Health Care Update. On January 12th the 217th Session of the New Jersey. Turning a Phrase in 2016 Modern communication is filled with many new words,

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1 Health Care Update Vol. 22, No. 1 January 2016 Turning a Phrase in 2016 Modern communication is filled with many new words, ideas and expressions. Digital media, from texting to Twitter, and our nation s ongoing love affair with slang is often cited as dumbing-down communication. Regardless of one s opinion on that matter, digital media has also presented us with avenues to more efficient approaches to internal and external communications including a 24-hour news cycle where events are instantaneously reported across the internet. So, whatever your preference, we all must learn to turn a phrase if our advocacy and communications are to be first rate. Turning a phrase is to create a particular linguistic expression which is strikingly clear, appropriate, and memorable. Its plural turn of phrase is similar in meaning; an expression which is worded in a distinctive way, especially one which is particularly memorable or artful. So, this month s article is dedicated to illustrating for you the phrases we used in 2015 and will promote this year as we advocate for you in 2016 and beyond. Jon Dolan President/CEO News from the State House 2015 closes with HCANJ focused on costly CNA ratio proposal On January 12th the 217th Session of the New Jersey Legislature begins. New members of the General Assembly will be sworn in that day and it is back to Square One for any bill not sent to the Governor by the day before. With State Senators not up for re-election this past November and both houses remaining under Democrat control, one can hardly describe the closing days of the current Legislature as a lame-duck session. Still, there has been plenty of drama as the State House focus shifts now to the 2017 gubernatorial election. Arguably the most contentious issue being considered now are competing Senate and Assembly proposals to allow casino gaming in two northern New Jersey counties. While the objective is to stem the flow of casino revenues to outof-state venues, the legislation appears to have ignited what one leader characterized as regional battle lines. It is an issue that will likely play out soon in the new legislative session. (Con nued on Page 5) The unexpected challenge of 2015 came late in the year and during the lame duck session of the legislature. According to the American Heritage Idioms Directory, this expression originated in the 1700s and then referred to a stockbroker who did not meet his debts and waddled away. It was transferred to officeholders in the 1860s to speak of the legislators or executives and/or the legislative sessions that occur after an election but before the new representative or executive takes office. The Lame Duck Amendment, 20th to the US Constitution, calls for Congress and each new President to take office in January instead of March (as before), thereby eliminating an extended lame-duck session of Congress. However, in Congress and Trenton, there is still time for much to occur regardless of how many seats are changing in the Assembly. While many expected little from this year s lame duck session, issues from pensions to casinos hit the legislative committees, Assembly floor and Governor s desk. Long term care faced legislation to mandate Certified Nurse Assistant (CNA)-toresident ratios for facility staffing across three shifts. While, HCANJ VP John Indyk s column will give the details, I want to compliment his fine work against this initiative and thank you and the members who came to testify against the legislation. Although the bill was passed, we are guessing its cost, ill-advised policy implications, and status as a major unfunded mandate, will see it vetoed by Governor Christie. There was much to be proud of and real success for us during the process. That included being fairly heard during the committee (Con nued on Page 5)

2 Health Care Update is published monthly by the Health Care Association of New Jersey 4 AAA Drive, Suite 203 Hamilton, New Jersey Telephone: (609) Fax: (609) EXECUTIVE COMMITTEE James Gonzalez Broadway House for Continuing Care Steve Heaney Brandywine Senior Living Brian Holloway Seacrest Village Walt Kielar Genesis HealthCare Trish Mazejy Bartley Healthcare Kevin Stagg Christian Health Care Center PRESIDENT & CEO Jon Dolan Camera-ready advertising is accepted for Health Care Update. Deadline for submission is the 15th of the month prior to publication. Rates: Full Page $500, Half Page (horizontal or vertical) $300, Quarter Page $175. As a Membership service, classified advertisements of 75 words or less for positions available can be placed without charge by HCANJ members for two consecutive months. For further information contact Pattie Tucker by phone at or via at pattie@hcanj.org. Who s Who in New Jersey Long Term Care Facilities Dr. Norman Reitman An Inspired Physician, Inspires Countless Others Born in Brooklyn, New York in 1912, Dr. Norman Reitman s ll fondly recalls the scene that inspired him to pursue a career in medicine. When he was 10 years old, his younger brother got ill and his worried mother called the physician. Norman remembers the doctor s knock on the door at 2 a.m., his large black bag and how his mother was reassured by the physician s words and presence. Now 103 years of age, and an accomplished doctor in his own right, Norman Reitman s ll recalls Dr. Wyman. Dr. Reitman s family moved to Bayonne, New Jersey when he was 12 years old. He a ended Bayonne High School, graduated Rutgers University in 1932, and received his Doctorate of Medicine from New York University in Dr. Reitman became Board Cer fied in Internal Medicine and moved back to New Brunswick, NJ to marry his college sweetheart, Syril. He ini ally worked as a physician for Rutgers and then started his own prac ce in A er taking a break to serve his country as a chief of medicine in the United States Army Air Corps for three years he resumed his prac ce in During a consulta on Dr. Reitman met Dr. Jerome Kaufman, the father of cardiology in New Jersey, who encouraged Dr. Reitman to study cardiology. Dr. Reitman a ended NYU School of Medicine, trained under master clinicians, and passed the cardiology boards in He remained a solo prac oner in the New Brunswick area for over 30 years. In 1970 he hired his first associate and that prac ce has since grown to ten doctors prac cing all aspects of cardiology. He is proud to have served as the first President of the Middlesex County Heart Associa on, as a New Jersey Governor for the American College of Cardiology, and as Chief of Staff at Middlesex General Hospital (now Robert Wood Johnson University Hospital). He has also consulted in medicine and cardiology at many other New Jersey hospitals. Dr. Reitman also made many contribu ons to the community. He served as chairman of the Board of Governors of Rutgers University and assisted in the fundraising that enabled Rutgers to establish the Allen and Joan Bildner Center for the Study of Jewish Life. In 1982 he and Syril established a scholarship fund at Rutgers to aid undergraduate students pursuing a career in medicine. In 2012 Rutgers reported that the fund had already benefited 150 scholars and prac oners around the world. A er 51 years of prac ce, Dr. Reitman re red in September The hospital and medical school honored him by establishing the annual Norman Reitman Lecture in Cardiology; the speakers, who are outstanding cardiologists, are very popular with a ending physicians and house staff. For the thousands of lives he has touched, and countless others he has inspired, Dr. Reitman is a true legend in his me. - Marcia Ortez Administrator, Parker at Stonegate 2

3 Upcoming Recognition Dates JANUARY National Glaucoma Awareness Month National Volunteer Blood Donor Month National Activity Professionals Week 25 National Intravenous Nurse Day FEBRUARY American Heart Month AMD/Low Vision Awareness Month National Cancer Prevention Month National Senior Independence Month 5 Women s Heart Health Day (National Wear Red Day) 1-5 Pride in Food Service Week National Cardiac Rehabilitation Week Alzheimer s & Dementia Staff Education Week At 107-years-young, Catherine Carlin was the oldest of the record-breaking group. HCANJ member makes 2015 edition of Guinness Book Most pancakes eaten in a minute? No. Tallest house of cards? Nope. Largest chocolate cookie? Nah. Oldest person? You re ge ng closer. The largest single gathering of centenarians? Yup! In the 2015 edi on of the Guinness Book of World Records on Page 76 there is an entry for Largest Gathering of Centenarians set on May 19, 2013 (the record wasn t cer fied in me to be included in the 2014 book) by Regency Nursing and Rehabilita on Centers. The event took place at Regency Heritage Nursing and Rehabilita on Center in Somerset (the company also has Nursing and Rehab Centers in Hazlet, Wayne and Dover) which hosted 41 people who are 100 years old or older five of those folks live there! Officially, the record book says that there were 31 in a endance because Guinness standards call for an original birth cer ficate for verifica on. The previous record was 28, which was set on September 25, 2009, at a tea party in Leigh-on-Sea, England, organized by a member of Parliament. The people at Regency reached out to the community and neighboring facili es to find those individuals who would join them for a wonderful party and help break the record. They had lunch, talked about the good old days, and listened to music - including You Make Me Feel So Young. This inspiring young-at-heart group has seen and experienced a lot - the Great Depression with its hunger and unemployment, and two World Wars - and some, even the horror of the Holocaust. But on this day they came together and reveled in the happiness of being together to celebrate. 3

4 CLINICAL C RNER CMS can do better on infection prevention and control (by Sue Peschin - reprinted with permission from McKnight s) Of the more than four million people in U.S. nursing homes, skilled nursing facili es, and assisted living facili es, the Centers for Disease Control and Preven on es mates that 380,000 die because of healthcare-associated infec ons annually. In an effort to reduce that alarming number, the Centers for Medicare & Medicaid Services included changes in infec on preven on and control in nursing homes and skilled nursing facili es as part of its larger proposed mega rule to improve overall quality and safety requirements. This represents a significant step because much has changed in the infec on-control landscape since CMS last updated its guidance 23 years ago. In addi on to infec ons harming residents, nursing facility staff is o en occupa onally exposed to infec ous diseases. The most common routes of infec ous disease transmission in nursing homes and skilled nursing facili es are contact and droplet. Contact transmission can be sub-divided into direct and indirect contact. Direct contact transmission involves the transfer of infec ous agents to a suscep ble individual through physical contact with an infected individual. Indirect contact transmission occurs when infec ous agents are transferred to a suscep ble individual when the individual makes physical contact with contaminated items and surfaces. One of the more serious contact infec ons that the CDC has iden fied as an urgent threat is Clostridium difficile (C. difficile), a deadly infec on that causes inflamma on of the colon. In February 2015, the CDC released a study that revealed more than 100,000 nursing home residents develop C. difficile infec ons each year. Droplets containing infec ous agents are generated when an infected person coughs, sneezes, or talks, or during certain medical procedures, such as suc oning or endotracheal intuba on. Transmission occurs when droplets generated in this way come into direct contact with the mucosal surfaces of the eyes, nose, or mouth of a suscep ble individual. One of the most common examples of droplet transmissible infec ons is the influenza virus. Unfortunately, the proposed CMS rule on infec ons is currently too broad to make much of an impact. Without mandates for specific rules on an bio c stewardship, infec on surveillance, preven on, and control, many otherwise preventable infec on-related illnesses and deaths will con nue unabated. An bio cs rank as among the most frequently prescribed medica ons in nursing homes. Up to 70% of residents receive one or more courses of systemic an bio cs in a given year. Yet studies show that anywhere from 40% to 75% of these an bio cs may be unnecessary or inappropriate. Harms from an bio c overuse significantly threaten the health of nursing home residents, including increased risk of serious diarrheal infec ons, adverse drug events and drug interac ons, and coloniza on and/or infec on with an bio c-resistant organisms an increasingly alarming public health issue. Some of these health threats also extend to staff. For instance, among the most dangerous risk factors for pa ents who take an bio cs is development of C. difficile. Unnecessary an bio c use and poor infec on control may increase the risk of C. difficile spreading within and among facili es. designed to op mize treatment of infec ons and promote appropriate use of an bio cs. CMS should consider manda ng the CDC s evidencebased Core Elements of An bio c Stewardship for Nursing Homes. This program would also provide state surveyors with guidelines to help them monitor effec veness. Another concern about the proposed rule is the lack of instruc on for staff on how to conduct infec on surveillance. Infec on surveillance can provide long-term care facili es with valuable informa on to monitor problem areas, measure progress of preven on efforts, and ul mately eliminate healthcare-associated infec ons. CDC research shows that when healthcare facili es, care teams, and individual prac oners recognize infec on problems and implement specific steps for preven ng them certain infec on rates can decrease by more than 70%. Currently, all CMS-cer fied nursing facili es use the Minimum Data Set for collec ng informa on on infec ons that impact longer-stay residents. However, the U.S. Department of Health and Human Services the umbrella agency that effec vely serves as CMS boss makes the following point in its 2013 Na onal Ac on Plan to Prevent Health Care-Associated Infec ons: There are limita ons to using MDS data as a universal data source to track HAI in nursing homes. The concern is that the assessments offer data for only a par cular point in me, o en only quarterly, and that the me between assessments may not capture important changes, including new infec on events. Addi onally, the MDS does not capture mul ple infec ons, ming of infec ons, or any data on short-stay residents admi ed from the hospital se ng for rehabilita on. The goal of calcula ng infec ons should not be just to count, but to portray the full scope of infec on pa erns and to then iden fy areas in which to intervene. For the last several years, hospitals and other acute care se ngs have used the CDC s Na onal Health Safety Network surveillance system to keep track of infec ons. Currently, 32 states and Washington, D.C., are legally required to report HAI data from 17,000 par cipa ng hospitals and other acute care se ngs to the NHSN. Nursing homes and skilled nursing facili es should be required by CMS to adopt the NHSN system for their infec on surveillance. Finally, CMS should include a mandate that requires all nursing home and skilled nursing facility staff who work directly with residents to get an annual flu vaccine. According to a 2010 CDC survey, over a third of healthcare professionals working in long-term care facili es did not receive a seasonal influenza vaccina on. Long-term care facility residents are par cularly vulnerable to contrac ng influenza because of o en compromised immune systems, as well as the fact that their healthcare se ng o en serves as their home. By extension, if a resident catches the flu, a staffer has an increased chance of catching it as well. CMS has an opportunity to make a significant difference on this issue. However, un l it does so, healthcare-associated infec ons will literally remain a life-and-death issue for our na on s long-term care residents and the staff who devote their careers to their care. Yet, in its proposed rule, CMS gives no guidance about how facili es should perform an bio c stewardship, which is a coordinated plan Susan Peschin, MHS, serves as President and CEO of the Alliance for Aging Research in Washington, D.C. 4

5 News from the State House (from Page 1) Meanwhile, HCANJ has been working hard to fend off a more imminent threat to our nursing facility members, namely, a proposal to establish certified nursing assistant-to-resident ratios. As introduced, this unfunded mandate would have cost nursing facilities at least $124 million annually to implement. The ratios have since been expanded to the point where the proposal would now cost nearly $70 million annually still a lot of money, especially with Medicaid reimbursement falling short by $30 a day for each beneficiary. Never before have so many HCANJ members felt compelled to make a trip to Trenton to testify, but a few hundred thousand dollars in additional operating costs is a great motivator. Without funding, this legislation would require facilities to reallocate resources. It could come in the form of fewer licensed nurses the skilled staff needed to care for increasingly sicker patients as managed care keeps individuals at home longer. Despite the significant cost, the legislation cleared committees in both houses along party-line votes in December. It also passed the State Senate, again along partylines. Our sights are now set on January 11, the last day for the Assembly to possibly take up consideration of the proposal this session. It is legislation like this a costly, unfunded mandate that makes running a nursing facility harder than it should be. Are there bad actors out there? Unfortunately, yes. Go after them. Do not make it harder for the quality providers to continue to offer their residents the best care possible. Legislation like this should provide an incentive for quality nursing facilities to be engaged in the legislative process, whether through testifying on legislation or inviting legislators for a facility tour so that they can see first-hand what it takes to maintain quality care. For 2016, resolve to be engaged! Your future depends on it. Turning a Phrase in 2016 (from Page 1) process. In addition, an amendment was added that cut the cost in half by making the ratios more reasonable. However, the premise and policy itself is unfair, ill-advised, and missing critical exemptions for those far exceeding the current statutory staff standard of 2.5 hours per patient day. Certainly, our special care nursing facilities and post-acute units, who regularly double and triple these standards, should not have to replace higher skilled nurses and therapists with an arbitrary ratio of CNA staffing requirements! So, our first turn of phrase was One size does not fit all. Testimony from quality providers focusing on acuity and other approaches to great clinical success as well as the myriad other employees needed and what each one of them brings to quality outcomes added to our argument. To make this point even further we added, Quantity does not equal quality. In the end, we are confident that we have done all we should to stop the initiative. We collaborated where we could and provided real answers and solutions to policy makers. That sets us up for the best possible position moving forward. Turning a phrase was also important as we addressed two of the most complex issues in our history marks the year HCANJ created two reasonable and credible documents to provide a roadmap to reform and success. The state met, listened and is acting on both our proposals for solving the decades-old problem of Medicaid-pendings, and the more recent challenges to come by ensuring provider fairness, rate transparency, and stability in MLTSS. Even the most complex issue can be made cogent with a humorous turn of a phrase. Yes, the world needs a little humor once in a while. That s why our report regarding the complex challenges facing New Jersey s long term care Medicaid application, determination & eligibility process was entitled, New Jersey Medicaid Eligibility Reform. The Solution is Pending. This approach was appreciated and internalized by our state leaders. With limited resources, solutions are not coming forth at a breakneck pace, however, the Medicaid office is combining our ideas with other reforms and is making real improvements to the process while keeping us in the loop. On the MLTSS and managed care front, the issues get even more complex. Failure to achieve our basic goals of fair and effective networks, rates and contract standards brings one terrible risk - a race to the bottom. Quality demands that we do not gut rates and networks and leave the lowest quality providers, taking the lowest rates and providing the least quality. By avoiding a race to the bottom and following the proposed federal regulation of actuariallysound rate-setting, transparency in the rate-setting and capitation process, effective measurement of quality and network standards, and other tried and true business practices and concepts, we can make managed care fair. We deserve that and efficiencies must come through true care management and better healthcare delivery, not by punishing providers and culling networks in a state with an over-80 population of more acuity ill folks who need our quality care, socialization and quality outcomes. Sure, in 2016, as we advocate for you, and you do so for your residents, we should all communicate most effectively and succinctly and turn a phrase when we can. However, by coming together, supporting HCANJ and pursuing quality every day, we do something much more - we turn the tide of support for our residents in appropriation for full funding and more fair and effective regulations that will vastly improve the daily lives and clinical outcomes of those we safeguard and serve. 5