2016 AHFSA Annual Conference Exploring and Enhancing Relationships between Advocacy and Regulatory Agencies Otis L. Woods, MBA, Administrator WI Division of Quality Assurance President, AHFSA Introduce self PPT and H/O’s available Ask QUESTIONS anytime

Ombudsman & Survey Agency Dialogue Agenda Wisconsin’s experience Challenges/barriers to positive relationships Improving communications Questions – going forward Topics to be discussed Some overlap due to nature of information

Wisconsin’s Experience CMS and WI continue with efforts with the Partnership to Improve Dementia Care in Nursing Homes aimed at promoting comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors. CMS released changes to Appendix P and PP to further support the initiatives to reduce antipsychotic use in residents with dementia and to increase the use of individualized approaches through person centered care principles. Quality Improvement Organization has changed structure

Wisconsin’s Experience Long history of working together on resident care issues Nursing Home & Assisted Living Memorandum of Agreement Annual presentation before Board Quarterly touch base meetings Regional meetings with Ombudsmen Collegial relationship Exquisite tension necessary to ensure accountability CMS and WI continue with efforts with the Partnership to Improve Dementia Care in Nursing Homes aimed at promoting comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors. CMS released changes to Appendix P and PP to further support the initiatives to reduce antipsychotic use in residents with dementia and to increase the use of individualized approaches through person centered care principles. Quality Improvement Organization has changed structure

Wisconsin’s Experience How do we ensure Ombudsmen are up-to-date on our nursing home issues? Keep them apprised of facilities with immediate jeopardy by sending them an email right after an immediate jeopardy (IJ) determination is made  Keep a short summary of IJ citations, which they’ve asked for at times, so they can show the serious types of situations occurring in nursing homes WI Regional Office communication every 2 – 3 weeks CMS and WI continue with efforts with the Partnership to Improve Dementia Care in Nursing Homes aimed at promoting comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors. CMS released changes to Appendix P and PP to further support the initiatives to reduce antipsychotic use in residents with dementia and to increase the use of individualized approaches through person centered care principles. Quality Improvement Organization has changed structure

Wisconsin’s Experience Will call them at times when we are wrestling with a potential resident’s rights violation to get their perspective on the issue Refer callers to them when: issues are outside the survey process; or there seems to be a need for an advocate to assist the family in talking with the nursing home Nurse Aide Program Waiver Requests Facility requested waiver Future discussion – involvement in enforcement! - Participatory Jurisprudence – Malcolm Braithwaite CMS and WI continue with efforts with the Partnership to Improve Dementia Care in Nursing Homes aimed at promoting comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors. CMS released changes to Appendix P and PP to further support the initiatives to reduce antipsychotic use in residents with dementia and to increase the use of individualized approaches through person centered care principles. Quality Improvement Organization has changed structure

Wisconsin’s Experience Assisted Living (AL) Connections Regular presenters at the AL Forums on topics that include balancing resident rights and substitute decision- maker actions, use of technology and resident rights. Stakeholders involved in assisted living gather in a collaborative spirit to discuss current issues.  Regional offices meet at least quarterly with the local ombudsmen to discuss regulatory trends Regional offices also share inspection results that are issued to assisted living facilities Often consult with the ombudsman during specific cases (involuntary discharges, resident/guardian/POA-HC) CMS and WI continue with efforts with the Partnership to Improve Dementia Care in Nursing Homes aimed at promoting comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors. CMS released changes to Appendix P and PP to further support the initiatives to reduce antipsychotic use in residents with dementia and to increase the use of individualized approaches through person centered care principles. Quality Improvement Organization has changed structure

Wisconsin’s Experience Assisted Living Connections Ombudsman program has been active in many cases: Focused training to the AL facilities as a result of regulatory action (resident rights training) Advocating on behalf of the tenant right to receive appropriate supervision and care  Family/responsible party and facility education has been key and sometimes not well-accepted Finding quality affordable assisted living  Work with them pre/active/post investigation and they have been part of focused technical assistance initiatives CMS and WI continue with efforts with the Partnership to Improve Dementia Care in Nursing Homes aimed at promoting comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors. CMS released changes to Appendix P and PP to further support the initiatives to reduce antipsychotic use in residents with dementia and to increase the use of individualized approaches through person centered care principles. Quality Improvement Organization has changed structure

Challenges/Barriers Across the nation the goal of a 15 % reduction in the use of antipsychotics was achieved in DEC 2013. One year after the original target date was announced. WI use at one time was as high as 19.1% but eventually use fell to where .. CMS has announced new goals in the reduction of the use of antipsychotics to a 25% decline in the use of antipsychotics by DEC 2015 and 30% by the end of 2016. WI – You have done well but more is being asked.

Challenges/Barriers Authority and jurisdiction Negative relationships Political changes/challenges Great tension Public face Coordinated response to growing quality of care concerns Dementia care across nation Across the nation the goal of a 15 % reduction in the use of antipsychotics was achieved in DEC 2013. One year after the original target date was announced. WI use at one time was as high as 19.1% but eventually use fell to where .. CMS has announced new goals in the reduction of the use of antipsychotics to a 25% decline in the use of antipsychotics by DEC 2015 and 30% by the end of 2016. WI – You have done well but more is being asked.

Improving Communication The CDC, health care experts in WI and across the US have identified antimicrobial resistance as 1 of the most serious threats to our health with the potential for catastrophic consequences. We need to change the way antibiotics are being used by adopting and adhering to the principals of antimicrobial stewardship. Research is indicating that about 50% of the antibiotics that are prescribed are done so with no need for the use of that antibiotic. Often times we hear that when residents go to the hospital the resident is prescribed an antibiotic and the use of the antibiotic continues after returning to the nursing home when there is no need for the use of that antibiotic. Why? Upon return to the nursing home whose resident is it? The hospital or the nursing home? When surveyors identify that a drug is not needed they could cite F 329 for the use of an unnecessary drug. Your help is needed to put a stop to the overuse of antibiotics. Discuss Publication 00886 DR’s Boero, Crnich, and Strobusch.

Improving Communication Understand each other’s roles Be open to dialogue on issues Engage in special projects highlighting each other’s responsibilities Be open to outside review of decisions Schedule periodic meetings Seek joint resolutions on matters of concern to both Respect the other’s role The CDC, health care experts in WI and across the US have identified antimicrobial resistance as 1 of the most serious threats to our health with the potential for catastrophic consequences. We need to change the way antibiotics are being used by adopting and adhering to the principals of antimicrobial stewardship. Research is indicating that about 50% of the antibiotics that are prescribed are done so with no need for the use of that antibiotic. Often times we hear that when residents go to the hospital the resident is prescribed an antibiotic and the use of the antibiotic continues after returning to the nursing home when there is no need for the use of that antibiotic. Why? Upon return to the nursing home whose resident is it? The hospital or the nursing home? When surveyors identify that a drug is not needed they could cite F 329 for the use of an unnecessary drug. Your help is needed to put a stop to the overuse of antibiotics. Discuss Publication 00886 DR’s Boero, Crnich, and Strobusch.

Wisconsin Division of Quality Assurance QUESTIONS? Working to Protect – Promote – Provide Quality in Wisconsin’s Health Care Facilities “We Are All In This Together”