care worth noting, including the following:
Enhance job quality for long-term care workers. The President is committed to improving the quality of long-term care jobs in this country so that Americans can get the reliable, high-quality care they deserve—whether in their homes and communities or nursing homes. To advance the President’s long-term care priorities, the Executive Order directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.
Support family caregivers. Without adequate resources, family caregiving can affect caregivers’ physical and emotional health and well-being and contribute to financial strain. These negative consequences are felt most acutely by women, who make up nearly two-thirds of family caregivers and who drop out of the workforce at higher rates than men. To provide greater support to family caregivers, the Executive Order directs HHS to consider testing a new dementia care model that will include support for respite care (short-term help to give a primary family caregiver a break) and make it easier for family caregivers to access Medicare beneficiary information and provide more support to family caregivers during the hospital discharge planning process. Additionally, VA will consider expanding access to the Program of Comprehensive Assistance for Family Caregivers and provide more mental health support for caregivers enrolled in that program. These actions build on the 2022 National Strategy to Support Caregivers.
Advance domestic care workers’ rights. To provide greater protection for domestic care workers providing care for our loved ones, the Department of Labor will publish a sample employment agreement so domestic child care and long-term care workers and their employers can ensure both parties better understand their rights and responsibilities.
Outlining our concerns
We have several concerns about today’s announcement, as spelled out in the fact sheet. The devil will be in the details, which are not announced yet. Our top five concerns are:
The entire continuum matters. Don’t frame the debate as HCBS vs. nursing homes. It’s time to stop the finger-pointing at nursing homes. The continued framing that pits home and community-based services against nursing home care fails to recognize that the entire continuum of aging settings and services needs attention and resources. The fact sheet suggests that the Administration will “leverage Medicaid” to ensure there are sufficient HCBS workers while simultaneously committing to adding additional regulations and requirements to the staffing ratio mandates (as yet, this proposed rule is not released) and punish nursing homes (by withholding Medicare SNF reimbursement) for not being able to retain staff.
Disability policy and aging policy are not the same. The announcement underscores the Administration’s continued conflation of needs, services, and supports for primarily working-aged people with disabilities with those of older people. While there are some commonalities, the fact sheet includes and is based on several fallacious assumptions that the issues are identical for both groups of consumers. For example, the “hundreds of thousands” of people on Medicaid HCBS waiting lists are working-aged people with disabilities, not older people.
Home and community-based services include community-based services. This fact sheet and other communications from the White House seem to be based on the assumption that “HCBS” happens almost exclusively in the individual home of each beneficiary. There are not enough care workers to provide this type of care; the financing is not likely to ever cover the costs even if there ever are enough workers, and care in each person’s home is not necessarily the best care for every beneficiary. Medicaid funds are used for adult day services and assisted living. Fact sheets and other communications should recognize that while home care is a vitally important part of the continuum, there is variability under the HCBS umbrella.
It will take focused aging expertise in the White House to address the aging of the population broadly and meaningfully. Asking multiple departments to talk with stakeholders is a small and early step and an acknowledgment that our message is being heard. However, the issues go well beyond caregiving, and the goal should be to tie together the work of all government agencies.
There will never be enough people to work in aging services without comprehensive immigration reform. Simply put, there are 1.7 jobs in the economy for every job seeker. The math doesn’t work without new people coming to the U.S. Supporting caregivers, leveraging payment incentives, and increasing their ranks cannot be done without changes to our immigration system.
Today’s order outlines ambitious goals at a high level, and we will keep you updated as we uncover additional details and advocate on your behalf every step of the way. Check Advantage and LeadingAgeMN.org for ongoing updates.
Thanks to LeadingAge, our national partner, for ongoing advocacy and partnership to shape policies at the federal level that impact older adult service providers.
CDC COVID-19 Vaccine Changes
On April 20, 2023 by Kari Everson
On April 19, the Centers for Disease Control and Prevention (CDC) released simplified vaccine recommendations. The CDC’s Advisory Committee on Immunization Practices (ACIP) met yesterday to discuss updated COVID-19 vaccine changes after the Food and Drug Administration (FDA) amended emergency use authorizations (EUA) for Moderna and Pfizer-BioNTech products earlier this week.
Bivalent vaccines will replace monovalent vaccines
Moving forward, the bivalent formulation will be used for all immunization doses, including the initial vaccination and subsequent boosters. The original (monovalent) COVID-19 mRNA vaccines produced by Moderna and Pfizer are no longer authorized for use in the United States. Alternatives are still available for those who cannot or choose not to receive an mRNA vaccine, including the Novavax protein subunit vaccine and Johnson & Johnson’s Janssen viral vector vaccine. The EUAs did not address the use or additional doses of either Novavax or Johnson & Johnson vaccinations.
Additional optional booster
Older adults and immunocompromised individuals are at greater risk for poor health outcomes if they become infected with SARS-CoV-2. The CDC updated vaccine recommendations to include an additional bivalent vaccine dose for those ages 65 years and older and for individuals and those who are immunocompromised. It is important to note that the additional COVID-19 vaccine booster, while approved, is not required. Authorization of an additional booster for this population gives medical providers more flexibility in administering more doses if needed.
Future discussions for COVID-19 vaccines
The FDA is scheduled to convene a meeting of their Vaccine and Related Biological Products Advisory Committee (VRBPAC) in June to discuss potential updates or changes to COVID-19 vaccination. Similarly to the FDA process for flu vaccines, the agency will ask for input from VRBPAC on SARS-CoV-2 variants most likely to circulate in the coming year. It will determine whether to switch to an annual immunization schedule.
State News
Assisted Living Survey Data - First Quarter 2023
On April 20, 2023 by Bobbie Guidry
In assisted living and assisted living with dementia care licensing surveys completed in the first quarter of 2023 by the Minnesota Department of Health, the average number of survey citations is 13.85. Analyzing the survey data can help assisted living settings provide safe, quality care and avoid citations on future surveys.
Here are a few key stats:
- 95 surveys were initiated for licensed facilities, with an additional 43 initial surveys of provisional licenses and 16 change of ownership surveys conducted.
- 18 providers had “conditions” placed on their licenses based on the survey results, but no licenses were revoked.
- 30 received a level three citation with no level four citations issued.
Most common citations
The top ten cited areas, including common issues triggering the citations, are:
1. Tag 480: AL Minimum Requirements – Food Code
- Proper food storage, temping, cooling
- Equipment – not commercial grade, not holding temps
- No staff illness log
- No CFPM
2. Tag 810: Fire protection and physical environment – Evacuation drills
- No written fire and evacuation plan
- Lack of required drills
- Training records for staff and residents capable of participating
- Floor plans lacking information
3. Tag 800: Fire protection and physical environment – Environment in good repair and operation
- Annual fire alarm and detector tests
- Missing carbon monoxide alarms
- Keyed exit doors/padlocks on gates of the patio in the emergency exit area
- Snow blocking egress windows/Excess storage in egress path or near mechanical room equipment
- Unsecured chemicals
4. Tag 680: Disaster Planning and Emergency Preparedness
- Lack of emergency and disaster plan or plan missing required elements/plan not posted
- Quarterly review of the missing resident plan
- For a site with a generator – missing monthly load test
5. Tag 1620 Initial reviews, assessments, and monitoring
- Exceeding time for every 90-day requirement for assessments
- Missing the 14-day assessment after the initial
- Missing Change of Condition assessments
6. Tag 1760: Documentation of administration of medication
- Meds were given but not yet recorded on MAR
- Quantity of medication given not recorded
7. Tag 2040: Fire protection and physical environment – additional requirements for ALDC
- Missing Hazard Vulnerability Assessments or unmitigated identified hazards
8. Tag 660 Tuberculosis prevention and control
- No TB screening in accordance with requirements
- Risk assessment not current
9. Tag 2310: Appropriate care and services
- Incomplete evaluation and communication regarding siderail use or other assist devices
- Checking for correct installation according to manufacturer’s guidelines/checking for recalls
10. Tag 510: Infection Control Program
- Hand Hygiene – washing hands when changing gloves/changing gloves according to policy
- Cleanliness of medication storage areas
- Safety lid on sharps containers
Survey results can be reviewed on the MDH website with searches available by dates, facility, or location.
Federal News
Several Updates to SNF Quality Reporting Program in Proposed PPS Rule
On April 20, 2023 by Julie Apold
The Center for Medicare and Medicaid Services (CMS) recently released its 2024 Skilled Nursing Facility Prospective Payment System Proposed Rule. It includes several proposed SNF Quality Reporting Program (QRP) changes.
Notable proposed changes to the SNF QRP program include adopting, removing, or modifying several measures and changes to the data completion thresholds.
New measures proposed for adoption
- Discharge Function Score: This measure would replace the current SNF QRP measure “Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function” beginning FY 2025. The collection of MDS data for this measure would begin Oct. 1, 2023, with reporting on Care Compare starting with the Oct. 2024 refresh.
- CoreQ - Short Stay Satisfaction: The CoreQ is a resident-reported outcome measure involving surveying short-stay residents discharged within a six-month period and calculating the percent of satisfied residents. SNFs would be responsible for contracting with a CMS-approved CoreQ survey vendor to administer the survey and report results to CMS. SNFs would begin sending resident information files to vendors in FY 2024 and must meet data completeness thresholds of at least 90% of required data fields submitted for at least 75% of the reporting weeks.
- Patient/Resident COVID-19 Vaccine: For FY 2026, CMS proposes adopting the measure “COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date.” Data would be based on a new item on the MDS assessments for SNF patients discharged during the reporting period. SNFs would begin reporting MDS data for residents discharged beginning Oct. 1, 2024, with reporting on Care Compare starting with the Oct. 2025 refresh.
Measures proposed for removal
- Application of Functional Assessment/Care Plan: The “Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and Care Plan that Addresses Function” measure would be removed from SNF QRP beginning FY 2025. CMS’ rationale for removing this measure points to the current high level of performance on this measure, not allowing for the meaningful distinction between providers. In addition, the “Discharge Function Score” measure proposed for adoption is more strongly associated with the resident functional outcomes being targeted. SNFs would not be required to report Self-Care Discharge Goals or Mobility Discharge Goals for residents admitted on or after Oct. 1, 2023, and these items would be removed from the MDS in the next release.
- Changes in Self-Care and Mobility Score: The two “Application of IRF Functional Outcome Measures” – “Change in Self-Care Score” and “Change in Mobility Score” would be removed beginning FY 2025. The rationale for removal is that the costs for SNFs and CMS associated with the measure outweigh the benefits of the information obtained. According to CMS, the measures are highly correlated with the “Discharge Self-Care Score” and “Discharge Mobility Score” measures and do not appear to measure unique concepts. Reporting on Care Compare for these measures would end by the Oct. 2024 refresh.
Measure modification
- HCP COVID-19 Vaccine Measure: The COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure requires reporting the percentage of healthcare personnel who have completed a SARS-CoV-2 vaccination course. The proposed modifications for FY 2025 replace the completed vaccination course language with HCP who are “up to date” based on the CDC’s definition of up to date. The modifications also specify the time frames within which HCPs are considered up to date.
Increases to data completion thresholds
- An increase is being proposed in data completion thresholds for SNF QRP MDS items to 100% submission of the required data on 90% of MDSs vs. the current completion threshold of 100% complete data for 80% of submitted MDSs.
Minnesotans Travel to DC for Leadership and Advocacy
On April 20, 2023 by LeadingAge
Several members of LeadingAge Minnesota attended LeadingAge's annual Leadership Summit in our nation’s capital city this week. LeadingAge Minnesota attendees visited with several members of Congress and their teams to discuss issues that our providers are facing all across the state.
We had the opportunity to meet with members and staff from the offices of:
- Representative Finstad (R-MN01)
- Representative Angie Craig (DFL-MN02)
- Representative McCollum (DFL-MN04)
- Representative Omar (DFL-MN05)
- Majority Whip Tom Emmer (R-MN06)
- Senator Klobuchar (DFL)
- Senator Tina Smith (DFL)
Throughout the day, Minnesota’s congressional delegation heard directly from our members on the challenges they currently face in our sector. We expressed our concerns with President Biden’s recent Executive Order that would hold hostage Medicaid funding by imposing a harmful condition on a portion of Medicaid payments based on turnover rates in nursing homes. We also shared frustration about minimum staffing standards in an industry already facing extreme staffing shortages.
Supporting solutions
Our members advocated for several bills that would support our workforce and the seniors we serve, including:
- Our Direct Care Workforce and Family Caregivers Act and the Direct CARE Opportunities Act: The bills would authorize $1 billion in competitive grants to support increasing direct care workforce positions and for the creation, recruitment, training, and retention of the direct care workforce. Sen. Kaine’s bill would allocate the funding to the Department of Labor; Rep. Scott’s bill would give the funding to HHS’s Administration for Community Living. Bill numbers in the last Congress: S. 2344 / HR 2999.
- Building America’s Health Care Workforce Act: This bill would extend CMS’s Temporary Nurse Aide (TNA) waiver flexibilities for 24 months beyond the Public Health Emergency, enable TNAs to continue working in their current roles, and put their on-the-job experience and training toward the 75-hour federal CNA training requirement. The legislation was first introduced last Congress in response to CMS’s announced rollback of certain 1135 waiver modifications implemented at the beginning of the pandemic. It was reintroduced this year by Representatives Brett Guthrie (R-KY) and Madeleine Deane (D-PA). Bill number in the current 118th session of Congress: HR 468.
You can review a complete list of federal bill priorities from LeadingAge here.
Notable News
OnTrack Pass Rates Continue to Exceed the State Average
On April 20, 2023 by Anna Mowry
Statewide nurse aide test pass rates are rising, but OnTrack nursing assistant students continue to exceed these averages.
Last week, we reported that statewide nurse aide knowledge test pass rates have increased by over 8% in the first quarter of 2023. OnTrack pass rates have increased along with the rest of the state, with a first-attempt pass rate of roughly 84% for the knowledge exam. OnTrack training programs exceeded 3% above the reported statewide average for the skills test, at a pass rate of 79%.
To improve student and program success, OnTrack was one of the first in the state to release updated content to align with Headmaster testing. These updates and more helped OnTrack have its best year yet in 2022. OnTrack is on trend to continue this success in 2023, assisting providers in training and certifying more nursing assistants.
Hear what members have to say:
- “OnTrack has been a great recruitment tool for hiring nursing assistants during COVID and going forward with the demand of workforce needs.” - Mary Springer, Presbyterian Homes & Services
- “OnTrack has provided a great opportunity for small, rural, and remote organizations. When an individual expresses an interest in joining our organization, we can get them started in the OnTrack program immediately; there is no waiting. Every shift counts, so the sooner we have new team members, the better for everyone.” - Kimber Wraalstad, North Shore Health
- “The customer service is excellent. OnTrack has been outstanding in working with us, solving problems, and answering our many questions.” - Anita Schiro, Auburn Homes & Services
OnTrack: a training and workforce solution
With over 100 active programs and over 5,000 nursing assistants trained around the state, OnTrack Nursing Assistant Training is a proven workforce solution available to all members to help train and certify future nursing assistants.
- OnTrack student pass rates are above the state average
- OnTrack classes are online and on-demand, 24/7
- OnTrack has any time enrollment
- OnTrack has no class minimums or maximums, and no class cancellations
- OnTrack includes instructions, guides, templates, and 1:1 support
Learn how OnTrack can help grow your workforce. Call 651-425-1110 for a free 1:1 consultation, or email ontracktrainingonline@gmail.com to get started today.
Member News
LeadingAge Minnesota Education Solutions
May Nurse Lunch and Learn – Join Us in 2 Weeks
On April 20, 2023 by Sharon Hollister
Documentation standards are critical in today’s healthcare settings to provide quality patient care and meet regulatory requirements. The SBAR technique provides a framework for communication between members of the healthcare team about a patient’s condition.
Join us for a quick learning byte on Wednesday, May 3, from noon – 12:30 p.m. for the Nurse Lunch and Learn: SBAR Documentation. During this complimentary, members-only webinar, learn how to create an SBAR narrative note and practice writing an SBAR note based on a case scenario.
Can’t wait until May? Gather your nurses, particularly staff nurses and direct care nurses, to watch our previous Nurse Lunch and Learn recordings and work through the exercises together. Find these titles in our Resource Library:
Find details and register now.
Virtual Institute On-Demand Content – Ends April 30
On April 20, 2023 by Sharon Hollister
On-demand content from this year’s Virtual Institute is available online for registered participants to view and earn CEUs through April 30. On-demand content includes 17 sessions for the Virtual Institute and the three keynote sessions from the in-person conference.
Access the on-demand content via the link used to participate in Virtual Institute. Please email education@leadingagemn.org with questions.
MDS Education Coming Your Way
On April 20, 2023 by Sharon Hollister
CMS released the updated MDS 3.0 Resident Assessment Instrument (RAI) user manual (version 1.18.11) in early April and will become effective Oct. 1. Watch for more information in the coming weeks on our training timeline.
The revisions to this manual are significant in scope. They will require organizations to stay in close communication with their software vendors, update their procedures to reflect added or updated questions, and provide additional training to staff completing documentation.