House lawmakers approved legislation in late June that would place limits on awards for medical malpractice cases — a move that would benefit long-term care, according to one provider group.

H.R. 1215, known as the Protecting Access to Care Act, would place a $250,000 cap on noneconomic damages in healthcare-related lawsuits where coverage of the care was provided by the federal government. The act passed the House on June 28 largely on partisan lines by a 218-210 vote; all 191 Democratic representatives opposed the bill, along with 19 Republicans.

The bill earned praise from long-term care providers, with one group stating that its House passage couldn’t come at a more opportune time.

“Rising liability costs to an already underfunded sector not only threatens access to care but can also cost jobs,” said Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living. “This legislation helps at a time when we need it the most. Now more than ever, it’s important to preserve dwindling resources to improve the lives of those who need it.”

The bill did not receive as warm a reception from attorneys’ groups, who fear it will prioritize providers’ interests while putting patients at risk.

“H.R. 1215 shamefully protects negligent medical providers, abusive nursing home corporations and careless drug companies when they place profits ahead of quality care,” said Julie Braman Kane, president of the American Association for Justice. “If this bill becomes law, victims and their loved ones will be unable to hold those responsible accountable.”

The bill’s next stop was the Senate, where similar bills have died or been extinguished in the past.

Two nursing home employees were credited in July with running into “heavy smoke conditions” to rescue two residents.

The fire broke out at Courville at Nashua in Nashua, NH, early on the morning of July 2. The workers, who were not identified, pulled the residents to safety. 

“They were two maintenance or housekeeping guys … they just saw the smoke, ran into the room, got the residents,” said Courville President and CEO Luanne Rogers. “It just worked perfectly.”

The average number of nursing home deficiencies has dropped, but staffing levels are lower than expert recommendations, according to a Kaiser Family Foundation report. 

Kaiser’s “Nursing Facilities, Staffing, Residents and Facility Deficiencies” report, published in July, outlines national SNF trends using data from the Online Survey, Certification, and Reporting system and Survey Provider Enhanced Reports.

Citations per facility fell from 9.33 to 7.28 between 2009 and 2013, with a slight increase to 8.6 in 2015.

Facilities that received no deficiencies rose from 7% in 2011 to 8% in 2013 before returning to 7% in 2015. 

Although the report showed total nursing hours averaged 4.1 per resident day in 2015 — which is higher than 3.9 hours in 2009 — it still falls short of recommendations from some experts, Kaiser noted. 

They include a panel of University of California researchers who suggested in an article in The Gerontologist that 4.55 hours per resident day is appropriate. 

Penalties for the next phase of nursing home survey guidelines will be postponed a year, the Centers for Medicare & Medicaid Services announced June 30.

Saying it had “heard concerns” about the requirements, a CMS memo noted providers still would have to follow the new rules. Transgressors, however, would not be hit with civil monetary penalties, payment denials or termination from the Medicare program.

“CMS would use this year-long [delay] period to educate facilities about certain new Phase 2 quality standards by requiring a directed plan of correction or additional directed in-service training,” the CMS memo stated.

Enforcement for other existing standards, such as those imposed in Phase 1 on Nov. 28, 2016, would remain subject to the normal process and penalties.

Most facilities will be surveyed on Phase 2 requirements during the first year, officials noted.

Providers averted potentially billions of dollars in Medicaid funding losses in July after a Senate GOP healthcare reform bill was pulled from consideration.

The Senate proposal called for almost $800 billion to be withdrawn from Medicaid over the next decade.

Sens. Mike Lee (R-UT) and Jerry Moran (R-KS) surprised their party’s leaders by coming out against the bill, effectively killing it. 

That set off a downward spiral that, as of press time, also left Senate Majority Leader Mitch McConnell (R-KY) without enough votes to simply pass a straight repeal of the Affordable Care Act without a replacement plan in place.

Well, the great state of Illinois finally has an operating budget.

It may have taken more than 700 days, the threat of junk bond status, hefty tax hikes and the spectacle of two stubborn old men playing high-stakes chicken. But elected officials showed that they can put a spending plan in place. All it took was the prospect of Armageddon.

By any objective standard, what took place in Illinois during the past two-plus years is a textbook example of bad governance. 

But in retrospect, perhaps it was inevitable.

After all, Illinois now has a governor who makes about a million dollars a week in personal and business dealings lining up on the side that’s complaining that union workers get too much money. 

But apparently that phrase about politics being the art of compromise is not to be seen in any of his multimillion-dollar dwellings.

Then there is his Democratic foil, House Speaker Mike Madigan. Patronage king Madigan is arguably the state’s most powerful man, despite routinely being re-elected with fewer than 30,000 votes. 

It’s hard to tell which of these two characters history will judge more severely. 

But here’s the thing. Despite the years-long intrigue, Illinois doesn’t really have a political problem. It has a math problem.

Simply put, the state cannot pay its bills. For this challenge, there are two surefire remedies: increase taxes or reduce spending. But just because a problem can be solved doesn’t mean it will be. All you have to do is ask Connecticut, Maine, Massachusetts, Michigan, Oregon, Pennsylvania, Rhode Island and Wisconsin. They too began July without a budget in place, for largely similar economic reasons. (New Jersey also kicked off the month without a spending plan, but has since resolved its impasse.)

So 10 states out of 50 greeted July with no budget. That’s a fairly robust 20%. Kind of makes you wonder what might happen if, say, an overdue economic downturn were to occur.

In that case, the Illinois fiasco might look less like a joke — and more like business as usual.

Should I stay or should I go after finally achieving success?

As nurse leaders, we may consider leaving a facility to start fresh with a new organization, often after achieving a herculean task such as earning a citation-free survey or implementing a new system. 

We came, we put in the time, we weathered the frustrations and we created the change that was asked of us — so what’s next? Before you make your next career move, you should identify what drives you and how you want others to perceive you by asking yourself these three important questions:

Are you a problem-solver? Many of us are motivated to fix problems or create positive changes, which we can skillfully implement again with new teams and new challenges. This drives us to move to a different organization where we thrive at improving operations and outcomes. 

Are you a loyalist? Others of us are driven by our connection to our organization. Whether we stay for convenience of location, or dedication to our staff or residents, we find ourselves contented where we are. We choose to stay in the same place where we create continued success throughout the waves of new staff, regulations and challenges, instead of changing positions every few years. 

Do you aspire to lead the leaders? For some of us, we need more than the next big problem to solve. We continuously aspire to reach that next level, taking what we’ve learned in the trenches to a regional or national level to support other nurse leaders.

As nurse leaders, you must remember that success isn’t defined by one accomplishment. Success is defined by continued operational changes that yield positive outcomes. If you choose to move on, remember to move on in a way that enables your facility to sustain the change you created. 

Please send your nursing-related questions to Amy Franklin at ltcnews@mcknights.com.

High turnover rates and small selection pools make it more difficult to hire entry-level healthcare employees, according to a task force report. Although healthcare jobs offer room for growth, the number of current employees is insufficient.

Turnover can be reduced if new workers see room for growth within the industry, the task force found. Programs such as tuition assistance or a visible career trajectory path may be options.

“Following this type of career pathway is the American dream,” report authors wrote. “But this dream is not achieved often enough.”

Institutions should consider ideas such as an internship program or revising minimum qualifications, they advised. Employers can also use standardized interview questions in the hiring process.

Entry-level positions are important to the current employees, too. “Work such as stocking rooms with supplies and transporting patients is important and needs to be done — but not by a physician or registered nurse,” wrote report authors.

The Advisory Board Company led the task force as part of the Health Careers Pathway Initiative. 

As online nursing education increases in popularity, researchers are finding institutional procedures may not be keeping up. 

“It is possible that institutional policies and practices that address support, resource allocation and faculty teaching have not kept pace with the rapid growth of online education,” said Elizabeth Gazza, Ph.D., RN, associate professor at University of North Carolina Wilmington.

In a survey of 2,175 higher education faculty, 49% thought their institution did not provide enough technical support, and 48% thought they did not provide adequate support for course creation. 

Gazza states online nursing education is not better or worse; it is just different. 

Her research showed online instructors strived for the back-and-forth interaction necessary for teaching. In an online setting, teachers need to be available to students more frequently because students can work at virtually anytime.

Typically, instructors’ workloads may be determined by credit hours. In online teaching, a better measure is class size. Institutions should evaluate this when scheduling faculty, along with workload allocation and compensation. A majority of study participants found online teaching takes longer than in-person teaching.  

Results of Gazza’s study appeared in the Journal of Nursing Education in June. 

We do background checks on new employees. But now there’s word we’ll be getting sued because a relatively new nurse aide allegedly improperly touched certain residents. How can we avoid a potentially nightmarish sexual assault scenario we knew nothing about, nor could have foreseen?

An employer can be held responsible for the acts of its employees if the acts occur within the scope of their employment. However, a nursing home in your scenario may preempt liability by adopting the following practices.

· First, ensure your facility is in compliance with the state and federal laws that require criminal background checks for nursing home employees. Adherence to these requirements should protect you from any claims of “negligent hiring.”

· Second, your employee handbook should contain a policy prohibiting all employees from committing any form of abuse against residents. The policy should encompass all forms of abuse — physical, sexual, verbal, psychological and emotional abuse, as well as neglect. Employees must be subject to discipline, including termination, for any such violation.

· Third, notice of any such resident abuse should trigger a two-part reporting protocol. Report the alleged offense to the governmental body — state or federal — that licenses your facility, and then fully cooperate with the surveyors in their audit. If the alleged abuse is criminal (e.g. sexual abuse, battery), then report the offense to local police and support their investigation.

Assuming that you had no notice of the alleged abuse, and your facility maintained these best practices, you will probably avoid liability.

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