A Long Term Care Monitor of Nursing Home and Assisted Living IssuesPulse

JANUARY 2003

FHCA

InsideBetter Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . 5Molly-Polly Q&A.. . . . . . . . . . . . . . . . . . . . . . 6LTC Business News. . . . . . . . . . . . . . . . . . 10New NHA Rules . . . . . . . . . . . . . . . . . . . . . . 11

FLORIDA HEALTH CARE ASSOCIATION

Update

Therapy caps back

Caps on certain Medicare-reim-bursed therapeutic services take

effect this month.The annual $1,500per patient limits on speech/physicaland occupational therapies weresuspended in 2000, but the mora-torium contained in the legislationexpired on December 31, 2002.“Our frail elderly now face the un-conscionable prospect of not gettingthe therapy they must have,” FHCAPresident Kelley Rice-Schild said.

Joint committee

F lorida Senate President JimKing (R-Jacksonville) and

House Speaker Johnnie Byrd (R-Plant City) named a Joint SelectCommittee on Nursing Homes for the coming 2003 legislative session.The panel, chaired by Sen.Lisa Carlton (R-Osprey), will tryto find ways to attract nursinghome insurers to the state and halt skyrocketing insurance rates.

AARP goals

The Florida AARP outlined its2003 legislative goals, which

includes support for full state fund-ing for increased nursing homestaffing as well as a prescriptiondrug program. Its Florida director,however, said AARP opposes anymodification of the lawsuit reformprovisions of SB 1202 legislationapproved in 2001.

CMS newsletter

The Centers for Medicare &Medicaid Services’ Open Door

Forum newsletter is free and helpsreaders stay current on the resultsof the 12 Open Door Forum subject groups comprised of thoseindividuals/entities who interactregularly with CMS. Go towww.cms.gov and click on “OpenDoor Forums.”

Florida Health Care AssociationP.O. Box 1459Tallahassee, FL32302-1459

PRSRT STDU.S. Postage

PAIDTallahassee, FLPermit No. 1007

2003: A ‘showdown’ yearfor long term careLiability insurance, staffing and funding head the list of must-face challenges in the new year

Elder care advocates warn that much of therecent progress made in improving the options

and quality of elder care could be undone if majorlong term care issues go unaddressed in 2003.

Joint committeeMeanwhile, Florida House and Senate leaders

announced the creation of a Joint Committee onNursing Homes, which will study the continuingdifficulty long term care providers are havingwith getting adequate and affordable liabilityinsurance.

“The creation of the joint committee is a pos-itive development, but too many of our facilitiesare still struggling just to get by,” FHCA PresidentKelley Rice-Schild said. In addition to insurance,Rice-Schild said Congress and the Florida legis-lature must address other important LTC issues:

Reimbursement■ In October, Congress cut crucial Medicare

funding for nursing homes by ten percent.Miserly per-patient caps on vital therapy servicestook effect this month (see “Update,” this page).

■ Florida faces the potentiallly dangerous combi-nation of projected revenue shortfalls and abudget-busting constitutional requirement toreduce school class size. Lawmakers could betempted to cut or cut off money meant fornursing home staffing increases and improvedquality. Home- and community-based elder careoptions, which were greatly expanded duringGov. Jeb Bush’s first term, also are threatened.

■ Despite recent increases, Medicaid reimburse-ments still fall $10.47 per Medicaid patient perday short of Medicaid “allowable” costs. Facilitylosses on the Medicaid side were heretoforeoffset by more generous Medicare funding,but no longer.

Staffing■ All Florida health care providers need nurses

desperately, but in long term care the precisenurse-to-patient ratios are spelled out in lawand the penalties for non-compliance aresevere. If facilities can’t get enough nurses, bylaw they must stop admitting new patients,

CONTINUED ON PAGE 11

Expecting the best: FHCA District XIVPresident Jo-Ann Grasso welcomes Rep. PatPatterson (R-Daytona Beach) to her facilityduring a recent visit. Patterson is one of 38 freshman legislators who will consider solutions to the many challenges facing long term care facilities.

New CNA Rules Ready See Page 9

CONTINUED ON PAGE 14

Florida Health CareAssociation

Kelley Rice-Schild,President

Bill Phelan,Executive Director

Dion Sena,Senior Vice President

David Sylvester,Secretary

Deborah Franklin, Treasurer

FHCA PulseJANUARY 2003

FHCA Pulse is produced monthly for theFlorida Health Care Association, P.O. Box1459, Tallahassee, FL 32302-1459, by EdTowey & Associates, Inc.

Editorial – To submit information, guestarticles, press releases, etc., contact EdTowey at (850) 224-6242 or via e-mail atetowey@fhca.org. Fax information to (850) 224-9823 and include your name,telephone number and e-mail address.

Advertising – For information on Pulse ad-vertising rates and availabilities, contact IanCordes at Corecare Associates at (561) 659-5581 or via e-mail at icordes@bellsouth.net.

All articles and advertising are subject toeditorial review.

FROM thePRESIDENT’S

DESK

by Kelley Rice-SchildFHCA President

Several years ago, I was selected to respond to a McKnight’s Long Term Care News reader poll.The question was,“What is the best part of working in long term care?” For me, it was an

easy question to answer.The best part is that there are so many parts to choose from.

Management + compassionI love the versatility that being a long term care administrator demands.You can be a

bookkeeper in the morning and an activity director that afternoon.Administrators need to bea jack (or jill) of all trades and willing to jump into each role as needed.Administrators couldnever just be “bean counters,” although one’s financial skills must be strong to succeed inhealth care. It’s no coincidence that it takes a full year for an Administrator in Training to rotate through each department in order to fully understand the many responsibilities of eachstaff member.A good administrator is a good manager, with compassion.

The “extras”It’s equally true that part of what makes for a quality nursing home or assisted living facility

are the “extras.” For example, every facility has an activity program, but the extras couldinclude beach parties with sand castles in kiddie pools, and giant aviaries with finches thepatients feed and name. The regulations state you must offer three balanced meals per day,plus two snacks without a 14-hour lapse in between. But you also can have omelettes madeto order, restaurant service, linen and stemware. All these additions take a dedicated team,but they also take money.

Bye bye, “extras”When the reimbursement for services does not keep up with the cost of providing the

care, it’s the extras that are the first to go. Over the years we’ve trimmed here and cut backthere in order not to impact on patient care. Now, with the recent Medicare cuts combinedwith anticipated across-the-board state Medicaid cuts needed to pay for an expensiveAmendment 9 approved last November,we risk a “perfect storm” financial nightmare scenariothat threatens to wipe out everything, not just the extras.

No magic wandsAs I said, long term care administrators are a versatile group who regularly come up with

creative solutions to problems, but they’re not magicians. They cannot wave a wand and make staff magically appear or pay nurses with pixie dust. It takes real dollars to do the reallyimportant work of long term care.

As we begin 2003, let’s help our state and federal legislators remember that cutting backon vital funding can’t and won’t improve long term care for the elderly. What’s needed now is what we’ve always needed – adequate financial resources combined with a system ofoversight that ensures full accountability.

The last thing we need is more hocus-pocus and reimbursement sleight of hand.

Houdini we’re not!Now is not the time to cut back on care for the elderly

FHCA JANUARY 2003 Pulse2

In addition to all FHCA members and associate members, FHCA Pulse is also mailed tolegislators, opinion leaders, reporters and state/federal regulators in Florida. The widerdistribution allows others to better understand long term care and the daily challengesfaced by the nursing homes and assisted living facilities we represent.

Note to Pulse readers

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Long term care profes-sionals are constantly

getting into trouble for failure to properly docu-ment.While the old saying,“If it isn’t documented, itisn’t done,” is not really true, lack of documentationreally makes it harder toestablish that something wasdone, and done properly. Ifyour nurses would obey theTen Commandments ofnurse documentation, muchof this problem would beeliminated.

LTC LEGAL

ISSUES andTRENDS

by Karen GoldsmithGoldsmith, Grout

& LewisFHCA Legal Consultant

The Ten Commandments of DocumentationFaithfully obey them and you will avoid trouble

I. Thou shalt not falsify documentationFalsifying records is a misdemeanor as well as

a good way to lose your license. You may say, “Iwould never falsify records.” However, even inno-cent corrections or late entries if not done properlycan be construed as falsifying records. Late entriesmust be so marked. Corrections should be done in amanner which does not obliterate the previous entryand clearly shows that it is a correction.Filling in theMedication Administration Record at the end ofthe month is clearly inappropriate. Just don’t do it.

II. Thou shalt always document criticalinformationMany cases are lost because nurses got busy and

did not document important information. Forexample, weight loss issues are hot deficiencies. If aperson is not eating, measures to get nutrition intothat person should be documented.We have gone toadministrative hearing on a number of cases where,if the staff had documented all the steps they hadtaken, the cite would never have been given.Are youoffering snacks every two hours? Then record it.Areyou or the family bringing in food from home thatthe patient likes? Take credit for it.Always assume thatthe person following behind and providing treatmentto the patient does not know that patient. Supply asmuch information as you can to that caregiver.

Anything ordered by the doctor should be docu-mented. Even simple things. For example, if a patienthas exceptionally dry skin and the doctor ordersdaily creams, you may wish to document this, eventhough creams may be a part of your daily toiletingprocedures. Why? Because a patient whose recordshows itching and scratching will be closely scruti-nized by the survey team, and you want that team toknow that you have done everything the doctorordered or even suggested.Will you document thison every patient? Of course not, but judge on whichones you should do this type of documentation.

III. Thine LPNs shalt observeIt has long been a sticking point with the Board

of Nursing that only RNs can assess a resident.LPNsobserve, record their observations and pass them on toRNs who may evaluate and make nursing diagnosis.LPNs should not use the term “assess.”Many forms inthe nursing home setting include the word “assess,”even though the document itself is really an observa-tion.Educate LPNs to know the limitations of whatthey can do by law. If a true assessment is being madeon the form, it must be made by and signed off byan RN. If the form is merely called an “assessment,”but is truly an observation, an LPN can fill it out.

IV. Thine RNs shalt assessSame observation. Only RNs can assess. If you

remember this, you will avoid many problems.

V. Thou shalt write legiblyNeed I say more? I cannot begin to tell you

of the number of records I have reviewed that areillegible. If your handwriting is not clear, your notescan easily be misinterpreted and serious harm couldcome to the resident. Also, if you cannot read yourown handwriting, how will you ever support yourposition on care rendered?

VI. Thou shalt follow upIf the doctor is called and he/she does not call

back, you, not the doctor,will be called on the carpet.Many, many deficiencies result from failure to followup.You should make it your practice to review others’notes as well and be sure that follow up has occurred.

VII. Thou shalt share thy observations withthy fellow professionals

Even though it may not be within the scope ofyour expertise, if you observe something that justdoesn’t seem right about a resident, make a note. Forexample, social services may note that a residentappears listless, let the nurses know.There may be anunderlying physical problem that needs attention.However, if you think something is important enoughto record it, see Commandment VI and follow upwith nursing or the discipline involved.A naked noteof your observation without communication will onlyhurt the facility and, more importantly, the patient.

VIII. It is easier to avoid a lawsuit than todefend one.

In many cases, the secret to a successful lawsuit isconscientious nurses who take the time to recordtheir observations, and, where appropriate, theirassessments. If you think something is important rel-ative to a patient, then you should write it down.Anything less leaves the facility and the patient at risk.

IX. It is easier to avoid probable cause thanto defend your licenseNone of us wants to be investigated, or worse,

disciplined by our licensing agency. Aside from theobvious issues like, say, drug use,most potential licen-sure actions in long term care result from failure toproperly document or follow up. Both of these arewithin your professional control.Avoid action againstyour license by writing down legibly what you thinkis important. Follow up is necessary. Be your broth-er’s keeper and ask questions of other professionalsworking with the patient if their notes do not appearaccurate to you.

X. Thou shalt think before speaking orwritingHow many times do we read survey reports which

quote (or in some cases, misquote) staff relative to

FHCA JANUARY 2003 Pulse4

CONTINUED ON PAGE 14

Here’s to better surveys in 2003!

Some do’s and don’ts toremember at survey time

by LuMarie Polivka-WestFHCA POLICY AND QUALITY ASSURANCE DIRECTOR

FHCA JANUARY 2003 Pulse 5

Part of the FHCA staff ’s work with theQuality Credentialing Foundation is to

keep informed of what is happening aroundthe state during the survey process. Ourinformation comes primarily from ourmember facilities’ staff, but we also maintainongoing communication with the Agencyfor Health Care Administration.

For example, we’ve heard that surveyorsdon’t particularly enjoy being greeted with:“This facility is not due for a survey, we are not in our survey window, why are youhere?” Can you blame them? The surveyshave to have a statewide 12-month average,but the survey window is nine to 15 months.That is, unless your facility is on a six-monthsurvey cycle authorized by the increasedenforcement provisions in SB 1202. Alsoremember state surveyors are authorized tovisit anytime, particularly when a complaintis filed.

Accentuate the positiveThink positive.Don’t begin a survey with

a negative attitude or overtone or with a state-ment such as: “We know this area office’ssurveyors cite more deficiencies and at ahigher scope/severity than any other area.”Please save such discussions for a requestedmeeting with the area office supervisorand/or with AHCA’s central office fieldsupervisor, Polly Weaver, at (850) 487-2528.

The beginning of the survey is an appro-priate time to highlight the positive pro-grams you have put in place since surveyorswere last in your facility. The majority ofFlorida nursing homes are reporting qualitymeasures at a better rate than the nationalaverage. Let the surveyors know this. Also be sure you tell surveyors how you have metor exceeded the minimum staffing stan-dards for CNAs and licensed nurses withoutcutting costs in dietary or activities.

Right place, right timeEven though it’s true, survey time is not

the time to complain that the state’sMedicaid program is not fully covering thecost of care and that facilities have to oper-ate within a total budget. Surveyors aretrained to look for regulatory compliance,not to focus on matters of what is adequateor fair reimbursement. Plus, problems withquality outcomes will only cost you moremoney later in the form of unhappy cus-tomers and federal and state fines.

ty before the increasing risk leads to a falland fracture. Other helpful components of a falls management program include specialmedication reviews to identify medicationsthat cause dizziness and drowsiness; educa-tion of staff about falls risks; environmentalchanges such as lowering of beds; visioncare; and weight resistance exercises.Another helpful hint is to have a regular and timely wheelchair check and mainte-nance schedule so patients do not tip overand fall.

Food prep, mealtimeSince F-tag 371 (food safety) continues

to be the most frequently cited deficiency in Florida facilities, we encourage you totake a close look at your food and sanitationprograms.Are there grievances coming fromthe resident council meetings, or from familymembers, or past survey deficiencies relatedto menus, the food temperatures, the staffdelivery of meals or the lack of attentiveness

Special interest areasWe always encourage nursing facility

staff to promote their quality focus by shar-ing their ongoing efforts to better meetpatients’ needs.Two areas of special interestare falls maintenance, because of the highrisk of residents to falling, and dietary pro-grams, because of the importance that foodhas for patients in their well-being and quality of life.

We recommend you fully explain yourfalls management program to surveyors.For example, have you spoken with yourmedical director about the OsteoporosisMeasurement Act of 2001? It expanded theMedicare coverage of bone mass measure-ment for beneficiaries at clinical risk ofosteoporosis. This coverage allows forscreening and treatment of low bone densi- CONTINUED ON PAGE 15

FHCA JANUARY 2003 Pulse6

SB 1202:Taking a lookone year later

Two top LTC facility regulatorssee improvement, but it’s still a little too early to tell for sure

(Editor’s note: FHCA Pulse talked withMolly McKinstry,Agency for Health CareAdministration Acting Chief, Bureau of LongTerm Care Services, and Polly Weaver, Chief of Field Operations.)

Pulse: Many of the quality improvementprovisions of SB 1202 have been in placeabout a year now.What are you seeing?

Molly McKinstry: Many facilities haveonly had one survey since the qualityenhancement provisions took effect, so interms of measuring objective outcomesfrom SB 1202, it’s too early to see anymajor changes or trends. Same thing withthe ALFs because they’re surveyed even lessoften.We’re certainly watching for signslike deficiencies and levels of deficiencies,serious problems,“watch list” appearancesand the like.

Pulse: What’s your general feeling?

MM: Facilities appear to be meeting thehigher staffing levels.We have cited facilitiesfor failing to meet staffing, but many of thoseappear to have been isolated or occasionalsituations, as opposed to any widespreadnon-compliance with staffing requirements.

Pulse: What about failure to self-impose a moratorium on admissions when staffingfalls below minimum levels for two consecutive days?

MM: We have cited this deficiency 16times since January 1, 2002, which is a relatively low number of times when youconsider all our visits and the number offacilities in Florida. However, it’s a defi-ciency that’s easy to avoid if facility staff are carefully monitoring staffing levels. It’salso a pretty serious deficiency – the statuterequires that it be cited as a Class II viola-tion, which means a fine, a conditionallicense and a “watch list” appearance.

Pulse: How many facilities are on a six-month survey cycle?

MM: We have 40 facilities on a six-monthsurvey cycle.

Pulse: AHCA also tracks liability insur-ance and monthly liability claims reporting.

MM: Yes, the facility’s insurance is checkedduring the license renewal process.Withnursing homes, we have not seen anyonewho hasn’t been able to come up withproof of coverage to date.We have had fiveassisted living facilities denied solely forfailure to have liability insurance.As of

November 5th, both nursing home andALF lawsuit filings have dropped rathersteadily, but when some of the associationssaw the numbers, it didn’t seem to repre-sent what they were hearing. So we sentout reminder-to-report letters and receivedsignificant response. Great care is takento be sure we don’t have duplicative information or double-count. Our reportto the legislature should be out by the time you read this interview.

Pulse: What about AHCA staffing? SB 1202 provided you with extra people and funding.

Polly Weaver: The new positions are awelcome addition to the fold, but hiringthe nurses to fill the surveyor positions is achallenge in and of itself.We have the samehiring challenges as the nursing homes do,but while facilities can pull from a staffingagency from time to time to fill in thegaps, we can’t do that.We’re looking forways to do a better job at recruitment.

Pulse: What makes a good surveyor?

PW: Somebody who’s compulsive andwilling to stay away from their family a lot! It’s definitely not an 8-to-5 job. Ifwe get a complaint that alleges inade-quate staff at two in the morning, that’swhen we need to investigate. So any ofour 252 surveyors can be pulled in onweekends and holidays.When we hire,a key trait we look for is the ability to communicate effectively with others,be that with a colleague or a facilityadministrator.

Pulse: What is the surveyor turnover?

PW: It’s about five percent overall, but wehave noticed that more recently we tend tolose surveyors earlier in the process. Somejust don’t stay as long – a few days, a month,a year. I guess the job may be overwhelmingto some, or perhaps it’s the money. Somealso just aren’t prepared to be available forthe off-hour investigations and surveys, butthat’s an essential part of the job.

Pulse: What about surveyor training?

PW: We’ve added some modules to ournew surveyor orientation/training.We nowhave three sessions and existing surveyorscan also be routed through them as arefresher course.All staff must pass the federal Surveyor Minimum QualificationsTest, so we train them, send them throughour “SMQT Academy,” send them throughthe federal basic training, then they takeand hopefully pass the test. Our pass rate isvery good, almost 100 percent. But simplypassing a test does not make one a goodsurveyor.Therefore, we have a whole train-ing process that involves on-site mentoring,either from the local staff or from ourSurvey Integrity & Support branch, inaddition to the didactic training sessions.

Pulse: What are you seeing in terms offuture nursing home closings?

MM: We've seen an increase in the num-ber of closures in the last two years, and thereasons for the closures have been diverse.Some were planned closures as part ofbankruptcy settlements, others were justunable to continue to operate and for avariety of reasons — a few closed for reno-vation, others appeared to have had finan-cial difficulties or reported issues with thecost of insurance or staffing, and others gaveno reason. It may be a function of supplyand demand, given that the occupancy rateis about 85 percent overall despite the clo-sures. Once a facility notifies us of its in-tention to close, we're in there monitoringthe operations until closure.

Pulse: Will you be sharing some of theGold Seal “best practices” with facilities?

MM: Yes, we’re working on publishingsome of them through the “Geri U” Website, www.geriu.org. It’s part of the contractthe state has with the “teaching nursinghome” created by the legislature in 2001.You can also find links to the Gold Sealfacilities at www.floridahealthstat.com.Improving nursing home quality is a veryhigh priority, both for Gov. Bush and(AHCA Secretary) Dr. Medows.

Polly WeaverMolly McKinstry

Life safety, building code:All together now

by Max Hauth

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CEUs for DONs, RNs, and NHAs! This program has been approved for 14 contact hours forFlorida licensed nurses and has been submitted to NAB/NCERS for

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FHCA JANUARY 2003 Pulse 7

The various NFPA Life Safety Codes arereviewed on a three-year cycle. At the

recent NFPA Fall Conference in Atlanta,some 29 NFPA codes and standards werepresented for review and adoption. Of thosecodes presented, six were of concern to the health care industry, especially NFPA101 Life Safety Code and NFPA 1 FirePrevention Code.All documents of concernwere reviewed and commented on by thehealth care section membership prior toadoption by the wider NFPA membership.

2000 edition adoptedWe learned that the Joint Commission

on the Accreditation of HealthcareOrganizations has adopted the 2000 editionof the Life Safety Code and will begin surveying under this document beginningMarch 1, 2003. Likewise, the Centers forMedicare & Medicaid Services will be publishing its intent to adopt the 2000 LifeSafety Code yet this year. CMS has also

started to work on preparing the surveydocument (for K-tag) and is expected tobegin using it by the middle of 2003.

Florida’s Agency for Heath CareAdministration has also been working onthe rewrite of Rule 59 A-4, FloridaAdministrative Code, with the intent tohave it adopted March 1,2003. This is thesame time that the new minimum construc-tion standards for nursing homes are to gointo effect in the Florida Building Code.

It is hard to believe, but by the middle of next year it will be the first time in over 15 years that CMS, JCAHO and theState of Florida will all be using the sameversion Life Safety Code for construction/design and survey.

Gentle reminderAHCA reminds administrators to notify

the Office of Plans and Construction whenever they are having renovation doneto their facility or when equipment is beingchanged out.

(Max Hauth is President, Hauth HealthCare Consultants, Lakeland, and a frequent contributor to FHCA Pulse on life safety issues. Contact him at (863) 688-0863.)

State and federal regulators are moving

toward a uniform standard

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FHCA JANUARY 2003 Pulse 9

Certified nursing assistants are becomingmore like all the other health care pro-

fessions and occupations in that they aresoon to be regulated under their own set of rules promulgated in the FloridaAdministrative Code.The CNA Council, asub-group of the Florida Board of Nursing,has been laboring over the rule developmentfor more than two years. The rules, whenimplemented, will affect the individualCNA as well as the schools that offer state-approved CNA training programs.

Duties, trainingEmployers will be especially interested in

two particular parts of the rule: those that dealwith the tasks to be performed by the CNA,enumerated under “authorized duties,” andthe requirements for “in-service training.” Inthe latter case, the new rules require in-serv-ice training in additional subject areas, suchas domestic violence, CPR skills, medicalrecord documentation and legal aspectsappropriate to nursing assistants.Your facili-ty already may have a domestic violenceprogram that you can use. If not, FHCAoffers a correspondence course on the topicand will be developing correspondencecourses in medical record documentationand CNA legal aspects topics. Watch yourweekly FHCA Focus on Florida e-mail tofind out when the rule is finalized.The finalversion should be available in early springand will be posted on the FHCA Web site.

Nurse, CNA legislationAmong its legislative recommendations,

the Florida Board of Nursing is proposing anew renewal process for CNAs.The two-yearrenewal would allow the board to update theCNA Registry, validate in-service mandatesand raise additional monies to support theirCNA-related responsibilities. In testimonybefore the board, FHCA pointed out thatwhile the renewal process will be the respon-sibility of the individual CNA, in the realworld it will likely fall to the facility.We haveasked the Board of Nursing that if such a legislative proposal were to pass, an on-linesystem for reporting and paying be provided,as well as an allowance for Medicaid reim-bursement to facilities who choose to do this for their employees. At this writing, theBON is considering a renewal fee of $20every two years. Tip: In the meantime, begin

of CNAs by long term care facilities.Further, BON staff added it would be verydifficult to confirm an applicant’s claim fortraining and/or experience. FHCA statedthat in light of new and ongoing staffingmandates, we could not support the creationof barriers to becoming a CNA. Be assuredwe’re watching this very closely.

CNA background screeningThe new CNA Criminal History

Screening procedures were implemented inNovember. As of November 19th, 1,716background checks were performed, ofwhich 247, or 14 percent of the records, had“hits” which required further investigation,according to Board of Nursing ExecutiveDirector Dan Coble. He said the 14 percenthit rate is lower than expected, at least so far.

Board of Nursing staff have been trainedto look at each of the hits and to clear perboard guidelines (available for review at

planning to regularly issue certificates of in-service completion so that your CNAsmay use it for their renewal requirements.

No more challengersThe Board of Nursing’s Legislative

Committee also has indicated it may seek tolegislatively limit an individual’s ability tochallenge the CNA exam.The committee’sstated goal would be to eliminate an individ-ual’s ability to sit for the CNA exam if theindividual has no experience and no train-ing. The committee admitted it would bedaunting to create a list of “exceptions” whocould, in fact, challenge the CNA exam ifthey had some training and/or experience,and they have no wish to impede the hiring

Big changes for CNAs in 2003

New rules will require additional training, but

not additional hours

by Lee Ann GriffinFHCA POLICY AND QUALITYASSURANCE SPECIALIST

CONTINUED ON PAGE 13

LTCBUSINESSNEWS

by Steven R. Jones, CPAand Dawn Segler, CPAMoore Stephens LovelaceFHCA CPA Consultantwww.ms-lovelace.com

One of the great unknowns as 2003 begins iswhether Congress will restore the Medicare

funding lost October 1, 2002 when the RUGadd-ons expired. This month, $1,500 annual caps on certain therapy services kick in, further complicating an already difficult situation for longterm care providers.

As you may recall, the 107th U.S. Congressended its session without reinstating the deep fund-ing cuts to long term care providers.The restora-tion, or so-called “give-back” legislation, has somekey proponents on both sides of the political fence.Sen. Charles Grassley (R-IA) is expected to returnas chairman of the Senate Finance Committeeand has vowed to make this issue a priority in thenew Congress. Sen.Ted Kennedy (D-MA) also haspledged his support of increased Medicare reim-bursement for providers. Despite its bipartisansupport, the balance of power has shifted since the November elections to the point where thelevel of any relief is uncertain. In 2002, both theSenate and the House promoted measures whichonly partially reinstated the reimbursement cuts.

GAO reportWhen they reconvene, legislators will have a

new General Accounting Office report to con-sider in their decision making. The BenefitsImprovement Protection Act of 2000 implement-ed the 16.66 percent increase in the nursing com-ponent of the PPS rates, which expired October1, 2002. It also mandated that the GAO auditnursing staffing ratios and assess the impact of theincreased payments on staffing. Their findings,issued in a report on November 13, 2002, statedthat SNFs did not have significantly higher nursingcosts following the increase in reimbursement forthose costs. Furthermore, the GAO urged mem-bers of Congress to take its report into considera-tion as it determines whether to reinstate theincrease to the nursing component of the rates.

The funding cuts already have had seriouseffects across the long term care provider commu-nity.We’ll closely watch any developments.

HIPAA complianceWith the federal medical privacy rules sched-

uled to go into effect on April 13, 2003, theDepartment of Health and Human ServicesOffice for Civil Rights is turning its attention toenforcement. Director Richard Campanelli toldattendees at the Fifth National Health InsurancePortability & Accountability Act “summit” that his

office, charged with enforcement of the privacyrules, would take a “complaint driven” approach.HIPAA compliance will be investigated only ifcomplaints are received and the process wouldemphasize voluntary resolution of privacy breach-es.The law allows the government to impose civilmonetary penalties of up to $25,000, however Mr. Campanelli stressed that fines would only beassessed in instances where the covered entity didnot make a good-faith effort to correct the viola-tion. Ruben King-Shaw Jr., deputy administratorof the Centers for Medicare & Medicaid Services,speaking at the conference, said that his agencyintended to work with providers on complianceplans and corrective action plans if necessary.

According to survey results released at theconference, the majority of covered entities areinvolved in HIPAA awareness and education.However, the survey also found that these entitieshave made slow progress toward compliance andCMS officials said that by the October 16, 2002deadline they had received more than 550,000requests for extension to file a compliance planwith the privacy rule.

Medicaid auditsIn 2002, the Agency for Health Care

Administration conducted a preliminary audit ofall Florida Medicaid nursing facilities of claimswith dates of service during August 2001. As part of a Medicaid Quality Control pilot project,they compared the patient responsibility amountsupon which the claims were paid to the amountestablished by the Department of Children andFamilies. Many facilities who were informed ofidentified discrepancies have not responded toAHCA’s notification letter. Even if the problem —if one existed in the first place — has been recti-fied, please contact AHCA to notify them theissue has been resolved or to provide informationto correct their records. AHCA will continue to work with providers who owe settlements as aresult of incorrect patient responsibility amounts.For that same time period, AHCA also auditedMedicaid patient eligibility. Many providers feltthat there were errors in AHCA’s findings and the Program Integrity Office has now agreed toconduct new audits in 18 to 24 months. Inresponding to these audits, keep in mind that current operators have no liability if a change ofownership occurred subsequent to the audit period and before preliminary audit overpaymentletters were issued.

Medicare restoration legislationon the way?A new GAO report may make it tougher

FHCA JANUARY 2003 Pulse10

FHCA JANUARY 2003 Pulse 11

New NHA rulesby Peggy RigsbyFHCA GOVERNMENT SERVICES DIRECTOR

No, that application feedidn’t really decreaseThe Department of Health has filed final

rules amending two sections of Rule64B10,Florida Administrative Code, the rulegoverning nursing home administrators:

■ Rule 64B10-12.002, FAC, was revised tospecify that the NHA licensure applicationfee is $155.This is not a reduction in thefee, DOH has just separated the applica-tion fee from the exam vendor fee, whichis $100 and goes directly to the vendor.

■ Rule 64B10-12.0105, FAC, was amendedto state that the fee for processing alicensee’s request to change licensure status shall be $25.

■ Rule 64B10-15.001, FAC, was revisedeffective November 4, 2002, to add a newsection 7(b) which states,“As a condition ofbiennial licensure renewal, each licenseemust participate in a Board approved con-tinuing education course on medical errorsas required by Section 456.013, F.S. Thecourse shall not be less than two (2) contacthours and must contain the following com-ponents:Root-cause analysis; error reduc-tion and prevention; and patient safety.”

■ Rule 64B10-15.002 has been updated toreflect the change from three hours toone hour as the minimum time for con-tinuing education programs, effectiveDecember 2, 2002.

Lawsuit notice, filingsChapter 400.147(9), Florida Statutes, was

revised during the 2002E special legislativesession, by HB 59E, to require nursing facil-ities to “report, by the 10th of each month,any notice received pursuant to Chapter

400.0233(2), F.S., and each initial complaintthat was filed with the clerk of the court andserved on the facility during the previousmonth by a resident...” The report mustinclude certain information as specified inthe law. In addition, the facility also must sub-mit a copy of the notices and complaints receivedpursuant to this statute. The Agency forHealth Care Administration has sent lettersto those facilities submitting reports thatwere not also accompanied by the requirednotices and complaints. Failure to submitthis required back-up information is a viola-tion of the statute and subject to fine.

It’s very important to keep both yourrecords and AHCA’s current by dutifullyreporting this information each month.

Posting staffingJust a reminder: Beginning January 1,

2003, nursing facilities must comply withthe posting information required under theBenefits Improvement and Protection Act of2000,which requires skilled nursing facilitiesand nursing facilities to post daily, for eachshift, the number of licensed and unlicensednursing staff directly responsible for patientcare in the facility.This information must bedisplayed in a clearly visible place.Of course,Florida facilities are ahead of the mark inthis area as Chapter 400.23, F.S., has requiredsuch posting for several years.

CDC releasesThe Centers for Disease Control and

Prevention has several items of interest on itsWeb site, www.cdc.gov, including:■ Updated “Guidelines for the Prevention

of Intravascular Catheter-Related In-fections,” published in the Morbidity andMortality Weekly Report, Volume 51,Number RR-10

■ A response to the Institute of Medicinereport, “The Elimination of Tuberculosisin the United States”

■ “Guidelines for Hand Hygiene in Health-Care Settings” that provides health careworkers with a review of the data regard-ing handwashing and hand antisepsis. Inaddition, the CDC reports on a studyfrom France that confirms that hand disin-fection with alcohol or an alcohol-basedsolution is essential for infection control.Availability of alcohol hand rubs is recom-mended near every patient bedside toimprove caregiver compliance to infectioncontrol practices and is likely to be moresuccessful than handwashing because it fitsmore conveniently into nursing routines.

which could deprive Florida’s frail elderlyof long term care when they need it.

Doctor exodus■ Doctors who practice in nursing homes

and who serve as state-required medicaldirectors are being forced out of theirpractices by their own difficulty in get-ting malpractice insurance.

■ According to a recent survey conductedby the Florida Medical Directors

Association, two-thirds of Florida facili-ties report an increase in the number ofphysician assistant and nurse practitionervisits – instead of doctor visits – to facilities.

“All the progress we’ve made thus farthat was envisioned in the 2001 law couldbe undone if our legislators don’t act now,”Rice-Schild said. “Congress must also ownup to its duty to do right by our parents andgrandparents.”

2003: A ‘showdown’ year for long term careCONTINUED FROM PAGE 1

(v) Any period of absence to receive multiple treat-ments (including any period of recovery therefrom)by a health care provider or by a provider of healthcare services under orders of, or on referral by, ahealth care provider, either for restorative surgeryafter an accident or other injury, or for a conditionthat would likely result in a period of incapacity of more than three consecutive calendar days in theabsence of medical intervention or treatment, suchas cancer (chemotherapy, radiation, etc.), severearthritis (physical therapy), kidney disease (dialysis).(b) Treatment for purposes of paragraph (a) of thissection includes (but is not limited to) examinationsto determine if a serious health condition exists and evaluations of the condition. Treatment doesnot include routine physical examinations, eyeexaminations, or dental examinations. Under para-graph (a)(2)(i)(B), a regimen of continuing treat-ment includes, for example, a course of prescription medication (e.g., an antibiotic) or therapy requiringspecial equipment to resolve or alleviate the healthcondition (e.g., oxygen). A regimen of continuingtreatment that includes the taking of over-the-counter medications such as aspirin, antihistamines,or salves; or bed-rest, drinking fluids, exercise, andother similar activities that can be initiated withouta visit to a health care provider, is not, by itself,sufficient to constitute a regimen of continuingtreatment for purposes of FMLA leave.(c) Conditions for which cosmetic treatments areadministered (such as most treatments for acne orplastic surgery) are not “serious health conditions”unless inpatient hospital care is required or unlesscomplications develop. Ordinarily, unless complica-tions arise, the common cold, the flu, ear aches,upset stomach, minor ulcers, headaches other thanmigraine, routine dental or orthodontia problems,periodontal disease, etc., are examples of conditionsthat do not meet the definition of a serious healthcondition and do not qualify for FMLA leave.Restorative dental or plastic surgery after an injuryor removal of cancerous growths are serious healthconditions provided all the other conditions of thisregulation are met. Mental illness resulting fromstress or allergies may be serious health conditions,but only if all the conditions of this section are met.(d) Substance abuse may be a serious health con-dition if the conditions of this section are met.However, FMLA leave may only be taken for treat-ment for substance abuse by a health care provideror by a provider of health care services on referralby a health care provider. On the other hand,absence because of the employee’s use of the substance, rather than for treatment, does not qualify for FMLA leave.

29 C.F.R. §825.114. What is a “serious healthcondition” entitling an employee to FMLA leave?

(a) For purposes of FMLA, “serious health condi-tion” entitling an employee to FMLA leave meansan illness, injury, impairment, or physical or mentalcondition that involves:(1) Inpatient care (i.e., an overnight stay) in a hospi-tal, hospice, or residential medical care facility,including any period of incapacity (for purposes ofthis section, defined to mean inability to work,attend school or perform other regular daily activi-ties due to the serious health condition, treatmenttherefor, or recovery therefrom), or any subsequenttreatment in connection with such inpatient care; or(2) Continuing treatment by a health care provider.A serious health condition involving continuingtreatment by a health care provider includes any one or more of the following:(i) A period of incapacity (i.e., inability to work,attend school or perform other regular daily activi-ties due to the serious health condition, treatmenttherefor, or recovery therefrom) of more than threeconsecutive calendar days, and any subsequent treat-ment or period of incapacity relating to the samecondition, that also involves:(A) Treatment two or more times by a health careprovider,by a nurse or physician’s assistant under directsupervision of a health care provider,or by a providerof health care services (e.g., physical therapist) underorders of, or on referral by, a health care provider; or(B) Treatment by a health care provider on at leastone occasion which results in a regimen of contin-uing treatment under the supervision of the healthcare provider.(ii) Any period of incapacity due to pregnancy, orfor prenatal care.(iii) Any period of incapacity or treatment for suchincapacity due to a chronic serious health condition.A chronic serious health condition is one which:(A) Requires periodic visits for treatment by a healthcare provider, or by a nurse or physician’s assistantunder direct supervision of a health care provider;(B) Continues over an extended period of time(including recurring episodes of a single underlyingcondition); and(C) May cause episodic rather than a continuing peri-od of incapacity (e.g., asthma, diabetes, epilepsy, etc.).(iv) A period of incapacity which is permanent orlong-term due to a condition for which treatmentmay not be effective.The employee or family mem-ber must be under the continuing supervision of,but need not be receiving active treatment by, ahealth care provider. Examples include Alzheimer’s,a severe stroke, or the terminal stages of a disease.

LABORRELATIONS

COUNSEL

by Mike MillerKunkel, Miller & Hament

FHCA Labor RelationsConsultant

As we enter the cold and flu season, it may

be helpful to review therules under the FamilyMedical Leave Act related to “serious health condition.”Unfortunately, what is andwhat is not a serious healthcondition is open to someinterpretation and is largelydependent on the facts in-volved in the particular case.

The FMLA broadlydefines “serious health con-dition” as “an illness, injury,impairment, or physical ormental condition” thatinvolves either “inpatientcare in a hospital, hospice,or residential medical carefacility” or “continuing treatment by a health careprovider.”This is not veryhelpful. However, theDepartment of Labor hasissued a regulation which,although it cannot answer all questions and must beused carefully, is very instructive as a starting point and, thus, is set forthhere in its entirety:

FHCA JANUARY 2003 Pulse12

Understanding ‘serious health conditions’FMLA–DOL regulations can be instructive

CONTINUED ON PAGE 15

FHCA JANUARY 2003 Pulse 13

Over the past 31 years, KPS has gained the knowledge and experience necessary to meet the ever changing needs of our pharmacy customers in the senior care industry.

We are dedicated to delivering quality, cost-effective pharmaceutical care with a commitment to customer-defined service and a focus on maintaining the highest standards of ethics, integrity and compliance.

KPS offers flexible pharmacy distribution systems, consulting services, infusion therapy,enteral therapy and disease state management services with reliable delivery, accurate billing and flexible PPS pricing programs.

To learn more about your prescription for success, visit us online at www.KPS-Rx.com or call us

1.866.KPS.DRUG

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KPS South Florida KPS Central /Southwest Florida KPS North Florida1.800.432.4902 1.800.642.4262 1.877.268.1322

www.fhca.org; click on “Members Only/CNA Information”). As of this writing,BON staff have been able to clear more than two-thirds of the applicants with hitsbased upon the Florida Department of LawEnforcement information. The remainingwill require a secondary review or addition-al information from the applicant before adecision can be made.

CNA testIn addition to releasing the scores from

the third quarter of 2002 (See “FHCA CNATest Prep Course completers do better!”),for the first time the Board of Nursing’s test-ing vendor provided a first-time combined

Big changes for CNAs in 2003 CONTINUED FROM PAGE 9

pass rate, the percentage of candidates whopass both the written skills and the clinicalskills portions of the CNA test on their firstattempt. The vendor said the first-time combined pass rate for the period is 50.28percent. This half-pass-half-fail rate causedus a little concern, but since it is the firsttime the number has been available, no oneis really certain what it means in terms ofimprovement or decline in pass rates.

“Hybrid” LPNAn initiative begun by River garden

Hebrew Home, Jacksonville, to create a facil-ity-based “hybrid” LPN program that focus-es on geriatrics is rapidly gaining momen-

tum following a workshop held by FloridaSenate President Jim King (R-Jacksonville).

Stakeholders include FHCA and theFlorida Association of Homes for the Aging, the Florida Board of Nursing, theDepartment of Health, the Agency forHealth Care Administration, the Depart-ment of Education and the Commission forIndependent Education, to name a few.River Garden’s early plan to create a new curriculum and test as an extension of anexisting nursing program would result in a“hybrid” LPN whose licensure status wouldonly allow for employment in a nursinghome with a specialty in geriatrics. This plan is certain to undergo modificationalong the way and will probably end uplooking more like a regularly licensed LPNtrained at the facility level with an addition-al geriatric focus. Stakeholders agree such a“hybrid” LPN program would be beneficialin creating a career ladder for CNAs whileincreasing the supply of LPNs in the state,especially in long term care. FHCA has beenapproached by Workforce Florida, Inc. tolink with River Garden, the Department ofEducation, and Sen. King’s office to solicit agrant from the Robert Wood JohnsonFoundation that would support a pilot project to begin a facility-based program.

Percentage passing CNA exam – July 1 - September 30, 2002

FHCA CNA TestPrep Coursecompleters do better!Passing rate for theCNA exam is 9 pointshigher overall

Those who complete the facility-based FHCA CNA Test PrepCourse continue to perform better on the CNA exam, compared with those who take their training elsewhere.

Clinical Skills Written

Approved Programs 59.8 72.9

FHCA CNA Test Prep Course 70.6 79.7

Challenger 58.7 74.9

Source: Experior

FHCA SERVICE CORPORATION SAVES YOU MONEY

We are proud to recommend these fine vendors who provide quality goods and services. They help keep you and FHCA on top!

Allstate Financial (distributed by LTC Business Solutions)Allstate Financial Workplace Division presents every FHCA memberthe opportunity to offer their employees a new limited benefithealth care program that has been designed to provide affordableand value-added benefits. This program has been very successful inhelping nursing homes and assisted living facilities improve theiremployee recruitment, retention, morale and overall quality of life,while reducing facility overhead. Call (888) 757-7483 for details.

Direct Capital Access, LLCA national mortgage company providing financing solutions tailoredto health care businesses from coast to coast. We provide customfinancing structures, HUD, Bridge, Bonds (taxable and tax-exempt),including Cash Out and Non-Recourse programs. Our experience,combined with creativity, consistently has produced solutions tooperators’ needs. How does a low, 7%, 35-year fixed rate sound?Call Scott A. Baldwin, Managing Director, at (800) 366-0443.

Edge Information Management Inc.Since becoming an approved service corporation company forFHCA in 1993, Edge has helped over 250 FHCA members meettheir background screening requirements and kept them informedof pertinent legislative issues. Edge offers a variety of backgroundchecks including: drug screening, fingerprints, criminal, sexualoffender, license verifications and references. Call (800) 725-3343.

FMS Purchasing & ServicesFMS has a full line of products and services in its Group PurchasingProgram. FMS services member needs by ensuring maximum savingsand service. Five area managers throughout the state assure membersan immediate response. Our services include: audits, a toll-free number, cost analysis, service reports and the Manufacturers ValueIncentive Program. Call (800) 456-2025.

Heaton Resources (a division of MED-PASS, Inc.)Heaton Resources is a nationally known company specializing inthe research and development of policy and procedures manuals,regulatory guides and in-service training programs for the long-term care professional. Heaton products are comprehensive, easy-to-use and continuously updated. Our cross-referencing makesfinding information easy. Call (800) 438-8884.

Office DepotOffice Depot offers Florida Health Care Association members extradiscounts and services due to the cooperative purchasing power ofFHCA. We offer a wide variety of benefits, including 167 items whichhave been reduced based on volume ordering up to 80 percent (the“High Use Item List”); next day delivery on any amount of products(no minimum order); an award winning website which links you toyour pricing and into the warehouse and keeps two years of trackinginformation at your fingertips. Call (800) 422-2654 to set up anaccount; call (800) 386-0226 to place an order.

Prestige Printing & DesignPrestige Printing & Design has been involved in the long-term careprinting and publishing business for the past 13 years. We provideboth state and federal regulations and manuals, comprehensive resi-dent rights and advance directive programs, as well as standardizeddocumentation forms for all phases of long-term care. We also handlefull commercial printing & graphic design work. Call (800) 749-6773.

Staffing Concepts of Florida, Inc.Staffing Concepts of Florida, Inc. is a professional employer organiza-tion which provides a comprehensive solution to your personnelneeds, including: employee benefits; workers compensation and safe-ty programs; human resources support; and payroll. SCI specializes inhelping health care facilities better manage their single largest cost —labor. Call (800) 932-4610.

FHCA JANUARY 2003 Pulse14

CONTINUED FROM PAGE 1Update

Membership renewal

Watch your mail for your 2003 FHCAmembership renewal information

and invoice. Respond promptly and helpkeep FHCA as the unquestioned leader inrepresenting Florida’s nursing homes andassisted living facilities. For more member-ship information, contact Leah Martineauat FHCA at (850) 224-3907.

Independent owner forum

The 2003 Independent Owner Leader-ship Forum is February 10-11th at the

Eden Roc Renaissance Resort & Spa inMiami Beach.The forum, sponsored by the American Health Care Association,offers numerous educational and network-ing opportunities customized specificallyfor the independent owner. To register, goto www.ahca.org and click on “Convention/Seminars.”

New guide

Anew consumer guide, Living in aNursing Home: Myths and Realities, is

now available.The nine-page booklet is in-tended for facilities, doctor’s offices, hospi-tals, offices on aging or any other organi-zation that works with families and theelderly. For information, call (800) 321-0343, or go to www.ahcapublications.com.

2003 Quality award

The American Health Care Association’s2003 Quality Award is a distinction

given to member facilities for applyingcontinuous quality improvement principles.The first step application is due March31st. For information go to the “MembersOnly” section of www.ahca.org or call (202) 898 2830.

issues ripe for citation. If a surveyor asks you a question, think about it and answer fromknowledge, not speculation. Likewise in documentation, offhand remarks have noplace. Speculating as to what caused a patient’sproblem has no place in documentation.Facts and observations do. If you are an RN,assessment based on those facts is appropriate,but make sure your assessment is supported by the recorded facts. If it is not, perhaps thefacts are wrong or incomplete. Investigate.

The Ten Commandments of DocumentationCONTINUED FROM PAGE 4

FHCA Calendar of EventsPrograms marked with an asterisk (*) have registration brochures available viaFHCA Fax-On-Demand at (850) 894-6299 and also are available at the

FHCA Web site at www.fhca.org. Click on “Seminars/Events.”

Note: FHCA will offer seminars on OSHA training,survey readiness and the new MDS Resident

Assessment Instrument. These seminars will takeplace in February and April. Information on these and other seminars will be available in the weekly

Focus on Florida e-newsletter in addition to the FHCAWeb site and registration brochure mailings.

2003J A N UA RY

Tuesday, January 14Professional Development

Committee Meeting9:30 a.m. - 2:30 p.m.

Tampa Airport Marriott

Tuesday, January 21*FHCA CNA

Train-the-Trainer SeminarRegistration 8:00 a.m.; Seminar 8:30 a.m.-3:30 p.m.;

5 contact hours for nursesTandem Health Care, 1650 Phillips Road,

Tallahassee, 32308 (850) 942-9868$150 per FHCA or FAHA member facility participant

Includes CNA Test Prep Course Instructor’s GuideLimited to 25 participants. No on-site registration.For questions on registration or the course itself,

call Lee Ann Griffin at (850) 224-3907.

IMPORTANT! All participants must be pre-registeredand registrations must be received by FHCA no laterthan the Wednesday before the session date selected

in order for you to attend the session.

Tuesday, January 28FHCA Associate Member

Support Committee meeting10:00 a.m.-2:30 p.m.

The Rosen Centre Hotel9840 International Drive, Orlando

Tuesday 28 – Thursday 30FHCA Quality Summit Meeting

JANUARY 299:00 a.m.-1:00 p.m. FHCA Risk Management

Workgroup at Embassy Suites USF1:00-7:00 p.m. Quality Credentialing Board Meeting

Dinner at Embassy Suites USF

JANUARY 309:00-11:00 a.m. FHCA Quality Credentialing Family

Advisory Board meeting at University of South Florida11:00 a.m.-4:00 p.m. Quality Summit at University

of South FloridaEmbassy Suites USF, 3705 Spectrum Blvd.,

Tampa 33612 (813) 977-7066

M A R C H

Wednesday 19 & Thursday 20FHCA & FALA

2003 Legislative MeetingDoubleTree Hotel,

101 South Adams Street, Tallahassee, 32301Room rate $145 single to quad occupancy.

Room block released February 25th. Room rate valid two days before and after event.

Reservations may be made by calling (850) 224-5000 or (800) 222-8733.

M AY

May 6National Nurses Day

May 11 – 17 National Nursing Home Week

May 21 – 23FHCA Nurse Leadership

Training ProgramThe Don Cesar Beach Resort & Spa

St. Petersburg Beach, 33706

J U LY

July 28 – 31FHCA 2003 Annual Conference

& Trade ShowThe Rosen Centre Hotel

9840 International Drive, Orlando (407) 996-9840

S E P T E M B E R

September 7 – 13 National Assisted Living Week

FHCA JANUARY 2003 Pulse 15

Labor Relations CounselCONTINUED FROM PAGE 12

(e) Absences attributable to incapacity under paragraphs (a)(2)(ii) or (iii) qualify for FMLAleave even though the employee or theimmediate family member does not receivetreatment from a health care provider duringthe absence, and even if the absence does notlast more than three days. For example, anemployee with asthma may be unable toreport for work due to the onset of an asthma attack or because the employee’shealth care provider has advised the employ-ee to stay home when the pollen countexceeds a certain level. An employee who ispregnant may be unable to report to workbecause of severe morning sickness.

In every case, the employer must carefullyevaluate all the facts in a light favorable to theemployee. Situations which are not specifical-ly addressed by the regulation or in whichsome doubt exists as to whether a “serioushealth condition” has been establishedshould be reviewed with legal counsel. Theconsequences of denying leave if a court laterdetermines that leave should have beengranted can be quite catastrophic to anemployer (for example, one federal juryrecently awarded an employee $10 million in punitive damages alone in an FMLA-retal-iation case).There-fore, it may be prudent toerr on the side of caution in close cases andallow the leave.

CLASS I F I EDSBusiness Development Manager: Crystal River,Florida area. Seeking person to expand client basenationwide for Quality Care Rehab, Inc., a premierFlorida health care company that contracts rehabservices with nursing homes, providing high qualitycomprehensive programs in physical, occupational,and speech therapy. This is a lucrative, full-timeopportunity for a highly motivated self-starter. Theperson must be a professional of high integrity, hav-ing excellent interpersonal, communication andleadership skills. Also needed is a proven and suc-cessful sales track record within the nursing homeindustry, as well as established business contactsrequired. Must have a bachelor’s degree in thehealth care or marketing field. We offer an attractivesalary, incentive plan and comprehensive benefitpackage. Please fax resume and salary requirementsto (352) 382-0212, or e-mail resume to amor-ris8@mindspring.com. For further information,please contact Andrew Morris, VPHR at (352) 382-4800, extension 15.

Interim Administrator Available statewide. A sea-soned professional who has both management andconsulting experience in the operation of healthcare facilities. You will get both a license and anopportunity to “fine-tune” the operation. Contact:Doug Eitel at (813) 991-7400 or e-mail to: dreit-el1@aol.com.

(“Help wanted” and “situations wanted” classified ads are free to FHCA members. You can also post yourad on the FHCA website at www.fhca.org. Click on“employment.”)

of staff during meal times? If not, then askthe patients and their family members whatthey think about the facility’s dining program.This goes beyond just asking aboutmenu choice, it is about consumer satis-faction with the total dining experience.Find out what they think because the sur-veyors will be asking patients and familiesthese questions too. Sure, it’s a challenge to meet the dietary desires of everyone inthe facility, but your patients will react in a positive manner when your staff interacts

kindly with patients and does not “rush”a meal.

Spreading the goodIf you have implemented special activi-

ties around dining or have any other help-ful hints to share with the QualityCredentialing Program, please send them in to lpwest@ fhca.org or dafasano@fhca.org.We want to hear from you as we continueour quest for higher quality and bettersurveys in 2003.

Here’s to better surveys in 2003 CONTINUED FROM PAGE 5

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