1. Introducing NC NOVA: New Organizational Vision Award A Voluntary Special Licensing Award for Home Care Agencies, Adult Care Homes & Nursing Facilities Part of the Better Jobs Better Care initiative funded by The Robert Wood Johnson Foundation and The Atlantic Philanthropies

2. NC NOVA: Overview and objectives Link state policy and practice through licensure Systematic, sustainable culture change Voluntary, incentive-based model Special license awarded independently of regulatory survey process Ultimate goal is financial reward for NC NOVA designation

3. NC NOVA’s focus is the workplace Help providers “raise the bar” to foster meaningful workplace culture change Flexibility in how the criteria are implemented Organizations with an operating license in good standing are eligible to apply Providers meeting the challenge are rewarded with special NC NOVA license

4. NC NOVA: Legal basis Established, in law, as a statewide program effective January 1, 2007 Broad-based Partner Team spent more than three years developing NC NOVA – Piloted in 60 organizations

5. NC NOVA Partner Team Association for Home & Hospice Care of N.C. Direct care consumer Direct care workers and frontline supervisor Direct Care Workers Association of N.C. Duke University Gerontological Nursing Specialty Program

6. NC NOVA Partner Team, continued N.C. Association, Long Term Care Facilities N.C. Assisted Living Association N.C. Association of Non-Profit Homes for the Aging N.C. Department of Health and Human Services

7. NC NOVA Partner Team, continued N.C. Foundation for Advanced Health Programs N.C. Friends of Residents in Long-Term Care N.C. Health Care Facilities Association N.C. Institute on Aging, UNC-Chapel Hill The Carolinas Center for Medical Excellence

8. NC NOVA: Creating workplace culture change Orientation Peer Mentoring Coaching Supervision Management Support Rewards & Recognition Worker Empowerment

9. NC NOVA Designees As of 6/12/08 – Total of 5 NC NOVA designees 3 nursing facilities 2 home care Had pilot sites that serve almost all Medicaid eligible residents –still working toward Only publish names of those that attain designation

10. NC NOVA: Application and review The provider obtains an application from www.thecarolinascenter.org (CCME) or www.ncnova.org www.thecarolinascenter.org www.ncnova.org The provider submits the completed application and supporting documentation to CCME CCME first verifies with DHSR that the provider’s license is in good standing

11. NC NOVA: Application and review, continued CCME conducts a desk review of the application – If the application is in order, the reviewer schedules a site visit – If not, CCME notifies the applicant During a site visit, CCME conducts separate interviews with direct care workers and supervisors CCME then determines whether the applicant has successfully met the criteria for NC NOVA

12. NC NOVA: Application and review, continued If the applicant HAS met the criteria – CCME notifies DHSR to reaffirm that the applicant’s license remains in good standing – If so, DHSR issues the special NC NOVA license If the applicant has NOT met the criteria – CCME gives applicant general information about areas needing additional work – Eligible for 1 time re-review no sooner than 90 days – nor later than 12 months from notification letter

13. NC NOVA: Term and conditions of designation NC NOVA designation is good for two years Provider must go through full process again If ownership change before two years up, the new owner may request an expedited review NC NOVA designation may be terminated early if action is taken against the provider’s license

15. Impact Measures Overall data efforts in NC Turnover data – Direct care workers – Administrators – Director of Nursing/Supervisor in Charge Wage Data Medication Aide/Geriatric Aide Registry Occupancy Data

16. NC NOVA: Expected benefit to workers Improve workplace environment and increase job satisfaction Provide opportunities for personal and professional growth Improve staff relationships and communications

17. NC NOVA: Expected benefit to providers Improve retention of quality direct care workers to care for clients or residents Reduce high cost of employee turnover Improve staff relationships and communication Improve care for consumers Boost marketing and recruiting Create possible future financial reward

18. Turnover Data 2007 Turnover Data: NH- Overall state aggregate data = 109.7% – NC NOVA NH designees – 35% HC – about same as state ave. & why Administrator & Tenure data NH – Occupancy – 94% vs. 86%

19. NC NOVA: Expected benefit to consumers Promote a stable, satisfied, quality direct care workforce now and in the future Identify providers committed to keeping a well- trained, effective and satisfied team of quality caregivers Track impact of NC NOVA practices on long- term care

20. Issues Related to Independent Review Organization Fairness & Capacity Recruitment & Training of Reviewers – Philosophy, Direct Care Workers, consistency Ability to increase trained reviewers quickly Program Integrity Contracting issues

21. Our experiences Developed under a grant Working to ensure on-going Review Costs Integrated all functions into existing operations Have worked to integrate NC NOVA into other QI initiatives State Statute- included: reviews, reviewer, partner Team (vs. admin. Rules), protect data

22. What’s Next Now – help providers “Get There” – DVD and Getting Started document – Self-Assessment – Readiness Tool Will develop “how to” guide for other states Beginning work on financial reimbursement differential Systems integrated Structure for Partner Team to meet - tweak

23. NC NOVA: Key points Awards special license designation Systematic, sustainable processes Voluntary, flexible, incentive-based model Requires an investment of time, energy and resources by the provider Ultimate goal is financial reward for NC NOVA designation

24. NC NOVA: Website www.ncnova.org

25. Resources Paraprofessional Healthcare Institute (www.paraprofessional.org) Better Jobs Better Care, national initiative (www.bjbc.org) Institute for the Future of Aging Services, national program office (www.futureofaging.org)

26. Acknowledgements NC NOVA Partner Team thanks the following for the technical assistance they provided Paraprofessional Healthcare Institute (PHInational) Institute for the Future of Aging Services Barbara Bowers, Ph.D., University of Wisconsin