Assisted Living Forum State of Assisted Living

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Assisted Living ForumState of Assisted Living

• March 11, 2008

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New DQA Assisted Living Boundaries effective
1-1-2007
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Where are we going?2008 - 2009
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Continue and Expand Collaborations
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Using data to effect positive change
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Proactive Compliance
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Implement HFS 83
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New facility video on Web
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Make more information available on the web
statistics, trends, etc.
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Support and Encourage Innovative
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To have the best staff with the tools and
training to do their job
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Trends Statistics
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Assisted LivingTrend in number of facilities
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Assisted LivingTrend in capacity for residents
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RCACs Certified vs. Registered
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AL vs. LTCTrend in number of facilities
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AL vs. LTCTrend in capacity for residents
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Family Care Impact on AL Industry

• Projections indicate 62 of the state will be
  covered by Family Care by June, 2009

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Relocations

• 540 of 1412 residents of ICF/MRs have been moved
• 449 moved into BAL regulated facilities
• 341 into 3-4 bed AFHs
• 108 into 5-8 bed CBRFs
• 872 residents are left to be moved
• 1,282 nursing home relocations have been
  completed (majority to BAL regulated facilities)
• 905 elderly residents
• 379 individuals with developmental disabilities

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Nursing Home Diversions

• 300 slots
• Majority to BAL regulated facilities

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Population Served

• 4215 assisted living residents with Long Term
  Care Functional Screen data
• 34 have diagnosis of Alzheimers disease
• 92.6 need assistance with bathing
• 70.5 need assistance with dressing
• 33.4 need assistance with eating
• 49.9 need assistance with toileting
• 18.3 require a behavior intervention
• 3,460 MH diagnoses (depression, anxiety, bipolor,
  schizophrenia)
• 56.7 use a walker
• 26.7 use a wheelchair or scooter
• These residents are publicly funded under MA
  Waivers, Family Care, or Pace/Partnership to live
  in AFHs, CBRFs, and RCACs

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Waiting Lists

• As of May 31, 2007 11,625 on the COP/Waiver
  waiting list
• With entitlement, how many of these will be
  living in BAL regulated facilities.?

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Publicly Funded Clients in AL Estimated
publicly funded clients in occupied AL beds
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Public Funding becoming more influential driver..
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New AL vs. Closed AL
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Why Facilities ClosedCY 2007
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Post Survey Questionnaire

• 2006 - 172 respondents (39 of total)
• Satisfaction with survey tasks 98.48
• On Site - 4.57
• Knowledgeable - 4.62
• Professional - 4.75
• Respectful - 4.72
• SOD - 4.43
• (1 strongly disagree, 5 strongly agree)

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Survey Results
2004
2005
2007
2006
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AL Citations Issued
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Top CBRF cites comparison 2006-2007
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Surveys with Enforcement
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Surveys with Enforcement (545) CY 2007
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of Facilities vs. Enforcement Surveys
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of Beds vs. Enforcement Surveys
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Sanctions Imposed (1,077)CY 2007
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Type of SanctionsCY 2007
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Forfeiture Assessments
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Impending Revocations
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Impending Revocations 2007
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Revocations
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35 Forfeiture Reduction
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Enforcement Action Appealed
CY 2005
CY 2006
CY 2007
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Complaints Received
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Complaints vs. Growth
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Complaints ReceivedCY 2007
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of Facilities vs. Complaints Received
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of Beds vs. Complaints Received
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Source of ComplaintCY 2007
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Ranking Subject areas complaint investigations
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Source of Complaint vs Substantiation CY 2006
Source rec. invest. substantiated Anonymous
26 27 Public Official 24 45 Relative/Gua
rdian 19 53 Current Employee 05 53 Former
Employee 11 40 Advocate 05 38 Citizen 0
5 63 Medical 02 31 Resident 03 56
100 43
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Self ReportsCY 2007
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Facilities Qualifying for Abbreviated Surveys
CY 2007

• Adult Day Care 65.7
• Adult Family Homes 48.5
• Community Based Residential Facility 58.1
• Residential Care Apartment Complex 57.8
• Statewide 54.5

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Facilities Qualifying for an Abbreviated Survey
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Achievements National

• Association of Health Facility Survey Agencies
  (AHFSA) Promising Practices
• - 2003 1st place Enforcement Manual
• - 2004 1st place Survey Process
• - 2005 1st place Web Based Application
• - 2006 1st place Directed Plans of
  Correction and Collaboration
• CMS Promising Practice Creative Enforcement
• Working with a number of states regarding AL
  regulation
• Governing Magazine 2007 Public Official of the
  Year

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Stories .(examples of enforcement actions)
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IN SUMMARY.

• Growth continues especially with AFH and RCAC
  with annual growth of approx. 8 in each area.
  More RCAC growth with certified as the gap with
  registered continues to widen
• ICF/MR rebalancing, NH relocation initiative and
  Family Care expansion having direct impact on AL
  growth. AL licensed beds projected to exceed NH
  ICF/MR licensed beds by early 2009
• In addition to overall growth there is
  significant turnover with increases in voluntary
  closures, and Change of Ownership (CHOW)
• Fit and Qualified policy having a positive effect
  with increase of license denials and withdrawn
  applications

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IN SUMMARY.

• Citations per survey remains flat.
• Enforcement actions increased with increases in
  surveys with enforcement, increase in sanctions
  and increase in of facilities making up
  enforcement, increase in impending revocations
  but decreases in revocations, NNA, and
  forfeitures
• BAL continues to refine directed plans of
  correction to help facilities achieve and sustain
  compliance
• Compared to number of facilities, CBRFs make up a
  significantly high proportion of enforcement
• Compared to number of beds, CBRFs and AFHs make
  up a significant high proportion of enforcement
• Facilities making up 100 of enforcement action
  increased

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IN SUMMARY.

• Despite growth, complaints have decreased
• Facilities making up 100 of the complaints
  decreased
• Compared to number of facilities, CBRFs make up a
  significantly high proportion of complaints
• Compared to number of beds, CBRFs and AFHs make
  up a significantly high proportion of complaints
• Complaints continue to come from multiple sources
  with a significant portion coming through
  collaborations with key stakeholders.
• BAL staff substantiate a high number of complaints

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IN SUMMARY.

• Falls resulting in hospitalization make up 42 of
  self reports received. Resident behavior, police
  intervention and elopements increased
  significantly in both numbers and of total.
• Self reports received increased by 28, but when
  investigated rarely result in deficiencies.
• Almost ½ of facilities responding to post survey
  questionnaire utilized the on-line version.
  Approximately 8 were returned. Overall, staff
  of BAL had excellent results.
• BAL not meeting the workload with overall growth
  in industry, more complex investigations,
  increased enforcement and self reports.

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IN SUMMARY.

• The new resident is impacting the regulatory
  activity
• Majority of assisted living in Wisconsin is very
  good and continues to improve
• Collaboration continues to move the bell curve
  to the right
• Significantly more facilities qualifying for
  abbreviated surveys
• For CY 2007 only 15 of facilities make up 100
  of the complaints and enforcement action.

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Moving the Bell Curve to the Right...

• Thank You!