2013 Biennial Survey of Long-Term Care Facilities - NURSING FACILITIES 1/1/ /31/2013. Please enter your password:

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1 2013 Biennial Survey of Long-Term Care Facilities - NURSING FACILITIES 1/1/ /31/2013 Please enter your password:

2 April, 2014 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: -and-supports-oh 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

3 Dear Colleague, The Biennial Survey of Long-Term Care Facilities is again being conducted by the Scripps Gerontology Center at Miami University. Again, 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, Steve R. Wermuth LeadingAge Ohio Peter Van Runkle Ohio Health Care Association Jean Thompson Ohio Assisted Living Association Chris Murray The Academy of Senior Health Sciences, Inc.

4 Instructions ***Please complete your survey by May 27, 2014*** -Use information from the calendar year 2013 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 May 27, 2014***

5 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, 2013 Q2 Did this name change during 2013? Yes No Q3 Mailing Address Q4 City Q5 State Q6 Zip Q7 County Q8 Facility address (General facility ; administrator only if no general ) Q9 Phone number

6 Q10 Do you have a physical address different from your mailing address? Yes No

7 Q11 Physical Address (If different from mailing address) Q12 City Q13 State Q14 Zip If we have questions about your survey responses, whom should we contact? Q15 Contact Name Q16 Contact Title Q17 Contact Phone Number Q18 Contact

8 Q21 Does your facility have a Medicaid Provider Number? Yes No

9 Q22 Our records indicate that your facility has the following Medicaid Provider Number: {Q19}. Is this Medicaid Provider Number correct? Yes No

10 Q23 Please enter your Medicaid Provider Number: Q24 Does your facility have a Medicare Provider Number? Yes No

11 Q25 Our records indicate that your facility has the following Medicare Provider Number: {Q20}. Is this Medicare Provider Number correct? Yes No

12 Q26 Please enter your Medicare Provider Number: Q27 Did your facility change ownership during 2013? Yes No

13 Q28 You indicated that your facility's name changed during Please enter the previous name. You checked a facility ownership change during If you have resident census records about your facility for only part of 2013, please provide the dates for which you have information. Q29 From: mm-dd-yy Q30 To: mm-dd-yy Q31 Ownership (check appropriate category): Not-for-profit For-profit Government

14 Q32 Is your parent organization traded on a stock exchange? Yes No Q33 Is your nursing home owned or leased by a multi-facility organization? (Two or more nursing homes in different locations) Yes No

15 Q34 How many nursing homes in Ohio (including yours) are owned or leased by your multi-facility organization? Q35 How many nursing homes (including yours) nationally, are owned or leased by your multi-facility organization? Q36 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 Q37 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

16 Q38 Does your facility offer independent living? Yes No Q39 Does your facility offer assisted living/residential care? Yes No

17 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 12/31/13, i.e. the number of beds you pay taxes on. Q40 Total number of ODH reported LICENSED facility beds on December 31, 2013 Q41 Total number of beds CERTIFIED for Medicaid, Medicare, or both on December 31, 2013 If the above numbers are not correct, please overwrite with the correct number. Q42 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

18 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 2013, you had {Q40} licensed beds and {Q41} 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 Q43 January 2013 Q44 February 2013 Q45 March 2013 Q46 April 2013 Q47 May 2013 Q48 June 2013 Q49 July 2013 Q50 August 2013 Q51 September 2013 Q52 October 2013 Q53 November 2013 Q54 December 2013 Q55 How many beds were dually certified for both Medicare and Medicaid? (Do not include Medicaid ICF/IID beds.) Q56 How many beds were certified for Medicare only? (Do not count beds previously reported as dually certified.) Q57 How many beds are certified for Medicaid only? (Do not count beds previously reported as dually certified nor ICF/IID beds.)

19 You indicated that you had {Q41} certified beds. The total of your Medicaid, Medicare, and dually certified beds is {V6}. If the two numbers are not the same, please go back to the previous page and correct your numbers for questions 55, 56, and 57. You indicated that you had {Q41} certified beds. The total of your Medicare certified beds is {Q56}. If the two numbers are not the same, please go back to the previous page and correct your numbers for question 56. ICF/IID Beds Q58 Were any of your certified beds ICF/IID beds? Yes No

20 Resident rooms in the facility as of 12/31/13 Q59 Q60 How many resident rooms were in your facility? How many private rooms were in your facility? Nursing Facility Rates July-Dec Q61 What was your average Medicaid per diem reimbursement rate for the last half of 2013? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicaid residents, record "0" (zero). Q62 How many Medicaid managed-care plans does your facility contract with? Q63 What was your average per diem Medicaid managed-care rate in the last half of 2013? Average among rates for all Medicaid managed-care plans your facility accepts. Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicaid managed-care plans, enter "0" (zero). Q64 What was your Medicare per diem fee-for-service (RUG) rate during the last half of 2013? (Total semi-annual Medicare reimbursement divided by Medicare fee-forservice (RUG) patient days between July 1 - Dec 31, 2013)? Do not include Medicare Advantage rates. Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicare fee-for-service residents, record "0" (zero). Q65 How many Medicare managed-care plans does your facility contract with? Q66 What was your average per diem Medicare managed-care rate in the last half of 2013? Average among rates for all Medicare managed care plans your facility accepts. Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Medicare-managed care plans, enter "0" (zero). Nursing Facility Rates July-Dec Q67 What was your average daily rate for a private pay (noninsurance) nursing home semi-private room in the last half of 2013? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no semi-private rooms, record "0" (zero).

21 Q68 What was your average daily rate for private pay nursing home private room in the last half of 2013? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no private rooms, enter "0" (zero). Q69 What was your average daily private-insurance rehabilitation reimbursement in the last half of 2013? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no private-insurance rates, enter "0" (zero). Q70 What was your average Veterans per diem rehabilitation reimbursement in the last half of 2013? Do not include dollar signs ($), only numbers, rounded to the nearest dollar. If no Veterans rates, enter "0" (zero).

22 Resident Days 1/1/ /31/2013 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. Q71 January 2013 Q72 February 2013 Q73 March 2013 Q74 April 2013 Q75 May 2013 Q76 June 2013 Q77 July 2013 Q78 August 2013 Q79 September 2013 Q80 October 2013 Q81 November 2013 Q82 December 2013

23 Total Resident Days for Calendar Year 2013 by Payment Source For the items below, indicate how many resident days were paid with each payment source. Include days beds were held for medical or therapeutic leave as full resident days. This is the total of all days for all residents with each payment source. If a resident has multiple payment sources only count that resident under their primary payment source. If you had no residents with that payment source, record "0" (zero). Do not include Medicaid days below. Those will come from the Medicaid Cost Report. Q83 Q84 Q85 Total Medicare days from cost report Schedule A-1 (column 8, line 13) Medicare fee-for-service (RUG) Medicare managed care

24 Your response to Total Medicare Days, {Q83}, is not equal to the sum of Medicare fee-for-service and Medicare managed care, {V5}. Please go back and re-enter those numbers.

25 Total Resident Days for Calendar Year 2013 by Payment Source For the items below, indicate how many resident days were paid with each payment source. Include days beds were held for medical or therapeutic leave as full resident days. This is the total of all days for all residents with each payment source. If a resident has multiple payment sources only count that resident under their primary payment source. If you had no residents with that payment source, record "0" (zero). Do not include Medicaid days below. Those will come from the Medicaid Cost Report. Q86 Q87 Q88 Q89 Private health insurance Private-Pay or Self-Pay Veterans Other (Do NOT include Medicaid or Medicare days)

26 Q90 You indicated other resident days. Please list the payment sources included in other days: Q91 In 2013, did any residents have stays paid for by long-term care insurance? Yes No

27 Q92 How many total resident days were paid by long-term care insurance?

28 Yearly Total 2013 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). Q93 Q94 Q95 Q96 Q97 Q98 Q99 Q100 Medicare fee-for-service (RUG) Medicare managed care Medicaid NF Medicaid managed care Private-Pay or Self-Pay Private Health Insurance Veterans Other type of payment

29 Q101 Please list other payment sources for these admissions Additional Facility/Organizational Services Q102 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) Q103 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

30 Q104 You indicated other services. Please describe:

31 Turnover & Retention The next set of questions is about employee turnover. Q105 Do you have a calculated annual turnover rate for your facility as a whole? Yes No

32 Q106 What is that turnover rate? No percent sign, no decimal point please. The next series of questions will allow us to calculate retention rates for STNAs and RNs/LPNS. Q107 How many STNAs were employed during the first payroll period of 2013?

33 Q108 Of the {Q107} STNAs employed during the first payroll period of 2013, how many of the same STNAs were employed during the last payroll period of 2013?

34 Your number of STNAs employed in question 108 is larger than the number employed in question 107. Please go back and correct your answers. Q109 How many RNs/LPNs were employed during the first payroll period of 2013?

35 Q110 Of the {Q109} RNs/LPNs employed during the first payroll period of 2013, how many of the same RNs/LPNs were employed during the last payroll period of 2013?

36 Your number of RNs/LPNs employed in question 103 is larger than the number employed in question 102. Please go back and correct your answers. What is the start date of your current DON? Q111 Month --Click Here-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Q112 Year (YYYY) Q113 How many directors of nursing (including the current one) has your facility had since 2011? What is the start date of your current administrator?

37 Q114 Month --Click Here-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Q115 Year (YYYY) Q116 How many administrators (including the current one) has your facility had since 2011?

38 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 file 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 2013 Q117 Total number of employees paid in all pay periods. (Include part-time, contract, and any other paid staff. Round to the highest whole number). Q118 Total hours worked by all employees last year - sum of hours paid in all pay periods. Number of cases Q119 Total number of cases with days away from work (H). Q120 Total number of cases with job transfer or restriction (I). Q121 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 Q122 Total number of days away from work (K). Q123 Total number of days of job transfer or restriction (L).

39 Injuries and Illness Types Q124 Total number of injuries (1). Q125 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.) Q126 Does your facility have a written policy about lifting residents? Yes No

40 How many of each type of equipment from the list below was available in your facility as of 12/31/2013? If you do not have that type of equipment, indicate "0" (zero). Q127 Total lift hoist (portable) Q128 Total lift hoist (ceiling mount) Q129 Gait transfer belts Q130 Bath lift/easy access bath tubs Q131 Friction reducing lateral aids Q132 Powered sit-to-stand devices Q133 Mechanical lateral transfer aids Q134 Electric Beds Q135 Toilet seat adjusted to height of wheelchairs Q136 How many of your residents, as of the last quarter of 2013, required extensive assistance or were totally dependent in transferring? (If using MDS, score of 3 or 4 on MDS 3.0 G0110B1) Q137 How many of your residents, as of the last quarter of 2013, did not transfer or only transferred once or twice? (If using MDS, score of 7 or 8 on MDS 3.0 G0110B1) Q138 How many of your residents, as of the last quarter of 2013, used a wheelchair as their main mode of locomotion? (If using MDS, "Yes" to wheelchair response on MDS 3.0 G0600C)

41 Younger Residents in Nursing Homes Q139 Do you accept residents under 50? Yes No

42 Q140 Younger residents often pose service challenges since most facility-based settings predominantly serve older adults. To what extent are each of the areas below a challenge in serving younger residents (those 50 and younger)? Meeting dietary preferences Not a challenge at all A little bit of a challenge Somewhat challenging A major challenge Needs for privacy Use of cell phones and Internet access Type of preferred activities Number of activities desired Adapting activities for conditions such as TBI, quadriplegia or mental health diagnoses Meeting psychosocial/emotional needs Addressing behavioral health needs Training staff to care for conditions common among younger residents Maintaining appropriate relationships among similar-age staff and residents Other

43 Q141 You indicated other areas. Please describe: Q142 What other issues are important when serving younger residents in facility-based settings?

44 Mental Health Services and Barriers Q143 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 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 Other

45 Q144 You indicated that other issues are a barrier to accessing mental health services for your residents. Please briefly describe those issues. Q145 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 Interrelationship between mental health and chronic illness 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

46 Nursing Home Quality Measures

47 Q146 In 2013 Ohio instituted a quality payment system based on a number of quality indicators. For each quality measure below, please indicate the extent to which you believe the item is an important measure of nursing home quality. Resident or family satisfaction overall facility score Participation in the Advancing Excellence in America s Nursing Homes campaign Resident review compliance, i.e. requesting a timely PASRR review for residents admitted under a hospital exemption Standard & complaint survey performance on last annual survey and on any complaint survey in previous year, i.e. no F-level deficiency or no deficiency that constitutes substandard care Choice in dining, i.e. for at least two meals a day residents can choose restaurant, buffet, family, open (2-hour service window) or 24-hour style dining Choice in bathing, i.e. 50% of residents must be able to bathe or shower as often as they choose Choice in rising and retiring, i.e. family or resident survey scores on resident s ability to choose when to go to bed AND when to get out of bed in the morning Advance care planning, i.e. at least 75% of facility residents have opportunity to discuss goals for care and preferences for end-of-life care Pain, i.e. not more than 13.35% of the facility s long-stay residents report moderate to severe pain as reported on the MDS Pressure ulcers, i.e. not more than 51.6% of the facility s long-stay high-risk residents were assessed with stage 2, 3, or 4 pressure ulcers as reported on the MDS Restraints, i.e. not more than 1.52% of the facility s long-stay residents may be physically restrained as reported on the MDS Urinary tract infections, i.e. less than 7.0% of the facility s long-stay residents may have had a urinary tract infection as reported on the MDS Hospital admission tracking, i.e. use a tracking tool and annually report hospital admissions by month Immunizations, i.e. 95% of long-stay residents receive pneumococcal vaccine and 93% receive seasonal influenza vaccine Private rooms, i.e. at least 50% of Medicaidcertified beds must be in private rooms OR semiprivate rooms with privacy criteria Consistent assignment, e.g. maintain a policy that requires consistent assignment with a goal that residents receive care from no more than 12 aides in 30 days This indicator is very important for nursing home quality This indicator is somewhat important to nursing home quality This indicator is not very important for nursing home quality Staff retention, i.e. staff retention rate of 75% Staff turnover, i.e. nurse aide turnover rate of 65% or lower Aide participation in care conferences, i.e. an aide who is a primary caregiver for the residents attends at least 50% of resident care conferences

48 Q147 How might the resident or family satisfaction score indicator be changed or replaced by a different indicator to be a better quality measure? Q148 How might the participation in the Advancing Excellence in America s Nursing Homes campaign indicator be changed or replaced by a different indicator to be a better quality measure? Q149 How might the resident review compliance indicator be changed or replaced by a different indicator to be a better quality measure? Q150 How might the standard & complaint survey performance indicator be changed or replaced by a different indicator to be a better quality measure? Q151 How might the choice in dining indicator be changed or replaced by a different indicator to be a better quality measure? Q152 How might choice in bathing indicator be changed or replaced by a different indicator to be a better quality measure?

49 Q153 How might the choice in rising and retiring indicator be changed or replaced by a different indicator to be a better quality measure? Q154 How might the advance care planning indicator be changed or replaced by a different indicator to be a better quality measure? Q155 How might the pain indicator be changed or replaced by a different indicator to be a better quality measure? Q156 How might the pressure ulcers indicator be changed or replaced by a different indicator to be a better quality measure? Q157 How might the restraints indicator be changed or replaced by a different indicator to be a better quality measure? Q158 How might the urinary tract infections indicator be changed or replaced by a different indicator to be a better quality measure?

50 Q159 How might the hospital admission tracking indicator be changed or replaced by a different indicator to be a better quality measure? Q160 How might the immunizations indicator be changed or replaced by a different indicator to be a better quality measure? Q161 How might the private rooms indicator be changed or replaced by a different indicator to be a better quality measure? Q162 How might the consistent assignment indicator be changed or replaced by a different indicator to be a better quality measure? Q163 How might the staff retention indicator be changed or replaced by a different indicator to be a better quality measure? Q164 How might the aide participation in care conferences indicator be changed or replaced by a different indicator to be a better quality measure?

51 Q165 The items listed below are also suggestions for quality indicators. For each of them, indicate the extent to which you think the item is a valid measure of quality nursing home care. Workforce satisfaction, i.e. conduct annual employee satisfaction surveys Aide hours of care, i.e. a specified number of hours of nurse aide care, per resident, per day Nurse hours of care, i.e. a specified number of hours of nurse (RN) care, per resident, per day Use of agency staff, i.e. a percentage of total aide hours that were worked by permanent, not temp/agency staff Complaints, i.e. a minimal number of substantiated ombudsman complaints Presence of volunteers, i.e. a minimum number of volunteer hours per resident each year This indicator is very important for nursing home quality This indicator is somewhat important to nursing home quality This indicator is not very important for nursing home quality Other quality measure

52 Q166 How might the workforce satisfaction indicator be changed or replaced by a different indicator to be a better quality measure? Q167 How might the aide hours of care indicator be changed or replaced by a different indicator to be a better quality measure? Q168 How might the nurse hours of care indicator be changed or replaced by a different indicator to be a better quality measure? Q169 How might the use of agency staff indicator be changed or replaced by a different indicator to be a better quality measure? Q170 How might the complaints indicator be changed or replaced by a different indicator to be a better quality measure? Q171 How might the presence of volunteers indicator be changed or replaced by a different indicator to be a better quality measure?

53 Q172 You indicated other indicator. Please describe: Q173 How might the other indicator be changed or replaced by a different indicator to be a better quality measure?

54 Q174 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

55 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. Q175 Staffing Physical or occupational therapist(s) on staff (not contract) Nurse practitioner or other physician extender(s) on staff (not contract) Different resident/staff ratios than the rest of the facility Different staff training/qualifications than the rest of the facility Different staffing patterns than the rest of the facility, e.g. more RNs or LPNs Cross-trained workers, e.g. universal workers or housekeeping staff also STNAs Q176 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 Users referred to as patients rather than residents Staff wear different uniforms than rest of the facility Q177 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 No visible nurses station In-room medicine station (no med carts)

56 Q178 Spa/Hotel Services Massages Reiki or Shiatzu Therapy Manicures Facials Whirlpools Concierge services Wellness programming Q179 Dining Services Buffet-style dining 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

57 Q180 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 Other

58 Q181 You indicated other. Please describe: Q182 How many licensed beds are in this post-acute or rehabilitation unit? Q183 How many rooms are in this post-acute or rehabilitation unit? Q184 What do you call the persons staying in this post-acute or rehabilitation unit? Patients Residents Other

59 Q185 You indicated other. Please describe: Care Integration Q186 Are you working on any programs to reduce hospital readmissions or admissions? Yes No Q187 To what extent are each of the following entities are your partners in integrating care in your community. For example, working on care transitions or reducing hospitalizations? 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) Private-market network/consortium of providers Local community care coordination coalition Medicaid managed care organization Medicare advantage organization Area Agency on Aging Other nursing home(s) Assisted living facility(s) Home care agencies Veterans Administration (home care services contracts, VA medical centers) Other partner

60 Q188 You indicated other partner. Please describe: Q189 For each activity described below, please indicate the extent to which you and/or your network of partners have a policy in place to assist with 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 Determined that post-acute services would be offered in our facility Hired new personnel or retrained current staff to implement new program(s) Developed strategies for effective communication of patient information among providers Developed common assessment tools, data elements, or tools for patient information Developed/purchased technology or record systems for access across multiple providers Determined payment approach-e.g. risk -based payments, bundled payments Established new billing strategy or system 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

61 Q190 Please check which specific care transitions model(s )your program is based on, if any. Check all that apply. Care Transition Intervention (CTI) (Coleman Model) Bridging Nursing Support/Transitional Care Model (Naylor Model) Better Outcomes for Older Adults Through Safe Transitions (BOOST) Best Practices Intervention Package (BPIP): Transitional Care Coordination Interventions to Reduce Acute Care Transfers (INTERACT) Guided Care GRACE - Geriatric Resources for Assessment and Care of Elders (Steven Counsell s model) Transferring Care at the Bedside (TCAB) Re-engineered Discharge (RED) Enhanced Discharge Planning Program (EDPP-Rush Bridge Program) Our program is not based on any of these models; ours is a hybrid of these models or newly developed for us Don't know

62 Q191 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

63 Q192 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 Other challenges or barriers

64 Emergency Issues and Planning The next section addresses some of the physical characteristics and the location of your facility. Q193 What is your facility s primary energy source for heating? Geo-thermal Electricity Propane (LPG) Natural Gas Other Q194 You indicated other energy source. Please describe: Q195 Is your facility located in a floodplain? Yes No Not sure Q196 Is your facility located in an emergency planning zone around a nuclear power plant or other industrial facility? Yes No Not sure Q197 Is your facility located within ½ mile of actively-used railroad tracks? Yes No Not sure

65 The next questions address issues related to emergency planning and management in your facility. For how many days does your facility store an emergency supply of each of the items below? If you aren t sure, mark DK in the box. If you do not have emergency supplies, mark 0. Q198 A supply of bottled water: Q199 Extra medical supplies and equipment: Q200 Extra pharmacy stocks of common medications: Q201 Non-perishable foods: Q202 Other emergency supplies: Q203 You indicated other emergency supplies. Please describe:

66 Q204 Place a check next to each area below that is included in your facility s emergency plan. We do not have an emergency plan Plans specific to freezing temperatures/loss of heat Plans specific to extreme heat/loss of air conditioning Plans specific to impassable roads (e.g. snowbound, flood) Plans specific to facility flooding Plans specific to facility fire Plans specific to wildfire Plans specific to tornado/windstorm Plans specific to extended loss of power Requirements for sufficient staffing levels during an emergency Backup plan for staffing during an emergency Plans for assisting/accommodating staff families and pets Identification of residents during emergency or evacuation (e.g. wristband or nametag) Specification of resident information to be transferred with resident Mode for transferring resident information during evacuation Strategy for tracking relocated residents Communications plan Public agency emergency contacts Agreements or contracts with hospitals for sheltering high-acuity residents Agreements or contracts with other pre-determined evacuation locations Agreements or contracts with appropriate transportation providers during evacuation (e.g. can accommodate wheelchairs) Other

67 Q205 Did you work with local partners (e.g. public health, hospitals, emergency responders, area agency on aging) and/or emergency management organizations to develop your emergency plan? Yes No Not sure Q206 Who were your primary partners in developing your emergency plan? List the one or two most important partners. Q207 Has your facility participated in a community wide emergency exercise or drill? Yes No Not sure Q208 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 any of these coalitions? Yes No Not sure Q209 Which one? (The coalitions coordinating agencies are in parentheses.) Northwest Region (Hospital Council of Northwest Ohio) Northeast Region (The Center for Health Affairs) Northeast Central Region (Akron Regional Hospital Association) Southeast Region (Ohio Hospital Association) West Central Region (Greater Dayton Area Health Information Network) Southwest Region (Greater Cincinnati Health Council) Central Region (Central Ohio Trauma System)

68 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 Q210 Residents, either individually or as a group, 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) At least 50% of residents are offered a restaurant, family, or buffet style meal at least once a day Q211 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

69 Q212 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 Q213 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

70 Q214 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 Q215 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

71 Q216 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 Q217 On average, how many residents are there in each household or neighborhood?

72 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. Q218 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 Q219 Which of the items below are true for the extent of culture change implementation in your facility as of March, 2014? 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 Q220 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 Q221 Have any of your competitors implemented or expanded culture change activities? Yes No Don t know Q222 Our facility has or would implement or expand culture change practices if our competitors did so. Yes No

73 Q223 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

74 Q224 Which of the campaign's nine priority areas is your nursing home focusing on? (Check all that apply) Staff stability Consistent assignment Patient-centered care Reducing unneeded hospitalizations Appropriate antipsychotic medication use Enhancing mobility Reducing pain Reducing pressure ulcers Reducing facility-acquired infections

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