2015 Biennial Survey of Long-Term Care Facilities - NURSING FACILITIES 1/1/ /31/2015
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1 2015 Biennial Survey of Long-Term Care Facilities - NURSING FACILITIES 1/1/ /31/2015 *** This is a pdf of the survey, not the actual NF survey itself *** May 2016 Dear Administrator, The Ohio Department of Aging has once again contracted with the Scripps Gerontology Center at Miami University to conduct the Ohio Biennial Survey of Long-Term Care Facilities. Participation in this survey is mandated for all nursing homes and residential care facilities by Section of the Ohio Revised Code. Beyond the statutory mandate for the survey, we wanted you to know how important and useful the survey results are. Data that you provide by completing the survey questionnaire are used for, among other purposes, continuing the longitudinal study of long-term care utilization in Ohio. We have found that data from the survey are used by the General Assembly, state agencies, and long-term care facilities themselves. We need your assistance to continue in this important effort. If you are interested in findings from previous surveys, you may view the most recent report on the Scripps Gerontology Center website at: miamioh.edu/cas/academics/centers/scripps/research/publications/2015/06/the-road-to-balance-two-decades-ofprogress.html Thank you for taking the time to complete the Biennial Survey. This survey provides the only source of information for every facility in Ohio - your participation is extremely important. Sincerely, Bonnie Kantor-Burman Director, Ohio Department of Aging
2 Dear Colleague, The Biennial Survey of Long-Term Care Facilities is being conducted by the Scripps Gerontology Center at Miami University. This year s survey has been streamlined in an effort to make it easier for you to complete and is done online. Scripps has collected and used these data to track the changes underway in the field of long-term care. Results from the study are communicated to long term care facilities by Scripps researchers through written reports and through presentations at our association meetings. We believe that good information places providers, industry representatives, and policy makers in a better position to make good decisions about skilled nursing facilities and residential care facilities. We strongly support these data-gathering and analysis activities and feel they are highly beneficial to a better understanding of our profession, by policy makers, and the general public. We urge you to complete this important and mandated survey within the next two weeks. Sincerely, Kathryn Brod LeadingAge Ohio Peter Van Runkle Ohio Health Care Association Jean Thompson Ohio Assisted Living Association Chris Murray The Academy of Senior Health Sciences, Inc.
3 Instructions ***Please complete your survey by June 17, 2016*** -Use information from the calendar year 2015 to complete this survey. -If your organization has both a licensed nursing home and a residential care facility (RCF), your organization will receive one survey for the nursing facility and another for the RCF. Complete this survey based on information from the nursing home only. -You may save your partially completed survey and return to it another time by choosing Save Responses at the bottom of the page where you end your work. Return to your survey from the link in your invitation and log in with your ID, which can be found in your invitation. -If you are using a HIPAA compliant connection or your web browser has a time-out feature, you may be logged off after a period of inactivity. Save your work often so you do not lose it. -Use the Back and Next buttons at the bottom of the page to move through the survey, not the buttons on your browser. If you use the back or forward buttons in your browser, you may be disconnected from the survey and will lose your work. -You may print your responses at any time by choosing the Print responses button on the bottom of the screen. When you choose "Print responses" a new page will appear with the entire survey displayed. You will need to allow pop-ups in your browser in order to see the screen to print your survey responses. Do not choose Submit until you have completed all work on your survey, printed a copy (if desired) and are ready to leave the survey. If you submit the survey before you are finished we will have to reset your survey and your work will be lost. -Due to skip patterns, the questions on your survey may not be consecutively numbered. If you choose to complete a paper version of the survey or want a paper copy to use as a worksheet, please print the PDF version of the survey found here: Please mail your survey to: Biennial Survey of LTC Facilities Scripps Gerontology Center Miami University Oxford, OH If you have any questions about this survey, please call or Scripps Gerontology Center biennialltcsurvey@miamioh.edu ***Please complete your survey by June 17, 2016***
4 If any of the following information is not correct, please overwrite it with the correct information Q1 Name of Facility as it appeared on your license December 31, 2015 Q2 Did this name change during 2015? Yes No
5 Q3 You indicated that your facility's name changed during Please enter the previous name. Q4 Facility address (General facility ; administrator only if no general ) If we have questions about your survey responses, whom should we contact? Q5 Contact Name Q6 Contact Phone Number Q7 Contact
6 Q10 Does your facility have a Medicaid Provider Number? Yes No
7 Q11 Our records indicate that your facility has the following Medicaid Provider Number: {Q8}. Is this Medicaid Provider Number correct? Yes No
8 Q12 Please enter your Medicaid Provider Number: Q13 Does your facility have a Medicare Provider Number? Yes No
9 Q14 Our records indicate that your facility has the following Medicare Provider Number: {Q9}. Is this Medicare Provider Number correct? Yes No
10 Q15 Please enter your Medicare Provider Number: Q16 Did your facility change ownership during 2015? Yes No You checked a facility ownership change during If you have resident census records about your facility for only part of 2015, please provide the dates for which you have information. Q17 From: mm-dd-yy Q18 To: mm-dd-yy Q19 Is your nursing home owned or leased by a multi-facility organization (i.e. two or more nursing homes in different locations)? Yes No
11 Q20 Is your nursing facility part of a hospital (i.e. nursing home beds in the hospital building or part of the hospital complex)? Yes No Q21 Is your facility part of a Continuing Care Retirement Community? (For our purposes, a CCRC has independent living and an assisted living/residential care facility along with a nursing home on the same campus.) Yes No
12 Q22 Does your facility offer independent living? Yes No Q23 Does your facility offer assisted living/residential care? Yes No
13 Beds in the Facility The items below, about the number of beds in your facility, should be answered based on beds in the facility on 12/31/15, i.e. the number of beds you pay taxes on. Q24 Total number of ODH reported LICENSED facility beds on December 31, 2015 Q25 Total number of beds CERTIFIED for EITHER Medicaid, Medicare, or both on December 31, 2015 If the above numbers are not correct, please overwrite with the correct number. Q26 Of the above beds, how many were dually certified for both Medicare and Medicaid? (Do not include Medicaid ICF/IID beds.) Q27 Of the above beds, how many beds were certified for Medicare only? (Do not count beds previously reported as dually certified.) Q28 Of the above beds, how many beds are certified for Medicaid only? (Do not count beds previously reported as dually certified nor ICF/IID beds.) You indicated that the sum of Q26, Q27 and Q28 is {V8}. This is not the same as the total number of certified beds in Q25 ({Q25}). Please go back and correct. Q29 Were all of these licensed and/or certified beds available for service the entire year? (Available for service refers to beds that are being used or could be used). Yes No
14 Bed Availability The number of nursing facility beds available for resident use includes beds that are in service (not banked or in a unit that is closed). Do not include any beds licensed for ICF/IID or Residential Care Facility. On the last day of 2015, you had {Q24} licensed beds and {Q25} certified beds. You indicated that some of these beds were not available for service the entire year. Please record the total number of nursing home beds available for service on the 1st day of each month in Q30 January 2015 Q31 February 2015 Q32 March 2015 Q33 April 2015 Q34 May 2015 Q35 June 2015 Q36 July 2015 Q37 August 2015 Q38 September 2015 Q39 October 2015 Q40 November 2015 Q41 December 2015 Resident rooms in the facility as of 12/31/2015 Q42 Q43 How many resident rooms were in your facility? How many private rooms were in your facility? You indicated that you have more private rooms ({Q43}) than resident rooms ({Q42}). Please go back and correct Q42 and/or Q43.
15 Nursing Facility Rates July-Dec Q44 What was your average Medicaid per diem fee-for-service reimbursement rate for the last half of 2015? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicaid residents, record "0" (zero). Q45 How many Medicaid managed-care (NOT MyCare) plans does your facility contract with? Q46 What was your average per diem Medicaid managed-care rate (NOT MyCare) in the last half of 2015? Average among rates for all Medicaid managed-care plans your facility accepts. Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicaid managedcare plans, enter "0" (zero).
16 Nursing Facility Rates July-Dec Q47 What was your Medicare per diem fee-for-service rate during the last half of 2015? (Total semi-annual Medicare reimbursement divided by Medicare fee-for-service patient days between July 1 - Dec 31, 2015)? Do not include Medicare Advantage rates. Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicare fee-for-service residents, record "0" (zero). Q48 How many Medicare Advantage plans does your facility contract with (e.g. Anthem, AARP)? Q49 What was your average per diem Medicare Advantage rate in the last half of 2015? Average among rates for all Medicare Advantage plans your facility accepts. Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicare-managed care plans, enter "0" (zero).
17 Nursing Facility Rates July-Dec Q50 What was your average daily rate for a private pay (noninsurance) nursing home semi-private room in the last half of 2015? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no semi-private rooms, record "0" (zero). Q51 What was your average daily rate for a private pay nursing home private room in the last half of 2015? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no private rooms, enter "0" (zero). Q52 What was your average daily private-insurance rehabilitation reimbursement in the last half of 2015? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no private-insurance rates, enter "0" (zero). Q53 What was your average Veterans per diem rehabilitation reimbursement in the last half of 2015? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Veterans rates, enter "0" (zero).
18 Resident Days 1/1/ /31/2015 Please complete the following chart regarding monthly total resident days. If residents were out of facility for medical or therapeutic leave with a bedhold, include them in the resident days on a full-day basis. Report the total number of resident days in the facility during the month, not the proportion occupied. For example, if you had 10 residents for 28 days in May and one resident for 22 days, then the total of resident days in May is 302. Q54 January 2015 Q55 February 2015 Q56 March 2015 Q57 April 2015 Q58 May 2015 Q59 June 2015 Q60 July 2015 Q61 August 2015 Q62 September 2015 Q63 October 2015 Q64 November 2015 Q65 December 2015
19 Total Resident Days for Calendar Year 2015 by Payment Source For the items below, indicate how many resident days were paid with each payment source. Q66 Medicare fee-for-service days reported in Medicaid Cost Report, Schedule A-1 Q67 Medicare fee-for-service days Q68 Medicare Advantage days (e.g. Anthem, AARP) If you completed the Medicaid Cost Report, the next four questions address the column headed "Medicare Managed Care Days, Veterans, and Other Days". Q69 Q70 Q71 Q72 Total number of Medicare Managed Care Days, Veterans Days and Other Days reported in Medicaid Cost Report, Schedule A-1 Medicare Managed Care Days from Q69 Veterans Days from Q69 Other Days from Q69 Q73 Q74 Veterans Days Other Days If you completed the Medicaid Cost Report, the next three questions address the column headed "Private Days". Q75 Q76 Q77 Q78 Private days reported in Medicaid Cost Report, Schedule A-1 Private health insurance days included in Q75 Private pay or self pay days included in Q75 Private health insurance days Q79 Private pay or self pay days
20 Q80 You indicated other resident days. Please list the payment sources included in other days:
21 Yearly Total 2015 Nursing Facility Admissions by Payment Status at Admission The following questions ask for a count of admissions by primary payer. Indicate the appropriate number of residents for each payment category. Residents admitted with multiple payment sources should be included under their primary payer. If no residents were admitted with a particular payment source, record "0" (zero). Include only residents for whom an admission assessment was completed, NOT residents who are determined to meet the CMS definition of reentry (See below). Reentry refers to the situation when all three of the following occurred prior to this entry: 1) the resident was previously in this facility and 2) was discharged return anticipated and 3) returned within 30 days of discharge. Upon the resident's return to the facility, the facility is required to complete an entry tracking record. In determining if the resident returned to the facility within 30 days, the day of discharge from the facility is not counted in the 30 days. For example, a resident who is discharged return anticipated on December 1 would need to return to the facility by December 31 to meet the "within 30 days" requirement. Q81 Q82 Q83 Q84 Q85 Q86 Q87 Medicare fee-for-service Medicare Advantage Medicare MyCare Total Medicare admissions Medicaid fee-for-service Medicaid managed care Medicaid MyCare Q88 Q89 Q90 Total Medicaid admissions Private pay or self pay (include long-term care insurance) Private health insurance Q91 Q92 Q93 Total private admissions Veterans Other type of payment
22 Q94 Please list other payment sources for these admissions
23 Additional Facility/Organizational Services Q95 What other services does your nursing home provide in your facility? (Check all that apply) (Include only services provided by your organization, not by contracted care.) Bariatric care services Dialysis services Formalized wellness programs Mental health services Spinal cord injury Substance abuse/addiction services Ventilator services Wound care We provide none of these services Home and Community Based Services (Services provided to individuals living outside the nursing home) Q96 What other services does your organization provide to individuals who are not nursing home residents? (Check all that apply) (Include only services provided by your organization, not by contracted care.) Adult day service Child care Community respite care Home delivered meals Home health Homemaker/Chore Outpatient rehabilitation therapy Outpatient hospice/end-of-life care Personal care Transportation Other We do not offer any home and community-based services
24 Q97 You indicated other services. Please describe:
25 Turnover & Retention The next set of questions is about employee turnover. Q98 Do you have a calculated annual turnover rate for your facility as a whole? Yes No Q99 What is your turnover rate? Round to nearest whole number. No percent sign, no decimal point please. Q100 Do you have a calculated annual turnover rate for your STNAs? Yes No Q101 What is your STNA turnover rate? Round to nearest whole number. No percent sign, no decimal point please. Q102 Do you have a calculated annual turnover rate for your RNs/LPNs? Yes No Q103 What is your RN/LPN turnover rate? Round to nearest whole number. No percent sign, no decimal point please. The next series of questions will allow us to calculate retention rates for STNAs and RNs/LPNS. Q104 How many STNAs were employed during the first payroll period of 2015?
26 Q105 Of the {Q104} STNAs employed during the first payroll period of 2015, how many of the same STNAs were employed during the last payroll period of 2015?
27 Your number of STNAs employed in question 105 is larger than the number employed in question 104. Please go back and correct your answers. Q106 How many RNs/LPNs were employed during the first payroll period of 2015?
28 Q107 Of the {Q106} RNs/LPNs employed during the first payroll period of 2015, how many of the same RNs/LPNs were employed during the last payroll period of 2015?
29 Your number of RNs/LPNs employed in question 107 is larger than the number employed in question 106. Please go back and correct your answers. What is the start date of your current DON? Q108 Month --Click Here-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Q109 Year (YYYY) Q110 How many directors of nursing (including the current one) has your facility had since 2013? What is the start date of your current administrator?
30 Q111 Month --Click Here-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Q112 Year (YYYY) Q113 How many administrators (including the current one) has your facility had since 2013?
31 Employee Safety This section provides aggregate information regarding the extent to which employee injuries are an issue for nursing facilities in Ohio. Please report the following summary values from the OSHA Form 300A that you filed in the first quarter of Letters and numbers in ( ) refer to the item on OSHA Form 300A. If you file another similar form, please provide comparable information here. Aggregate Employment Information for 2015 Q114 Total number of employees paid in all pay periods. (Include part-time, contract, and any other paid staff. Round to the highest whole number). Q115 Total hours worked by all employees last year - sum of hours paid in all pay periods. Number of Cases Q116 Total number of cases with days away from work (H). Q117 Total number of cases with job transfer or restriction (I). Q118 Total number of other recordable cases (J). (Recordable cases as defined by OSHA on Form 300A include work-related injuries and illnesses that result in death, loss of consciousness, days away from work, restricted work activity or job transfer, or medical treatment beyond first aid.) Number of Days Q119 Total number of days away from work (K). Q120 Total number of days of job transfer or restriction (L).
32 Injuries and Illness Types Q121 Total number of injuries (1). Q122 Total number of other illnesses (2-6). (Recordable cases as defined by OSHA on Form 300A include work-related injuries and illnesses that result in death, loss of consciousness, days away from work, restricted work activity or job transfer, or medical treatment beyond first aid.) Q123 Does your facility have a written policy about lifting residents? Yes No
33 Mental Health Services and Barriers Q124 Some nursing facilities have identified barriers to accessing adequate mental health services for their residents.to what extent is each of the issues below a barrier to accessing mental health services for your residents? Mental health professionals unwilling to accept Medicaid or Medicare payments Mental health professionals unwilling to come to facility Mental health professionals unavailable to come to facility Residents' reluctance to see mental health professionals Families' reluctance for residents to see mental health professionals Not a barrier at all A little bit of a barrier Somewhat of a barrier A major barrier A large enough barrier to hinder access Not familiar with this issue Q125 If you have other issues that are a barrier to accessing mental health services for your residents, please describe those issues. Q126 For each of the topics below, indicate the positions on your staff who have received training on each topic: (Check all that apply) Behavior management of aggressive residents Behavior management of residents with dementia Side effects of psychoactive medications Issues related to resident's nursing home adjustment Care planning to manage residents with severe mental health issues Mental health commitment processes in case of psychiatric emergencies (e.g. involuntary versus voluntary commitment, which resources to use) Identification of behaviors related to depression and anxiety disorders RNs/LPNs STNAs Other direct-care staff All other staff
34 Q127 If you have other training needs related to caring for individuals with mental health issues, please describe:
35 Nursing Home Quality Q128 How do you gauge your facility s involvement, if any, on each of the quality improvement areas listed below? Choose the response that most closely describes your facility s involvement. Little or no involvement with this issue (either currently or in any future plan) Have a plan to work on this but don t have a timeline Plan to begin work on this in the next 12 months Have made progress on this and we are still actively engaged in i mplementing program Have an established, ongoing program in place; our main efforts are routine monitoring Pressure ulcer prevention/management Psychoactive medication reduction Employee retention/employee turnover prevention Prevention of hospitalizations/ reducing hospital readmissions Preferences for Everyday Living Inventory (PELI) Pain prevention/management Restraint reduction Falls prevention Unintentional weight loss prevention Incontinence management Delirium assessment/prevention Urinary tract infection prevention/management Consistent assignment Discharge planning to the community Transitions from hospital to nursing home End-of-life care planning/management Assessing staff satisfaction Q129 Are there any other quality improvement areas you are working on? If so, please describe:
36 Q130 To what extent has your facility implemented the Preferences for Everyday Living Inventory (PELI) this year? (Check all that apply) We haven t heard about implementing the PELI We don t plan to implement the PELI We are aware of the PELI implementation, but we have not started We are in the planning phases of implementing the PELI We have identified a person or team to implement the PELI We have conducted PELI interviews with some residents We have completed PELI interviews with all residents who are able to be interviewed We have conducted PELI interviews with family proxies of residents who are unable to be interviewed We have used information gathered from the PELI to guide our care planning Q131 To what extent are each of the issues below a barrier in implementing the PELI? Lack of trained staff to conduct interviews Lack of time for staff to conduct interviews Not a barrier Little bit of a barrier Somewh at of a barrier Major barrier Enough to stop efforts Not familiar with the issue Staff Turnover Staff resistance/lack of interest Lack of guidance/information about how to implement the PELI interviews Lack of guidance/information about how to use PELI information to guide care Resident(s) is (are) unable to complete the interview due to cognitive impairment Resident(s) do(es) not have a family member or significant other to interview as proxy Resident(s) refuse(s) to complete the interview
37 Q132 If there are any other barriers, please describe:
38 Hospital Readmissions Q133 Are you working on any programs to reduce hospital readmissions or admissions? Yes No Q134 To what extent are each of the following entities your partners in reducing hospitalizations and hospital readmissions? Check all partnership agreements/arrangements that apply. Individual physician(s) or physician practice(s) Do not work with this group Formal partnership such as memo of understanding, contract, business partnership Informal Partnership Individual hospitals Hospital or health care system Local or regional hospital council/consortium Health information exchange/electronic health record consortium Accountable Care Organization(s) Medicaid managed care organization Medicare Advantage organization Area Agency on Aging Other nursing home(s) Assisted living facility(s) Home care agencies Hospice agencies Pharmacy or pharmacist Veterans Administration (home care services contracts, VA medical centers) Q135 If there are any other partners, please describe:
39 Q136 For each activity described below, please indicate the extent to which you and/or your network of partners have made progress in reducing hospital readmissions and avoidable admissions? Do not plan to work on this Developed a clear understanding of new healthcare regulations and initiatives Chose or developed an evidence-based practice model Hired new personnel or retrained current staff to implement new program(s) Developed strategies for effective communication of patient information among providers Developed/purchased technology or record systems for access across multiple providers Participating in alternative payment approach-e.g. risk-based payments, bundled payments Developed tools for monitoring patient outcomes Developed marketing and advertising plan for new networks/partnership Developed a plan for measuring/ensuring quality Treated patients/residents under this new model of care Plan to work on this but have not begun Have begun working on this but have not completed the activity Have completed the activity or implemented the practice
40 Q137 What specific evidence-based transition programs do you use? (Check all that apply) Interventions to Reduce Acute Care Transfers (INTERACT) Other evidence-based programs Our program is not based on any current evidence-based model; ours is a hybrid of existing models or newly developed for us Don't know Q138 You indicated other evidence-based programs. Please specify:
41 Q139 To what extent are the following issues challenges or barriers to collaborative efforts with acute care and other long-term care providers in order to reduce hospital readmissions and avoidable admissions? Lack of a common language Lack of common understanding of proposed programs/services Differences in technology availability between our facility and acute care providers Resistance of hospital/health care staff to working with nursing homes Additional funds to implement changes/plans( e.g. new staff, new EMR system) Lack of time to implement changes/make new plans Establishing fair and sufficient reimbursement rates Establishing new billing methods/systems Confusion with billing and bundled payments Unwillingness of our health care partners to take financial risk Competition within the healthcare community Slow, inconsistent or unreliable payment Not a barrier Little bit of a barrier Somewh at of a barrier Major barrier Enough to stop efforts Not familiar with the issue
42 Q140 To what extent are the following issues challenges or barriers to collaborative efforts with acute care and other long-term care providers in order to reduce hospital readmissions and avoidable admissions? Not a barrier Competition within the long-term care community Health care system expectations regarding our nursing home s financial resources Unwillingness of our own facility/board or corporate office to take financial risk Our facility s lack of expertise with outreach and marketing to acute care patients Attitudes of health care professionals towards nursing homes and/or our facility Attitudes of our nursing home staff toward health care community Lack of clarity regarding division of labor between our facility and other partners Determining leadership within the partnership Lack of clarity regarding program accountability Legal issues/agreements that will be needed Little bit of a barrier Somewh at of a barrier Major barrier Enough to stop efforts Not familiar with the issue Lack of data sharing Resources required for new training of staff Lack of physical facilities to accommodate acute care needs Q141 If there are other challenges or barriers to collaborative efforts, please describe:
43 Special Units Q142 Many nursing homes have special units or multiple models of care in their facilities. What special units does your nursing home provide? Dedicated postacute/rehabilitation unit Dedicated dementia or memorycare unit Dedicated ventilator unit Short-term respite unit Behavioral Health Unit -secured Behavioral Health Unit-unsecured Bariatric unit Hospice unit Other special unit We have no special unit Q143 You indicated other special unit, please describe:
44 The following list includes amenities and special practices that are often found in special post-acute or rehabilitation units. Place a check next to each of the following items that describe your post-acute/rehab unit. Q144 Staffing Physical or occupational therapist(s) on staff (not contract) Full-time physician on staff (not contract) Nurse practitioner or other physician extender(s) on staff (not contract) Different staffing patterns than the rest of the facility (e.g. more RNs or LPNs) Q145 Distinct facility model Separate outside entrance to the unit Different or distinguishing name from the rest of the facility Different marketing strategies than for the rest of the facility Separate marketing materials only for the unit (e.g. website, brochures) Q146 Amenities All private rooms Full, private bathroom in each room Flat-screen TV in each room Hotel or homelike furnishings Table lamps rather than over-the-bed lighting Wi-fi in each room Q147 Spa/Hotel Services Massages Whirlpools Concierge services Wellness programming
45 Q148 Dining Services Restaurant -style dining (e.g. table service, and prepared to order) Chef-prepared meals Café or club room for food access outside of mealtimes Nutrition or dietary consultations Weight control programming
46 Q149 Nursing homes often look to other kinds of care and services for ideas. Which term most closely describes what you strive for in your special unit? Hospital or specialty clinic Home or small house Hotel or Spa Resort Combination of all these Other
47 Q150 You indicated other. Please describe: Q151 How many licensed beds are in this post-acute or rehabilitation unit? Q152 How many rooms are in this post-acute or rehabilitation unit? Q153 What do you call the persons staying in this post-acute or rehabilitation unit? Patients Residents Guests Other
48 Q154 You indicated other. Please describe: MyCare Q155 Does your facility have experience with MyCare Ohio? Yes No In the last 3 months, to what extent have each of the issues below been a challenge in implementing and participating in MyCare for your facility? Q156 Not a challenge A little bit of a challenge Somewhat of a challenge Major challenge Not familiar with issue Timeliness of payment Transportation providers Policies and procedures vary by MyCare plan Resident identification as a member of a MyCare plan Communication with plans Q157 If there are other challenges, please describe: Q158 If you could change one thing about MyCare Ohio, what would it be?
49 Emergency Issues and Planning Q159 During the past 12 months has your facility experienced any of the following? (Check all that apply) Power outage of more than 12 hours Water outage of more than 12 hours Flooding which impacted your facility A fire An event that required you to lock-down your facility A need to evacuate residents to another facility A need to evacuate residents to another section of your facility Another emergency that damaged your facility and/or impacted your residents Q160 You indicated another emergency. Please describe: Q161Does your facility have an emergency plan? Yes No Q162 Has your facility reviewed its emergency plan? Yes No Q163 When did your facility last review its emergency plan (MM/YYYY)? Q164Has your facility conducted an emergency planning exercise? Yes No
50 Q165 When did your facility last conduct an emergency planning exercise? (MM/YYYY)? Q166 Did you work with any of the following local partners to develop your emergency plan? (Check all that apply) Local emergency management agency Local hospital Area Agency on Aging Fire department Police department Other nursing home(s) Senior center(s) Ambulance companies American Red Cross YMCA Public health department Utility (electric, water) provider Other Did not work with any local partners to develop emergency plan Q167 You indicated other local partner. Please describe:
51 Q168 Did you work with any of the following local partners to conduct an emergency plan exercise? (Check all that apply) Local emergency management agency Local hospital Area Agency on Aging Fire department Police department Other nursing home(s) Senior center(s) Ambulance companies American Red Cross YMCA Public health department Utility (electric, water) provider Other Did not work with any local partners to conduct an emergency plan exercise Q169 You indicated other local partner. Please describe: Q170 Have you discussed your facility's emergency plan with your area's representative of the Office of the State Long-Term Care Ombudsman program? Yes No
52 Q171 In Ohio, there are 7 regional healthcare coalitions (one in each of the state's Homeland Security Regions), which focus on preparedness-planning activities, and primarily comprised of public health, emergency management, and healthcare organizations. Has your facility been contacted by or been engaged with your regional coalition? Yes, our facility has had contact and has worked with our regional healthcare coalition Yes, our facility has had contact, but has not begun working with our regional healthcare coalition No, our facility has not had contact with our regional healthcare coalition Not sure
53 Emergency Supplies For how many days does your facility store an emergency supply of each of the items below? If you do not have emergency supplies, mark 0. Q172 A supply of bottled water: Q173 Do you hold an agreement with supplier(s) to provide additional bottled water during an emergency? Yes No Q174 Extra medical supplies and equipment: Q175 Do you hold an agreement with supplier(s) to provide additional medical supplies and equipment during an emergency? Yes No Q176 Extra pharmacy stocks of common medications: Q177 Do you hold an agreement with supplier(s) to provide additional common medications during an emergency? Yes No Q178 Non-perishable foods: Q179 Do you hold an agreement with supplier(s) to provide additional non-perishable foods during an emergency? Yes No Q180 Does your facility have a back-up generator? Yes No
54 Q181 Q182 Q183 What type of fuel does it use? Propane Gasoline Diesel fuel Natural gas Is your facility wired to accept a portable generator? Yes No How many day's supply of generator fuel do you have on hand? Q184 Does your facility have other forms of communication in place (walkie-talkies, ham radios, text messaging systems, etc.) in the event of telephone and cellular failure? Yes No
55 Emergency Plan Details Q185 Does your plan include specific actions to be taken for the following hazards or emergencies? (Check all that apply) Freezing temperatures/loss of heat Extreme heat/loss of air conditioning Facility flooding Facility fire Tornado/windstorm Extended loss of power Hostile action (active shooter, etc.) Q186 Does your plan address specific actions to be taken for indirect hazards (those that affect the community, but not the facility and as a result interrupt necessary utilities, supplies or staffing) such as impassable roads or wildfires? Yes No Q187 Does your plan have communication procedures to inform staff, families, and individuals receiving care, before, during, and after an emergency? Yes No
56 Sheltering in Place Procedures to shelter in place ensure that there is water, extra pharmacy stocks of common medications, and extra medical supplies to last at least 7 days. Q188 Does your emergency plan address procedures to shelter in place? Yes No Q189 Do the procedures specify: (Check all that apply) Need to communicate with local agencies about the decision to shelter in place Requirements for sufficient staffing levels during emergencies Plans for assisting/accommodating staff families and pets Triggers to move from sheltering in place to evacuation? Evacuation Procedures Q190 Does your emergency plan address evacuation procedures? Yes No
57 Q191 Do the procedures specify: (Check all that apply) Agreements or contracts with hospitals to shelter high-acuity residents Agreements or contracts with other pre-determined evacuation sites with suitable space, utilities, security and sanitary facilities for individuals receiving care and staff Agreements or contracts with appropriate transportation providers during evacuation (e.g. accommodate wheelchairs) with assurances that they are capable of providing service even if the emergency affects an entire area (e.g. their staff, vehicles and other vital equipment are not overbooked) How medication and other supplies will be transported during evacuation How water will be transported during evacuation How resident information will be transferred with resident A strategy for tracking residents during relocation Mode for transferring resident information during evacuation Whether/how staff will be deployed if residents move to another facility
58 Guardianship Q192 As of April 1, 2016, how many residents have court-appointed legal guardians? In your estimation, what proportion of those guardians are (enter whole numbers, no percent signs): Q193 Resident's family member or friend Q194 Professional guardians Q195 Volunteer or paid guardians from a county guardianship program Q196 Don't know The sum of questions 193 thru 196 is {V5}. If this total is not the same as {Q192}, please go back and correct your Reponses for Q193-Q196. Q197 When you determine a resident needs a guardian, how difficult is it to secure one? Not difficult Somewhat difficult Very difficult
59 Person-Centered Care The following questions address organization and care practices in your facility. Please check the extent to which each practice or characteristic below describes your nursing home. Do not include practices in your independent living or RCF. Choice and Decision-making Q198 Residents make decisions about: Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility Their menus and food choice When to get up When to go to bed When to eat their meals When to bathe The way they bathe (for example, shower, bed bath or bathtub) Where to eat their meals Q199 Individualized Care The facility offers activities designed for residents with memory problems The facility offers activities designed specifically for younger residents The facility offers activities designed specifically for men The facility conducts memorials/remembrances for individual residents upon death Residents usually participate in care plans that indicate their preferences and goals Families usually participate in care plans to understand their role in their loved one s care Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility The facility has adopted Music and Memories The facility has adopted Opening Minds through Art (OMA) The facility has adopted another arts-based program for persons with dementia
60 Q200 Organizational Design STNAs are consistently assigned to a group of residents so that no resident is cared for by more than 8 different STNAs within a 30-day period Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility Staff scheduling is managed by staff teams Staff work together to cover shifts when someone can t come to work STNAs participate on quality improvement committees/teams Direct care staff make decisions about hiring and selecting other staff A career path/ladder program has been implemented for nursing assistants Q201 Community Integration We have indoor and outdoor play areas for children Residents go on facility-sponsored outings (other than medical appts.) in the community at least once a week Members of the community regularly use our facility (club meetings, polling place, park district classes, etc.) We have programs in conjunction with our local schools (student volunteer, residents read to young students, etc.) In an average week, all residents spend time with someone (e.g. family, friends, volunteers) other than staff and other residents We regularly assist groups of residents in planning their own outings (e.g. providing transportation to a concert, purchasing tickets at a group rate, etc.) Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility
61 Q202 Physical Environment We do not have traditional nursing stations in the facility Long stay residents throughout the facility are able to make their rooms unique through such options as choosing furniture or paint Residents throughout the facility have free access to a kitchen with a stove or cooktop, a sink, and a refrigerator Throughout the facility, the overhead paging system is turned off, or used only in emergencies Residents can get to outdoor spaces without staff help Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility Q203 Physical Environment (Cont'd) Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility Facility is organized into households or neighborhoods of 20 or fewer residents
62 Q204 Physical Environment (Cont'd) Each household or neighborhood has its own dining area where meals are regularly served Each household or neighborhood prepares the meals for their residents Each household or neighborhood conducts activities for their residents at least 2-3 times a week Yes, this describes our facility This partially describes our facility; we have this in progress No, this does not describe our facility Q205 On average, how many residents are there in each household or neighborhood?
63 Our nursing home leaders face many challenges and are at different points in changing the culture of their facilities. The Pioneer Network defines culture change as an ongoing transformation based on person-directed values that restores control to elders and those who work closest with them. This transformation includes changing core values, choices about the organization of time and space, relationships, language, rules, objects used in everyday life, rituals, contact with nature, and resource allocation. Q206 To what extent has culture change impacted the care you provide to residents? There is no discussion around culture change Culture change is under discussion but we haven t changed the way we take care of residents Culture change has partially changed the way we take care of resident in some or all areas of the organization Culture change has completely changed the way we take care of residents in some areas of the organization Culture change has completely changed the way we take care of residents in all areas of the organization Q207 Which of the items below are true for the extent of culture change implementation in your facility as of April, 2016? A plan for culture change has been developed Managers (administrators, directors, supervisors) have been educated about culture change Staff have been educated about culture change Culture change projects have been implemented Culture change projects have been evaluated Q208 How many years has your nursing home been involved in culture change activities? Less than 1 year 1 year but less than 2 years 2 years but less than 3 years 3 years but less than 5 years 5 years or more Don t know Q209 Have any of your competitors implemented or expanded culture change activities? Yes No Don t know Q210 Our facility has or would implement or expand culture change practices if our competitors did so. Yes No
64 Q211 We'd like to know a little bit about your facility. Please check all statements below that describe your facility. This facility is a registered Eden Alternative facility This facility is based on the Eden Alternative, but is not registered This facility is a member of the Ohio Person-Centered Care Coalition This facility is registered as a participant in the national coalition on Advancing Excellence in America's Nursing Homes Our facility is based on the Greenhouse/Small House Concept
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