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News & Press: Regulatory

LTC Advisory Council Summary - March 13, 2018

Monday, March 19, 2018   (0 Comments)
Posted by: Sarah Bass
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From Forbes McIntosh, Government Policy Solutions, WALA Lobbyist


The Wisconsin Department of Health Services held its Wisconsin Long-Term Care Advisory Council meeting on Tuesday in Madison. Items discussed included:
Family Care caregiver workforce funding

Curtis Cunningham, assistant administrator of long term care benefits and programs, reported that DHS has developed - in conjunction with stakeholder groups - a methodology for managed care organizations and providers to distribute the $60.8 million that was allocated in the 2017-19 state budget for Family Care caregiver wage and bonus increases. The state budget provision was meant to address the LTC workforce shortage by providing funds for increases in wages, bonuses or paid time off. Once the proposal is approved by the U.S. Centers for Medicare and Medicaid Services (CMS), DHS will send out information to LTC facilities and MCOs with detailed instructions on how the dollars may be used. Providers that choose to accept the additional funds will be required to maintain payroll records and other documentation showing exactly how the funds were allocated to their direct caregiver workforce should an audit ever occur. Grant Cummings of DHS Bureau of LTC Financing said some providers might choose to not participate due to administrative requirements. Payments will go to MCOs to be passed along to providers' direct caregiving workforce that will include: adult day care, respite care, supportive home care, residential care, etc. Vocational workers (i.e. vocational coaches) are not included in the payments. Council member Christine Witt of Advanced Employment Inc. questioned why workers who provide supported employment services to adults with developmental and physical disabilities were not included - and Cunningham and Cummings said DHS believes legislators' intent when allocating the money was for it to go to other traditional direct care workers. DHS plans to issue a survey in the future to try to determine the impact of the payments in addressing the workforce shortage, however Cummings noted this could be difficult to measure due to many other factors.
State dementia plan

DHS is hosting a small summit with certain stakeholders this week - Thursday and today - to put together a five-year dementia plan for the state. This will build on work from a previous summit held a few years ago to make Wisconsin a dementia-capable state. This week's summit is meant to identify new goals and develop long-term strategies.

Electronic visit verification

DHS will be looking to implement an electronic visit verification system by January 2020. Section 12006 of the federal 21st Century CURES Act requires states to implement an EVV system for personal care services Jan. 1, 2019, and for home health care services by Jan. 1, 2023. Cunningham said Wisconsin DHS will be looking for a single vendor across all programs for the check-in, check-out system. DHS officials are currently looking at how to develop the stakeholder input and how to roll this out.

State of Assisted Living

Otis Woods, administrator of the DHS Division of Quality Assurance, gave a brief report on the State of Assisted Living in Wisconsin. He said there was a slight dip in the number of licensed long-term care and assisted-living facilities in 2017 compared to the previous year. He expects that to go back up again this year, as the AL industry has been on an upswing over the past few years.  

  • Meanwhile, average capacity is increasing with more larger facilities, leading to concerns by DHS officials on whether those large facilities will have enough staff to provide needed services for many residents in light of the paid caregiver shortages.
  • Woods also noted that falls continues to be a concern - with 55 percent of all facility self-reports in 2017 related to resident falls.
  • DHS has asked the UW-Madison LaFollette School of Public Affairs to conduct a survey of assisted living facilities to see how technology is being used. The survey results will be analyzed to see if any flexibilities could be allowed to make caregiving more efficient due to technology advances. A report will be forwarded to DHS Secretary Linda Seemeyer in May with a report published to stakeholders shortly thereafter.

Staff stability survey

Mary Lou Bourne of the National Association of State Directors of Developmental Disabilities Services shared results of a National Core Indicators LTC staff stability survey. She said that by 2024, 1.1 million more workers will be needed nationwide for personal care, home health and other caregiving workers. She noted the high turnover in the caregiving paid workforce and said the estimated cost of turnover per employee is $4,200. She said wages are important for recruiting and retaining workers, but work-life balance, work satisfaction and job stability are also important. In one survey of exiting direct support professionals, 88 percent indicated wages as a reason for leaving; the second-highest response was difficulties/stress of work performed (66 percent).
WisCaregiver Careers campaign

Kevin Coughlin reported that DHS did a "soft launch" of the WisCaregiver Careers media campaign on March 1 and has already had 380 people signed up for the program. The official campaign starts April 9 statewide - promoting the long-term care caregiving profession and encouraging people to enter a CNA (certified nursing aide) program through their local technical college. WisCaregiver Careers offers nurse aide training at no cost to the student through participating approved nurse aide training programs. Testing fees for the state competency exam will be covered for all students who successfully complete training and program requirements through these programs. After successfully completing the free training and testing, participants who apply for a job with a WisCaregiver Careers participating nursing home may receive a $500 retention bonus paid by the nursing home after six months of employment with that nursing home. More than $2 million is being made available (primarily through the nursing home civil penalty fund) for grants to pay for the retention bonuses. The goal is to have 3,000 new CNAs to come into the program. As another facet to the WisCaregiver Careers initiative, DHS is hosting monthly webinars with national experts to talk about employee recruitment and retention. Although the CNA grant program primarily will benefit nursing homes, the webinars are open to the public for all LTC and AL facilities and their employees able to participate.
Innovative practices

DHS recently surveyed managed care organizations (MCOs) and IRIS consultant agencies (ICAs) on some of their innovative practices to make staffing more efficient. Among those mentioned: remote monitoring systems for front doors and med drawers, using Alexa for reading to residents, using smartphones for medication reminders, iPads to control resident TVs and tablets to control light switches, having multiple contracts with remote monitoring companies, electronic medication dispensing devices, and more. Council member Beth Swedeen suggested that DHS hold a summit on technology or innovation in LTC.
The Council then shared some of the innovative practices they use for recruiting or retaining their workers. Among the strategies being used: paid time off, simple IRAs, birthday/anniversary recognition, 0% loan to purchase personal vehicles (paid back via paycheck deductions), internships, flexible scheduling, free tickets for community events and more.

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