I’m hearing about facilities going bankrupt and closing. As a director of nursing, what can I do to help manage my department’s budget without degrading quality of care?

We DONs can be so busy ensuring resident care and improving clinical systems that we disregard our responsibility of managing our department’s budget. Often, that’s the LAST thing we want to do!

However, the roles are not entirely separate; sound finances are necessary for good resident care. Here are some ways you can help your facility not only survive, but thrive financially.

Do financial rounds — Look for unused rented beds, oxygen tanks, etc. Are you paying unnecessarily?

Use a barcode or supply tracking system — Label nursing supplies for residents — such as incontinence products, wound materials, stock meds, soaps, toothbrushes and pillows — with a scanning system that will help you track usage and assign expenses to individual residents and payer sources. Knowing how much each resident’s supplies cost is key to understanding your facility’s operating costs, which will assist when negotiating contracts with accountable care organizations and other group purchasing networks.

Read and understand your department’s financials at least monthly — Knowing as soon as possible if the financials are off target will allow you to put a specific action plan in place.

Share your financial status with your team — Staff members are the “boots on the ground,” so getting their ideas and buy-in for financial steward- ship is critical to success.

As nurse leaders, we are and should be focused primarily on clinical care. But we also need to know that sound clinical care requires the department and company’s financial health.

Please send your nursing-related questions to Judi Kulus at ltcnews@mcknights.com.

Working the night shift isn’t just bad for sleep — it could be seriously bad for your health.

Working 12-hour shifts may have a positive effect on job satisfaction and allow nurses more flexibility to further their education, according to a study conducted in Pennsylvania.

Researchers at the Villanova University College of Nursing set out to better understand nurses’ perception of shift work, especially 12-hour shifts. They found facilities should avoid changing patient assignments in the middle of a shift and avoid scheduling nurses for shifts longer than 12 hours to reduce fatigue.

The results were based on a 30-minute questionnaire completed by nurses who had worked 12-hour shifts in a rehabilitation setting at some time in the last 10 years.

“Family life, communication with nurses, patient care, continuity of care, time off and job satisfaction received the highest scores in the survey, indicating that 12-hour shifts allowed greater satisfaction in these areas,” the researchers wrote.

But nurses also reported greater fatigue and lack of continuity of care when patient assignments changed during the shift. The study was con- ducted in a single facility and did not contrast feelings about 12-hour shifts during the day against 12-hour overnights.

What is the new RCS-1 payment system all about?

The Centers for Medicare & Medicaid Services has proposed a new payment system to replace RUGs IV. It was written as a proposed rule in 2017 and the comment period is closed.

According to CMS, the need for a new system was to eliminate incentives to increased payment based on higher therapy usage in the industry. In addition, CMS information indicates that the new RCS-1 system would more appropriately reimburse facilities for nursing care and non-therapy ancillary cost.

That is an issue that has plagued providers since the inception of the RUGs system — inadequate reimbursement for high-cost items such as IV antibiotic therapy.

The RCS-1 payment system would break down payment based on case- mix scores in four different areas: PT/ OT, SLP, Nursing and Non-therapy ancillary services. Each component would be calculated based on diagnoses, clinical factors and other criteria.

Non-therapy ancillary services would reflect high cost services such as HIV/AIDS, Parenteral/IV feedings, infections and other high-cost comorbidities.

In addition to these categories, there will be variable payment for both PT/ OT and non-therapy ancillaries, thereby reducing reimbursements based on length of stay.

Overall, it will be a more complex system but one that will reflect resource utilization in a different way. It’s anticipated that the RCS-1 rule will roll out for fiscal 2019, which begins Oct. 1, 2018.

The best suggestion now is to keep up to date on when CMS publishes the final rule, and then educate appropriate staff in the system. Stay tuned!

Please send your payment-related questions to Patricia Boyer at ltcnews@mcknights.com.

Spending growth in nursing care and continuing care retirement communities is on the rise and expected to continue for at least the next eight years, according to new federal estimates.

The growth rate, which was 3% annually in 2013, will climb to 5.3% by 2026, leading to about $261 billion in yearly expenditures.

Also by 2026, federal, state and local governments are projected to finance 47% of national health spending, up from 45% in 2016, according to Centers for Medicare & Medicaid Services Office of Actuary data released Feb. 14.

Larger numbers of beneficiaries who can enroll and faster growth in utilization will power Medicare to the largest (7.4%) annual growth rate among U.S. health sectors this year. That’s a bit of good news for providers.

However, Medicaid is projected to grow at a 5.8% rate through 2026, slower than previous years.

From 2014 to 2016, Medicaid grew at an 8.3% rate due to expansions through the Affordable Care Act. The program is the largest payer of U.S. long-term care services. Medicare is a distant second.

Even though a new, unified payment system has been discussed for several years, the mere mention of it in President Trump’s budget proposal jolted observers in February.

The budget specifically said a new system is needed due to “excessive payment” currently going to post-acute providers.

Such a system would be based on resident/patient need instead of the care setting — be it skilled nursing facilities, home health agencies, inpatient rehabilitation facilities or long term care hospitals.

The Medicare Payment Advisory Commission was expected to make a recommendation to Congress about a unified payment system in its March report. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) requires the com- mission to develop a prospective payment system covering the four PAC settings.

Trump’s budget also calls for allowing accountable care organizations to cover primary care visits in order to encourage Medicare beneficiaries to use the ACO’s providers.

One of providers’ biggest concerns about the budget is support shown for Medicaid per-capita caps or block grants that would replace the current funding, starting in fiscal 2020.

Another concern for some observers is that the budget calls for expanded use of State Section 1115 Medicaid Waiver authority to “foster state-level Medicaid reform.”

We’ve taken reasonable precautions, posted signs, added many hand sanitizers, urged hand washing or mask wearing by visitors, etc., but one of our residents got the flu. Now family members are trying to hold us legally responsible for his sickness and ultimate death. What more could we have done? Do we have anything to worry about?

Residents or their families can sue for wrongful death or other injuries to a resident. But for a plaintiff to win damages under any negligence theory, they must show the provider caused the injury. To prove cause to impose liability, a jury must find that the provider did not act as a reasonable provider would have acted.

You state you have policies and procedures in place that were reasonable and would have prevented the injury. Let’s assume you trained employees about these policies and procedures and did not ignore the enforcement of policies and procedures. Let’s also assume you did not disregard some other policy or procedure required by federal or state laws or regulations. If these assumptions are factually correct, it would be hard for the plaintiffs to prove that a provider caused the resident to get the flu.

Without proof of provider causation, the provider should not be found liable for negligent conduct and therefore is not exposed to any liability. The provider should notify its insurance carrier of a potential claim so that, if there is
a lawsuit filed, the cost of defending the lawsuit and any liability from the lawsuit should be the responsibly of the insurance carrier and not the provider.

The insurance carrier, under its policy, generally reserves the right to retain legal counsel to defend the claim, striving to settle at the lowest amount possible.

Please send your legal questions to John Durso at ltcnews@mcknights.com.

An Illinois skilled nursing and rehab center was fined $25,000 after a certified nurse aide admitted to posting a partially nude photo of a resident on social media.

The Illinois Department of Public Health cited the 120-bed Illini Restorative Care in September, according to the agency’s fourth-quarter report. The facility, owned by Genesis Health System, self-reported the incident to the department after another CNA saw the photo online. In the photo, the male resident can be seen unclothed from the waist up, according to the health department report.

State investigators said the CNA called the photo’s post- ing “a complete accident,” not- ing that she was using social media on her cellphone in the resident’s room. When he got restless, she dropped the phone in her pocket, “not realizing it had taken the picture and posted it.”

The CNA acknowledged she had received training on abuse prevention and cell-phone use, and admitted that she was not supposed to have her cellphone in her pocket.

In citing the facility for three code violations, the health department said Illini “failed to ensure a resident’s right to be free from exploitation on social media,” and that failure caused the resident “to suffer public humiliation and dehumanization.”

Genesis spokesman Craig Cooper reinforced that employees are trained annually about protecting patient privacy, and prohibited from using phones in resident rooms.

“This was a regrettable mistake by one employee who is no longer employed by Genesis Health System,” Cooper told McKnight’s. “While Illini Restorative Care, as a facility, did everything correctly, one employee did not.”

The U.S. Equal Employment Opportunity Commission has sued a Nashville-based skilled nursing and rehabilitation company for refusing to provide a reasonable accommodation to an employee who suffers from an anxiety disorder, and then ring the employee because of her disability.

Federal officials say that West Meade Place LLC — operating as The HealthCare Center at West Meade Place — hired the employee as a laundry technician in February 2015. When she requested leave that November to cope with her anxiety disorder, she was told that the Family and Medical Leave Act did not apply to her.

West Meade then required the employee to provide a doc- tor’s note clearing her to return to work without any restrictions less than 36 hours later. It fired her when she could not produce one, according to the suit.

Such alleged conduct violates the American Disabilities Act, the commission said in a February press release announcing the lawsuit, which was led in the U.S. District Court for the Middle District of Tennessee after first attempting a settlement.

The lawsuit seeks an injunction to keep West Meade from discriminating against employees based on their disabilities in the future, as well as back pay and compensatory and punitive damages for the dis- crimination victim.

“Management officials have a responsibility under federal law to consider all reasonable requests to accommodate employees’ disabilities,” said Katharine W. Kores, district director of the EEOC’s Memphis District Office. “When an employer refuses to do so, the EEOC is here to put things right.”

The 120-bed HealthCare Center at West Meade Place employs more than 200 people, according to the company’s website. The facility did not return a McKnight’s call for comment.