1. Michigan Department of Community Health Bureau of Health Systems Mike Pemble Director Joint Provider/Surveyor Training March 30, 2010

2. Complaints VS. FRIs Intake History Complaints VS. FRIs Intake History Source: ACO 3/22/10

3. Health Systems  License, certify and regulate facilities 443 Nursing Homes / 174 Hospitals 443 Nursing Homes / 174 Hospitals 1,496 Substance Abuse Facilities 1,496 Substance Abuse Facilities 571 Home Health Agencies (19% increase) 571 Home Health Agencies (19% increase) 7,397 Clinical and Physician Office Labs 7,397 Clinical and Physician Office Labs 10,080 Radiological Facilities 10,080 Radiological Facilities  Complaint / Enforcement Activity (FY09) 2,657 Radiation Safety Violations (5% increase) 2,657 Radiation Safety Violations (5% increase) 2,133 LTC Care Facility Investigations (28% increase) 2,133 LTC Care Facility Investigations (28% increase) 3,422 Abuse Allegations (7% decrease) 3,422 Abuse Allegations (7% decrease) 1,257 Complaint Intakes 1,257 Complaint Intakes 5,063 Facility Reported Incident Intakes (10% decrease) 5,063 Facility Reported Incident Intakes (10% decrease) 463 Standard Surveys (12% increase) 463 Standard Surveys (12% increase)

4. Health Systems  Key Accomplishments Reduced nursing home complaint backlog 80% since beginning of FY09 from 22 months (882 open intakes) to 3 months (177 open intakes) currently. Reduced nursing home complaint backlog 80% since beginning of FY09 from 22 months (882 open intakes) to 3 months (177 open intakes) currently.

5. Health Systems  Other Key Accomplishments Innovative nurse recruitment techniques result in filling most health care surveyor vacancies Innovative nurse recruitment techniques result in filling most health care surveyor vacancies Improved coordination and efficiencies in the survey process - Combined annual and abbreviated surveys Improved coordination and efficiencies in the survey process - Combined annual and abbreviated surveys Improved communication with provider community Improved communication with provider community

6. Budget Updates  Furlough and banked leave days  State employee retirement proposal  Health Systems Funding: 18% GF, 20% Licensing Fees, and 62% Federal (Title 18 and Title 19)  One of eight states nationally to receive ARRA grant to help reduce the spread of infections acquired in outpatient surgery centers.  $1.4 million increase in Title 18 (Medicare) funding in FY10

7. Nursing Home Baseline Survey Trends 2010

8. Health Facilities Surveys & Inspections  Aging Buildings  Aging Roofs  Minimally Sized Emergency Generators  Low Lighting Levels  No Make-up Air to Resident Rooms  Conversion of Required Day/Dining Space  Elimination of Required Central Bathing Facilities

9. Heating Considerations  Subzero Weather  Cold Weather Design  Building Concerns  Insulation  Single Pane Window  Metal Frames  Leaks and Infiltration

12. Baseline Surveys Completed Baseline Surveys Completed  Over 90 nursing homes  Over 10,000 licensed beds  Avg size NH surveyed - 115 beds  Oldest NH orig build date of 1927  47 had portions built before 1969

13. Sprinkler Systems By August 2013

14. SMOKING BAN  May 1, 2010 (House Bill 4377) Excerpt Section 12603 (1) An individual shall not smoke in a public place…….. Section 12601 (1) (q) “Public place”, except as otherwise provided in subsection (2), means any of the following: (i)An enclosed, indoor area owned or operated by a state or local governmental agency and used by the general public or serving as a meeting place for a public body, including an office, educational facility, home for the aged, nursing home, county medical care facility, hospice, hospital long-term care unit, arena meeting room, or public conveyance. (ii)An enclosed, indoor area that is not owned or operated by a state or local governmental agency, used by the general public, and is any of the following: A home for the aged, nursing home, county medical care facility, hospice, or hospital long-term care unit.

15. Average Number of Deficiencies Standard Surveys Source: CMS Nursing Home Data Compendium 2009

16. Michigan LTC Complaints/FRIs Prioritized as Immediate Jeopardy Source: PPM Reports

17. Analysis of Disputed Citations FY 09  Total of all health citations 4,419  Total number of standard survey citations 3,847 (Average 8.5 per survey) (Average 8.5 per survey)  Total number of complaint survey citations 572 (Average.9 per survey) (Average.9 per survey)  Number of health citations appealed through the IDR process 305 (7% of total) BHS NH Survey Report - October 2009

18. Informal Deficiency Review Statistics 2009 Total tags reviewed 305 BHS=195 (64%) MPRO=110 (36%) Source: BHS-Enforcement Data

19. Informal Deficiency Review Statistics 2009 Total tags supported 200 (66%) Informal Deficiency Review Statistics 2009 Total tags supported 200 (66%) Source: BHS-Enforcement Data BHS= 124 (64%) MPRO= 76 (69%)

20. Informal Deficiency Review Statistics 2009 Total Tags Amended 40 (13%) BHS=27 (14%) MPRO=13 (12%) Source: BHS-Enforcement Data

21. Informal Deficiency Review Statistics 2009 Total Tags Deleted 65 (21%) BHS=44 (23%) MPRO=21 (19%) Source: BHS-Enforcement Data

22. U.S. Census  The Department of Community Health is pleased to support the efforts of the 2010 Census.  The Census is a count of everyone living in the United States. Most people should be counted in the residence in which they sleep. The 2010 Census data is used to apportion seats in Congress and directly affects how more than $400 billion per year in federal funding is distributed to state, local and tribal governments.  According to the Census Bureau, Census staff will visit each nursing home and complete the Census form for each resident.

23. Keynote Speaker: Dr. Larry Lawhorne “Managing Residents on Psychoactive Drug Therapy”